In this segment, a list of general dental procedures is described to provide information on some of the most commonly asked-about subjects. Here is a convenient reference list:
- Preventive and Diagnostic Service
- Restorative Fillings, Metal vs. Composite (Tooth Colored)
- Root Canal Therapy (Endodontic Procedures)
- Oral Surgery, including a discussion on Wisdom teeth.
- Fixed Prosthetics: Crowns and Bridges
- Removable Prosthetics: Partial and Complete Dentures
Preventive and Diagnostic Services:
Consultation Appointment: We offer no-charge consultation appointments. A patient can ask about new dental procedures, or clarify their existing dental treatment plan. Patients can learn more about treatment options, financial arrangements, watch CD ROM and video programs on dental procedures or browse through our before and after gallery. Consultation appointments are available 7 days a week.
Diagnostic Exam: The diagnostic exam consists of a gathering of information. Necessary x-rays, diagnostic casts, health history, charting of existing conditions, diagnosis of needed dental treatment, and intraoral pictures are all part of our thorough exam process. Meeting patients expectations begins with this important information.
Emergency Exam: Pain knows no schedule. Toothaches and tooth injury, like those associated with sports, can happen without warning. At this appointment, the immediate needs are assessed and treated. Follow-up appointments can be scheduled to evaluate the patient’s priority of care.
Periodic Recall Exam: Usually performed in conjunction with a patient’s routine visit with the hygienist. Bitewing x-rays are taken at least once annually in order to reveal the beginning of any oral problems. Supportive tissues of bone and gingiva (gum) are monitored. It is also important for our denture wearers to schedule appointments with the hygienist and their dentist at least once a year. Your dentist will also check for any signs of oral cancer, which is a growing concern.
Preventative Dental Sealants: Sealing the pit and fissures of primary and permanent teeth can be performed as recommended. This procedure seals the occlusal (biting surface) or groves of teeth before decay has the chance to start. A plastic-like resin is bonded to the pit of the tooth, thus sealing out bacteria. The patient does not need to be numb, but only those teeth that have no decay or existing fillings are candidates.
The Prophylactic or Preventative Oral Cleaning Appointment: This procedure, by definition, is the professional, mechanical removal of harmful plaque, calculus, debris and stains from coronal tooth surface and into the gingival sulci (under the gumline). At this appointment the patient is educated in plaque control, proper brushing and flossing technique and good nutrition. Remember that bone and gum tissues support teeth. Keeping these tissues healthy is necessary in keeping healthy teeth. More teeth are lost due to gum disease than from decay.
Basic and Restorative Procedures:
Restorative Fillings: If a tooth cavity requires a filling, there are three basic types of restorative materials for our patients to choose from.
Amalgam: Otherwise known as a “silver” filling, amalgam is a mixture of metals (alloy) that when combined with mercury (liquid metal) form a pliable metal that is “packed” into the cavity, once the decay is removed. Due to its simplicity, this procedure is quick, effective and relatively inexpensive. More facts:
Composite: This is a “tooth-colored” material designed to match the existing tooth. It is a plastic material made of resin and tiny glass particles. It is effective for both fillings and to repair defects in teeth. Also known as “adhesive fillings,” composite materials further support the remaining tooth structure. Due to this bonding quality, the dentist won’t need to drill as much of the tooth structure as with amalgam fillings. During the past 40 years, dental research has led to special materials suitable for posterior fillings.
Visible decay on several anterior teeth
“Tooth-colored” and so natural looking it is almost invisible.
Gold: Gold is the oldest, yet absolutely the best material to use for the repair of most teeth. Its only disadvantages are its color and its cost. Nothing performs better or outlasts gold in the mouth. This is why many dentist still highly recommend yellow gold fillings or crowns to repair back teeth.
Root Canal Therapy (endodontics):
What is Root Canal Therapy?- A severe toothache can be caused by damaged tissues in the tooth. Root Canal therapy can relieve pain and save tooth function. Also referred to as Endodontics, root canal therapy involves the diagnosis and treatment of diseases of the living core (pulp chamber) of the tooth. The pulp chamber consists of nerve and blood vessel tissues. The pulp tissues help to develop the hard tissues around it. If tooth enamel and root cementum is fully developed, this purpose is basically satisfied. Nutrients are then supplied by the periodontal ligament that surrounds and supports the tooth. When a tooth has deep decay involving the pulp chamber, or is fractured or traumatized by force, root canal therapy may be recommended to save the tooth from otherwise being extracted. Treatment involves removal of any bacteria, toxins, nerve and blood vessel tissues. The canals are disinfected, and filled it with a rubber-like compound that seals off the apex at the root tip. Root canal therapy only treats the canal ; further restoration of a crown and or post/core build-up may be recommended. More simply, root canal treatment is a filling that continues to the root tip.
Steps for Root Canal Therapy: (Simplified)
- Local anesthetic is given.
- Decay is removed and pulp chamber is accessed.
- Mechanical debridement: Vital pulp tissues containing bacteria and toxins are carefully removed by means of special spiral endodontic files.
- Chemical debridement: Chelating agents are used to irrigate, clean, and widen canals.
- X-rays are taken during treatment to verify the location of the root tip.
- Irrigation and sterilization of the canal is insured.
- The root canal is dried .
- Obturation completes the filling and sealing of the entire root canal area.
- The orifice of the canal is recored with restorative materials.
- Final restoration may include a full coverage crown to give strength to compromised tooth structure.
Why do I need a Root Canal? Root canal therapy is indicated when the pulp chamber (nerve and blood vessel tissues) is damaged by decay, trauma, or is chipped or fractured. Pain is usually a symptom. Other signs include sensitivity to heat or cold, discoloration of the tooth, or swelling, although there may be no symptoms. If the tooth is left untreated, the pulp becomes irreversibly damaged and dies. Pain can range from mild discomfort to moderate or even chronic and may be associated with an odor or foul taste. If removing the decay of a tooth involves nerve and blood tissue, a simple filling can not be done because doing so would obstruct the circulation of the living tissues. Therefore, the circulating tissues are removed and the canal is filled to the root tip. Trauma force injury to teeth, like that from a sport injury or car accident, may cause the pulp to become necrotic. This means that the cells of the pulp are dead or dying. If this happens, successful root canal therapy can save the injured tooth and in turn save surrounding bone. Root Canal Therapy also retains chewing function and proper spacing of other teeth. It can even save a smile from losing a front tooth.
How much does Root Canals cost? The cost of treatment is measured by the time and difficulty involved. The root structure of teeth differ. Some roots are curved and some have multiple roots. Anterior or front teeth have a single root. First upper bicuspids have a bifurcation. Upper molars have a trifurcation root structure. Lower molars have two roots with up to two canals present in each. Root canal therapy ranges in cost from $375-$800. Recurrent problems from existing root canals may require additional time and expense for retreatment. Everyone wants to enjoy their teeth for a lifetime. The value of a single tooth can be measured in terms of the quality of life it affords the individual.
Can “Baby teeth” be Root Canaled? Primary teeth, although not a permanent set of teeth, serve a vital function to a child and should remain healthy until time for their natural replacement to occur. First and Second primary molars should not be lost until the child is between 9-12 years old. When primary teeth become damaged by decay or fracture, pulp therapy can be done to save teeth and thus retain the proper spacing needed for future eruption of permanent dention.
Pulp Therapy for primary and young permanent teeth depends on the extent of pulpal involvement and root formation. Your dentist may recommend one of the following treatments for your child’s specific needs.
- Indirect pulp capping- treats deep decay that is not yet into the pulp chamber. If removing all the decay would involve the pulp, then some decay is left in the tooth and a mixture of calcium hydroxide or formocresol is placed on the thin layer of carious dentin in effort to produce reparative tissue.
- Direct pulp capping- is an option only when a minimal of vital pulp is exposed. A sedative dressing is placed on the exposed pulp in effort to produce secondary dentin creating a insulating barrier over the sensitive pulp.
- Vital Pulpotomy- treatment involves only partial removal of pulp”horn” tissues and the root portion of vital pulp is not involved. Calcium hydroxide is placed over the opening of the canals to aid in healing and the formation of a new dentin barrier. Symptoms should be carefully monitored for several weeks and pain resembling a toothache should be relayed to the dentist. If the tooth responds successfully, a permanent restoration is an option after about 8 weeks.
- Pulpectomy- is the total removal of all vital pulp tissues. Teeth with long term pathology, abscesses, periodontal involvement, or with infection that involved exposed pulp, may be treated with this procedure. All nerve and blood vessel tissues are removed from the canal and then filled with an inert material.
Is there an alternative treatment to Root Canal Therapy?
The alternative to root canal therapy is usually tooth extraction. Sometimes the patient’s medical condition does not permit treatment, or the reason may be a financial one. If the tooth is ultimately extracted, tooth replacement may be accomplished with a fixed bridge, an implant or even a removable partial denture, depending on other oral factors. The best option, is usually, saving a natural tooth.
How long will my Root Canal last?
A tooth that has been successfully root canaled and maintained with good oral hygiene, can be retained for many years. Endodontic treatment has a very high success rate. Many root canal treated teeth last a lifetime. Root canal therapy is still considered a cost effective way to save natural teeth. Although an extraction is initially less expensive, tooth replacement can be more costly and can involve treating adjacent teeth.
What is an Apicoectomy? Sometimes referred to as endonontic surgery, this procedure is done to remove cysts from root tips or when needed to remedy certain problems that can occur with root canal therapy. This is a small surgery done through the soft tissue. This technique is often used to seal troublesome roots.
For more information on Root Canal Therapy see the Website by the American Association of Endodontists.
Oral Surgery: Simple and Surgical Extractions
Teeth have different shapes and sizes. Some teeth extract simply due to their simple root structure. The bone around a tooth’s root structure can be healthy or diseased. The angle a tooth erupts can also be a factor in the dentist decision of how the tooth will be removed. Through the use of radiology and experience, the dentist will diagnosis the type of tooth extraction. A tooth with extensive periodontal disease, maybe surrounded by very little bone. Molars usually require sectioning to remove them. This is a surgical procedure. If a tooth can be removed with out retracting the gum tissue, or making an incision on the tissue, it will probably be diagnosed as a simple extraction.
Wisdom Teeth almost always erupt abnormally. There is simply not enough space in the back of the jaw for them to erupt without complications. Usually, the lower wisdom teeth, with their curved roots and proximity to nerve locations, make them more complicated to remove. Sometimes wisdom teeth are still covered with bone, and are diagnosed as either Partial Boney Impacted, Soft tissue Impacted or Full Boney Impacted. “Impacted” refers to the angle at which the tooth is positioned in the jaw.
Multiple, adjacent teeth extractions often involve the shaping of the alveolar ridge to remove any high or sharp points of bone. By smoothing the bone ridge, the placement of a denture or other prosthesis will be more comfortable to the patient.
Fixed Prosthetics: Crowns, Bridges
Fixed Crown and Bridge: Crowns help cover or restructure a tooth when the natural coronal crown of a tooth is damaged. Full coverage crowns can be either full gold, porcelain fused to metal, or all porcelain. The structural needs and the desired esthetics will help determine the type of crown a patient will elect.
Full Crown- a full crown covers the entire anatomical crown of the tooth. It is a precision cast restoration. The dentist reshapes the tooth and takes an impression that is sent to our dental lab. A temporary crown is fabricated to protect the prepared tooth. The permanent crown is usually ready in about 2 weeks. A full coverage crown can be a single unit or be an abutment to a bridge in which missing teeth are replaced with a unit called a pontic. A bridge consists of abutments (either a natural tooth or an implant) which connect to a pontic, that replacing the missing tooth.
Full Gold Crown- Gold is an ideal metal for restorative use in the mouth. It is able to withstand the occlusal forces of back teeth and will not chip or fracture. Color, however, is a limiting factor, but gold can be used esthetically as a gold thimble base for porcelain to be fused to. Because pure gold is too soft, it must be alloyed with other metals to provide strength.
Porcelain Fused to Metal (PFM) Crown- Porcelain mimics natural enamel in the way it absorbs and reflects light. Porcelain has a translucent quality ideal for esthetic use on teeth. The metal used in PFM’s can vary. Nobel metals of gold, palladium, and platinum are alloyed with base metals like silver, tin, copper, and zinc to provide the framework to which porcelain is added to. Below is a summary of the qualifications used to describe the metals used in PFM”S.
Noble alloy: a noble metal crown consists of at least, or more than, 25% of the noble metals. No fixed amount of gold is required.
High Noble alloy: a high noble crown consists of at least or more than 60% noble metals and at least 40% must be gold.
At Capital Dental Group, only High Noble Metal is used for our Porcelain Fused to Metal Crowns.
All Porcelain Crown- When esthetics are of the upmost concern, an all porcelain or non-metal crown may be an option. (Porcelain Veneers will be discussed in the Cosmetic Dentistry Section of this website.)
Removable Partial Dentures, Full Dentures, Overdentures, and Implants.
Tooth replacement is necessary in order to improve chewing ability, vertical dimension, and esthetics. When back teeth are missing, a person compromises posterior function and will cause undue wear on other teeth. When front teeth are missing, a person’s social confidence is compromised. When teeth are lost, the bone begins a resorbsion or shrinking process. This bone loss causes a change in our facial support and effects our food choices. Partial and Full Dentures can economically replace multiple missing teeth and can make immediate changes in a person’s appearance. Although dentures can be a more affordable and sometimes immediate solution, long term concerns will continue for the person with missing teeth.
Removable Partial Denture- This prosthesis can be an option when a patient has some remaining healthy teeth on which to anchor or clasp a partial denture to. Treatment success depends on the strength of the existing teeth and bone loss present. Usually made of a cast chrome framework, and acrylic base and teeth, the design tries to accommodate the occlusal forces it is to be subject to. The patients chief complaints are any visible clasps and that food particles become lodged underneath the saddle of the partial. Removing the Partial and rinsing after eating can help relieve some discomfort associated with wearing a removable denture.
Full Denture- A full Denture replaces a complete set of teeth in an arch. An upper denture relies on retention from the suction of the palate. Due to the loss of anchoring from any natural teeth, a patient can expect to have occlusal force in chewing reduced by approximately 85%. A patient should learn to chew with a more up and down movement of the lower jaw instead of shearing movements used in chewing with natural teeth. Also, the pulling and tearing action which is possible with natural teeth will dislodge most dentures. Try to minimize the necessity for hard chewing. Hard chewing can lead to soft tissue damage. With some practice, patients learn to chew and talk to satisfy daily needs.
If you are interested in a book called “Facts You Should Know About Your Dentures,” please call our office and request it. It contains lots of practical answers and solutions to common concerns of the denture wearer.
Overdentures: An overdenture is a complete denture that is anchored to the ridge by several retained natural teeth or by implants.
Natural Tooth Supported Overdentures- when natural teeth are used, only the root structure is utilized. The tooth is root canaled and an attachment is cemented into the root structure. An interlocking component is placed into the denture allowing it to snap into the root component. This is a wonderful solution for patients that need and want more stability with chewing and speaking. By retaining root structure, the bone around the root is stimulated to grow, and therefore shrinks less with time. Only compressive-type forces that natural teeth and implants deliver to the inside of bone, can stimulate bone to grow. External forces can actually facilitate bone loss.
An Implant Supported Overdenture attaches to titanium posts that are placed in the bone. Multiple implants can be joined together by a bar which becomes the framework on which a denture is engaged. Upper implants can allow the elimination of the need for acrylic to cover the palate. Bone resorbs less around implants, which helps to maintain vertical dimension(the space between the nose and the chin). The amount of implants placed depends on available bone width and height and the financial limits of the patient. With the success of implants now in the 90% range, more patients are looking at the long-term investment with Implant dentistry.