Prevention

Dental Prophylaxis

The first and foremost part of a robust dental regimen is the dental prophylaxis and recall appointment. This routine procedure involves inspection of the mouth and the removal of stain, hard, and soft deposits from the teeth at or above the gumline. During this appointment, a highly trained hygienist will use an ultrasonic tip which vibrates many times per second. This tip, when placed on the tooth, will remove stain and hard debris. Next, the hygienist then uses specialized hand instruments to clean every surface of the teeth until all surfaces are glassy smooth. Routine removal of debris accumulation of the teeth promotes healthy gums,as well as reduces the risk of developing cavities, gingivitis and periodontitis. In addition to the cleaning, the hygienist will either take radiographs or gum probings. This data is then conveyed to the doctor, who will then evaluate and discuss with the patient in order to make appropriate recommendations.

Fluoride

At the end of every cleaning, we recommend the application of a fluoride varnish. This product is painted on the surfaces of the newly cleaned teeth, and adheres for up to an hour. During this time, the fluoride mineral becomes incorporated into the outer surfaces of the teeth, which in turn makes them more cavity resistant. Sadly, many dental benefit plans do not include a fluoride treatment for adults, but some do! We always recommend fluoride application for most kids and adults because it has proven time and time again to be safe and greatly reduce the incidence of dental decay. Even though a patient may be low risk for decay, sometimes health or medication changes can suddenly increase the risk. Having the teeth pre-hardened from regular fluoride applications after cleanings can make a big difference to keeping your teeth for a lifetime. 

Fillings

When a cavity affects a tooth, it turns the affected part of the tooth into a crumbly and soft sticky substance. Often, this soft  hole in the tooth leads to more food getting trapped, difficulty cleaning, and the eventual progression and enlargement of the decay. A filling is generally a suitable treatment to replace the missing tooth structure when the cavity has affected less than 50% of the tooth. In the past, amalgam (silver) fillings were commonplace but have become less common due to perceived health concerns and compromised esthetics. Amalgam fillings are not technically difficult to place, and many patients and dentists alike can attest to their longevity. However, long term amalgam metal fillings can contribute to catastrophic failures in a tooth through the formation of cracks. Your dentist should not remove a silver filling just because, but will inform you if there are any signs of failure. 

At Genesee Pines Dental, we no longer place silver fillings for the above mentioned reasons. When a tooth meets the right criteria, a tooth colored filling is usually the most economical and best option for teeth needing smaller cavities or cracks repaired. We utilize top of the line techniques and materials to ensure the longevity of these esthetic dental restorations.

Esthetic Front Fillings

A white filling is an economical, durable, and reliable method to restore a damaged front tooth edge. The materials available today are very effective at blending seamlessly into the natural tooth. Composite/resin fillings in the anterior may need to be repaired or polished, as the material can stain and wear faster than harder ceramic materials. Nonetheless, it is also an excellent conservative option to try a new smile out before investing in more costly ceramics. Easy repairability of front fillings make them well suited as a placeholder in children or teens who may have damaged a front tooth from an accident. Then when they are older, a more definitive ceramic restoration may be placed.

Gum Disease

Gingivitis

Gingivitis literally means inflammation of the gums, and plaque is a thin biofilm consisting of partially digested food debris and various bacteria. When plaque sits on or slightly below the gums it causes gingivitis from the bacterial irritation. Gums can appear puffy, swollen, and bleed from brushing, flossing, or even the slightest touch. The proper brushing, flossing, and various oral hygiene techniques can remove plaque from these susceptible areas and reduce this inflammation. If gingivitis is untreated long term, it can progress to periodontal disease.

Periodontal Disease

In a sizable portion of the population, if gingivitis goes untreated, the disease can progress to periodontitis. As more plaque and bacteria accumulate below the gums up against the root of the tooth, the body’s immune system attempts to eliminate the bacteria. As a result, the immune system inadvertently causes damage to the bone that holds the teeth in place. If left to progress, the continual bone loss can lead to deeper pockets, more bacteria, and ultimately the loss of the one or multiple teeth. In most cases, the development of periodontitis also has a strong genetic component.

Periodontitis Treatment

Typical treatment for mild to moderate periodontal disease includes a thorough disinfection of the gums and roots. This occurs with a procedure called scaling and root planing, more commonly known as a deep cleaning. During this procedure, a licensed provider such as a hygienist or dentist uses various instruments to remove hard and soft debris from the root surfaces below the gums. In order to comfortably provide a thorough disinfection and debridement, the patient is usually numbed for this procedure. A robust periodontal treatment regimen also includes homecare education and medication options. Some of these medications work to kill residual bacteria in the periodontal pockets, while others facilitate the gums’ reattachment to the root surface in order to keep bacteria out of the deeper areas in the first place. 

Importantly, research maintains that patients with a history of periodontal disease and periodontal treatment require more frequent cleanings in order to keep their teeth and jaw bone long term, usually every 3 to 4 months. This more frequent recare is called periodontal maintenance and is more involved than a regular cleaning due to more root surfaces requiring touch ups to maintain health. This is why a periodontal maintenance costs more than a traditional prophylaxis. 

Some dental insurance plans cover up to four maintenance visits in a year. Unfortunately many only cover two despite the strong research evidence in favor of 3 to 4 periodontal maintenance appointments per year.  

Severe Periodontal Disease

More advanced periodontal disease often requires the expertise of a specialist and adjunctive procedures in order to stabilize the patients gum and bone health. 

Same Day CEREC Crowns

At Genesee Pines Dental one of our goals is to ensure our restorations last as long as possible. This means when we treat a patient’s tooth, we want to go in, complete the treatment, and not have to intervene on that tooth for many years. This is our guiding principle when it comes to advising on restorations that will balance cost, saving tooth structure, and longevity. The ultimate goal of this restorative philosophy is to help the dentition last a lifetime.

When a white filling becomes approximately 50% or more of the tooth structure, that is when we start to recommend a more durable material. Big fillings can weaken the tooth and lead to catastrophic failure and more costly treatment, whereas the use of stronger ceramics can in fact strengthen the tooth when properly executed. 

Today, ceramic is the material of choice for long lasting and natural looking restorations. Traditionally, ceramic restorations are fabricated in a third party dental lab while the patient wears a plastic temporary tooth for about two weeks. Then the patient has to return to have the temporary removed, tooth cleaned, and final ceramic restoration placed. These temporaries come with their own faults and frustrations for both patients and dentists. Temporaries can break, become loose, or be difficult to clean. They can even leak and cause sensitivity and sometimes result in tooth infection down the road. On top of this, temporaries do not lend themselves well to conservative ceramic restorations such as onlays, veneers or partial crowns. 

At Genesee Pines Dental, we offer Cerec chairside restorations, the top of the line system of its kind. We have the ability to design and fabricate in office chairside custom esthetic restorations on the same day! No temporaries, no return visit! This technology also allows us to perform hyper conservative, strong and long lasting dental ceramic restorations without the frustrations that temporaries can cause. These are all the same quality materials that traditional dental labs use in their facilities. 

Cosmetic Veneers

A cosmetic veneer is an esthetic restoration that covers the ‘outward’ facing aspect of the tooth. Veneers can be used to enhance shape, size, symmetry, texture, and shade of the teeth in the  smile. They can be fabricated in a dental lab or on the same day with the Cerec system. Veneers can only be performed on teeth with minimal existing dental work, and where the patient’s bite does not interfere with the ceramic. In some situations, ‘no prep’ veneers can be done and no reduction of tooth structure is needed. In other scenarios, tooth preparation may be required to achieve the desired esthetic result. 

Dental Bridge

A dental bridge, also called a fixed partial denture, is a non surgical treatment option in order to replace a missing tooth. Essentially, the two adjacent teeth are reduced to accommodate traditional crowns. These crowns each have a connector to the false tooth which sits over the gums. Depending on each patient’s individual situation, a bridge can be a good option to replace multiple or missing teeth. The downside of a bridge is that sometimes healthy tooth structure needs to be removed in order to accommodate the fixed prosthetic. Bridges are cemented in and do not get taken out at night.

Extractions and Grafting

When a tooth is deemed to be unsavable, a patient may opt to have it removed. Usually prior to extraction, various replacement options are discussed with the patient including implants, bridges or removable prosthetics. Sometimes a patient may not opt to replace the tooth. 

When the tooth is removed, there is a hole where the tooth used to be. If a patient is planning to get an implant placed later or wants a solid bone foundation for another prosthetic, it is always a good idea to perform a bone graft at the site. A bone graft helps preserve and increase the bone that remains after healing from an extraction and/or infection.  A good bone foundation will allow an implant to be more stable and more predictable, and also give more support to a removable prosthetic.

Endodontics / Root Canals

Endodontic therapy, commonly known as the ‘root canal,’ is a procedure that is not only highly successful in the right hands, but is also backed by robust research. When a cavity gets too deep, the bacteria reaches the nerve/blood supply of the tooth. From there, the tissue inside the tooth dies, and the bacteria progresses through the space where the nerve used to reside, and travels on to infect the jawbone. The purpose of root canal therapy is to find and thoroughly clean all of these intricate internal spaces, and then plug up the space so bacteria can no longer reside there and cause reinfection. Root canals are a challenging procedure because no two tooth are alike, and some teeth have complex internal anatomy that needs to be meticulously navigated in order to properly disinfect.. Oftentimes, microscopes are needed along with specialized instruments to reach these spaces where bacteria hide.

Dental Implants

Despite the numerous advances in technology and techniques to save natural teeth, there are situations when a tooth is not saveable. Sometimes saving the tooth would be unpredictable and cost ineffective compared to alternative more predictable treatment options. This is where dental implants can be utilized, which are one of the most predictable procedures available in dentistry.

A dental implant is a specially coated threaded titanium screw of varying sizes. First, the surgeon prepares an osteotomy (hole) in the bone to receive the implant. Then, the appropriately sized implant is precisely placed with the proper angulation and depth. It helps  to think of an implant as analogous to the natural root of the tooth embedded in bone. After placement, over a 3 to 4 month period, the bone intimately heals to the threads of the implant and securely locks it in place. After healing, the surgeon will evaluate the implant stability prior to placing a tooth over it.. Once cleared by the surgeon,, the implant position is registered, and the restorative dentist can build a tooth that attaches to the implant. 

Implants can be used for a number of tooth replacement options. This includes replacing  individual teeth as mentioned above, bridges, removable snap in teeth, and fixed full arch dentures that screw down into the implants. 

Mild Sedation

Nitrous (Laughing Gas)

Nitrous oxide (ie laughing gas) is a commonly used anxiety reducing gas that a patient breathes in during a dental procedure.  It is proven to be safe and effective for minimizing mildly anxious patients during treatment. At the end of your appointment, we flush your system with oxygen so you are able to drive as soon as your appointment is finished.

Oral Anxiety Medications

There are various low dose oral medications which can be used for anxiety during dental treatment. This process typically entails dosing before the appointment while a friend or family member drives the patient to and from the office. Monitoring at home afterward is always recommended for these medications when administered for dental work.

Diagnostic

Traditional Diagnostic Techniques

Visual inspection

• Inspecting grooves for darker discolored areas, diffuse  shadows. Evaluation of the teeth and previous dental work for fit issues, leaking, cracks, cavities at the edges of older restorations.

Instrument Detection

• Cavities can often feel sticky when probed with a fine instrument. 

Radiographic Imaging

• Inspecting for cavities between the teeth or deeper cavities under the biting surface. Radiographs can also sometimes detect infections developing in the jawbone or other anomalies within the tooth.
• Note that at Genesee Pines Dental, we utilize very low dose x-ray images due to the use of digital sensors that require less exposure time.

CBCT – Cone Beam Computed Tomography

• Most people have heard of a CT scan, which utilizes x-rays to create a highly detailed 3D reconstruction of the target site for diagnosis. The concern with a CT scan is that comparatively, it uses a high dose of radiation to obtain its imagery. In dentistry, CBCT technology is a variation of CT technology which uses hundreds of times less radiation to create a 3D reconstruction of the teeth, jawbone, airway and TMJ joint. This data is then used to detect tooth infections, illuminate tooth anatomy for root canals, evaluate the bone pre-surgically, among many other purposes. 

Technology and Diagnostic Techniques

• Transillumination
  • This  is a specially designed concentrated bright light that is placed up against the side of the tooth. The light helps to detect cracks, leaking restorations, and even cavities under the surface of the tooth. Transillumination is effective at picking up issues in teeth  that would eventually become catastrophic.

• Itero 3D Scanner
  • This digital scanner takes 6000 images per second and reconstructs a patient’s teeth and gums on the computer. From there the scan can be used as a diagnostic aid, education tool. This particular scanner also has a technology called NIRI (Near Infrared-Imaging) that enables detection of cavities in between the teeth. Follow up scans can be taken in order to track tooth changes over time. Finally, the data from this scanner is used to formulate a sequence for Invisalign orthodontic treatment. This scanner does not use dangerous radiation to capture its 3D reconstruction. 

Full Mouth Rehabilitation/Reconstruction

Sometimes a patient may present with an entire mouth full of damaged dentition. In these situations, the damage may have been caused by rampant cavities, a destructive bite, grinding, injury, to name a few. When patients present with widespread damage,  fixing individual teeth will not prevent further breakdown and tooth loss. In these situations, the dentist and patient may elect to rebuild every tooth in the mouth. The purpose may be cosmetic, functional, or biological. The end goal is to reconstruct a harmonious dentition where forces are evenly distributed to minimize long term breakdown. The dentist can use various methods to create a new bite that aligns with the muscles, joints, airway, and meets the esthetic goals of the patient. These cases are challenging and require far more time, with detailed planning and execution. As a result these cases have a higher price tag than single tooth dentistry, but in certain situations the rewards pay off and bring more long term stability to the patient’s dentition.