In My Book: Health
Dental ImplantsThe part of an implant restoration that brings the height of an implant from below to above the gum line. This allows the restoration to be attached to the implant.
BridgesA fixed bridge in which the false tooth, or pontic, is supported only on one side. The supporting side, or abutments, must be especially strong and well designed, and the bite must be scientifically arranged to minimize leverage forces.
Dental BondingThe material traditionally used for bonded restorations. Made from an admixture of various glass particles in a polymerized gel-like matrix, this material is generally applied to etched enamel and primed dentin. It is then polymerized with a curing light—a visible blue light that activates a catalyst in the composite and causes it to harden almost instantly. Today's composite bonding materials are extremely esthetic because of the way the glass particles reflect and refract light similarly to natural enamel.
FillingsThe name given to the process of placing esthetic white fillings. As different from amalgam fillings, these bonded fillings actually adhere to the tooth structure and make the tooth stronger. There is a slightly higher incidence of short-term sensitivity than with silver fillings, but they are often indistinguishable from natural teeth.
VeneersA covering placed on a tooth to replace missing structure and reinforce or strengthen it. The most common crowns made today are from a cast metal (preferably a gold alloy) with esthetic porcelain baked to the outside. In non-esthetic areas, or for patients with extremely strong masticatory musculature, gold crowns are still used and are still the most durable restorations known. Today, all-porcelain crowns are also an option, offering incredible esthetics (see “Procera”). Crowns are indicated for broken or cracked teeth, and any tooth in which the previous filling encompassed more than one-half of the width of the tooth. Crowns are also still used to solve some cosmetic problems when bonding or veneers are be adequate. Crowns generally require two visits, and fine-crafted provisional crowns are placed for the interim.
CrownsChecking the esthetics and function of a crown prior to the final finishing and glazing of the porcelain. Sometimes called a "Biscuit Bake."
ApicoectomyThrough the animal's chin to the outside. The doctors were called in to treat the suffering animal's many needs. Dr. Miller anesthetized the dog and took diagnostic x-rays. Several infected teeth were found that required extraction. One upper and one lower canine tooth were found to require root canal therapy and strong bonded fillings. The lower canine was determined to be the cause of the draining infection, and was treated with an outside-the-mouth approach to root canal therapy called an apicoectomy. The wild dog did well through the procedure and was on several weeks of antibiotics afterward. Later that year, the same wild dog became the father of a large litter of puppies!
Root Canal TreatmentMost of the treatments required are root canals. Common injuries to carnivores are "slab fractures" of canine teeth. These are oblique fractures that make the tooth appear to be split in half, but almost always leave enough structure to maintain the tooth. This situation exposes the nerve of the tooth, which dies and can get infected. If not treated, the infection can hamper the animal's ability to eat. The big cats also use their teeth in sexual behaviors. Nerve death can result in septicemia, and eventually death of the animal after extended suffering.
DenturesNot teet h. Masticatory function and comfort are greatly diminished with removable dentures. These alternatives, while still valid, are chosen less and less by health, cosmetic, and comfort conscious individuals.
Tooth WhiteningCausing the teeth to appear brighter by applying certain medicaments. Many products are available to conduct whitening at home. Treatments are not permanent, typically lasting 6–12 months, and are easily maintained or retreated.
Cosmetic DentistryCosmetic Dentistry is a broad term, encompassing everything from reshaping teeth, to whitening them, to aligning them orthodontically, to improving their appearance and character with bonding or porcelain crowns or veneers. We also have the ability to reshape gum and bone contours. And then, we have the power to improve facial character with Botox and dermal fillers ! The doctors at Dental Leaders agree that there has been no better time in history to be a dentist- we have the greatest arsenal of aesthetic weapons ever in history!
Teeth CleaningThe scientific term for tartar, which is the accumulation of calcified substance that adheres to the teeth. Calculus is microscopically porous and provides a multitude of hiding places for the bacteria that cause gum disease. As the primary target of dental cleanings, it should be removed on a schedule chosen specifically for the individual needs of each patient.
Fluoride TreatmentTo prevent radiation cavities, head and neck radiation therapy patients must give themselves daily fluoride treatments for the rest of their lives. This is usually done in custom applicators provided by a dentist. The fluoride is a prescription medication and comes in many flavors. Cavity-prone individuals may even need these treatments twice a day. The fluoride is kept in the mouth for four and one-half minutes, usually before bed and after other hygiene. The fluoride should be spit out, not swallowed, and nothing should be put in the mouth for at least 30 minutes after. Some salivary function usually returns, but it will not be the same. Fluoride protection, and care with dietary sweets and acids, well be a life-long need.
Dental SealantsOver the past forty years, the fluoride found in drinking water, the foods available to eat, and the toothpaste used for brushing have cut the prevalence of cavities in half. Flouride, however, only protects the smooth surfaces of the teeth and not the biting areas. Dental sealants, as pictured below, are a type of bonding that flows into the crevices and grooves of the biting back teeth to protect them from the accumulation of bacteria and food debris that can cause cavities, The American Dental Association recommends applying sealants to children's back teeth as soon as they erupt (starting at about 6.5 years old), with which Dental Leaders agrees. Sealants are also strongly recommended for adults who have deep grooves but have so far avoided cavities. Today there is no reason that a person with good habits, fluoride, and sealants should ever get a cavity. A small amount of prevention goes a long way.
Dental ExaminationDecades ago, patients were sent to the dentist to extract all of their teeth prior to radiation therapy. With current knowledge, this is necessary only for patients under the most dire circumstances. Careful dental examination prior to radiation therapy will reveal whether any teeth need to be extracted. Teeth with a hopeless, poor, or questionable prognosis must be extracted prior to radiation therapy. Patients should allow 14 to 21 days to heal completely prior to starting radiation therapy after an extraction, especially in the lower jaw.
X-raysA series of dental x-rays angled to show the roots of all teeth, as well as the surrounding bone and other structures. This is the only way to examine the health of the tooth roots and to check for some types of tumors and lesions. The series usually consists of about 16 to 18 small films, and for the radiation conscious, the dosage is about the same received from three hours in the summer sun. Depending on the patient's previous history, full-mouth radiographs are recommended about every three to five years. These are often alternated with a panorex radiograph, which gives similar information but shows more structures.
Oral and Maxillofacial Surgery
Oral SurgeryGigi is the hands of our orthodontic program. A career orthodontic technician and dental assistant, Gigi is new to our practice but certainly not new to orthodontics. She has relocated from Washington DC, where she worked for years in orthodontics and oral surgery. Her secret skill is as a world-class professional DJ!
Gum SurgeryThe use of lasers for gum surgery is a viable treatment modality for some specific gum problems. Its use on teeth themselves is still being studied, and despite the hype from the manufacturers and the media, is not a proven technology. The Dental Leaders practice is carefully following the progress of this treatment modality and plans to incorporate it when the time is right. Lasers can also be used for bleaching teeth but the long-term effects are not yet known.
Tooth ExtractionsAn absolute requirement to place dental implants is to have sufficient bone, in all three dimensions, to firmly hold the implant while healing. Many people lose bone volume after tooth extraction. Long term denture users often have great deficits in the bone of the jaw. Bone grafting and management is an integral part of our implant planning in the Dental Leaders practice. We are firm believers in socket grafting, which is a technique used to fill in sockets with freeze-dried bone at the time of tooth loss. We have tremendous success with this technique. We can also graft small areas at the time of implant placement to augment small deficiencies. We also routinely use two techniques in the upper jaw, where the maxillary sinus is often too big, occupying space where we need bone. When large and complex grafts are needed, we utilize the services of trusted specialists in our community and work as a team.
Bone GraftingA special technique for bone grafting that greatly increases the success rate. There are two types of membranes used—one, which needs to be removed, and another, which slowly dissolves by itself. The membranes allow bone grafts to consolidate without interference from certain types of cells.
Gingivectomy and GingivoplastyThe reshaping of gum contours, often for esthetic purposes. Generally very easy and non-painful, gingivoplasty is often a good solution for a "gummy smile." Performed with a device very similar to a laser in function, there is very little inconvenience or recovery time.
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