Operative Dental Services
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Types of X-Rays
- Intraoral Radiographs
- Extraoral Radiographs
- Digital Radiographs
X-rays are divided into two main categories, intraoral and extraoral. With extraoral X-rays, the film is outside the mouth. With intraoral X-rays, the film is inside the mouth.
Intraoral X-rays are the most common type. They give a high level of detail. These X-rays allow the dentist to:
- Find cavities
- Look at the roots of the teeth
- Check the health of the bony area around the tooth
- See the status of developing teeth
- Otherwise monitor good tooth health
- To find abscesses and infection
Bite-wing X-rays highlight the crowns of the back teeth. Dentists take one or two bite-wing X-rays on each side of the mouth. Each X-ray shows the upper and lower molars and bicuspids (teeth in front of the molars). These X-rays help the dentist find decay between the back teeth.
Periapical X-rays highlight only one or two teeth at a time. It looks similar to a bite-wing X-ray but shows the entire length of each tooth, from crown to root.
Depending on your oral health and dental history, the dentist may recommend a full-mouth radiographic series, or FMX. This is a series of 18 X-rays, including bite-wings and periapicals, which gives a comprehensive look at every tooth, from crown to root to supporting structures.
Extraoral X-rays are made with the film outside the mouth. They’re what we’d consider the ‘big picture’ because they not only show the teeth but also the jaw. These would be used to:
- Keep track of growth and development
- Examine the relationships between teeth and jaws
- Look at the status of impacted teeth
- Examine the bones of the face
- View locations of nerves and sinus cavities
These X-rays are less detailed than intraoral X-rays. For this reason they are not used for detecting cavities or flaws in individual teeth.
Panoramic X-rays show the entire mouth on a single X-ray. They include all teeth on both upper and lower jaws. This type of X-ray requires a special machine. The tube head that emits the X-rays circles behind your head while the film circles across the front. That way, the full, broad view of the jaws is captured on one film. Because the machine moves in a set path, you have to be positioned carefully. All of this may look and feel intimidating, but the process is very safe. It typically uses less radiation than intraoral X-rays.
Digital radiographs are one of the newest X-ray techniques. The image goes into a computer, where it can be viewed on a screen, stored or printed out. Digital X-rays taken at different times can be compared by using a process that highlights differences between the images. Tiny changes can be caught earlier.
Sometimes the dentist needs to numb a part of your mouth. She injects medicine into your gum or cheek after using a topical anesthetic to numb the injection area. This medicine is called local anesthesia.
Lidocaine is the most common local anesthetic that dentists use. There are several others commonly used that also end in “-caine”. Although many people think of Novocaine when they think of dental visits, Novocaine is not used anymore because many other drugs work better, last longer, and cause less allergic reactions. In our office, we commonly use Lidocaine and Septocaine. We also offer Carbocaine for patients are unable to tolerate epinephrine.
Side effects for local anesthesia in a dental office are very rare. However, possible side effects include the forming of a hematoma (a blood-filled swelling), numbing outside of the targeted area (which will recover when the drug wears off), or injury to a nerve by the needle.
Allergic reactions to local anesthesia are very rare but be sure to tell us about any medications (prescriptions, over-the-counter, and vitamins) as well as any past reactions to medicine you have had.
Another concern many people have is how long they will be numb. Numbing effects of local anesthesia vary from person to person, lasting anywhere from 1-4 hours. However, we also offer a product called OraVerse that can reduce the length of time you will be numb after your procedure. If interested in this product, please ask us prior to the start of your appointment.
Determining If You Need a Restoration
You may need a restoration if you have decayed, cracked, worn, or broken teeth.
A dentist can determine if you have decay through any of several methods including observation, using a cavity-detecting dye, viewing the decay on an x-ray, or with the use of a fluorescent laser that aids with cavity detection.
Cracked, worn, and broken teeth can also need restorations. Cracks and wear on teeth can be caused by things like nail-biting, tooth grinding, using your teeth to open things, chewing ice or hard nuts, and many other things.
Why Replace a Restoration
Restorations don’t last forever. Some last 15 years or longer while others need to be replaced in as little as 5. Over time, they can stain and become discolored. In addition to this, your teeth and the restorations inside of them are also subject to tremendous chewing and biting forces which can cause them to crack or leak. If a restoration has a crack or leak in or around it, bacteria and debris can get underneath it where a toothbrush will not reach. This can cause decay to form beneath the restoration.
Crowns (Caps), Bridges, and Veneers
Crowns, bridges and veneers each take at least two visits to our office. The first visit is preparing the teeth, making impressions, and placing a temporary. We then send the impressions to a lab to have materials custom made for your teeth. The second visit is the delivery of your crown, bridge, or veneer.
A crown is a tooth-shaped cover placed over a prepared tooth that has been badly damaged or decayed or is severely discolored and placed for aesthetic purposes. In these situations, placing a restoration on the tooth would not allow it to keep its strength because too much of the tooth structure is compromised.
Crowns usually last at least seven years but in many cases, can last up to 30 years if well taken care of. They can be made of porcelain, gold or layers of materials which provide added strength for grinders.
A dental bridge is a type of multi-unit crown that is sued to span an empty space between two teeth, which usually occurs after a tooth has been extracted or was genetically missing. The crowns can be supported by natural teeth or implants.
Bridges generally last about 5-7 years. A major reason bridges fail is due to new decay on supporting teeth. With proper hygiene, including flossing under your bridge, bridges can last much longer.
Dental veneers are thin shells of porcelain that are bonded to the front of prepared teeth. They can be used to fix aesthetic problems on teeth such as chips, stains, unevenness, abnormal spacing, etc.
An implant is a device that replaces the roots of a missing tooth and supports a crown, bridge, or denture. Implants are typically placed surgically into the jawbone. They are the most realistic and successful option available for replacing a missing tooth.
Before dental implants, the only options available to people who had lost a tooth were bridges or dentures. Dental implants offer an attractive and comfortable solution for those who have lost a tooth, even by injury, providing a permanent replacement tooth that looks and feels like a real tooth.
Why Should I Replace Missing Teeth?
First of all, tooth loss affects personal self-confidence through aesthetics as well as speech. It can also affect how well you chew and the kinds of things you are able to eat. If you are missing teeth, it can eventually change your bite and lead to problems in your Tempromandibular Joint (jaw joint).
Benefits of Implants
First of all, implants are aesthetically pleasing; however, they also have functional advantages as well. Unlike a bridge, no adjacent teeth need to be prepared or ground down to hold your new replacement tooth/teeth in place. Additionally, an implant supported crown makes it easier to eat and speak since the titanium post is secured directly into the jaw and securely holds the implant in place. Because of that, the implant doesn’t come loose like a denture. An implant crown is cleaned just like a normal tooth with standard brushing & flossing whereas flossing becomes more of a challenge with a bridge.
How do Dental Implants Work?
The implant is surgically placed directly into the jawbone. Once the surrounding gum tissue has healed, a second appointment is needed to connect a post to the original implant. Finally, an artificial tooth (or teeth) is attached to the post-individually, or grouped on a bridge or denture.
To receive implants, you need to have healthy gums and adequate bone to support the implant. In many situations, if adequate bone is not available, a procedure to graft the bone can be performed. You must also commit to keeping these structures healthy. Meticulous oral hygiene and regular dental visits are critical to the long-term success of dental implants.
Root Canal Therapy
What is a Root Canal?
Root canal treatment is the removal of the tooth’s pulp, a small, thread-like tissue in the center of the tooth. Once the damaged, diseased or dead pulp is removed, the remaining space is cleaned, shaped and filled. Years ago, teeth with diseased or injured pulps were removed. Today, root canal treatment saves many teeth that would otherwise be lost.
The most common causes of pulp damage or death are:
- A cracked tooth
- A deep cavity
- An injury to a tooth, such as a severe knock to the tooth, either recent or in the past.
Once the pulp is infected or dead, if left untreated, bacteria can build up at the root tip in the jawbone, forming an abscess. An abscess can destroy the bone surrounding the tooth and cause pain starting with a dull ache to severe discomfort and swelling.
How is a Root Canal Done?
Root canal treatment consists of several steps that take place over multiple office visits, depending on the situation. These steps are:
- First, an opening is made through the back of a front tooth or the biting surface of a molar or pre-molar.
- After the diseased pulp is removed (a pulpectomy), the pulp chamber and root canals are cleaned, enlarged and shaped in preparation for being filled.
- If more than one visit is needed, a temporary medicated treatment is placed in the crown opening to protect the tooth between dental visits.
- The temporary filling is removed and the pulp chamber and root canal are permanently filled. A tapered, rubbery material called gutta-percha is inserted into each of the canals and is often sealed into place with cement. Sometimes a metal or plastic rod is placed in the canal for structural support.
- In the final step, a crown is usually placed over the tooth to restore its natural shape and appearance. If the tooth is very broken down, a post may be required to build it up prior to placing a crown.
How Long Will the Restored Tooth Last?
Your treated and restored tooth/teeth can last a lifetime with proper care. Because decay can still occur in treated teeth, good oral hygiene and regular dental exams are necessary to prevent further problems.
As there is no longer a nerve keeping the tooth alive, root-treated teeth can become brittle and are more prone to fracture. This is the important reason why we recommend crowning teeth after a root canal.
To determine the success or failure of root canal treatment, the most relied-upon method is to compare new X-rays with those taken prior to treatment. This comparison will show whether bone continues to be lost or is being regenerated.
Can I Get a Root Canal in a Crowned Tooth?
Yes. Root canals can be done by making a small hole on the chewing surface of the crown. This will be filled in with a traditional restoration after the root canal has been completed.
Why are Teeth Removed?
Teeth are extracted for a variety of reasons:
- Decay has reached deep into the tooth
- Infection has destroyed a large portion of the tooth or surrounding bone
- There is not enough room for all the teeth in your mouth
Many dentists recommend extracting impacted teeth that are only partially erupted. Bacteria can enter around a partially erupted tooth and cause an infection, which can extend into the surrounding bone and become extremely serious. Impacted teeth continue trying to break through the gum tissue even if there is not enough room to accommodate them. The continued pressure caused by this attempted eruption can eventually damage the roots of nearby teeth. Removing a tooth that is impacted can often prevent infection, damage to adjacent teeth and bone, and save pain in the years to come.
How are Teeth Removed?
Before a tooth is removed, your dentist will thoroughly review your medical and dental history and take the appropriate X-rays. From this information, your dentist can estimate the degree of difficulty of the procedure and decide whether to refer you to a specialist called an oral surgeon.
Before removal, the area around your tooth will be anesthetized. Dentists use a local anesthetic to numb the area of the mouth where the extraction will take place. Once the area is anesthetized, the tooth is loosened with the help of a tool called an elevator, then extracted with dental forceps. Your dentist may also want to smooth and recontour the underlying bone. When he or she is finished, they may choose to close the area with a stitch.
What can I Expect After an Extraction?
It is critical to keep the area clean and prevent infection immediately following the removal of a tooth. Your dentist will ask you to bite down gently on a piece of gauze, which you must keep in place for up to 30 to 45 minutes to limit bleeding while clotting takes place. For the next 24 hours, you shouldn’t smoke, use a straw, rinse your mouth vigorously, or clean the teeth next to the extraction site as these will cause a crucial clot being formed to be dislodged and could lead to a very painful condition called ‘dry socket.’
A certain amount of pain and discomfort is to be expected following an extraction. In some cases, your dentist will recommend a pain killer or prescribe one for you. It may help to apply an ice pack to the face for 15 minutes at a time. You may also want to limit strenuous activity, as well as avoid hot liquids. The day after the extraction, your dentist may suggest that you begin gently rinsing your mouth with warm salty water (do not swallow the water). Under normal circumstances, discomfort should lessen within three days to two weeks. If you have prolonged or severe pain, swelling, bleeding or fever, we want you call our dental office at once.
Download our extraction post-operative instructions here.
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