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Oral Hygiene/Gum Treatment

Gum diseases are treated in a variety of ways depending on the stage of disease. Treatments range from nonsurgical therapies that control bacterial growth to surgery that restores supportive tissues.

Professional dental cleaning:

During a typical checkup the doctors or the dental hygienist will remove the plaque and tartar (plaque that builds up and hardens on the tooth surface and which can only be removed with professional cleaning) from above and below the gum line of all your teeth. If you have some signs of gum disease, the doctor or the hygienist may recommend professional dental cleaning more than twice per year.

Scaling and root planing:

This is a deep-cleaning, nonsurgical procedure, done under a local anesthetic, whereby plaque and tartar from above and below the gum line are scraped away (scaling) and rough spots on the tooth root are made smooth (planing). Smoothing the rough spots removes bacteria and provides a clean surface for the gums to reattach to the teeth. Scaling and root planing are done when you have plaque and calculus (hardened plaque, also called tartar) under the gums that needs to be removed.

Medications:

Antibiotic treatments can be used in combination with surgery and other therapies or alone to reduce or temporarily eliminate the bacteria associated with periodontal disease or suppress the destruction of the tooth’s attachment to the bone. Chlorhexidine is an antimicrobial used to control plaque and gingivitis in the mouth or in periodontal pockets. The medication is available as a mouth rinse or as a gelatin-filled chip that is placed in pockets after root planing and which releases the medication slowly over about 7 days. Other antibiotics, including doxycycline, tetracycline, and minocycline (Arestin) may also be used to treat gum disease, as determined by the doctors.

In addition, nonprescription toothpaste that contains fluoride and/or an antibiotic may be prescribed.

Composite Fillings

The clear alternative to traditional mercury fillings

The Problem:

  • Decay on a portion of any tooth
  • Small to medium sized cavities
  • Desire to maintain a white, beautiful smile

The Solution:

A composite filling is a tooth colored quartz-like material. After tooth decay is removed and cleaned, this tooth colored material is layered into the tooth. Each layer is hardened or cured with highly intense visible light, and the final surface is shaped and polished to match the tooth. The final restoration is virtually invisible.

Advantages:

Composite fillings are more than just attractive. They are environmentally non-toxic because they use no mercury. They are stronger because they bond directly to the surface of the tooth. They protect the tooth from fracturing because they don't require the severe "undercut" (removal of healthy tooth structure) of a mercury filling.

Alternatives:

Gold or porcelain inlays and onlays, and amalgam (silver) restorations are sometimes good alternatives to composite fillings, offering excellent long term durability. In cases of extensive decay, inlays/onlays or crowns are the only alternative.

 

Crowns 

Protect and keep badly decayed or fractured teeth

The Problem:

  • Badly decayed teeth
  • Fractured teeth
  • Need to protect and strengthen teeth

The Solution:

A crown (often called a cap) covers the tooth and restores it to its original shape and size. Decay is removed and cleaned from the tooth and a highly accurate impression or mold is made of the prepared surface. This mold is used to create a model of the tooth which is then sent to a special laboratory that will create a gold or porcelain (tooth colored) crown. The crown is then cemented onto the prepared surface of the tooth.

Advantages:

Crowns are incredibly strong due to the fact that they are created in a laboratory. This protects and strengthens the remaining tooth structure. In the hands of a skilled dentist, a crown will fit almost perfectly onto the prepared surface of the tooth, reducing the size of the seam between the crown and the tooth. This helps keep decay from eventually occurring under the crown.

Crowns should be placed before the tooth is so decayed that it may fracture. This can often help prevent the expense of root canal therapy in the future. It can also prevent the possibility that a fractured tooth may need to be removed, requiring the expense of a bridge or implant to replace the missing tooth.

Alternatives:

In the event that a tooth is so decayed or fractured that it needs to be removed, the best alternatives to a crown are bridges and implants that replace the missing tooth.

 

Fixed Bridges

A great way to replace missing teeth

The Problem:

  • A missing tooth or teeth
  • Potential bite and jaw joint problems from teeth shifting to fill the space
  • The "sunken face" look associated with missing teeth
  • Desire to improve chewing ability
  • Desire for a more permanent solution than dentures

The Solution:

A bridge is a single appliance that is generally attached to two teeth on each side of the space where a tooth is missing. An artificial tooth attached in the middle of the bridge fills in the gap where the missing tooth was. The teeth on either side of the gap are prepared for crowns (see crowns) and a highly accurate impression or mold is made of the prepared area. This mold is used to create a gold or porcelain (tooth colored) bridge in a special laboratory. The bridge is then cemented onto the prepared surface of the teeth, effectively creating the appearance of a "new" tooth.

In some instances, a resin-bonded bridge may be used. In this case, the two teeth on each side of the gap are not prepared for crowns. Instead, the bridge consists of a false tooth with metal brackets on the back of each side of the gap. The brackets are attached to the backs of the real teeth on each side.

Advantages:

Unlike dentures, a fixed bridge is never removed. It is stable in the mouth and works very similar to natural teeth. By filling the gap and stopping the movement of other teeth, a fixed bridge is an excellent investment, providing better chewing ability, heading off jaw joint problems and saving money that might otherwise be spent on future dental treatment.

Disadvantages:

Fixed bridges are excellent restorations and have few disadvantages. They are highly durable, but they will eventually need to be re-cemented or replaced due to normal wear.  They are difficult to clean underneath and require special kinds of hygiene tools in order to keep clean.  The teeth next to the missing space also need to be prepared to create the bridge.

Alternatives:

In the event that the use of a fixed bridge is not feasible, the best alternative is a dental implant.  A dental implant functions more like a tooth, does require preparation of the teeth next to the space and can be flossed in the normal way.

 

Root Canal Therapy

Protect and keep a sick or dying tooth

The Problem:

  • Infected or sick tooth due to decay or injury
  • Chronic tooth pain from contact with hot and cold liquids
  • Pain from pressure or biting down
  • Danger of infection spreading

The Solution:

Inside each tooth is a pulp chamber that contains the nerves and blood supply for the tooth. When the pulp becomes infected due to decay or injury to the tooth, the pulp must be removed from the center of the tooth and the canals of each root. Once the infected pulp is removed, the remaining chamber is filled with a rubber-based material to seal it off.

All teeth that have had root canal therapy must be protected with a tooth-like artificial covering known as a crown (see crown section.) This is because teeth that have had the pulp removed are more susceptible to fracture.

Advantages:

Root canal therapy is an excellent way to save a tooth that would otherwise die and need to be removed.

Disadvantages:

If a tooth is sick, there are no disadvantages to root canal therapy. On rare occasions, however, root canal therapy may need to be redone to ensure that all of the infection has been removed.

Alternatives:

The only real alternative is to remove the sick tooth. However, this will require a dental implant or bridge to fill the empty space and prevent the shifting of surrounding teeth. These solutions will ultimately cost more than the root canal therapy, and they will never equal the quality of keeping your natural tooth.