General dentistry encompasses a broad range of diseases and disorders of the oral and maxillofacial region. Everyone should see a general dentist for routine oral health examinations, twice-yearly cleanings, and treatment of routine oral health complications, such as minor tooth decay. General dentistry is as much about prevention as it is about treatment. Patients who visit our Pasco, WA dental office can expect professional oral health care, education, and recommendations about proper home care between office visits.
that the American Dental Association recommends that every American visit a dentist a minimum of one time every six months? Doing so can aid in the detection of decay, oral disease and other dental health problems before the progress and become severe. If you are at risk for certain complications or have a history or periodontal disease and advanced decay, you may need to visit your general dentist on a more frequent basis. Patients who visit their dentist regularly and as recommended are more likely to retain their natural teeth and enjoy a lifetime of good oral health.
Yes. Even if you are not currently experiencing any symptoms of tooth decay or gum disease, it is important to visit your dentist for a thorough examination and cleaning. Waiting till you experience pain or discomfort can be too late. Despite daily brushing and flossing, your teeth can still accumulate tartar that can harbor bacteria. These bacteria can lead to gum disease and tooth decay if not professionally removed at your dentist’s office.
Your visit will begin with a general inspection of the condition of your teeth. If you have not been to the dentist in a while, your dentist may order x-rays. An oral hygienist will then use special metal instruments to gently scrape away tartar along your gum line. Later, your dentist will review your x-rays and discuss any symptoms you may have been experiencing. He or she will then make a recommendation for treatment (if applicable) and answer any questions you may have.
Based on the results of your dental check-up, your general dentist may recommend that you return for treatment or follow a special at-home oral care plan. You may also be referred to a dental specialist for treatment of advanced oral health conditions.
Third molars, commonly referred to as wisdom teeth, are usually the last four of 32 teeth to erupt (surface) in the mouth, generally making their appearance between the ages of 17 to 25. They are located at the back of the mouth (top and bottom), near the entrance to the throat. The term “wisdom” stems from the idea that the molars surface at a time typically associated with increased maturity or “wisdom”.
In most cases, inadequate space in the mouth does not allow the wisdom teeth to erupt properly and become fully functional. When this happens, the tooth can become impacted (stuck) in an undesirable or potentially harmful position. If left untreated, impacted wisdom teeth can contribute to infection, damage to other teeth, and possibly cysts or tumors.
There are several types, or degrees, of impaction based on the actual depth of the teeth within the jaw:
Soft Tissue Impaction: The upper portion of the tooth (the crown) has penetrated through the bone, but the gingiva (gum) is covering part or all of the tooth’s crown and has not positioned properly around the tooth. Because it is difficult to keep the area clean, food can become trapped below the gum and cause an infection and/or tooth decay, resulting in pain and swelling.
Partial Bony Impaction: The tooth has partially erupted, but a portion of the crown remains submerged below the gum and surrounding jawbone. Again, because it is difficult to keep the area clean, infection will commonly occur.
Complete Bony Impaction: The tooth is completely encased by jawbone. This will require more complex removal techniques.
While not all wisdom teeth require removal, wisdom teeth extractions are most often performed because of an active problem such as pain, swelling, decay or infection, or as a preventative measure to avoid serious problems in the future. If impaction of one or more wisdom teeth is present, and left untreated, a number of potentially harmful outcomes can occur, including:
As with any dental procedure, your dentist will want to initially conduct a thorough examination of the wisdom and surrounding teeth. Panoramic or digital X-rays will be taken in order for your dentist to evaluate the position of the wisdom teeth and determine if a current problem exists, or the likelihood of any potential future problems. The X-rays can also expose additional risk factors, such as deterioration or decay of nearby teeth. Early evaluation and treatment (typically in the mid-teen years) is recommended in order to identify potential problems and to improve the results for patients requiring wisdom teeth extractions. Only after a thorough examination can your dentist provide you with the best options for your particular case.
Wisdom teeth removal is a common procedure, generally performed under local anesthesia, intravenous (IV) sedation, or general anesthesia by a specially trained dentist in an office surgery suite. The surgery does not require an overnight stay, and you will be released with post-operative instructions and medication (if necessary), to help manage any swelling or discomfort.
Orthodontics is a branch of dentistry specializing in the diagnosis, prevention, and treatment of jaw, face and bite irregularities (malocclusions*). Orthodontic treatment is provided by an oral health care provider known as an orthodontist, who has completed two to three years of additional training beyond dental school.
Recent years have brought about many changes within the dental industry, specifically with regards to orthodontic treatment and care. Now more than ever patients are experiencing fewer incidences of cavities and missing teeth due to the heightened awareness of fluoride use and preventative dentistry. This increasing awareness on the health and look of a patient’s smile has fueled the desire for many to seek out orthodontia not only as a medical necessity, but for cosmetic reasons as well.
Whether it’s traditional braces or custom made removable appliances, orthodontics can help you have the healthy, straight, beautiful smile you’ve been waiting for!
Give us a call today and schedule your orthodontic consultation!
*Malocclusion is the technical term for teeth that don’t fit together correctly. Malocclusions not only affect the teeth, but also the appearance of the face. Most malocclusions are inherited; however some are due to acquired habits such as thumb sucking and tongue thrusting. The spacing left from an adult tooth being extracted or an early loss of a baby tooth can also contribute to a malocclusion.
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Fluorine, a natural element in the fluoride compound, has proven to be effective in minimizing childhood cavities and tooth decay. Fluoride is a key ingredient in many popular brands of toothpaste, oral gel, and mouthwash, and can also be found in most community water supplies. Though fluoride is an important part of any good oral care routine, overconsumption can result in a condition known as fluorosis. The pediatric dentist is able to monitor fluoride levels, and check that children are receiving the appropriate amount.
Fluoride fulfills two important dental functions. First, it helps to staunch mineral loss from tooth enamel, and second, it promotes the remineralization of tooth enamel.
When carbohydrates (sugars) are consumed, oral bacteria feed on them and produce harmful acids. These acids attack tooth enamel – especially in children who take medications or produce less saliva. Repeated acid attacks result in cavities, tooth decay, and childhood periodontal disease. Fluoride protects tooth enamel from acid attacks and reduces the risk of childhood tooth decay.
Fluoride is especially effective when used as part of a good oral hygiene regimen. Reducing the consumption of sugary foods, brushing and flossing regularly, and visiting the pediatric dentist biannually, all supplement the work of fluoride and keep young teeth healthy.
Since community water supplies and toothpastes usually contain fluoride, it is essential that children do not ingest too much. For this reason, children under the age of two should use an ADA-approved, non-fluoridated brand of toothpaste. Children between the ages of two and five years old should use a pea-sized amount of ADA-approved fluoridated toothpaste on a clean toothbrush twice each day. They should be encouraged to spit out any extra fluid after brushing. This part might take time, encouragement, and practice.
The amount of fluoride children ingest between the ages of one and four years old determines whether or not fluorosis occurs later. The most common symptom of fluorosis is white specks on the permanent teeth. Children over the age of eight years old are not considered to be at-risk for fluorosis, but should still use an ADA-approved brand of toothpaste.
The pediatric dentist is the best person to decide whether a child needs fluoride supplements. First, the dentist will ask questions in order to determine how much fluoride the child is currently receiving, gain a general health history, and evaluate the sugar content in the child’s diet. If a child is not receiving enough fluoride and is determined to be at high-risk for tooth decay, an at-home fluoride supplement may be recommended.
Topical fluoride can also be applied to the tooth enamel quickly and painlessly during a regular office visit. There are many convenient forms of topical fluoride, including foam, liquids, varnishes, and gels. Depending on the age of the child and their willingness to cooperate, topical fluoride can either be held on the teeth for several minutes in specialized trays or painted on with a brush.
Pediatric dentistry (formerly Pedodontics/Paedodontics) primarily focuses on children from birth through adolescence. The American Dental Association (ADA), recognizes pediatric dentistry as a specialty, and therefore requires dentists to undertake two or three years of additional training after completing a general dentistry degree. At the end of this training, the American Board of Pediatric Dentistry issues a unique diploma (Diplomate ABPD). Some pediatric dentists (pedodontists) opt to specialize in oral care for children with special needs; specifically children with autism, varying levels of mental retardation, or cerebral palsy.
One of the most important components of pediatric dentistry is child psychology. Pediatric dentists are trained to create a friendly, fun, social atmosphere for visiting children, and always avoid threatening words like “drill,” “needle,” and “injection.” Dental phobias beginning in childhood often continue into adulthood, so it is of paramount importance that children have positive experiences and find their “dental home” as early as possible.
Pediatric dentists fulfill many important functions pertaining to the child’s overall oral health and hygiene. They place particular emphasis on the proper maintenance and care of deciduous (baby) teeth, which are instrumental in facilitating good chewing habits, proper speech production, and also hold space for permanent teeth.
Other important functions include:
Education – Pediatric dentists educate the child using models, computer technology, and child-friendly terminology; thus emphasizing the importance of keeping teeth strong and healthy. In addition, they advise parents on disease prevention, trauma prevention, good eating habits, and other aspects of the home hygiene routine.
Monitoring growth – By continuously tracking growth and development, pediatric dentists are able to anticipate dental issues and quickly intervene before they worsen. Also, working towards earlier corrective treatment preserves the child’s self-esteem and fosters a more positive self-image.
Prevention – Helping parents and children establish sound eating and oral care habits reduces the chances of later tooth decay. In addition to providing check ups and dental cleanings, pediatric dentists are also able to apply dental sealants and topical fluoride to young teeth, advise parents on thumb- sucking/pacifier/smoking cessation, and provide good demonstrations of brushing and flossing.
Intervention – In some cases, pediatric dentists may discuss the possibility of early oral treatments with parents. In the case of oral injury, malocclusion (bad bite), or bruxism (grinding), space maintainers may be fitted, a nighttime mouth guard may be recommended, or reconstructive surgery may be scheduled.
If you have questions or concerns about pediatric dentistry, please contact our office.
Dental emergencies are quite frightening and often painful. Prompt treatment is almost always required to alleviate pain and to ensure the teeth have the best possible chance of survival.
Sometimes teeth become fractured by trauma, grinding or biting on hard objects. In other cases, fillings, crowns and other restorative devices can be damaged or fall out of the mouth completely. If there is severe pain, it is essential to make an appointment with the dentist as quickly as possible. The pain caused by dental emergencies almost always gets worse without treatment, and dental issues can seriously jeopardize physical health.
Types of dental emergency and how to deal with them
If a tooth has been knocked clean out of the mouth, it is essential to see a dentist immediately. When a tooth exits the mouth, tissues, nerves and blood vessels become damaged. If the tooth can be placed back into its socket within an hour, there is a chance the tissues will grow to support the tooth once again.
Here are some steps to take:
The dentist will try to replace the tooth in its natural socket. In some cases, the tooth will reattach, but if the inner mechanisms of the teeth are seriously damaged, root canal therapy may be necessary.
Usually, a crown or filling comes loose while eating. Once it is out of the mouth, the affected tooth may be incredibly sensitive to temperature changes and pressure. Crowns generally become loose because the tooth beneath is decaying. The decay causes shape changes in the teeth – meaning that the crown no longer fits.
If a crown has dropped out of the mouth, make a dental appointment as soon as possible. Keep the crown in a cool, safe place because there is a possibility that the dentist can reinsert it. If the crown is out of the mouth for a long period of time, the teeth may shift or sustain further damage.
When the dentist is not immediately accessible, here are the steps to take:
The dentist will check the crown to see if it still fits. If it does, it will be reattached to the tooth. Where decay is noted, this will be treated and a new crown will be made.
The teeth are strong, but they are still prone to fractures, cracks and breaks. Sometimes fractures are fairly painless, but if the crack extends down into the root, it is likely that the pain will be extreme. Fractures, cracks and breaks can take several different forms, but are generally caused by trauma, grinding and biting. If a tooth has been fractured or cracked, there is no alternative but to see the dentist as quickly as possible.
Where a segment of tooth has been broken off, here are some steps that can be taken at home:
The nature of the break or fracture will limit what the dentist is able to do. If a fracture or crack extends into the root, root canal therapy may be the only effective way to retain the tooth. In the case of a complete break, the dentist will usually affix the fragment back onto the tooth as a temporary measure.
When a tooth has been dislodged or loosened from its socket by trauma or decay, it might be possible to save it. If the tooth remains in the mouth and attached to the blood vessels and nerves, there is a good chance root canal therapy will not be necessary.
It is important to call the dentist immediately to make an appointment. In the meantime, use a cold compress and over-the-counter medications to relieve pain. The dentist will reposition the tooth and add splints to stabilize it. If the tooth fails to heal, root canal therapy may be required.
A significant number of Americans do not visit the dentist for regular checkups because they are too fearful or suffer from dental anxiety. Sedation dentistry offers an excellent way to provide a safe, anxiety-free, dental experience to those who are afraid of the dentist.
Sedation dentistry is often mistakenly thought to induce sleep. In fact, most sedatives allow the patient to stay awake during the procedure. Sleepiness is a side effect of some medications, but nitrous oxide, oral conscious sedation and IV sedation only work to calm anxiety throughout the dental visit.
Sedation dentistry is popular because most sedatives can be taken by mouth, meaning no injections, no anxiety and no pain. Some sedatives work so effectively that even the smells and details of the procedure cannot be recalled afterwards. Safety and compliance are two important aspects of treatments, so sedation dentistry offers both the individual and the dentist the best alternative.
Whatever the form of sedative, it is essential to be accompanied by a caregiver. Sometimes, sedatives are provided the night before the dental visit, which means that driving to or from the appointment is not advisable.
Here are some advantages associated with sedation dentistry:
The most popular types of dental sedatives are nitrous oxide, oral conscious sedation, and IV sedation. Different levels of sedation (mild, moderate and deep) can be utilized depending on individual needs. Before administering any sedative, the dentist must analyze the full medical history of the patient, as well as taking note of any current medications.
Here is an overview of some of the most common types of dental sedatives:
Nitrous oxide, or “laughing gas,” is used as a mild sedative. It is delivered through a nose hood, and is administered throughout the entire procedure. Nitrous oxide elevates the general mood and can evoke a general sense of well-being. Most importantly, it relieves anxiety and reduces pain during the procedure. In addition, some tingling and numbness may be felt. There are few side effects associated with nitrous oxide, and it has been safely used in dentistry for many years.
Intravenous sedation is a moderate type of sedation. Patients who have previously experienced IV sedation often report feeling like they slept through the entire procedure. Generally, IV sedation is used for shorter treatments. It is administered via direct injection into the bloodstream, which means the effects are immediate. Sometimes patients feel groggy and sleepy when the IV sedatives are withdrawn. This is why it is important to bring a designated driver for the drive home.
Oral conscious sedation is an excellent choice for people who fear needles. Oral medication is provided prior to treatment in order to induce a moderate state of sedation. Though oral sedatives do not cause sleep, they usually dull the senses. This means that most patients cannot remember the pain, smells or noises associated with the procedure. Usually, a dose of medication is taken prior to the appointment, and then topped up during the procedure as required.
Most of the drugs used in sedation dentistry are classified as benzodiazepines. Benzodiazepines reduce anxiety, muscle spasms, insomnia and seizures. Each medication has a different half-life, meaning that the effects last for varying amounts of time. The estimated length of the procedure determines which type of drug is going to be most effective.
Here are some of the most common drugs used in oral conscious sedation:
Valium® – This sedative has amnesic properties and a long half-life. It is usually used for time-consuming, complex procedures.
Halcion® – Usually used to treat insomnia, Halcion is an effective sedative with amnesic properties. A short half-life makes this sedative useful for shorter procedures.
Ativan® – This sedative is best known for reducing anxiety. It has amnesic properties and a medium half-life. Ativan is typically used for treatments shorter than two hours.
Versed® – This sedative has the shortest half-life and is therefore less commonly used. It alleviates anxiety in much the same way as nitrous oxide, and is used for visits that will take less than 30 minutes.
Endodontics is a specialized branch of dentistry that deals with the complex structures found inside the teeth. The Greek word “Endodontics” literally means “inside the tooth,” and relates to the tooth pulp, tissues, nerves and arterioles. Endodontists receive additional dental training after completing dental school to enable them to perform both complex and simple procedures, including root canal therapy.
Historically, a tooth with a diseased nerve would be removed immediately, but endodontists are now able to save the natural tooth in most cases. Generally, extracting the inner tooth structures, then sealing the resulting gap with a crown restores health and functionality to damaged teeth.
Signs and symptoms of endodontic problems:
Endodontic treatment (or root canal therapy) is performed to save the natural tooth. In spite of the many advanced restorations available, most dentists agree that there is no substitute for healthy, natural teeth.
Here are some of the main causes of inner tooth damage:
Bacterial infections – Oral bacteria is the most common cause of endodontic problems. Bacteria invade the tooth pulp through tiny fissures in the teeth caused by tooth decay or injury. The resulting inflammation and bacterial infection jeopardize the affected tooth and may cause an abscess to form.
Fractures and chips – When a large part of the surface or crown of the tooth has become completely detached, root canal therapy may be required. The removal of the crown portion leaves the pulp exposed, which can be debilitating painful and problematic.
Injuries – Injuries to the teeth can be caused by a direct or indirect blow to the mouth area. Some injuries cause a tooth to become luxated, or dislodged from its socket. Root canal therapy is often needed after the endodontist has successfully stabilized the injured tooth.
Removals – If a tooth has been knocked clean out of the socket, it is important to rinse it and place it back into the socket as quickly as possible. If this is impossible, place the tooth in special dental solution (available at pharmacies) or in milk. These steps will keep the inner mechanisms of the tooth moist and alive while emergency dental treatment is sought. The tooth will be affixed in its socket using a special splint, and the endodontist will then perform root canal therapy to save the tooth.
Root canal therapy usually takes between one and three visits to complete. Complete X-rays of the teeth will be taken and examined before the treatment begins.
Initially, a local anesthetic will be administered, and a dental dam (protective sheet) will be placed to ensure that the surgical area remains free of saliva during the treatment. An opening will be created in the surface of the tooth, and the pulp will be completely removed using small handheld instruments.
The space will now be shaped, cleaned and filled with gutta-percha. Gutta-percha is a biocompatible material that is somewhat similar to rubber. Cement will be applied on top to ensure that the root canals are completely sealed off. Usually, a temporary filling will be placed to restore functionality to the tooth prior to the permanent restoration procedure. During the final visit, a permanent restoration or crown will be placed.
If you have questions or concerns about endodontic procedures, please ask your dentist.
In rare cases, root canal therapy fails to work as expected. The treated tooth might not heal properly or a patient might experience post-surgical complications that jeopardize the tooth. Root canal retreatment involves the removal of the previous crown and packing material, the cleansing of the root canals, and the re-packing and re-crowning of the tooth. In short, root canal retreatment is almost identical to the original procedure, aside from the structural removal. The success rate for a root canal retreatment runs at around 75%.
Root canal treatments and retreatments are a better alternative than extraction for most individuals. If a tooth has good bone support, a solid surface and healthy gums beneath it, it stands a good chance of being saved. Opting for root canal retreatment can be far less expensive than the alternatives. Dental implants, extensive bridgework and the creation of aesthetically pleasing prosthetic teeth cost far more than working with the natural tooth. They also require maintenance and feel less natural than a “real” tooth.
Though the prospect of more endodontic surgery might not be pleasant, root canal retreatment is fairly simple. In general, the whole treatment can be completed in 1-3 visits.
There are a number of reasons why root canal therapy unexpectedly fails, including:
On the day of the retreatment procedure a local anesthetic will be administered, unless another type of anesthetic has been selected. The affected tooth is isolated with a rubber dam. The dam protects the tooth during treatment from bacteria and saliva. The amount the dentist can do within a single appointment will much depend on the amount of inflammation present, and the complexity of the treatment.
The first step in a root canal retreatment is to gain access to the inner tooth. If a crown and post have been placed, these will be removed.
Next, filling material and obstructions that block the root canals will be removed. This removal is conducted using an ultrasonic handpiece. The advantage of using this tool is that any unwanted material is vibrated loose. Tiny instruments will then be used to clean and reshape the root canals. X-rays may be taken to ensure that the roots are thoroughly clean. If this part of the treatment proves to be complex, medicated packing material will be applied, and the rest of the cleansing procedure will be done at the next visit.
When the dentist is confident that the root canals are completely clean, gutta-percha is used to pack the space. This rubbery material seals the canals to prevent bacterial invasion. Finally, a temporary crown or filling is applied to tooth. At a later date, the color-matched permanent crown will be placed.
Cracked and fractured teeth are common dental problems. As people retain their natural teeth longer (due to advances in dental technology), the likelihood of cracked teeth increases. There are many reasons why teeth may crack, for example, biting on hard objects, trauma, grinding and clenching of teeth. All of these behaviors place the teeth under extra strain and render them more susceptible to cracking.
When tooth enamel is cracked, pain can become momentarily debilitating. When no pressure is exerted on the crack there may be no discomfort. However, as the cracked tooth performs a biting action, the crack widens. The pulp and inner workings of the tooth then become exposed, and painful irritation occurs. As pressure is released again, the two parts of the crack fuse back together, and pain subsides. If left untreated, the pulp becomes irreversibly damaged and constantly painful. The resulting pulp infection can affect the bone and soft tissue surrounding the tooth.
Symptoms of a cracked tooth may include:
There are many ways in which a tooth can be cracked. The specific type of crack will determine what type of treatment is viable. In many cases, if the crack is not too deep, root canal therapy can be performed and the natural tooth can remain in the mouth. In other situations, the tooth is too badly damaged and requires extraction.
Here is a brief overview of some of the most common types of cracks:
Crazes – These are generally tiny vertical cracks that do not place the teeth in danger. These scratches on the surface of the teeth are considered by most dentists to be a normal part of the tooth anatomy. A craze rarely requires treatment for health reasons, but a wide variety of cosmetic treatments can be performed to reduce the negative aesthetic impact.
Oblique supragingival cracks – These cracks only affect the crown of the tooth and do not extend below the gum line. Usually, the affected part of the tooth will eventually break off. Little pain will result, because the tooth pulp (that contains the nerves and vessels) will remain unaffected.
Oblique subgingival cracks – These cracks extend beyond the gum line, and often beyond where the jawbone begins. When a piece breaks off, it will usually remain attached until the dentist removes it. Oblique subgingival cracks are painful and may require a combination of periodontal surgery (to expose the crown), and endodontic treatment to place a crown or other restorative device.
Vertical furcation cracks – These cracks occur when the roots of the tooth separate. This type of crack almost always affects the nerve of the tooth. Because the tooth will not generally separate completely, root canal therapy and a crown can usually save the tooth.
Oblique root cracks – These cracks tend not to affect the surface of the tooth at all. In fact, the damage is only apparent below the gum line and usually below the jawbone. Root canal therapy may be possible; depending on how close the fracture is to the tooth surface. However, extraction is almost always the only option after sustaining this classification of fracture.
Vertical apical root cracks – These cracks occur at the apex (tip of the root). Though the tooth does not require extraction from a dental perspective, many patients request an extraction because of the high degree of pain. Root canal therapy alleviates the discomfort for a while, but most often, teeth affected by such cracks are eventually extracted.
There are many different types of cracked teeth. Some can only be exposed using X-ray machines, while others are clearly visible to the naked eye. In cases where the tooth root is affected, root canal therapy is the most viable treatment option. The pulp, nerves and vessels of the tooth will be removed, and the resulting space will be filled with gutta-percha. A crown or filling will be added to stabilize the tooth and it will continue to function as normal.
When the crack is too severe for the tooth to be saved, the dentist will perform an extraction. There are a number of restorative options in this case, such as bridges, dental implants and partial dentures. All of these structures can restore biting, chewing and speaking functions.
