Veneers

Veneers are a dental procedure in which a covering is placed over the outside (visible area) of the tooth. Veneers are usually only applied to the part of the tooth that is visible when talking or smiling. The procedure can be direct or indirect.

The direct technique usually involves placing composite resin on the outside of the tooth using bonding. This method is usually referred to as bonding.

The indirect technique usually involves two appointments because the veneers will be fabricated at a dental laboratory.  At the first appointment the teeth are prepared, impressions taken, and the teeth are given a temporary covering. In two to three weeks the veneers are back from the laboratory, the temporaries are removed and the veneers are bonded to the teeth. The laboratory fabricated veneers are usually made using porcelain or pressed ceramic and are very aesthetic.

The advantage of veneers versus crowns is that much less tooth material is removed, and the procedure is generally less uncomfortable. Veneers are recommended for teeth that have large fillings or little tooth structure.

In between regular visits to the dentist, there are simple steps that each of us can take to greatly decrease the risk of developing tooth decay, gum disease and other dental problems. These include:

• Brush thoroughly twice a day and floss daily
• Eat a balanced diet and limit snacks between meals
• Use dental products which contain fluoride, including toothpaste
• Rinse with a flouride mouth rinse if advised to do so
• Make sure children under 12 drink fluoridated water or take a fluoride supplement if they live in a non-fluoridated area
• Visit your dentist regularly for professional cleanings and oral exams
• Replace your toothbrush every 3-4 months

The following are indications of good oral hygiene:

Dental Cleaning

A dental cleaning is a professional cleaning you receive from a dentist or dental hygienist. Most dental cleanings take approximately 45 minutes.  Cleanings should be performed every six months to prevent excessive plaque buildup.  Plaque left untreated can lead to unhealthy gums and tooth decay.  During your routine cleaning we will remove excess plaque and polish your teeth. 

Halitosis - bad breath

Halitosis is sophisticated word for “bad breath”.  Depending on the cause, bad breath may strike on occasion or be a persistent condition. The most common cause of bad breath is bacteria.  Because the mouth is moist and warm, it creates perfect conditions for the millions of bacteria that live in the mouth.  In fact, approximately 80% of bad breath is caused by something in the mouth.

Some types of bad breath, such as "morning mouth," are considered fairly normal and are not usually health concerns. However, persistent bad breath may be a sign of more serious problems with the gums and teeth.

Bad breath may be caused by the following:

• Poor dental hygiene – poor oral hygiene can leave food particles to decay in the mouth
• Infections in the mouth such as periodontal (gum) disease
• Respiratory-tract infections such as throat infections, sinus infections, lung infections
• External agents including foods such as garlic, onions, and coffee, as well as cigarettes and chewing tobacco
• Dry mouth caused by salivary gland problems or by breathing through the mouth
• Systemic illnesses such as diabetes, liver disease, kidney disease, lung disease, sinus disease, reflux disease and others

Call our office promptly if you have bad breath with painful, swollen gums that bleed easily or loose teeth.  We will perform a physical examination of your mouth to determine the cause.  If we discover that systematic problems are the cause, we may refer you to your family physician.  In severe cases of gum disease, we may recommend a specialized periodontist. 

Sealants

Sealants are used to fill narrow grooves in a tooth that cannot be adequately cleaned by brushing.  In some cases, the tooth structure has fine grooves or pits which accumulate plaque, not because the person doesn't brush, but because they're too narrow to allow even one bristle into them.  To avoid cavities developing over time, the dentist will brush on a coating that seals the grooves and pits, making it possible to brush off all the plaque and keep your teeth healthy. 

Bonding

Bonding involves adhering composite resin material that is matched to the color of the tooth, to the front of the tooth. This is performed to repair damage caused by decay, to alter the alignment of the tooth, close gaps between the teeth, or for other cosmetic purposes. 

First the surface of the tooth is roughened in order to accept the bonding.  A gel is applied so the resin will adhere to the surface of the tooth.  The composite is then placed on the tooth and the bonding agent hardens with intense light. The last step is shaping and polishing to give a lustrous finish. 

Fillings

A filling is a way to restore a tooth damaged by decay back to its normal function and shape.  If you have a tooth that requires a filling, the dentist will first remove the decayed tooth material, clean the affected area, and then fill the cleaned out cavity with a filling material.  A filling helps prevent further decay by closing off any cracks or spaces where bacteria can enter.

There are a variety of filling materials available including gold, silver, plastic and porcelain. The dentist will work with you to determine which material is best, depending on the extent of repair, where in the filling is needed, and cost.  Each filling material is briefly explained below:

• Gold fillings are custom made in a laboratory and then cemented into place.  While gold fillings are often the most expensive choice, many consider it the best filling material.  Gold inlays are well-tolerated by gum tissues and may last more than 20 years.
  
  
• Amalgam (silver) fillings are a more inexpensive choice and are tolerant to wear.  However, due to their dark color they are more noticeable than porcelain or composite restorations and are not recommended for fillings in very visible areas such as front teeth.
  
  
• Composite (plastic) resins are custom made to the exact color of your natural teeth, creating a more natural appearance. While white fillings may be less noticeable than other materials, they usually only last between 3 and 10 years and may not be ideal for large fillings as they may chip or wear over time.  They can also become stained from coffee, tea or tobacco.
  
  
• Porcelain fillings are called inlays or onlays and are custom created in a lab and then bonded to the tooth.  They can be matched to the color of the tooth, resist staining, and are about the same cost as gold fillings.  A porcelain restoration generally covers most of the tooth, making the filling nearly undetectable.

If decay or a fracture has damaged a large portion of the tooth, a crown (or "cap") may be recommended.  Decay that has reached the nerve may be treated through root canal therapy or through a procedure called pulp capping. 

Sedation Dentistry / Dental Anxiety

Dental sedation is a technique that can be used when a patient suffers from dental anxiety or dental phobia.  We are happy to offer a number of solutions for our patients to make their dental visit as comfortable as possible.  Sedation dentistry techniques enable patients who might otherwise avoid the dentist, to receive dental treatment necessary for a healthy smile. Depending on the extent of the anxiety or phobia, varying degrees of dental sedation can be utilized as described below.

Nitrous Oxide Sedation
Nitrous Oxide sedation, also known as “laughing gas” is commonly used to make treatment more comfortable.  This sedation is inhaled through a mask that allows you to breathe in the medication and induces a state of relaxation.  Local anesthetic will be administered in conjunction with nitrous oxide to eliminate pain.

Non-Surgical Gum Treatment

The gums, ligaments, and bone around the teeth form the foundation for  teeth. All structures are also referred to as the periodontium. When the periodontium is not healthy, it jeopardizes the teeth just as a bad foundation would threaten the stability of a house.  Signs of unhealthy periodontium include: gums that are red and bleed easily, persistent bad breath, gums that are pulled away from the tooth, loose teeth, and changes in the position or bite of the teeth.  With proper gum treatments,  it may be possible to return gum tissue to a healthy state.  If you're having a problem, come in and see us so we may treat it right away. The treatment usually involves a deep cleaning or root planing done under a local anesthetic, along with local antibiotic agents.  It is important to have gum problems checked promptly, as gum disease left alone may eventually need treatment through surgery or extraction.

Crowns may be used to:

• Replace a large filling when there is little tooth structure remaining
• Protect a weak tooth from fracturing
• Restore a fractured tooth
• Attach a bridge
• Cover a dental implant
• Cover a discolored or poorly shaped tooth
• Cover a tooth that has had root canal treatment

A bridge is an ideal method to fill the space created by missing teeth. A bridge is one or more artificial teeth cemented into place using the teeth on either side for support. This is an option for filling the space created by a missing tooth.  Bridge work is as much an art as it is an exact science since it replaces a missing tooth both functionally and cosmetically. The materials used may be gold alloys, porcelain bonded to metal alloy, or all ceramic material made to match your natural tooth color.  The choice of material depends on requirements for strength, wear, and aesthetics.

It is important that a missing tooth be replaced as soon as possible.  If not treated, the teeth surrounding the gap begin to shift inward. Since teeth use their neighbors for support, if one is missing they begin to "fall” and shift into the open spaces. This may worsen the bite because of the changes in pressure and can eventually result in problems with the jaw such as TMJ.

Bridges and crowns are made by first taking an impression of your mouth.  The impression is sent to a dental lab where your crown or bridge will be custom made to fit your mouth and match your natural tooth color.  A temporary crown or bridge will be placed into your mouth until your permanent crown or bridge is ready and cemented into place. 

Bridges and crowns are very durable and can last a lifetime with extra care and good oral hygiene.

Tooth Extractions

Good oral hygiene should always be practiced since the loss of a single tooth can have major impact upon your oral health and appearance.  Although dentists will use every measure to prevent tooth loss, there are still sometimes necessary occasions when a tooth may need to be extracted.  A tooth may need to be extracted for the following reasons:

• Severe decay
• Advanced periodontal disease
• Infection or abcess
• Orthodontic correction
• Malpositioned teeth
• Fractured teeth or roots
• Impated teeth

After careful examination and treatment, the dentist may advise to have a tooth extracted.  Before a tooth is removed, the dentist will take an x-ray in order to understand the shape and position of the tooth and surrounding bone.  Based on the degree of difficulty, we may refer you to a specialized oral surgeon.

For a simple extraction, we will first apply a local anesthetic to prevent pain and discomfort. The tooth will be loosened with a tool called an elevator and then removed with dental forceps. Once the procedure is complete, the area may be closed with one or two stitches.  We will then provide you with care instructions to alleviate discomfort and ensure proper healing.

Wisdom Tooth Extractions

Wisdom teeth are the third and final set of molars that most people get in their late teens or early twenties. Sometimes these teeth can be a valuable asset to the mouth when healthy and properly aligned, but more often, they are misaligned and require removal.

Poor alignment of wisdom teeth can crowd or damage adjacent teeth, the jawbone, or nerves. Wisdom teeth that lean toward the second molars make those teeth more vulnerable to decay by entrapping plaque and debris. In addition, wisdom teeth can be entrapped completely within the soft tissue and/or the jawbone or only partially break through or erupt through the gum.

Teeth that remain partially or completely entrapped within the soft tissue and /or the jawbone are termed "impacted." Wisdom teeth that only partially erupt allows for an opening for bacteria to enter around the tooth and cause an infection, which results in pain, swelling, jaw stiffness, and general illness. Partially erupted teeth are also more prone to tooth decay and gum disease because their hard-to-reach location and awkward positioning makes brushing and flossing difficult.

Dental Implants

A dental implant is an ideal tooth restoration for people who are missing one or more teeth as a result of injury, periodontal disease, or any other reason.  A dental implant is a metal post that a periodontist or oral surgeon surgically positions into the jaw.  Once in place and bone surrounding the implant has had time to heal, a replacement tooth is attached to the post.  While implants are typically more expensive than other methods of tooth replacement, they provide superior benefits.  Implants are stronger than natural teeth and generally last 10-20 years.  They are also a more favorable approach than bridgework since they do not depend on neighboring teeth for support.

To receive implants, you need to have healthy gums and adequate bone to support the implant.  You must also be committed to excellent oral hygiene and regular dental visits as these are critical to the long-term success of dental implants.

Dentures

A denture is a removable replacement for missing teeth and surrounding tissues.  There are two types of dentures available, including partial and complete dentures.  Partial dentures are used when some natural teeth remain, while complete dentures are used to completely replace all teeth.  Dentures are made to resemble your natural teeth so there should be no noticeable change to your appearance. In fact, dentures may even improve your smile!

This restoration method is used to restore your smile and mouth function if all your teeth have been lost.  The dentures are custom created to resemble natural teeth and are positioned to take the place of natural teeth.  Complete dentures are removable and may require adjustments in order to create a proper fit with the gums and mouth.

A removable partial denture is a device used when one or more natural teeth still remain in the upper or lower jaw.  They usually consist of replacement teeth attached go a gum-colored plastic base which is held in place in the mouth.  A fixed partial denture acts the same as a removable denture, but it is cemented into place using adjacent teeth for support.

New dentures may feel awkward or loose for the first few weeks until the muscles of your cheek and tongue learn to keep them in place and you are comfortable eating and speaking. Although this may require some practice you will adjust and enjoy the benefits a full mouth of teeth can provide.

Nightguards and Mouthguards

Custom designed mouthguards and nightguards are made of flexible plastic and molded to fit the shape of your teeth. Mouthguards are recommended to protect the jaw and teeth during physical activity and sports such as boxing, football, basketball, or other activities where your mouth may be hit.  Guards also protect the soft tissues of your tongue, lips and cheek lining.  Nightguards are recommended for patients who clench or grind their teeth at night as a way to protect their teeth and bite.

If you have decided a guard is right for you, we will take an impression of your teeth which will then be sent to a lab to make a custom fit guard.  In most cases you can choose from a variety of colors and styles. On average, guards last between 3 and 10 years.

Neuromuscular and TMJ Treatments

TMJ stands for temporal-mandibular joint.  Temporal, as in temple area of skull; mandibular as in mandible, or lower jaw; joint as in where the head and jaw meet.  Problems in this joint may be caused by a misalignment of the teeth, trauma, or excess muscle tension. Cartilage buffers the two bones and five muscles that meet in this area, but any problems in this area can create quite a bit of pain and biting difficulties.  

Symptoms of TMJ include:

• Headaches
• Earaches
• Trouble/soreness in opening and closing the mouth
• Clicking or popping of the jaw
• Pain in the jaw muscles
• Soreness in the area, sometimes extending to the face

Dental treatments for the condition can include replacing missing teeth, moving teeth, adjusting the bite and filling gaps between teeth. There is no one solution that is right for all cases. Occasionally a plastic mouthpiece is used to prevent clenching or grinding that is contributing to the problem. If untreated and in severe cases, surgery may be required to repair a badly damaged joint.

More information on Neuromuscular Treatments

Common dentistry treats only the teeth. It ignores the jaw joints and active muscles that are responsible for moving the jaw and bringing the teeth together. In other words, common dentistry forces the jaw joints and muscles to accommodate to the existing bite of the teeth.

Sometimes it is obvious that teeth don’t fit properly. But even when the teeth appear to mesh together uniformly, the bite might be forcing the jaw joints and muscles out of alignment.

Jaw joints forced out of alignment by the bite of the teeth can become damaged, noisy and uncomfortable. Physical damage and uncomfortable symptoms vary from intermittent and barely noticeable, to constant and severe.

Muscles forced out of alignment can become tight, tired and sore. Headaches are common. And so is teeth grinding and many other symptoms actually caused by an improper bite.

Most fillings, crowns, bridges and even orthodontic braces performed using common techniques are done without accurately diagnosing the condition of the bite. Furthermore, the jaw joints and muscles tend to become more misaligned and more common dentistry is performed.

Neuromuscular dentistry differs from "common" dentistry in that neuromuscular dentistry recognizes the importance of the muscles, and treats the jaw to a comfortable, relaxed muscle position that is in harmony with the bite of the teeth.

The neuromuscular approach is very effective for treating various levels of head and neck pain, and it also greatly contributes to the longevity of the teeth, dental restorations and periodontium.

Establishing a neuromuscularly balanced jaw position before starting any major restorative, dental prosthetic or orthodontic procedure, helps prevent muscular imbalances that lead to compromised posture and instability of the teeth and their supporting bones.

Patients looking for state-of-the-art care, especially those who find themselves in the complex or difficult to treat category, should seriously consider neuromuscular dentistry. And those who are tired of educated guesses, ineffective bite splints and trial and error treatment protocols.

A comprehensive assessment will help to accurately diagnose and develop a treatment plan that will best meet an individual’s needs for long term optimal dental health and comfort.

Teeth, muscles and jaw joints in conflict can cause a variety of physical problems and symptoms:

• Migraines, muscle tension headaches and sinus headaches
• Face or jaw pain
• Muscle twitching
• Neck, shoulder or back pain
• Forward head posturing
• Numbness in arms or fingers
• Sensitive or sore teeth
• Loose or shifting teeth
• Worn, cracked, chipped or broken teeth or dental restorations
• Teeth clenching or grinding
• TMD (temporomandibular/jaw joint dysfunction)
• Clicking, popping or grating sounds in the jaw joints
• Soreness or pain in or around the jaw joints
• Limited jaw movement
• Ringing in the ears
• Congestion or stuffiness of the ears

Many people suffer from one or more of these symptoms. Unfortunately, misdiagnosis is generally the rule in the medical profession when it comes to jaw joint and neuromuscular disorders of the jaws. Symptoms are often overlooked, ignored or mistakenly attributed to other ailments. Sometimes, the misaligned bite causes no pain, but it is still responsible for chipped, worn, cracked and shifting teeth. To complicate matters, it is not uncommon for people to feel normal when they have symptoms, because having symptoms is all they have ever experienced.

New techniques of collecting objective computerized data have made it possible for Dr. Dale Steele to help many people who have previously been unable to find relief. Many of those people never knew how much more comfortable they could be. We invite you to ask us about how neuromuscular dentistry might improve your life.