Preventive Dentistry
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Fillings
Teeth that have been affected by tooth decay (caries or cavities) require a filling.
A tooth filling is a very common procedure and is used to fill up the cavities in the teeth. There are generally three types of tooth filling: amalgam, or alloy mixed with mercury composite, or white filling with same color as that of teeth indirect filling, or filling made in a lab
Dental amalgams, also known as silver fillings, are comprised of a mixture of mercury (45 to 50 percent), and an alloy of silver, tin, and copper (50 to 55 percent). When it is combined with other materials in dental amalgam, mercury's chemical nature changes and it is no longer considered harmful to the body.
The procedure to fit an amalgam filling involves excavating the intended tooth and removing all the decay present. The tooth is then shaped in a specific manner in order to accept silver filling. After shaping the tooth, a band is placed around the tooth and the amalgam is condensed into the prepared tooth. The final filling is then carved and adjusted to the persons bite.
A new filling takes almost two weeks to become fully hardened with light sensitivity to cold or hot occurring for up to six weeks after surgery is completed.
Cleaning (Prophylaxis)
Prophylaxis refers to the cleaning of teeth as a preventative measure against periodontal (gum) disease and tooth decay. This treatment can include plaque detection, the removal of plaque and tartar in the supragingival (upper) and subgingival (lower) levels of the gum line, the application of caries-preventing agents, checking for signs of food impaction, and the checking of restorations and prostheses.
In prophylaxis, the procedures of dental scaling and dental polishing are used. Dental scaling refers to the removal of plaque and calculus from the surface of tooth, within periodontal pockets, or the surface coronal to the gingival margin. Dental polishing refers to process of maintaining a smooth and glossy surface finish on a denture or amalgam.
Extractions
Extraction is the term given to a tooth extraction and can also be known as Exodontia. Tooth extraction is the removal of a tooth from its socket in the bone.
Teeth may also be extracted to make more room in the mouth prior to straightening the remaining teeth (orthodontic treatment), or because they are so badly positioned that straightening is impossible. Extraction may be used to remove teeth that are so badly decayed or broken that they cannot be restored.
Tooth extraction can be performed with local anesthesia if the tooth is exposed and appears to be easily removable in one piece. An instrument called an elevator is used to loosen the tooth, widen the space in the bone, and break the tiny elastic fibers that attach the tooth to the bone. Once the tooth is dislocated from the bone it can be lifted and removed with forceps.
If the extraction is likely to be difficult, the dentist may refer the patient to an oral surgeon. Oral surgeons are specialists who are trained to give nitrous oxide, a general anesthetic to relieve pain. Extracting an impacted tooth is one such difficult extraction.
Before an extraction, the dentist will take the patient's medical history, noting allergies and prescription medications. A dental history is also taken, with particular attention to previous extractions and reactions to anesthetics. The tooth is also x-rayed to determine its full shape and position, especially if it is impacted.
An important aspect of tooth extraction is the aftercare and encouraging a clot to form at the extraction site. The patient should put pressure on the area by biting gently on a roll for several hours after surgery. Once the clot is formed, it should not be disturbed. The patient should not rinse, spit, drink with a straw or smoke for at least 24 hours after the extraction and preferably longer.
For the first two days after the procedure, the patient should drink liquids without using a straw, and eat soft foods. Any chewing must be done on the side away from the extraction site. The mouth may be gently cleaned with a toothbrush, but the extraction area should not be scrubbed.
Root Canals
Root canal refers to a component of an individual tooth that lies within the tooth's root. There are at least one and as many as four root canals in each tooth and their function is to connect the tooth's nerve (which lies at the tip of the tooth's root) to the tooth's crown (the visible portion of a tooth above the gum line). The term is also used to describe a specialized treatment in the branch of dentistry is Endodontics.
Endodontics, or root canal therapy, is an effective way of cleaning out infected pulp from a tooth. If the pulp of a tooth becomes damaged beyond repair, it essentially means that the tooth has died. This damage is usually a result of a cracked tooth or a deep cavity and becomes visible if an abscess (a pocket of pus forming at the tip of the tooth root) develops. In this procedure, the infected pulp must be removed from the pulp chamber and the root canals. The pulp chamber and root canals are then thoroughly cleaned and enlarged after the infected pulp is removed. A filling is then attached in order to prevent bacteria from entering the root canals and pulp chamber areas. A crown is placed over the tooth in order to retain the original shape of the tooth.
If treatment is not sought at that point, there is a possibility that the infection of the pulp can spread to the root canals. In this case, the bone holding the tooth will deteriorate and can lead to the falling out of the tooth. In these instances, it is recommended that the tooth be extracted and replaced. A missing tooth will lead to the shifting of teeth, to compensate for the empty space, to the point where the existing teeth will become crooked. Due to the difficulty of cleaning between crooked teeth there is a chance that these teeth will become infected and eventually further tooth loss.
Dentures
A denture is a removable replacement for missing teeth. A denture is made of acrylic resin, sometimes in combination with various metals, and comes in two types; complete denture or partial denture. Complete dentures replace all the teeth, while a partial denture fills in the spaces created by missing teeth and prevents other teeth from changing position.
Complete dentures are either "conventional" or "immediate." A conventional denture is placed in the mouth about a month after all the teeth are removed to allow for proper healing, whereas an immediate denture is placed as soon as the teeth are removed, however a drawback to the immediate denture is that it may require more adjustments after the healing has taken place.
People who have lost most or all of their teeth are ideal candidates for complete dentures. A partial denture is suitable for those who have some natural teeth remaining.Advantages of using a denture are that it improves chewing ability, speech and provides support for facial muscles whilst greatly enhancing the facial appearance and smile.
New denture wearers need time to get accustomed to their new teeth because even the best fitting dentures will feel awkward at first. While most people can begin to speak normally within a few hours, many people report discomfort with eating for several days to a few weeks after having dentures fitted.
Dentures are no longer the only way to restore a mouth that has little or no non-restorable teeth. Strategically placed implants can also used to support permanently cemented bridges, eliminating the need for a denture. The cost tends to be greater, but the implants and bridges more closely resemble the feel of real teeth, although not everyone is a candidate for implants. Sometimes dentures or partial dentures may irritate soft tissues in the mouth. If the irritation continues, a person may develop mouth sores, which can be found on the upper jaw, lower jaw, under the tongue, or on the palate. They are usually red and a little swollen. The main causes of theses denture sores include alcoholism, allergies, smoking and chewing tobacco.
Periodontal Treatment
Dr. Wakim can refer you to a local periodontist when he detects an early sign of gum problems. Although subtle, dentists are trained to detect early gum problems. These signs include: pockets (when the collar of gum becomes infected and detaches from the tooth, the space it leaves is called a pocket); bleeding (although a common occurrence, gums should not bleed regularly and is an early sign that pockets and boneless will occur); bone loss (if left untreated bone loss due to periodontal decay can lead to teeth removal); loose teeth; spaces forming between front teeth (although crowding of the mandibular (lower) front incisors occurs naturally as we age, space forming between some of the maxillary (front) teeth is a sign of advanced bone loss. This bone loss is due to the lack of tooth support which is a manifestation of progressive gum disease.); halitosis (bad breath); and abscess (the expansion of a gum pocket due to trapped bacteria.)
The main cause of periodontal disease is bacterial plaque which produces toxins that irritate the gums, causing swelling and bleeding. Bacterial plaque constantly forms on one's teeth and if it is not removed by daily brushing and flossing will harden into calculus (tartar). Additional causes of gum disease are smoking, genetics, stress, diabetes, poor nutrition, medication(s), and grinding or clenching one's teeth.
A periodontist has a variety of treatments to aid gum disease depending on its severity. This includes non-surgical treatments such as scaling and root planing (removing plaque and tartar from deep gum pockets through the thorough cleaning of root surfaces and also smoothing the tooth root to remove bacterial viruses). Periodontal surgery would be necessary if one's periodontist determines non-surgical treatment would be ineffective. The four most common periodontal surgical treatments are pocket reduction procedures (recommended when daily at-home oral hygiene and regular dentistry visits are insufficient due to pockets becoming too deep), regenerative procedures (recommended when the bone supporting the teeth have been destroyed, this procedure regenerates the lost tissue and bone), crown lengthening (recommended when one's teeth have been covered with excessive gum tissue, this procedure reshapes the excess gum and bone tissue in order to further expose the natural tooth), and soft tissue grafts (recommended when gum recession leads to exposed tooth roots, this procedure is used to cover roots or develop gum tissue if it is absent.)
