We offer a wide range of dental service offerings to help you achieve total oral health. Our techniques embrace the latest technologies and are delivered with care to make your visit as comfortable as possible.
Our list of services offerings include:
Simple fillings are placed to restore teeth that have been damaged or have decay.
Our office only places composite restorations which are chemically plastic and are tooth-colored. As such, they are very aesthetic and because the shades can be modified, they can be matched to just about any tooth. Composite has been around for over 40 years and has revolutionized the way teeth are restored resulting in beautiful restorations that are bonded into place and also have less of an environmental impact. These restorations are quite durable, require that only the decayed tooth structure is removed, and the bonded seal to the tooth helps reduce “leakage” and subsequent decay. (Composites are also the material used to do what is generally referred to as “bonding”.)
Of course, there is no material that can compare to natural tooth structure so our emphasis will always be on prevention.
Minor Oral Surgery
At some point, it may be determined that you need to have a tooth extracted. Teeth are extracted because they are extremely decayed and unrestorable, are severely fractured, have severe gum disease, are required as part of an orthodontic treatment plan, or are malpositioned and interfering with overall oral health. Prior to any extractions, we will discuss the pros & cons of this procedure including shifting of adjacent teeth, hypereruption of opposing teeth, as well as decreased function and changes in appearance. We will also discuss replacement options, if there is such a need.
Regardless of the reason, we can do minor oral surgery right here in the office, and of course nitrous oxide is always available and certainly every patient receives local anesthesia. The procedure does involve a fair amount of pressure, however you will be numb. Sometimes, a tooth needs to be sectioned, which simply means that we will cut the tooth into small sections in order to remove each small piece separately. Some, not all, extractions will require sutures. Should this be the case, resorbable (aka dissolvable) sutures will generally be used. Post operative care instructions will be given upon discharge.
Occasionally, we will refer our patients to a local oral surgeon should you feel the need for general anesthesia or if we feel the extraction is too complex.
Tooth whitening, aka bleaching, is a great way to rejuvenate your smile inexpensively. While there are many different versions available, we have a proven successful track record and are confident in recommending it to the appropriate candidates who are looking to brighten up their smiles. After a quick consultation to gauge your desired outcome, we will recommend what we believe is the best treatment for you.
We offer “take home” systems as well as an “in- office” treatment. With either treatment, we will take impressions of your mouth and fabricate stone models. From these models, we will then fabricate custom plastic “trays” into which a prescription-strength bleach can be placed and then inserted into the mouth and worn for the appropriate amount of time. For the take home system, within 10-14 days, patients enjoy a more youthful smile! For the in-office treatment, Zoom, following a sensitivity prevention regimen, you can unlock a smile up to 8 shades whiter in just 90 minutes. The added bonus? You get outstanding results with little to no sensitivity. You will also be given your custom whitening trays so that you can “touch up” your vibrant new smile as you see fit. You can always purchase additional tubes of prescription strength whitening gel at a nominal cost.
While there are many over-the-counter products available, they are not as strong as those available through a professional office and side effects cannot be monitored. Also, inconsistencies in tooth position presents issues for over-the-counter products. Unfortunately, whitening products do not bleach existing fillings, veneers, crowns or bridges.
The American Dental Association recommends that you have your teeth professionally cleaned every 6 months. This is very important prevention because regular checkups allow us to identify problems when they are small rather than issues becoming larger than they need to be.
During these visits, your medical history will be updated and any necessary radiographs will be taken as well. Following this, an extraoral head and neck exam will be done and then an intraoral cancer screening will be done. Then it’s down to teeth!
We will measure the “pockets” around your teeth—this refers to the space between the tooth and gums that is not firmly attached; any reading greater than 3mm will be documented. This periodontal screening is an invaluable tool that allows us to find existing periodontal disease as well as identify areas that are becoming diseased or need more attention. Following this, we will examine your teeth and look for signs of decay, excessive wear and fractures; many times we will take intraoral photos of teeth that are showing excessive cracks or wear. All of these findings will be discussed along with recommendations to remedy any problems.
Following all examinations by your hygienist, she will use a series of special instruments called scalers to remove plaque and calculus from your teeth and just below your gumline. When this is complete, she will polish your teeth and then floss. Annually, you will be given a full exam by the dentist.
A dental sealant is a plastic material that is applied to the chewing surfaces of the back teeth (premolars & molars). The plastic resin bonds into the depressions and grooves (pits and fissures) of the chewing surfaces of these teeth and acts a barrier to protect the enamel from plaque and acids.
Sealants are a preventive measure that is taken when these adult teeth are erupted into the mouth. They are typically first recommended on the "6 year molars", and will be recommended as adult teeth erupt into your child's mouth. Insurance plans do not pay for sealants on premolars, however these teeth will benefit greatly from sealants as much as the molars. Also, because of how they function, adults with unrestored premolars and molars can benefit from this procedure, however insurance plans typically cover sealants applied only to children.
The procedure is quite simple; the teeth to be sealed are cleaned with a pumice slurry on a rotary brush and then rinsed. The teeth are then etched with a gel for about 15 seconds and then rinsed again. Finally the sealant material is applied to the grooved and pits of the teeth and then light-cured into place. Because they are placed on top of existing teeth, they are often dislodged and will need to be replaced. To increase the longevity of dental sealants, recipients are encouraged to avoid sticky, chewy foods that have a "pulling" effect on the tops of the back teeth.
Soft Tissue Management
Occasionally, as part of your periodontal screening, we will identify several pockets that are greater than the acceptable 1-3mm range. In these cases, we will often recommend a soft tissue management program. We offer three different programs and the type of program that we will recommend will depend upon the severity of periodontal disease that you present with. Every once in a great while, a patient might present with periodontal needs that fall out of the range of what our soft tissue program can treat and in such cases, a referral to the periodontist is given.
Our programs consist of a thorough periodontal exam including recorded pocket measurements at 6 points on each tooth. A series of subsequent appointments will be made for treatment. At each treatment visit, oral hygiene will be readdressed so that we are sure that you will benefit from the program. Following this, many patients are anesthetized and a thorough cleaning will be done deep below the gumline into all of the pockets at which time any plaque and calculus are removed. The treated areas are subsequently irrigated with appropriate medicaments. This deep cleaning may take 1, 2 or 4 visits to complete, depending on the severity of your disease.
After all of the “deep cleaning” has been finished, you will be re-evaluated at a 6 week follow-up visit. At such time a thorough periodontal examination will be repeated. We will share your results with you—which are typically astounding if you do your part at home!
Following this type of periodontal therapy, typically it is recommended that your “periodontal maintenance” be readdressed every 3 or 4 months; this means that instead of regular biannual cleanings, you will be seen every 3-4 months so that we may ensure your oral health and should there be any needs that arise, we do not let it go so long that it becomes a big issue.
If you have any questions about these programs, your dental hygienist will be happy to discuss them with respect to your needs.
Dental implants have revolutionized the way that dentists can treat patients with missing teeth and loose dentures. They are small titanium posts surgically implanted into the jaw bone where the tooth is missing. With good healing the bone grows into the surface of the implant creating a solid foundation for the restoration. While they are recently “hyped”, implants have been in existence for over 30 years and have evolved so that they now are an option in almost all circumstances.
Implants require a bit more treatment planning that many other procedures that we do. Most often, if we feel that your situation can benefit from implant therapy we will refer you to a periodontist who will typically do a CT scan to determine adequate placement and will subsequently do the surgery. Once healed, the periodontist will refer you back to us so that we can restore the implant and your ideal function.
Often denture patients complain about the “floppiness” of their dentures due to lack of adequate bone. Implants are the viable solution to floppy dentures; the surgeon will place a few smaller implants and the underside of the existing denture is modified to “clip” onto the implants.
The first phase is the surgical/healing phase. The implant itself is a substitute for the root of a natural tooth. The surgeon will numb you and in a fairly short appointment time actually place the implant and then place a healing cap on the abutment and typically place a suture. You will then begin your healing phase of 3-6 months; if needed, a prosthesis can be fabricated to satisfy cosmetic issues and allow for limited function.
The second phase is the restorative phase. Once the implant has fully “bonded” to the jawbone, the surgeon will send you back to our office. We will place an abutment which is a metal part machined to fit your implant precisely. This abutment will be placed and screwed into position after an x-ray verifies that it is properly placed. We will use guide posts and impression instruments to make an impression for the lab. Your original healing abutment will be placed back onto the implant. Our lab will use “dummy implants” on which they will fabricate your crown. At the subsequent visit, your abutment will be replaced onto the implant and “torqued” to a specific strength and your crown will be cemented onto it.
A few advantages include preservation of the thickness and quality of bone in the area of treatment, inability to decay (titanium doesn’t get cavities!), preservation of the adjacent teeth by not compromising them by anchoring a prosthesis, and the closest replacement for feel, function and appearance!
Endodontics (Root Canal Therapy)
When teeth are subjected to decay, repeating fillings, fracture or trauma, the pulp of the tooth (nerve and associated blood vessels) can be adversely affected. Typical symptoms include pain, increased pressure in the tooth, discomfort eating, extreme sensitivity to cold, and sensitivity to heat; sometimes the tooth is asymptomatic. However, regardless of symptoms, any of the above can lead to an abscess which can eventually infect the bone and compromise adjacent teeth.
The treatment for both abscessed teeth and severely hypersensitive teeth is typically a choice between extraction and root canal therapy. Root canal therapy consists of removing the infected pulp of the tooth, cleaning, reshaping and sterilizing the canals and then sealing in a filling into the root of the teeth. After this procedure, you will leave with a temporary filling in the top of the tooth. On posterior (back) teeth, during a subsequent visit, a post and core build-up will be done to serve as a solid foundation for a crown. A crown will be necessary since the tooth will become brittle and will fracture over time without this restoration.
Successfully treated, these teeth can last a lifetime. Root canal treatment has come a long way and is most commonly completed in one visit, is painless and allows you to keep your tooth.
Dentures and Partial Dentures
Dentures are removable appliances fabricated to replace missing teeth. They can be either partial or full.
A partial denture is fabricated for an arch that has some remaining natural teeth and some missing teeth. Typically they have clasps, or arms, that attach to adjacent teeth; they can be fabricated with a metal framework base onto which acrylic teeth and pink gums are bonded or entirely in acrylic.
A full denture is fabricated for an arch that no longer has any natural teeth. Because there are no teeth for clasping onto, they rely on the “suction cup” of the palate for upper full dentures and on the height of bone for lower full dentures. Adhesives are commonly used with these dentures because retention is a very common problem. Sometimes a denture will need to be relined to help make up for shrinkage of bone and gums over time; in cases where this is not adequate, we will discuss the option of using implants so that your denture can “snap” into place.
Inlays and Onlays
Inlays and onlays are indirect restorations that are indicated when the remaining tooth structure after decay removal or a fracture is insufficient. They are 2 step procedures: step 1 is the preparation & impression of the tooth and step 2 is the cementation or bonding of the restoration into the tooth. They are termed “indirect” because the restoration is fabricated out of the mouth. While they are similar to crowns in that they are indirect, they are far more conservative of natural tooth structure.
Inlays are placed in teeth that have sufficient cusps but a regular filling would be too weak; onlays are placed in teeth that need to have certain functional parts of the tooth replaced.
While traditional fillings fill the void after decay is removed, they do not help to replace the loss in strength of the tooth. Inlays & onlays use cast metals or special high-strength resins that when bonded into place can actually increase the strength of the tooth resulting in a restoration that can last for 10-30 years.
Both of these restorations are done using the Cerec machine for increased accuracy; should it be determined that you would benefit most from an all-ceramic crown, we will use the Cerec technology; otherwise, we will fabricate a temporary crown for you and cement your permanent crown in a subsequent visit.
Crowns are indirect restorations that fully cover the entire "visible" tooth and are a treatment for insufficient tooth structure due to very large old fillings, accidents, fractured teeth and hairline cracks in the tooth that cause pain when biting "a certain way". They are a long-lasting treatment, generally lasting 15-35 years with good hygiene—which is as close to permanent as dentistry can get. They can be fabricated out of cast metals, high strength porcelain, or out of porcelain fused to a cast metal (containing a high amount of gold). The type of material that is right for your case differs from patient to patient and should be discussed. Should it be determined that you would benefit most from an all-ceramic crown, we will use the Cerec technology; otherwise, we will fabricate a temporary crown for you and cement your permanent crown in a subsequent visit.
Like other indirect procedures, it is a two-step process. The first step will entail preparing the tooth for the crown including removal of decay and imaging the tooth involved as well as adjacent and opposing teeth; the second step consists of bonding the crown onto the tooth.
The benefits to crowns are: they restore your tooth to proper function, they can improve aesthetics, they protect damaged teeth, and they can look perfectly natural. A crown does not require that root canal treatment be done first; however, a crown is usually necessitated after root canal treatment on back teeth.
Bridges are indirect restorations that are used to replace missing teeth when there is a natural tooth before and after the “space.” A bridge is essentially a crown on each of the teeth adjacent to the space. However, the dental lab will fabricate a prosthesis that fully covers the adjacent teeth but also has the replacement tooth attached. Like crowns, they are available in a variety of materials and what is appropriate for each patient varies on many parameters. When replacing front teeth, all-porcelain bridges are generally an option that affords optimal aesthetics; when replacing back teeth, we generally prefer the strength of porcelain-fused-to-metal in order to withstand the chewing forces. Even porcelain-fused-to-metal bridges are very pleasing to the eye.
Bridges are charged by the “unit”; each of the teeth involved count as a unit including those covering the adjacent teeth as well as those replacing missing teeth. Three and four unit bridges are typically 2-step procedures like crowns; 5 unit bridges and longer are typically a 3-visit procedure. Regardless of the length, bridges are cemented into place and do not get removed at night.
The most common alternatives to bridges are removable partial dentures and implants. We are always happy to discuss all of your options with you as well as the pros & cons for your particular needs.
Veneers are thin shells of porcelain that bond directly to the front surfaces and edges of teeth; they are very simple and can be used to aesthetically enhance your smile. They can be used to fill spaces that exist between teeth, to correct chipped, poorly shaped, worn or crooked teeth, and to correct dark and discolored teeth. They are virtually undetectable and are quite resistant to staining. When cared for properly, veneers can last well over a decade. While we can ensure that they are crafted in the USA from the highest quality materials and the cements that we will use to bond them will be the best available, they are subject to fracture the same way natural teeth can fracture. For this reason, we will typically recommend a night guard to prevent fracture of your veneers while you sleep.
Like crowns & bridges, veneers are an indirect procedure as well which means they require more than one visit. Larger cases will start with a “diagnostic wax up” which entails impressions that can be sent to the dental laboratory which will in turn send back a “mock up” of what we can expect your veneers to look like on the stone model of your mouth. We can make any aesthetic adjustments based on your preferences and can easily communicate that to the lab. The second visit will entail the preparation of the teeth for the veneers, impressions of the prepared teeth as well as the fabrication of temporary veneers for the interim. During the final appointment, we will bond the veneers to your teeth after they have been tried in and we all agree that the aesthetics are as good as, or better than you had hoped!
Occasionally, patients request a less expensive option where veneers are placed directly after the teeth are prepared using resin instead of porcelain. This, too, is an option and we can generally achieve a nice result; however resins are not as translucent as porcelain and will not allow light to shine through resulting in a “flatter” look. In the right cases, they can be an economical way to correct small problems.
Nitrous oxide, aka "laughing gas" or "sweet air", is a gas delivered through a nasal mask that is used to reduce anxiety. Nitrous oxide is commonly used for patients with fear of dental procedures. The gas will relax you, however it will not put you to sleep and you will be able to converse with us throughout the entire procedure; it is easily reversed at the conclusion of the procedure with oxygen for about 4-5 minutes through the same mask. Most patients feel a "floaty" feeling or the feeling of having had a glass or two of wine—awake and oriented, just lest anxious. There are very few contraindications to its use and the decision to use it can be very "last minute."
Deep Sedation Dentistry/ "True Sleep Dentistry"
True sleep dentistry is another term for general anesthesia. By definition, it is a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug- induced depression of neuromuscular function. Cardiovascular function may be impaired. General Anesthesia is a controlled state of unconsciousness. We maintain a state required facility permit which allows a dental anesthesiologist to legally come into our office and provide anesthesia services for patients that require them. While under general anesthesia, we will provide all the the previously agreed upon dental procedures...from simple restorations to complex extractions and implants. Obviously, this type of care requires a full consultation with subsequent coordination of care with the anesthesiologist. We work exclusively with McCarty Anesthesiology for these procedures.
Cerec refers to a CAD software program that "makes" crowns, inlays, and onlays. This software is highly specialized in the dental field and available in less than 5% of dental offices. In conjunction with a "milling machine", Cerec allows us to fabricate these restorations, start-to-finish, in one visit. The other huge bonus for so many, in addition to single-visit crowns, is the lack of need for conventional impressions (no goopy stuff to bite into!); because you get your completed crown/inlay/onlay in the same visit, there is also no need for temporary crowns that can be sensitive or become dislodged.
After we have determined and agreed that this is the best way to proceed with your treatment, we will remove any decayed tooth structure and prepare the tooth appropriately for the type of restoration that you will receive. Once that step is completed, a 3-D measuring camera is used to capture images of the prepared tooth and its opposing teeth in just a few seconds. At that point, you are done for the time being while the software works its magic; the computer will design your restoration, we may or may not need to customize it further, and then we will send it to the milling unit to be fabricated out of a solid ceramic block with the click of a button. About ten minutes later the result is a beautiful, natural-looking restoration that we will try in and subsequently bond into place.
You can only have yellow gold crowns??? Cerec is still the answer, except you will need to come back about a week or so later; we can still bypass the messy impressions and capture digitally-perfect images, but instead of milling it here out of ceramic, we will electronically send your images to a lab that will build and cast your gold crown which will be cemented at a subsequent appointment.
The bottom line: Cerec is the key to accuracy and absolute perfection both visually and radiographically!
Laser dentistry is a term for any dental procedure done using a laser as an instrument. Our office has been using a laser since 2009 and have since upgraded to Biolase's "iLase Plus"…the industry's latest and greatest laser for hard and soft tissue. Lasers enable us to provide pain-free and needle-free restorations as well as other surgical procedures.
The most common application for this laser is the removal of decay typically without the need for local anesthesia in smaller "cavities". This is most appreciated by patients when they are able to leave the office without being "numb". The patient population that benefits the most is our pediatric population since children generally are fearful of the feeling of being numb since it is such an abnormal sensation for them.
The laser can be used to do many soft tissue (gums) procedures without the use of a scalpel and with the added benefit of the "laser bandaid effect"; these procedures include frenectomies (removal of the muscle attachment of the lip to the gums or the tongue to the floor of the mouth), crown lengthening procedures, gum tissue recontouring, treating periodontally diseased teeth, and many others. The benefit to using the laser is that the laser also disinfects the tissue so that healing is much more rapid than with traditional means and therefore patient downtime is reduced.
Additionally, laser dentistry can be used by hygienists as well. Our office has a SIROLaser Advance+ available to our hygienists to use on patients who require soft tissue management and pocket decontamination. Hygienists are able to use the laser to promote greater oral health and disease prevention.
Frenectomy aka Tongue/Lip Tie Release
For babies with tongue-tie or lip-tie, there’s a problem with something called the frenulum. That’s the small stretch of tissue that connects the underside of your tongue to the bottom of your mouth or the upper lip to the gum tissue that is or will be between the two front teeth. It might be too short and tight, or attached way up near the tip of the tongue/lip. Either way, it ties the tongue or lip in place. For some, it’s not much of an issue. For others, it can lead to problems breastfeeding. Later on, it can affect eating and speaking. Using a laser, we will release this tissue connection, thus allowing the tongue to move freely and subsequently latch onto the breast properly. Even if the patient is beyond breastfeeding, this procedure is commonly recommended prior to orthodontics (in the case of the lip tie) to ensure that the front teeth will move together and that position will be maintainable. A very informational consultation is required.
Botox/ Botox for TMJ
Botox is made from a neurotoxincalled botulinum toxin produced by the bacterium Clostridium botulinum. Botox can be used to treat vartious muscle conditions, remove wrinkles, excessive sweating, and migraines resulting from teeth grinding. Botox is a popular treatment method for patients with temporomandibular joint dysfunction (TMJ) and joint tension. Injecting botox into certain facial muscles that are afflicted with soreness and discomfort can provide relief for many.
Dental Cone Beam CT
Dental cone beam computed tomography (CT) is a special type of x-ray equipment used when regular dental or facial x-rays are not sufficient. Your doctor may use this technology to produce three dimensional (3-D) images of your teeth, soft tissues, nerve pathways and bone in a single scan. This procedure requires little to no special preparation. Tell your doctor if there’s a possibility you are pregnant. Wear loose, comfortable clothing and leave jewelry at home.