Frequently Asked Questions

1. First, there is the periapical dental abscess. This is usually the result of tooth decay, and occurs at the tip of the root, where the nerves and blood vessels leave the tooth and connect with the surrounding bone.

When the nerve dies, the abscess forms at the root tip, and a toothache usually results.

The treatment for this condition is usually either an extraction or a root canal.

2. The second type of dental abscess is the periodontal abscess. This occurs in the bone around the root (not generally at the root tip) and is usually due to some form of gum disease. With periodontal disease and the periodontal abscess, the problem is not blood supply to the nerve at the root tip, but rather the health of the bone and fibers that hold the tooth in the socket.
There is an example of early to moderate bone loss and a periodontal abscess forming along the root of one of the teeth. The treatment for early periodontal disease can sometimes be non-surgical, involving scaling and root planing in conjunction with Arestin therapy.


3. This is an example of advanced periodontal disease, and third type of dental abscess - the combination endo - perio abscess. What happens here is that the infection at the root tip and the one along the side of the tooth combine into one. The result can be a loose tooth, a severe toothache, and sometimes the need to extract the tooth. Here is an example of severe bone loss that occurs with the combination endo-perio abscess.

As you can see, the tooth on the left is hopeless, and will probably have to be removed.

---

Endodontics or root canal therapy is a process where the
nerve and associated blood-vessels and lymphatics are
removed from the tooth and replaced with an inert rubber
material called gutta percha.

The most common reasons for needing a root canal are:

The most common symptom is a toothache.
When we suspect that the nerve is dead, we will take
an x-ray to determine if there is an abscess. Sometimes,
however, the abscess is not visible yet, and we have
to use your description, or other secondary diagnostic
signs, to decide if a root canal is needed.

Here is a picture of a healthy tooth.

As you can see, the tooth consists of a crown,a root, a pulp
chamber and pulp canal. When everything is healthy,
there is no abscess at the root tip and the blood flow is normal.

Sometimes the nerve dies and you have a toothache.

When the nerve dies, the result is an abscess at the root tip.
The reason the tooth hurts is because this abscess is pressing
against nerves outside the tooth, in the surrounding bone,
creating pressure and pain.
 
When this happens, we do a root canal treatment.

The process of doing the root canal involves removing
the diseased nerve tissue from the pulp chamber and
canal, and replacing it with  gutta percha - an inert rubber
material that is cemented in place.

After the root canal is finished, the abscess goes
away and the tooth is comfortable again.

After the root canal is finished, the abscess heals naturally
and the tooth is comfortable again.

Restoration of the tooth

After having an endodontic procedure, a crown is almost
always needed, to reinforce the biting part of the tooth
and seal out future decay. This crown can sometimes be
made at the same appointment as the second step of the
root canal procedure, and sometimes it must be made later.

Occasionally, we must also place a post in the tooth to
reinforce it against fracture. These posts are either made
of gold, or stainless steel, depending on the shape of the
tooth and amount of stress that the tooth will have to bear.

Bad reputation - undeserved!

In spite of the bad reputation that root canals have, they
are actually quite comfortable! In fact, we often mention
to our fearful patients that it will be "as comfortable as a
haircut" or it's free.

We use the very best anesthetic, and never start until the
tooth is 100% numb. And, we use special materials, techniques,
and numbing procedures designed just for root canal teeth, to
ensure that your appointment is uneventful and absolutely pain free.

extensive tooth decay

a large cavity under a filling or crown

a dental abscess

the fracture of a tooth.

---

Traditionally, people with missing teeth, or structural tooth problems, like fractures or teeth severely damaged by decay, were subject to endless dental office visits and a mouthful of very unnatural looking and feeling teeth. We have advanced the science of crowns and bridges to offer solutions that remedy problems safely and restore a full, attractive smile.

When a tooth is fractured, has a large, old filling, or is severely damaged by decay, we may recommend the placement of a crown, or cap. Crowns strengthen and protect the remaining tooth structure and can improve the appearance of your smile. Types of crowns include the full porcelain crown, the porcelain-fused-to-metal crown and different variations of these. Fitting a crown requires at least two visits to our office.

---

The About Cosmetic Dentistry dental procedures area is where you learn about each cosmetic dentistry procedure in detail. In many cases, a cosmetic dentist will implement a combination of several of the following procedures to give you that perfect smile.

Procedures:

---

If you are missing one or more teeth and wish to eat your favorite
foods, increase your chewing ability, and improve your appearance,
speech, and self-esteem, then you are a candidate for dental
implants. A dental implant replaces the root of a missing
tooth and is made from surgical-grade titanium alloy
(Ti 6Al-4V ELI) to exacting specifications. Initially, the implant
is placed into the jawbone either immediately after the loss of
a tooth, or after an extended period of time. If there is
insufficient bone, various bone enhancing procedures can
be performed prior to the implant placement. An abutment,
which acts as a base for a prosthetic tooth replacement such
as a crown, is inserted into the implant at the time of implant
placement, or subsequently after a period of healing.

In the past, dentists would try to keep or replace teeth
with treatments such as root canals, bridges, and fixed
or removable dentures. Unfortunately, a significant number
of root canal treated teeth fail, bridges require that healthy
adjacent teeth be cut down and removable dentures can
often be unstable and require the use of sticky adhesives.
Dental implants are a solution to these problems, and many
of the concerns associated with natural teeth are eliminated,
including dental decay.

---

While the placement of dental implants was attempted for many decades in the twentieth century, it was not until the 1950's that discoveries were made that laid the foundation for modern dental implant reconstructive surgery.

Professor Per-Ingvar Brånemark was perhaps the most important figure in the advancement of implant dentistry. His significant breakthrough, in the 1950's, was the discovery that bone can integrate with titanium components. That is, living bone could become so fused with the titanium oxide layer of an implant that the two could not be separated without fracture. This process, whereby nature allows the attachment of bone cells to the titanium surface became known as "osseointegration."

As a result of studying the osseointegration process, scientists developed dental implants, which are simply small titanium cylinders placed into the jawbone to support replacement teeth. These titanium dental implants fuse with your bone and provide a permanent anchorage for a prosthetic reconstruction which looks and feels like a natural tooth. Worldwide more than 800,000 patients have been treated since 1965 with dental implant reconstructions.

---

Dental Implants Eliminate Pain and Discomfort
Aside from dental implants, one of the other methods of replacing missing teeth is thru the placement of removable full or partial dentures. However, since dentures sit on top of the jawbone and gums, continuous shrinkage of the jaw bone alters the fit of the denture, resulting in slipping or rocking of the dentures. Exposed nerves and irritation of the gum tissue may add to the discomfort. Dental implants eliminate the pain and discomfort of removable full or partial dentures. Dental Implant supported replacement teeth are like natural teeth because they are anchored securely to your jawbone. Gum irritation and the pain of exposed nerves associated with conventional full or partial dentures are eliminated.

Dental Implants Prevent Bone Loss
As a result of losing one or more teeth, you inevitably lose mass in your jaw. This affects the overall skeletal structure of your face which not only changes your profile, but also may result in thin lips, drooping muscles, jowls or witch's chin. Spreading bone loss in the jaw affects the gums and ridges in your mouth, as well as the muscles and nerves in and around the mouth. Dental implants prevent bone loss, because implants halt and even reverse the bone loss that results from losing teeth. Complete denture wearers on the other hand become aware of jawbone loss as their dentures become loose. People who lose one tooth, which is replaced by a bridge, may even be unaware that the jaw bone is dissolving.

It is as if dental implants "trick" the bone into thinking there is still a tooth present. By transmitting the natural forces of chewing to the jaw, dental implants increase bone density. Dental implants have been proven not only to stop bone loss, but in some cases actually to reverse bone loss and restore the health of the jaw. By preventing the loss of the bony structure of the jaws and face they prevent facial collapse. This preserves your youthful appearance. No one will ever know that you have a replacement tooth.

Dental Implants Improve the Quality of Your Life
One of the most important benefits of dental implants is that they greatly improve the quality of your life.

---

In general, anyone missing at least one tooth and healthy enough to undergo routine dental treatment, including tooth extraction, is probably able to undergo dental implant treatment. There are some medical conditions that warrant special consideration before placing dental implants. Certain chronic diseases, heavy smoking or alcohol abuse may contraindicate dental implant treatment.

If you already wear dentures but are psychologically uncomfortable with them (e.g. You lack confidence due to the appearance or poor fit of your false teeth) or find them physically diffcult (e.g. You cannot taste food properly due to the dentures), you should consider implants. You are never too old to get dental implants.

There are two things to keep in mind, however, when considering dental implants. First, they may not be covered by your dental insurance, although that is currently changing. Second, you will need to have the patience to wait three to eighteen months for the entire dental implant process to be completed, depending on the type of restoration that will best serve your needs.

---

Interestingly, most people assume that dental implant treatment is more expensive than alternative methods of tooth replacement. In reality, dental implant treatment is actually more cost effective other methods of tooth replacement. The basic reason for this cost differential is due to the fact that other treatments require extensive repairs, replacements, and procedures to preserve the integrity of facial structures and prevent additional tooth loss compared to dental implants.

In other words, additional procedures will probably be necessary in the future to treat the teeth that were cut down, repair the resulting bone defects, or replace the initial bridge.

---

The first step in the decision for dental implants is to make an appointment with a qualified dentist for an evaluation. He/She will examine your mouth and teeth and take a thorough medical and dental history. You'll receive X-rays and possibly a CT scan, which will give the dentist a good idea of your bone density and the shape of your jaw.
Dental implants are usually completed in two phases:

• Phase #1 is the actual dental implant placement, a process generally performed in the office with local anesthesia or light sedation to help make the patient more comfortable. Using precise, gentle surgical techniques, the implants are placed into the jawbone for 6-8 weeks while osseointegration (bonding to bone) takes place. This helps ensure a strong, solid foundation for replacement teeth. During this time, temporary bridges or dentures may be used to minimize any cosmetic or chewing inconvenience.
  
• Phase #2 involves creating and attaching the new tooth or teeth to the anchored dental implant(s) in your jaw. Dental implants can replace a single tooth, several teeth or complete dentures. Your dentist can recommend the best choice for you.

• Recently, an alternative to the two-step method has been developed that allows you to have the dental implant installed in one whole piece in one single session at your dentist. This new method has simplified the dental implant procedure a lot, both for patients and dentists. After iimplantation that is also possible to make permanent crowns or bridges immediately.

The procedure is chosen depends on several factors, such as the patient’s dental health, the number of teeth involved and which teeth are replaced. These factors will also determine the total number of visits to the dentist throughout the dental implant treatment period.

---

Two of the major questions that people ask when it comes to dental implants is, "What is the long-term success rate?" and "How long will they last?".

The simply answer to the long-term success rate of dental implants are that dental implants can fail, but fortunately very infrequently. Failure rates vary depending on the site in the mouth, whether they are placed into natural or grafted bone and whether the patient smokes. The overall success rates in natural bone is 95%, though this falls to between 85 and 90% in grafted bone. If a patient smokes it has been shown that they are statistically two and a half times more likely to have an implant fail than a non-smoker.

As to the longevity of dental implants, honestly at the present time we cannot answer this question. At the moment we can only say that the first patient who had dental implants placed in 1965 still has his original implants in function today.

With that being said, undoubtedly, the best steps to take avoid encountering ailing or failing dental implants are to maintain meticulous oral hygiene, and evaluate the dental implant both clinically and radiographically at frequent recall visits with your dentist.

---

There are many causes. The most common include genetics, aging, consumption of staining substances (smoking, coffee, tea, colas), tetracycline (antibiotic) staining, excessive fluoride, and old fillings. Whitening toothpaste can remove stain that is on the outside of the teeth. Dentists call this extrinsic staining. However, whitening toothpaste and professional dental cleanings will not change the color or intrinsic staining of the teeth.  That is why tooth whitening (sometimes called tooth bleaching) is so popular.

---

A whitening gel is placed in a tray that fits over your teeth. As the active ingredient in the gel, carbamide peroxide, is broken down, oxygen enters the enamel and bleaches the colored substances. The structure of the tooth is not changed; only the tooth is made lighter and whiter. Fillings, Crowns, and Bonding will not lighten.

---

Laser is done by a dentist who applies a 35% Hydrogen Peroxide solution on your teeth. Once this solution is on, a light is held a couple of inches away from your teeth to speed up the chemical reaction of the Hydrogen Peroxide. Many dentist advertise that this works better than tray type whitening. That has not been our experience. There is NO clinical data to indicate the laser whitening works any better than tray whitening. NONE! The problem with this procedure is that after a year of your normal eating habits (drinking coke, tea, coffee, etc.) your teeth become slightly discolored again and develops a new stain. With the custom mouthpieces, you already have the custom mouthpieces that you can wear a year later for a night to take off the new stain at no cost.

---

For most people, the treatment is long-lasting. Exposure to coffee, smoking, red wines, and some medicine products will gradually darken teeth again over time. After an initial treatment, most people do touch-ups one day about every 3-6 months.

---

Ultra-White 16% and 22% use Carbamide Peroxide as the whitening agent. When wearing the trays Carbamide Peroxide is slowly broken down to Hydrogen Peroxide which whitens the teeth. The 16% gel whitens more slowly but causes less tooth sensitivity. The 22% gel whitens quickly but can cause temporary sensitivity to temperatures. Both the 16% and 22% gels need to be worn for about 10-14 days to achieve maximum whiteness.
Virtually everyone who whitens their teeth will see improvement. 

The ultimate whiteness will be determined by the length of time the teeth are exposed to the whitening gel and the mineral composition of the teeth. Teeth whitening is kind of like a reverse suntan. Some people get great results in only one or two days while others need more treatment time.

---