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General and Restorative Dentistry

General and restorative dentistry involves the diagnosis of all issues relating to the health and function of the smile, including the treatment and repair of broken, infected, or otherwise damaged teeth, gums, and tissue. General dentists serve as the primary care provider for their patients, managing their oral health care needs and coordinating treatment with specialists when necessary. Throughout our website, you will find an abundance of information about our practice, procedures we provide, and dentistry in general. Please explore and learn as much about dentistry and General Dental services as you desire. We believe our patients should have as much information as possible in order to make important, informed decisions regarding their oral health and treatment options .

Click on on the Topic below

• General and Restorative Dentistry Procedures

• Types of Dental Restorations or Filling materials:Dental Filling Choices

• Benefits of Tooth-Colored Fillings

• What are Inlays/Onlays?

• Dental sealants

• Crown Lengthening

• Dental Bridges

• Dental Crowns or Caps

• Root Canal Therapy

• Extractions

• Dentures

• Gum Disease Treatment

• Post Op-Instructions

General and Restorative Dentistry Procedures

The following is a brief description of dental health issues that fall under the heading of general and restorative dentistry. Click on the links for more in-depth information about each subject.

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• Dental Implants - an ideal solution for patients missing teeth. Implants are permanently set in the jaw and affixed with replacement teeth, preventing painful shifting in the mouth.

• Dental Crowns - when a tooth is severely damaged or decayed, dental crowns act as a protective cover, strengthening the tooth and reinforcing the jaw.

• Dental Bridges - for one or more missing teeth, dental bridges literally "bridge the gap" between remaining teeth, stabilizing the jaw by surrounding those teeth with attractive crowns.

• Dentures - replacing one or more teeth is easier than ever before with the multitude of denture alternatives available to patients. Dentures are now more comfortable and affordable than ever before.

• Root Canal - infected tissues in the tooth pulp can cause severe pain and eventually lead to tooth loss. Root canal therapy is designed to remove infected tissue with the goal of saving the tooth.

• Gum Disease - periodontal disease is characterized by swollen, tender, or bleeding gums. Both early and advanced periodontal disease can be treated with both surgical and non-surgical therapy.

• TMJ Disorders - a misaligned bite, bruxism (teeth grinding), and other factors can put stress on the temporomandibular joint (TMJ). TMJ disorders can be the source of a variety of painful symptoms, from headaches to ear and neck pain.

• Full-Mouth Reconstruction - patients with severe dental problems often require a full-mouth reconstruction. Dentists performing full-mouth reconstructions often draw on both cosmetic and restorative dentistry solutions to improve the health, function, and appearance of the smile.

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Types of Dental Restorations or Filling materials: Dental Filling Choices

There are two types of dental restorations: direct and indirect.

Direct restorations are fillings placed immediately into a prepared cavity in a single visit. They include dental amalgam, glass ionomers, resin ionomers and some resin composite fillings. The dentist prepares the tooth, places the filling and adjusts it during one appointment.

Indirect restorations generally require two or more visits. They include inlays, onlays, veneers, crowns and bridges fabricated with gold, base metal alloys, ceramics or composites. During the first visit, the dentist prepares the tooth and makes an impression of the area to be restored. The impression is sent to a dental laboratory, which creates the dental restoration. At the next appointment, the dentist cements the restoration into the prepared cavity and adjusts it as needed.

DIRECT RESTORATIONS

1.Amalgam Fillings

Used by dentists for more than a century, dental amalgam is the most thoroughly researched and tested restorative material among all those in use. It is durable, easy to use, highly resistant to wear and relatively inexpensive in comparison to other materials. For those reasons, it remains a valued treatment option for dentists and their patients.

Dental amalgam is a stable alloy made by combining elemental mercury, silver, tin, copper and possibly other metallic elements. Although dental amalgam continues to be a safe, commonly used restorative material, some concern has been raised because of its mercury content. However, the mercury in amalgam combines with other metals to render it stable and safe for use in filling teeth.

While questions have arisen about the safety of dental amalgam relating to its mercury content, the major U.S. and international scientific and health bodies, including the National Institutes of Health, the U.S. Public Health Service, the Centers for Disease Control and Prevention, the Food and Drug Administration and the World Health Organization, among others have been satisfied that dental amalgam is a safe, reliable and effective restorative material.

Because amalgam fillings can withstand very high chewing loads, they are particularly useful for restoring molars in the back of the mouth where chewing load is greatest. They are also useful in areas where a cavity preparation is difficult to keep dry during the filling replacement, such as in deep fillings below the gum line. Amalgam fillings, like other filling materials, are considered biocompatible-they are well tolerated by patients with only rare occurrences of allergic response.

Disadvantages of amalgam include possible short-term sensitivity to hot or cold after the filling is placed. The silver-colored filling is not as natural looking as one that is tooth-colored, especially when the restoration is near the front of the mouth, and shows when the patient laughs or speaks. And to prepare the tooth, the dentist may need to remove more tooth structure to accommodate an amalgam filling than for other types of fillings.


2. Composite Fillings

Composite fillings are a mixture of glass or quartz filler in a resin medium that produces a tooth-colored filling. They are sometimes referred to as composites or filled resins. Composite fillings provide good durability and resistance to fracture in small-to-mid size restorations that need to withstand moderate chewing pressure. Less tooth structure is removed when the dentist prepares the tooth, and this may result in a smaller filling than that of an amalgam. Composites can also be "bonded" or adhesively held in a cavity, often allowing the dentist to make a more conservative repair to the tooth.

The cost is moderate and depends on the size of the filling and the technique used by the dentist to place it in the prepared tooth. It generally takes longer to place a composite filling than what is required for an amalgam filling. Composite fillings require a cavity that can be kept clean and dry during filling and they are subject to stain and discoloration over time.

3. Glass ionomers

Glass ionomers are translucent, tooth-colored materials made of a mixture of acrylic acids and fine glass powders that are used to fill cavities, particularly those on the root surfaces of teeth. Glass ionomers can release a small amount of fluoride that may be beneficial for patients who are at high risk for decay. When the dentist prepares the tooth for a glass ionomer, less tooth structure can be removed; this may result in a smaller filling than that of an amalgam

Glass ionomers are primarily used in areas not subject to heavy chewing pressure. Because they have a low resistance to fracture, glass ionomers are mostly used in small non-load bearing fillings (those between the teeth) or on the roots of teeth.

Resin ionomers also are made from glass filler with acrylic acids and acrylic resin. They also are used for very small, non-load bearing fillings (between the teeth), on the root surfaces of teeth, and they have low to moderate resistance to fracture.

Ionomers experience high wear when placed on chewing surfaces. Both glass and resin ionomers mimic natural tooth color but lack the natural translucency of enamel. Both types are well tolerated by patients with only rare occurrences of allergic response.

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INDIRECT RESTORATIONS:

Indirect Restorative Dental Materials (Two or more visits)

Sometimes the best dental treatment for a tooth is to use a restoration that is made in a laboratory from a mold. These custom-made restorations, which require two or more visits, can be a crown, an inlay or an onlay. A crown covers the entire chewing surface and sides of the tooth. An inlay is smaller and fits within the contours of the tooth.

An onlay is similar to an inlay, but it is larger and covers some or all chewing surfaces of the tooth. The cost of indirect restorations is generally higher due to the number and length of visits required, and the additional cost of having the restoration made in a dental laboratory. Materials used to fabricate these restorations are porcelain (ceramic), porcelain fused to a metal-supporting structure, gold alloys and base metal alloys.

All-Porcelain (Ceramic) Dental Materials

All-porcelain (ceramic) dental materials include porcelain, ceramic or glasslike fillings and crowns. They are used as inlays, onlays, crowns and aesthetic veneers. A veneer is a very thin shell of porcelain that can replace or cover part of the enamel of the tooth. All-porcelain (ceramic) restorations are particularly desirable because their color and translucency mimic natural tooth enamel.

All-porcelain restorations require a minimum of two visits and possibly more. The restorations are prone to fracture when placed under tension or on impact. The strength of this type of restoration depends on an adequate thickness of porcelain and the ability to be bonded to the underlying tooth. They are highly resistant to wear but the porcelain can quickly wear opposing teeth if the porcelain surface becomes rough

Gold Alloys

Gold alloys contain gold, copper and other metals that result in a strong, effective filling, crown or a bridge. They are primarily used for inlays, onlays, crowns and fixed bridges. They are highly resistant to corrosion and tarnishing.
Gold alloys exhibit high strength and toughness that resists fracture and wear. This allows the dentist to remove the least amount of healthy tooth structure when preparing the tooth for the restoration. Gold alloys are also gentle to opposing teeth and are well tolerated by patients. However, their metal colors do not look like natural teeth.

Base Metal Alloys

Base metal alloys are non-noble metals with a silver appearance. They are used in crowns, fixed bridges and partial dentures. They can be resistant to corrosion and tarnishing. They also have high strength and toughness and are very resistant to fracture and wear.

Some patients may show allergic sensitivity to base metals and there may be some initial discomfort from hot and cold. However, due to their metal color, gold alloys do not look like natural teeth.

Indirect Composites

Crowns, inlays and onlays can be made in the laboratory from dental composites. These materials are similar to those used in direct fillings and are tooth colored. One advantage to indirect composites is that they do not excessively wear opposing teeth. Their strength and durability is not as high as porcelain or metal restorations and they are more prone to wear and discoloration.

What's Right for Me?

Several factors influence the performance, durability, longevity and cost of dental restorations. These factors include: the patient's oral and general health, the components used in the filling material; where and how the filling is placed; the chewing load that the tooth will have to bear; and the length and number of visits needed to prepare and adjust the restored tooth.

With so many choices, how do you know what's right for you? To help you better understand what's available, here are the advantages and disadvantages of commonly used dental restorations.
The ultimate decision about what to use is best determined by the patient in consultation with the dentist. Before your treatment begins, discuss the options with your dentist.

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Dental sealants

Sealants are clear or white plastic coatings that stick or bond to the surfaces of teeth. They are used to cover particular teeth to help prevent tooth decay. Sealants do not dissolve in saliva and are safe. They were developed in the 1960s and have been widely used since this time.

Sealants block the physical effects of early tooth decay

A combination of sealants (on teeth) and fluoride (in water or toothpaste) will virtually eliminate decay in the permanent teeth of many children. In children:

• Fluoride in the water supply and toothpaste, and the School Dental Program, have reduced tooth decay in children.

• Decay is now much less common, although preventable decay still occurs.

• Most decay starts as narrow pits and grooves on the biting surfaces of teeth in the back of the mouth, these narrow grooves are too small for the thick bristles of toothbrushes to get in to clean.

• Germs from plaque living in the grooves can make acid, which may causes tooth decay.

Sealants fill up the grooves

Sealants painlessly fill and block up grooves that are too small for the toothbrush to clean.
Sealants:

• Are applied by a dentist or dental therapist

• Fill and block up the small pits and grooves in the teeth to prevent decay

• Take a few minutes to apply to the teeth

• Are painless

• Do not require injections

• Do not require drilling.

• Can last from two to seven years, but may last up to 15 years.

• Your dentist or dental hygienist should check sealants regularly

How sealants are put on teeth

To apply sealants, the dental care provider will:

• Prepare teeth - clean and dry the tooth or teeth

• Apply sealant - a thin layer of plastic liquid into the groove or pit, just like how nail polish is painted onto a fingernail.

• Placed on permanent teeth - in the back of the mouth those have the highest risk of tooth decay. In most children, the first permanent molars appear about age six or seven years and the second molars about age 11 or 12 years.

The liquid then hardens into a tough layer that prevents decay occurring.

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Crown Lengthening

When decay occurs below the gumline, it may be necessary to remove a small amount of bone and gum tissue. Your dentist may ask for this procedure before he or she makes a new crown for your tooth.

Crown Lengthening procedures are done for both restorative dentistry and/or to improve the esthetics of your gum line. General practitioners often refer for crown lengthening procedures prior to restoration of broken or severely decayed teeth. This procedure adjusts the gum and bone level to expose more of the tooth so it can be restored.

Sometimes crown lengthening is done to improve a "gummy" smile because the teeth appear short. The teeth may actually be the proper length but excess gum tissue may be covering these teeth. During this procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth
 

Dental Bridges

A bridge is one of the few options that you have when deciding how to deal with a missing tooth or teeth. The replacement of these missing teeth is necessary in order to maintain the proper mouth functions. Tooth loss can affect the way you eat, speak, and the alignment of other teeth in your mouth.

Types of Bridges

A bridge, by definition, is a link or connection between two permanent structures. A dental bridge is very similar in that it attaches the restorative teeth (bridge) to the natural teeth on either side of the gap. This bridge acts as your new teeth, closing the gap and restoring your smile. Bridges are often constructed of gold or metal foundations with porcelain fused to the foundation. This ensures that the bridge will support the normal functions of the mouth.

There are three main types of bridges:

• Traditional bridges involve creating a crown for the tooth or implant on either side of the missing tooth, with a pontic in between. Traditional bridges are the most common type of bridge and are made of either porcelain fused to metal or ceramics.

• Cantilever bridges are used when there are adjacent teeth on only one side of the missing tooth or teeth.

• Maryland bonded bridges (also called a resin-bonded bridge or a Maryland bridge) are made of porcelain teeth and gums supported by a metal framework. Metal wings on each side of the bridge are bonded to your existing teeth.

Procedure

The procedure begins with preparation of the natural teeth, or abutments. We will shape the abutment teeth so that the ends of the bridge will fit comfortably on each one. The next step is to take an impression of the area. This impression will be sent to our lab where your new restoration will be crafted. While this new tooth is created, we will provide you with a temporary restoration. Our temporary restorations will resemble your natural teeth so that you can continue with your daily life without worrying about a missing or unattractive tooth.

During your second visit to the office, we will proceed with the placement of your final restoration. This bridge will be fitted comfortably into the mouth. We will make every effort to ensure that the new bridge feels exactly like your natural teeth. The final step in the process is to cement the bridge into your mouth, leaving you with a beautifully restored smile.
 

Dental Crowns or Caps

As we get a little older, our teeth begin to change and are prone to decay. There are many possible reasons for this change in your smile. These reasons can include bruxism(teeth grinding), general decay, cracked fillings, root canals, and many others. If your tooth is beyond repair with a filling material, we may recommend that the best viable option to save the tooth is a full crown. The reasons for this type of restoration in a badly damaged tooth are durability, cosmetic appearance, and overall support of the chewing function.

Types of Crowns

If we decide that you are in need of a full crown, there are a few different options for the repair of your tooth. These options include a full porcelain crown, a porcelain fused to metal or gold crown, or a full gold crown. We will make the determination as to which of these options is the most appropriate for your situation. You can be comfortable in knowing that your new tooth will be virtually unnoticeable and will flawlessly complement the rest of your smile.

Procedure
When we have decided to go ahead with a full crown restoration, we will set aside 2-3 appointments for the entire process. Although the majority of crowns are completed in two visits, there is sometimes a need for a third visit to ensure a proper fit.

The procedure begins with the removal of all decay in the tooth. Once we have removed the decay, we will take an impression of the tooth. This impression will be sent to our lab where your new restoration will be crafted. While this new tooth is created, we will provide you with a temporary restoration. Our temporary restorations will resemble your natural teeth so that you can continue with your daily life without worrying about a missing or incompatible tooth.

During your second visit to the office, we will proceed with the placement of your final restoration. This crown will be fitted comfortably into the mouth. We will make every effort to ensure that the new tooth feels exactly like one of your natural teeth. The final step in the process is to cement the crown into your mouth, leaving you with a beautifully restored smile.

Postoperative care After crown and bridge appointments

Crowns and bridges usually take two or three appointments to complete. In the first visit, the teeth are prepared and molds of the mouth are taken. Temporary crowns or bridges are placed to protect the teeth while the custom restoration is being made. Since the teeth will be anesthetized, the tongue, lips and roof of the mouth may be numb. Please refrain from eating and drinking hot beverages until the numbness is completely worn off.

Occasionally a temporary crown may come off. Call us if this happens and bring the temporary crown with you so we can re-cement it. It is very important for the temporary to stay in place, as it will prevent other teeth from moving and compromising the fit of your final restoration.

To keep your temporaries in place, avoid eating sticky foods (gum), hard foods, and if possible, chew on the opposite side of your mouth. It is important to brush normally, but floss carefully and don't pull up on the floss which may dislodge the temporary but pull the floss out from the side of the temporary crown.

It is normal to experience some temperature and pressure sensitivity after each appointment. The sensitivity should subside a few weeks after the placement of the final restoration. Mild pain medications may also be used as directed by our office.

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