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Procedures

Cosmetic Bonding

Cosmetic bonding is a procedure that involves using a resin based material that adheres to the tooth, to restore decay, alter tooth shape or size, close spaces and variety of other uses. This material comes in many tooth colors so the color of you tooth can be matched to create an invisible restoration. The composite resin material has a chemical bond to the tooth and can require little or no tooth preparation.

Bonding is a minimally invasive procedure when done for cosmetic reasons. It usually requires minimal tooth preparation. If a tooth is being bonded for cosmetic reasons, it typically will not require dental anesthesia. It is a one visit procedure, so your new cosmetic restoration will be complete when you leave the office after your appointment. Another big advantage of bonding is that almost no enamel has to be removed from your tooth to bond your teeth.

In order to determine if you are a good candidate for bonding to make a cosmetic change to your teeth, it is best to see your dentist for evaluation. Not every dental condition can be solved with bonding. In addition, the occlusion (bite) will also play a big role to determine if bonding is the right solution for your mouth.

The procedure, from the patient’s point of view is relatively simple. There is usually no pain involved in the bonding procedure. The tooth is roughened up and then treated with a special tooth conditioner. A clear bonding agent is then applied to the tooth. This is the chemical agent that adheres the bonding material to the tooth. Then the bonding material is applied to the tooth and cured with a special light. This light hardens the bonding material so it attaches to the tooth. Once applied and hardened , the material is polished with special disks and burs to simulate the appearance of enamel.

Bonding can typically last 5-10 years. It does stain and can chip or break depending upon what you eat or if you grind or clench your teeth. The good news is that bonding can easily be repaired in the mouth.

The cost of bonding is typically about 30- 40 percent less that other cosmetic restoration which require laboratory procedures. As time progresses, the quality and color stability of bonding materials are improving dramatically. The big advantage of bonding is that there is minimal alteration to the tooth, which means there is always the option of making other types of porcelain restorations, which are not as conservative, in the future when needed. This is by far the restoration of choice in young patients, when the criteria for bonding is met.

Veneers

A veneer or more commonly referred to as a porcelain veneer, is a thin piece of porcelain which is a facing or covering on the front surface of your tooth. This facing is fixed to the tooth with a bonding material. A veneer can change the size, shape and color of teeth. This restoration does require tooth preparation and is considered non reversible.

The benefit of veneer over bonding is that the porcelain is very compatible with gum tissue and can be made very thin. The veneer can be made opaque so that it covers over dark stain in the teeth. This restoration is much more conservative than a crown if the circumstances are favorable for a veneer.

If you have an interest in veneers, your dentist can help you determine if a veneer is the right restoration for your tooth. A veneer is not suited for every situation. The typical life of a veneer is about 5-10 years, although with excellent home care and maintenance, the life of a veneer, can be significantly longer.

Veneers vary by the material they are made of and the situation that is being corrected. There are very thin veneers that have been referred to as lumineers, which require almost no tooth preparation, but must be used in specific situation. Your dentist can advise you what type of veneer is best suited for your mouth.

Veneers are minimally a two visit procedure, once the diagnosis is made and the treatment is agreed upon. The first visit requires the tooth to be prepared and then a provisional veneer restoration is constructed. The next step is to take an impression of the teeth. This records the shape of the teeth for the lab to be able to made a temporary restoration.

Veneers can be maintained like your real teeth. The teeth need to be flossed and brushed as if they were your own teeth. Veneers can develop decay, so impeccable home care is key. In addition if there is any bite or occlusal discrepancy, then a night guard appliance must be constructed , to protect the porcelain.

Veneers are typically more costly that bonded facings, they can get recurrent decay, they take multiple visits and can cause teeth to become sensitive. But in the properly selected situation, veneers are a magnificent restoration, which can strengthen the tooth and last for many years.

Dental Implants

A dental implant is simply the way to replace the root of a missing tooth. It is a fixture (metal post) that is placed in the bone and once the bone grows and attaches to the metal post (called osteointegration) can be used to support a crown. Implants can eliminate the need for denture and partial denture restorations in many cases.

Implants have many benefits. The are more functional than removable restorations, more comfortable, more esthetic, more durable, easier to eat with and improves your speech.

There are two parts to restoring the mouth with implants. The first phase is the surgical stage. It requires surgical placement of the implant body. This surgical phase requires 4-6 months of healing postsurgical before the implant attaches to the bone and is solidly embedded so that a restoration can be constructed to attached to the implant. The second phase of implant therapy is to restore the implant body that was surgically placed in the bone with a crown. The crown is similar to a cap or crown done on natural teeth, except it has special parts which allow it to fit on the implant body. This is done with an impression that the dental lab makes the crown. Upon returning to the office, the implant is adjusted and attached to the implant abutment. This then functions like a natural tooth.

The selection of the proper situation for implant placement is critical. Smoking is a contraindication for implant placement. In smokers, the implant body can be rejected due to smoking. In addition, the bite, space and the amount of bone must be evaluated to determine if the implant is indicated. Many times the bone has to be augmented to make the site acceptable for implant placement.

The implant tooth will feel natural and should be maintained the same as a natural tooth. The same way a natural tooth can develop periodontal problems, an implant can also have complications. Maintenance is critical in the long term success of the implant restoration, just as with any dental restoration. In the well maintained mouth, an implant have a 98% long term success rate.

Sleep Apnea

Sleep apnea is a condition where a person pauses breathing multiple times during sleep. The pause can be for several seconds and can occur 30 or more times an hour. The end of an episode usually is associated with a snorting sound. This interrupts deep sleep and results in daytime sleepiness. This condition is many times not diagnosed unless detected by a bed partner.

The most common type of sleep apnea is obstructive sleep apnea (OSA) which is caused by a collapse of the airway. When you breathe the air squeezes past the collapsed airway and causes a loud snoring sound. When you have the pause in breathing, your brain wakes you up and causes you to start breathing again.

There are three types of sleep apnea, obstructive, central and complex sleep apnea. Obstructive sleep apnea is a collapse of the airway. Central sleep apnea is a central nervous system disorder and complex is a combination of both types.

Chronic sleep apnea results in daytime sleepiness, slow reflexes and decreases your ability to concentrate. Due to these symtoms, it is common for individuals with sleep apnea to have car accidents. In addition, sleep apnea can lead to many health problems including high blood pressure, diabetes, heart disease and stroke.

It is common that individuals who are overweight will have sleep apnea, but thin individuals can also have sleep apnea. It is related to neck size. The larger the neck, the more tissue in the throat area, the higher risk of sleep apnea. It is more common in men than women. Children who have obstructions like large tonsils can also have sleep apnea.

If your bed partner observes the symptoms or you realize you are not fully rested after sleep, there is a questionnaire that can be filled out and give you a better idea if you have the symptoms. The next step is to have a sleep study done which can be done in a sleep center or by using a take home device like the watermark. This will be interpreted by a sleep physician and determine what the diagnosis is.

Historically, the most common treatment of sleep apnea has been the c-pap, which is a pump that pumps air down your throat by wearing a face mask during sleep. The problem is that many people are not compliant wearing this appliance. Unless sleep apnea is severe, most people can be treated with an intraoral device. These devices open the airway and allow the patient to sleep during the night without the apnea events. The intraoral devices are much easier to use than the c-pap and there is much more compliance. The intraoral device is like a night guard. They are suitable for treating mild to moderate sleep apnea. These appliances are made by your dentist and reposition your lower jaw to open the airway. These devices require adjustment from time to time but are much easier to wear than a c-pap.

It is critical to identify if you have sleep apnea. If you snore, there is not the same level of interference with sleep as with sleep apnea. The intraoral devices will also help to stop snoring. Ask your dentist to evaluate you for sleep apnea, it can save your life.

Teeth Whitening

Tooth whitening is a procedure that removes superficial and deep stain from the teeth to make the tooth whiter. It is similar to the way you put bleach in a wash to remove the yellow from white fabrics. Teeth are made of enamel and dentin which pick up stains from the environment that cause the teeth to get a yellow color. The whitening material removes the discoloration from the teeth and bring the teeth back to the original color.

There are different ways to whiten your teeth, tray whitening and in office whitening are the most effective techniques. The over the counter methods such as white strips and rinses and toothpastes are not consistent and will not give you an ideal result.

In office whitening is the quickest way to whiten teeth and the most expensive way. It takes several hours in the office and will give you the result of about 1 week of tray whitening. A whitening product is applied to the teeth and exposed to a light which whitens the teeth. Typically tray whitening is necessary to follow up with in office whitening to get the desired result.

Tray whitening is the most common whitening procedure. An impression is take of you teeth and then thin clear plastic trays are constructed to use with a whitening gel, usually a form of carbamide peroxide, and worn 15-30 minutes daily for a period of 2 to 3 weeks. Since whitening is dose and time dependent, there is a certain amount of time you will need to wear the trays to achieve the desired result.

Whitening is a cosmetic procedure and requires maintenance. With tray whitening you have the ability to touch up every month or two by using the tray with the whitening gel. The gel is available for purchase in touch up kits so that you can maintain the level of white desired.

The level of white that the tooth can achieve is different with every individual. No everyone will get the level of change they want since the color is determined by the enamel on the teeth. It is also important to remember that restorations and crowns do not whiten. Therefore, after whitening your teeth, existing crowns and fillings will not match the new color of your teeth and will have to be replaced.

The only side effect of whitening is that your teeth can become sensitive during the process. In order to minimize this , fluoride can be used simultaneously with the whitening gel. The sensitivity resulting from whitening is transient and usually will subside after you stop the whitening process. In addition, using to much whitening gel in the trays can cause sensitivity.

Sports Mouthguards

The estimate is that 20 to 25 million youths participate in competitive sports. A number that is continually growing. Along with this growth in participation, the incidence of injury has also increased. Sports has been reported to account for as much as 36% of all unintentional injury in children and adolescents. Of these injuries, the American Dental Association has reported that 10-20% of these injuries are maxillofacial injures.

The National Youth Sports Foundation for Safety reports that the most common type of facial or tooth related injury is sustained during sports. An athlete is 60 times more likely to sustain tooth damage if they are not wearing a protective mouthguard. The result of oral facial injuries, especially to the teeth, is typically permanent damage and requires treatment.

Types of Dental Injuries:

    • Fractures – root fractures, broken teeth or chipped tooth
    • Avulsion- the entire root and tooth is knocked out
    • Luxation- the tooth is in the socket but moved into the wrong position

It is important to remember that time is critical when handling dental injuries. Do not allow the athlete to wait until the end of the game to be treated for a dental injury. Make sure they get to a dentist within 2 hours for the best outcome.

Prevention of Dental Injuries

The best way to prevent dental injures is by wearing a properly fitted custom mouthguard. This can reduce the rate of concussion as well as dental injuries.

The American Dental Association recommends wearing custom mouthguards for all sports. They further recommend the mouthguard be worn during all practices and competition.

There are three types of mouthguards, ready- made stock mouthguards, mouth formed boil and bite mouthguards and custom –made mouthguard made by a dentist.

The best protection against dental injuries is a custom made and fitted mouthguard. The American Dental Association has recommended that a mouthguard should be comfortable, resistant to tearing and resilient. The mouthguard should also fit properly, durable, easily cleaned and not restrict speech or breathing. A mouthguard such as the Under Armour sports mouth guard, will in fact, increase endurance, strength and speed. It is specifically designed to decrease cortisol levels which decreases lactic acid formation and leads to decreased recovery time for muscle. Decreased lactic acid will result in increased strength, power and speed. The Under Armour mouth guard also opens the airway to increase oxygen levels during sports activity.

It is important to remember that damaged teeth do not grow back. Protect that perfect smile—Wear a custom mouthguard!

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