Our Services
- First Visit
- Hygiene/Periodontal Health
- Fluoride Treatment
- Nightguard
- Extractions
- Dentures/Partials
- Root Canal Therapy
- Teeth Whitening
- Inlays/Onlays
- Bonding/Tooth-Colored Fillings
- Porcelain Veneers and Crowns
- Crown and Bridge
- Dental Implant Placement
- Dental Implant Crowns
First Visit
During your first visit, we listen to your concerns and reasons for your appointment. After we understand the purpose of your visit, we will take all necessary X-rays. Then Dr. Alexander or Dr. Monahan will perform a comprehensive oral examination. During this exam, an intraoral and extraoral exam will be completed as well as an oral cancer screening exam. Your X-rays will be reviewed, checking your dentition for any cavities that you may have. A periodontal screening exam will also be completed to determine the type of cleaning that you will need. Finally, we will discuss your treatment options and design the ideal treatment plan for you. The purpose of this visit is to inform and educate you to ensure that you receive the highest quality of dental care possible.
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Crown and Bridge
A crown is a laboratory-fabricated restoration that completely encapsulates the tooth. There are several indications for a tooth needing a crown: 1. If a tooth has had root canal therapy, 2. If a tooth has one or more cusps missing due to a large restoration or fractured tooth, and 3. If there is an aesthetic need to change a smile. The procedure normally takes 2 appointments. After the tooth is prepared and an impression is taken of the tooth, a temporary is fabricated for the patient to wear until the permanent crown is fabricated by the laboratory technician. The patient returns in 2-3 weeks, the temporary is removed, and the final crown is permanently cemented or bonded onto the tooth.
There are three main types of crowns that are fabricated for patients. Gold crowns are restorations that have been placed for many years and are normally indicated on back teeth. Porcelain fused to metal crowns offer a more aesthetic option and have a metal substructure for a well fitting crown. These crowns are indicated anywhere in the mouth; however, on front teeth, some metal may show due to the fact that the metal can "show through" the porcelain. This can sometimes give a slightly grey line around the base of the crown near the gumline. For these situations, the final type of crown, an all ceramic crown, is indicated. These types of crowns have developed into a very strong, durable and aesthetic restoration. All ceramic crowns, called Emax crowns, are even indicated for back teeth due to their incredible strength. We will determine the crown that suits the patient's situation.
A bridge is a type of dental restoration that involves multiple crowns cemented to two or three teeth. These restorations are indicated if a space is present between two teeth. This procedure involves preparing the two teeth beside the space for crowns. The rest of the process is very similar to the crown procedure. Bridges can also be full gold, porcelain fused to metal or all ceramic.
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Periodontal Health and Types of Cleanings
The word periodontal means "around the tooth." The health of this area is divided into two main sections: Gingivitis and Periodontitis.
Gingivitis is a mild form of periodontal disease in which the gums become red or inflamed due to inefficient oral hygiene. Normally, little if any discomfort is present. This disease is reversible with a professional dental cleaning procedure called a dental prophy and improved home care. A dental prophy is a general cleaning performed by a dental hygienist or general dentist. The procedure is either done manually or with an ultra sonic instrument called a cavitron, or with both. After all of the plaque and tartar are removed from your teeth, a rotary machine that looks like a toothbrush is used. It removes any remaining plaque and polishes the outer surface of your teeth to help prevent future plaque build-up. Finally, the dental professional will floss between every tooth in your mouth and review oral hygiene instructions with you.
Periodontitis is a chronic bacterial infection that affects localized areas or generalized areas of your teeth and gums. Untreated gingivitis can advance very quickly to periodontitis. The longer this is left untreated, plaque and tartar can spread below the gum line. During this process, the gum tissue and bone that surround the teeth become very irritated and begin a self-destructive process. The tissues that support the bone and the teeth become infected and pockets are formed between the teeth and the gums. As the disease progresses, the pockets deepen and bone loss becomes more severe, causing mobility of the teeth. If the teeth become too loose, they eventually have to be removed. If this disease is treated early enough, your dentition will stabilize and your overall oral health will improve. In order to treat this disease, a periodontal scaling and root planning procedure is performed. This is a non-surgical procedure in which the dentist or dental hygienist removes plaque and tartar below the gum line. The root surfaces of the affected teeth are cleaned and smoothed with specially designed instruments to ensure that any additional plaque and bacteria can not adhere to the surface. Sometimes, placement of a localized antibiotic (Arestin) may be need in deep pockets to help reduce sensitivity. After the procedure, the patient is normally placed on a 3 — 4 month recall program to monitor how well the tissues have responded and how well the patient is improving his or her oral hygiene.
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Fluoride Treatment
In-office fluoride treatment is performed to help prevent cavities. It helps the enamel of your teeth remineralize and stops the bacteria in your mouth from forming acid. Fluoride treatments are normally given to children as their permanent teeth are developing; however, fluoride treatment can be performed if a patient has a history of cavities, infrequent dental visits, poor brushing habits or poor diet habits. After the treatment, the patient should not eat, drink or smoke for at least 30 minutes. This ensures the fluoride's contact with the teeth.
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Nightguard or Mouthguard
A nightguard, or mouthguard, is a dental prosthesis that is made to prevent a patient from destroying their natural teeth. If a patient is a grinder or bruxer, their teeth will become "flatter" on the chewing surface and the gums will recede, causing increased sensitivity. Mouthguards are also used by people who play contact sports such as football, basketball, etc. Both types of guards usually are formed over your top teeth.
Dental Extraction
A dental extraction is a procedure in which a tooth is removed from the mouth. There are a variety of reasons why this would be indicated: 1. Tooth decay that has rendered the tooth non- restorable, 2. Impacted or problematic teeth such as wisdom teeth, and 3. Teeth that need to be removed for orthodontic treatment. If the extraction is going to be very complex, a referral to an oral surgeon is commonly recommended. After any extraction, post operative instructions will be given verbally and on paper by the dentist and/or dental assistant to ensure a good recovery. Following these instructions will help prevent a dry socket and prolonged post surgical pain.
Dentures/Partial Dentures
Dentures are removable appliances that are fabricated to restore missing teeth. These appliances are not going to feel the same as your original teeth, but they will give you a natural-looking smile and return your chewing ability. Full dentures replace all of the teeth in each arch; where as partial dentures are designed to use existing teeth for support.
There are two types of full dentures: Immediate and Conventional.
1. Immediate dentures are indicated if a patient does not want to go without teeth after removing their remaining teeth. On the day of dental extractions, these dentures can be placed immediately. The drawbacks to immediate dentures are that you can never try the dentures in to see if the aesthetics fit the patient, and they become loose over time due to the healing process. Due to the shrinkage of the gums after extractions, a reline is always indicated for an immediate denture to ensure a better fitting appliance.
2. A Conventional Full Denture is fabricated by the dentist after all of the healing has taken place from the dental extractions, normally 6 — 10 weeks. After this period, a series of molds is taken of the patient's mouth. The teeth, which are placed in wax, are tried in, and the patient is able to approve the setup before the denture is processed. During this visit, any changes can be made to the tooth setup; however, after the approval is given, the tooth setup cannot be altered.
Partial dentures are indicated if a patient is missing several teeth, but their remaining teeth are in very good condition. This type of appliance uses a metal framework to support the teeth that are being replaced. These prostheses are designed to fit very snugly around the natural teeth to ensure they stay in your mouth during chewing and/or speaking. These appliances provide an alternative treatment to a patient who does not want a bridge or implants.
Most of the time, these appliances create sore spots on your gums. If this happens, you need to schedule an appointment so the dentist can adjust the denture to fit better in your mouth. This is a very common occurrence with denture wearers.
Root Canal Therapy
Root Canal (Endodontic) Therapy involves the removal of the pulp (nerve) chamber of the tooth as well as the individual nerve canals in the roots of the teeth.
Signs and Symptoms for Root Canal Therapy:
- If a cavity has become too large and has come into contact with the pulp
- If a tooth has had a severe trauma
- If a crack is present within the tooth and goes to the pulp
- Lingering pain to hot/cold drinks or foods
- Pain to biting on a tooth
- Toothache that wakes you up at night
- A pimple on your gum that releases pus or blood
- Spontaneous pain in one area or that radiates around your mouth
The canals in the roots are cleaned, shaped and decontaminated with files and irrigating solution. After the canals are cleaned and all of the decay is removed, the canals are filled with an inert filling material called Gutta Percha. After the procedure, a temporary filling is normally placed to ensure the tooth responded well. If the tooth is in the back of the mouth, a crown is always indicated; however, if the tooth is in the front of the mouth, the need for a crown varies. Root canal-treated teeth do discolor over time, so a crown in the front may be indicated for aesthetics. If the case is too complex, a referral to an endodontist, a dental professional specializing in root canal therapy, is indicated.
Teeth Whitening
Over time, teeth become naturally darker or stained from many sources: smoking, coffee, tea, soda, wine, and many other food and drinks people consume. We offer a safe and effective solution to this problem. In our office, we will take full impressions of your teeth. Your custom bleaching trays will be fabricated from the models. The purpose of these trays is to fit your teeth very accurately in order to prevent gum damage from excess bleaching solution and remained snugly secure to your teeth during the treatment. The trays are worn for a few hours a day, since a side effect of bleaching is tooth sensitivity. Within 10-14 days you will see a significant improvement in the shade of your teeth. You can bleach until your desired shade is reached. Bleaching only works on natural teeth and will not change the color of any crowns, fillings or veneers.
Inlays/Onlays
Inlays and onlays are sometimes referred to as partial crowns. They are recommended for large cavities or for the replacement of large silver or tooth-colored fillings. This type of restoration is indicated if there is significant tooth structure remaining. After the old filling and the cavity are removed from the tooth, an impression is taken and sent to our lab, where our ceramist handcrafts the restoration. A temporary is placed and the patient returns at a later date to have the permanent restoration placed. The inlay or onlay will be bonded onto the tooth, ensuring a very strong and long-lasting restoration.
Bonding/Tooth-Colored Fillings
Bonding is a procedure in which a tooth-colored resin material, composite, is bonded to the tooth structure. This restoration can be used in the back or the front of the mouth. It is a good option for patients who have old silver fillings in their mouth that need to be replaced due to decay, cracks or stains. Bonding can also be performed on front teeth that have chipped if the chip is not too large.
The procedure can be completed on the same day. Several steps are carried out to actually bond the composite resin to your tooth. The restorations are very natural looking and are a good alternative to more expensive restorations. Nevertheless, these tooth-colored fillings will wear over time and normally begin to darken as they pick up stains from food and drinks. If this begins to happen, normally within 5-10 years, they would need to be replaced with a new fillings or another restorative procedure.
If bonding is performed in the correct situation, they are very durable and long-lasting restorations for many patients.
Porcelain Veneers and Crowns
A porcelain veneer is a thin shell of porcelain that is bonded to a patient's natural teeth. Veneers are placed if a patient is concerned with the appearance of his or her smile due to discolored, worn, chipped or misaligned teeth. We pay very close attention to each patient's overall smile in order to achieve the best aesthetic result. Veneers are bonded to the natural tooth structure just as tooth-colored fillings are; however, since they are fabricated in a dental laboratory, they are more durable and keep their aesthetics for a much longer period of time.
Porcelain crowns closely resemble a veneer. They have no metal in them and are bonded to the tooth structure as well. These crowns have beautiful aesthetic properties and have been shown to be stronger than most other crown materials we use today. Porcelain crowns can be great options on front teeth as well as back teeth.
Dental Implants (Crowns and Denture Support)
A dental implant is a titanium "screw" that is placed in a patient's maxilla or mandible to support one tooth, multiple teeth or dentures. The implant is made of titanium and has several threads along the surface of the body to allow for integration of the bone. Implants, as we know them today, have been around for 50 years.
After the implant body has been placed, a healing period of anywhere from 3-6 months is indicated. The patient returns for an impression. If the patient is having a crown or bridge fabricated, an impression coping is screwed into the implant body and an impression is taken. From this impression record, a stock or custom abutment is fabricated by the laboratory technician. The type of abutment depends on the specific case. The abutment is the connection from the implant to the crown. After the technician has created the abutment, a crown or bridge is fabricated to the abutment. The patient returns for delivery to have the abutment screwed in and the crown cemented to the abutment.
The benefit of having an implant-supported crown is that a patient is getting as close to a new tooth as possible. The two teeth beside the space are not altered during this type of procedure because the restoration does not depend on them for support. This type of conservative dentistry is very beneficial to a patient.
Dental implants can also serve as "anchors" for upper and lower dentures and partials. If you have ever worn dentures or partials, you may understand how these appliances feel as if they "float" on your gums. After placement of dental implants, dentures and partials can be "snapped" onto the implants. This creates much-needed support to allow little if no rock of these appliances. Patients will experience a much more efficient chewing experience and no rocking from the dentures. Also, no adhesive will be needed to keep the appliances in, due to the retention from the implants.
If you currently have a set of dentures or partials, we can use those with your new implants as well. You will not have to have a new set made in order to get a better-fitting denture.
Call today for a consultation. Dr. Alexander is currently placing implants and would be glad to discuss your individual treatment options with you.