Preventive Dental Care

There is no doubt about it: The best type of dental care is preventive! Through proper brushing, flossing, and regular dental visits, the chances of significant dental decay and gum disease are greatly reduced.

ROUTINE CHECKUPS

The American Dental Association (ADA) recommends visiting a dentist every 6 months. A regularly scheduled check-up is often referred to as a "cleaning", which is necessary to the prevention of oral disease.

The dental visit includes:

• Oral Examination / Dental Screening - The oral examination includes an inspection of the hard and soft tissues of your mouth. The hard and soft tissues include the teeth, gums, top and sides of the tongue, and inner lining of the cheeks. A metal, needle-like tool (called a probe) is used to detect the depth of the pockets between the teeth and the gum. The examination is painless and takes about 5 to 7 minutes. The depth of the pockets is recorded on your dental chart.

• X-Rays - A dental hygienist takes x-rays of the mouth to document the condition of your teeth. Children seldom need x-rays before the age of five. (see x-ray section below)

• Teeth Cleaning - Teeth cleaning can be performed either by the dentist or the dental hygienist. During the teeth cleaning procedure, harmful plaque and tartar both above and below the gum line are removed.

• Advice - The dental hygienist may provide you with special instructions on brushing, flossing, and good oral hygiene, emphasizing areas of the mouth that have significant plaque and tartar buildup.

X-RAYS

Dental x-rays reveal the health and position of teeth. Any impacted, un-emerged, or extra teeth can easily be seen on an x-ray. Other abnormalities of the teeth, such as cysts, pre-cancerous, or cancerous growths may also be seen.

X-rays are able to reveal many dental defects that cannot be detected by the naked eye. Examples of such defects include decay under old fillings, teeth trapped below the gums, cavities between the teeth, bone loss as a result of gum disease, bone damage, gingivitis problems (including a fractured jaw), and changes in jaw bone structure. Changes in jaw bone structure are very important to detect because they can be caused by a systemic disease (disease that affects the whole body) and may be indicative of a greater medical condition.

Dental x-rays are considered safe due to the relatively low amount of radiation emitted. The amount of radiation received from a dental x-ray exam is extremely small compared to other naturally-occurring sources of radiation. Numerous precautions and advances in x-ray equipment help protect you from receiving unnecessary radiation. The beam of radiation is very narrow, passing only through the cheek. The dentist should provide you with a lead apron before taking x-rays to protect your body from any stray particles.

A dentist will usually take a small series of x-rays every 6 months. These x-rays will help detect any current and/or potential oral problems.

TOOTH FILLINGS

Tooth fillings are the most common, most effective, and least expensive restorative method for preventing tooth loss. If a cavity is detected in a tooth, the dentist will need to drill into the tooth to remove the decay. Fillings are used to "fill" the hole in the tooth made by the dentist after the removal of tooth decay. This helps re-strengthen the tooth.

Types of fillings include:

• Amalgam Fillings: According to the American Dental Association (ADA), amalgam is the best filling material for the posterior (back) teeth. The amalgam filling is placed, with pressure, over the cavity. Dental amalgam is a mixture of liquid mercury and an alloy powder composed of silver, tin, copper, and sometimes smaller amounts of zinc, palladium, or indium. Amalgam has been used in dentistry for over 100 years.

• Composite Fillings (White Fillings): Composite fillings are a durable alternative to amalgam fillings. Composite fillings are made of a composite plastic material and, due to their natural tooth color, are typically used for front teeth and the area of teeth that are closest to the gum line. The composite plastic filling material is applied layer by layer and then cured using an ultraviolet light. Composite fillings take more time and may be more difficult to apply than amalgam fillings, thus the cost of the procedure may be higher than that of amalgam fillings. Composite fillings can also be used for posterior (back) teeth if the filling will be noticeable by others and you prefer a more natural look. When applied to posterior teeth, composite fillings may require resurfacing every 5 to 7 years.

• Inlay or Onlay: An inlay or onlay is used to repair damage involving over ½ of the biting surface of a tooth. They can be made of porcelain, gold, or composite resin materials. An inlay or onlay is used when the damage to the tooth is too large to be repaired by a filling but not large enough to be repaired by a crown. Inlays and onlays are set following the removal of tooth decay. This requires approximately 2 visits to the dentist.

An inlay is a large filling that fits within the cusp tips of the tooth. An onlay, also known as an overlay, is used to cover one or more cusp tips. Both procedures serve to protect and strengthen the tooth.

During the first visit to the dentist, the tooth is numbed and then shaped with a dental drill. An impression of the tooth is taken to create a model for the dental laboratory. A temporary restoration filling is placed in your mouth.

During the second visit, the temporary restoration filling is removed, and the new inlay or onlay is fit. The dentist checks the restoration for bite and color match (in the case of composite or porcelain) to the adjacent teeth. When the cosmetic dentist is satisfied with the fit, the new inlay or onlay is bonded in place.

Inlays and onlays can last for 10 to 20 years.

COST OF FILLINGS

Most dental insurance will cover between 50% to 80% of the cost of fillings. The cost of a typical amalgam filling ranges from approximately $75 to $145 per filling. The cost of composite resin fillings range from $150 to $200 per filling. The cost for an inlay or onlay procedure ranges from $500 to $1200.

GUM TREATMENT

Gum treatment is the treatment of active periodontal (gum) disease. Gum disease refers to any condition in which bacteria attack the gum and bone tissues that surround and support teeth. Gum tissue and bone can be destroyed, resulting in tooth loss. Because there are different stages of gum disease, ranging from gingivitis to advanced periodontitis, there are different levels of treatment. In some cases, you may need to see a specialist.

Gum treatment consists of one or more of the following procedures, depending on the individual case:

• Scaling and Root Planing: Scaling and root planing is a common non-surgical treatment for gum disease. The dentist "scales" the teeth by removing bacteria and infection from unhealthy deep pockets below the gum line (this procedure is also known as a "deep cleaning"). After the removal of plaque and tartar, the root is smoothed, or "planed." Planing eliminates any rough areas on the root that can trap plaque or bacteria. A smooth, clean root provides a healthy environment to allow the gums to heal naturally and reattach to the tooth.

• Oral Medications: A new medication, called Periostat^®, has been developed specifically to combat periodontal infections by bolstering the body's immune response to the bacteria that causes periodontal disease. Periostat^® can be prescribed at the discretion of your dentist.

ROOT CANAL THERAPY

Root canal therapy may need to be performed when the nerve of a tooth becomes irreversibly infected or abscessed (pocket of infection at the base of the root). A tooth can become abscessed as a result of deep decay, cracks, or trauma to the tooth. This is usually caused by the infiltration of bacteria into the center-most part of the tooth (called the pulp). Root canal therapy is the only procedure that can save the tooth.

The root canal procedure involves the removal of the entire nerve system of the tooth. During a root canal, the tooth is numbed and a small opening is made in the pulp chamber (innermost part of the tooth that consists of connective tissue, nerves, and blood vessels, which nourish the tooth). The unhealthy nerves are removed and medication is applied to the tooth to treat the infection. After the infection is treated, a filling is placed in the root where the unhealthy nerve once was.

A tooth that has undergone root canal therapy is brittle and must be crowned to give the tooth sufficient strength. The tooth is typically restored within a couple of weeks. A crowned tooth is cared for in the same way as other natural teeth by brushing and flossing daily and through regular visits to the dentist.

The number of visits necessary to complete a root canal may vary depending upon the degree of infection, the number of canals in the tooth, the anatomy of an individual's tooth, and the complexity of the procedure.

Due to technological advancements, root canals can be performed faster, more accurately, and with less discomfort than before. If the root infection is too severe for a root canal to be performed, then the only other alternative is tooth extraction.

SEALANTS

Dental Sealants are plastic materials that coat the biting surfaces of the teeth. Sealants can be used as a good preventive measure because the plastic coating creates a barrier between the tooth and decay-causing bacteria that can be found in plaque. The dental sealant makes it more difficult for plaque to stick to the tiny grooves on the biting surfaces of the teeth. This will reduce the risk of forming cavities and tooth decay.

When applying a sealant, the dentist first cleans the teeth and then etches the teeth with a solution that will help the sealant adhere to the teeth. Next, the sealant is "brushed on" and a special ultraviolet light is used to cure the material. The procedure is considered "child-friendly" because there is no need for anesthesia or drilling.

Sealants are an effective preventive measure to reduce the need for fillings and other more expensive treatments that may be required to repair damage caused by cavities. Therefore, sealants can save you money in the long run.

Sealants are most effective in reducing cavities in children with newly formed permanent teeth. Sealants are recommended for all children when they get their permanent first molars (around 6 years of age) and their permanent second molars (around 12 years of age). They are also useful in reducing the formation of decay in adult teeth.

EXTRACTION

Extraction is the complete removal of a tooth. Extraction is the only alternative if root canal therapy is unsuccessful. Extractions may also be recommended prior to orthodontic treatment. (see orthodontics)

The extraction procedure is performed by either an experienced dentist or an oral surgeon. An extraction can be surgical or non-surgical depending upon the difficulty of the extraction, whether or not the tooth is impacted or erupted, and whether the tooth has straight or curved roots.

The reasons for an extraction are:

• Advanced gum disease

• An infected, abscessed, or decayed tooth that cannot be saved.

• A tooth that has broken at the gum line.

• Impacted teeth (teeth that are unable to break the gumline because they are caught beneath existing teeth or are growing sideways below the gum line). Typically "wisdom teeth" are extracted due to impaction.

Types of impacted teeth include:

• Soft Tissue Impaction: Soft tissue impaction refers to the extraction of a third molar or wisdom tooth that is not fully erupted. An incision is made in the overlying gum tissue to force the tooth out of the socket. Forceps or a lever-shaped instrument is used to extract the tooth from below the gum line.

• Bony or Partial Bony Impaction: Bony or partial bony impaction is usually performed on the unerupted third molar before its roots have developed if the dentist determines that there is not enough room for the tooth to erupt properly. An incision in the overlying gum tissue is required to remove the overlying bone and the tooth in one piece.

• Bony Impaction: Bony impaction is performed when a tooth is lying sideways, is completely covered in bone, and/or has no possibility of eruption. The dentist makes an incision through the gum, removing the gum tissue and overlying bone. The tooth is extracted in small pieces.

When an extraction is performed, it is important to put something in the place of the missing tooth or teeth. Leaving the space open may cause the teeth to shift and therefore cause further, unnecessary complications. An extracted tooth may be replaced by a temporary or permanent bridge, an implant, or a partial or complete denture.

The different types of extraction procedures are:

• Routine (Non-Surgical) Extraction: A routine extraction is performed when a tooth has broken the gum line and needs to be removed. This procedure would remove the whole tooth.

• Surgical or Complicated Extraction: If a routine extraction cannot be performed, a surgical or complicated extraction may need to be performed if a tooth is erupted but cannot be removed whole. This is due to a fracture or decay of the clinical crown (portion of the natural tooth that extends and is visible above the bone and gum tissue). During the procedure, a small amount of bone is removed to gain access to the root. If the tooth fractures during the complicated extraction procedure, additional surgery may be required.