GENERAL DENTAL SERVICES

GENERAL INFORMATION THAT YOU SHOULD KNOW ABOUT YOUR ORAL HEALTH
Aside from accidents, the three major reasons that a person lose their teeth are (1) Periodontal disease (Gum and bone), (2) Dental caries (tooth decay), and (3) Bite problems.

1. Periodontal disease is the leading cause of tooth lose. It is an infection of the gums and ultimately the bone caused by bacteria that have imbedded themselves in the roots of the teeth. This causes the gums to become infected where they ultimately separate from the teeth creating gum pockets. This process continues until ultimately the bone that supports the teeth becomes infected. This results in destruction of the bone that holds the teeth in place and will ultimately result in the loss of the teeth.

2. Dental caries is also caused by bacteria. Caries may start on the surface of the tooth eventually penetrating the enamel or outer tooth structure. After the enamel is penetrated, the bacteria enter the dentin or underlying tooth structure. Here the decay grows and spreads like a cancer ultimately destroying the tooth. This occurs because the dentin is composed of material that is very vulnerable to the bacteria. In addition, because the dentin is more susceptible to bacterial breakdown, the decay can spread very rapidly. Decay may also occur around old fillings that are deteriorating and allowing leakage to occur. When this leakage occurs between the tooth and the filling, the bacteria are allowed an easy entrance to the underlying tooth structure. This is especially dangerous because the environment around and under the filling is the perfect incubator for growing the germs.

3. Bite problems occur when the teeth do not fit together properly when the teeth close together. If the teeth do not hit or mesh together correctly, one of the following can happen; (1) The teeth will get loose (like rocking a fence post in the ground). This can eventually cause the loss of the tooth and in addition, make the tooth more susceptible to bone disease if the proper germs are present. (2) The teeth will ultimately break, especially if they have large fillings that have weakened them. (3) The teeth will wear down (sometimes clear to the gum) or may cause headaches (TMJ disorders).

With few exceptions, these three causes of tooth loss do not cause pain until damage has become extensive. This is the one major reason why we recommend periodic check ups in our practice. We know it is our patients best interest to detect problems early in their development. Treatment is less complicated to complete.

The following is a check list that could indicate one or more of the above conditions:

• Do your gums bleed when you brush? (Even a little bleeding is not normal).
• Are your gums red, swollen, or tender?
• Do you have persistent bad breath or a bad taste in your mouth?
• Do you have teeth that are loose or separating?
• Does dental floss tear or hang up on use?
• Is there any change in the way that your teeth fit together when you bite?
• Do you have areas where the gums have pulled away from the teeth?
• Do you have a grating, clicking, or popping sound in either or both jaw joints when you open, close or chew?
• Do you clench your teeth during the day or grind your teeth at night?
• Are your teeth sensitive to hot/cold, pressure or sweets?

THE BEST WAY TO START
We always recommend a complete examination for all of our new general dental patients. A thorough examination allows us to detect problems while they are still small and less complicated and therefore less costly to correct. While most people are aware that we check the teeth for cavities, it is only a small part of the complete dental/oral examination. It may surprise you to know that it is not the most common oral problem or the one that we most frequently see. Our complete examination includes:

• Health History
• Radiographs (x-rays) of your teeth, jaws, and surrounding structures.
• Oral Cancer Examination
• Lymph Node Evaluation
• Periodontal (gum and bone) Disease Evaluation
• Caries (cavities) Evaluation
• Evaluation of Existing Dental Restorations * Evaluation of the Bite to Screen for Potential Problems
• Evaluation of the head and neck musculature
• Temporomandibular Joint (TMJ) Screening Exam
• Orthodontic Evaluation Where Indicated

If the results of the examination are less complicated, we will discuss treatment needs at the end of the visit. If, however, your needs are more complex, we may require special diagnostic records and we will set up a separate treatment conference appointment to discuss your needs after the case has been more thoroughly studied.

A PARTIAL LIST OF THE SERVICES THAT
WE PROVIDE INCLUDE:

Complete Restorative Services:

• Fillings-white (tooth-colored) or gold
• Crowns
• Bridges
• Complete dentures
• Partial dentures

Cosmetic Dental Services:

• Porcelain Bonded Veneers
• Composite Bonding
• Porcelain and Composite Inlays
• Tooth Colored Fillings
• Tooth Whitening

Periodontal Disease Treatment (gum and bone)

Endodontic Therapy (root canal)

Implant Services (Permanent Tooth Replacement)

Complete Mouth Reconstruction

Oral Surgical Services

Diagnosis and Treatment of Temporomandibular Disorders (TMJ)

COSMETIC DENTAL SERVICES

ARE YOU PLEASED WITH YOUR SMILE?
It is well-accepted that our appearance affects the way we feel about ourselves and often the way others feel and interact with us. Studies have shown that the face is one of the first things that people notice about us and that the smile rates first on the list of features noticed. The mouth is a focal point of our appearance -it is our means of communication in speech and in our expressions of love, anger, joy and laughter. Everyone wants a beautiful smile. Modern cosmetic dental technology has provided us with the means to improve almost any smile. With modern cosmetic dentistry we are able to:

• Whiten teeth
• Close spaces between teeth
• Fill gaps where teeth have been lost
• Change the shape of teeth
• Change the size of teeth
• Make crooked teeth appear straight

CONSIDER THESE QUESTIONS

• Are you confident about smiling in front of people?
• Do you ever put your hand up to cover your smile?
• Do you smile with your mouth closed?
• Do you wish your teeth were whiter?
• Are you happy with the shape and size of your teeth?
• Are you happy with the alignment of your teeth?

To correct these problems, we offer and provide the following cosmetic dental services:

• Porcelain Bonded Veneers
• Composite Bonding
• Porcelain and Composite Inlays
• Tooth Colored Fillings
• Tooth Whitening

47 year old female with old plastic facing crowns.	Old crowns replaced with porcelain veneer crowns.
23 year old male with mis-aligned teeth.	Treated with porcelain veneers.

IMPLANT DENTAL SERVICES

PERMANENT TOOTH REPLACEMENT
Dental implants or permanent tooth replacement is now a proven and accepted means of replacing one or more missing teeth.

If any type of denture, full or partial, is being worn, dental implants can allow for comfort in chewing often approaching the comfort of natural teeth. There is frequently an improvement in appearance and patients are no longer subject to the inconvenience of loose fitting dentures that slip at the most inappropriate time, cause pain and embarrassment or make eating difficult.

Our office prides itself in working in a TEAM approach with an oral maxillofacial surgeon. Together, the patient's case is carefully planned for appropriate placement of implants depending on the type of replacement teeth that will be utilized. At the completion of this planning phase, the oral surgeon places the implants utilizing the skill that only their specialized training can provide. After healing is complete, we then construct the replacement teeth or prosthesis in order to provide the optimum in chewing, comfort, and aesthetics.

If you avoid laughing aloud, smiling or eating in public because your denture may slip or unsightly gaps appear where teeth once existed, dental implants may be the answer.

SNORING AND SLEEP DISORDERS

SNORING
Snoring is to obstructive sleep apnea as thunder is to lightening. They may, but not always, appear together. One may be just an annoyance, but the other may be serious trouble.

OBSTRUCTIVE SLEEP APNEA
With obstructive sleep apnea, muscles of the soft palate at the base of the tongue and the uvula (the small, conical, fleshy tissue hanging from the soft palate) relax and sag, obstructing the airway, making breathing labored and noisy. Collapse of the airway walls blocks breathing entirely. When breathing periodically stops, a listener hears the snoring broken by pauses. As pressure to breathe builds, muscles of the diaphragm work harder. Sleep is then temporarily interrupted, sometimes only for seconds. This, in turn, activates throat muscles and "un-corks" the airway. The effort is akin to slurping a drink through a straw that is stuck in a lump of ice cream. A listener hears deep gasping as breathing starts. With each gasp, the sleeper awakens, but so briefly and incompletely that he does not remember doing so in the morning. Someone with obstructive sleep apnea may stop breathing for ten seconds or longer-dozens, even hundreds of times each night.

Each time breathing stops, oxygen in the blood stream falls and the heart must work harder to circulate blood. Blood pressure rises and over time, may stay elevated after breathing restarts. The heart sometimes beats irregularly and may even pause for several seconds. This may account for some deaths during sleep of people who went to bed in apparent good health.

Dotted circled area shows tongue against the back of thraot. This allows air to vibrate tissues and create SNORING. In addition if severe enough it can block the flow of air and create sleep apnea.	Circled area shows airway open with dental appliance in place bringing the jaw forward.

DENTAL APPLIANCE THERAPY
A dental appliance is a small plastic device, similar to an orthodontic retainer, or an athletic mouthguard. It is worn in the mouth during sleep to prevent the soft throat tissue from collapsing and obstructing the airway. Dentists with training in dental appliance therapy can design, construct and fit these special appliances to meet their patient's individual situations and conditions.

In recent clinical studies, physicians and dentists have found that in the majority of patients, a well made, well fitted dental appliance will effectively reduce or eliminate snoring.

Dental appliances work by bringing the lower jaw forward, by holding the tongue forward and by lifting the drooping soft palate.

Silencer dental appliance has been shown to be effective in reducing or elimating snoring and sleep apnea.

WHAT TREATMENT OFFERS
Most people with sleep apnea benefit from both general measures and specified treatments.

• Lose excess weight
• Get regular exercise
• Avoid alcohol, heavy meals and medications that make you drowsy

When symptoms are more severe, and these measures don't solve the problem, other treatment options include:

• Nasal CPAP (continuous, positive airway pressure). Pressure from an air compressor forces air through nasal passes and into the airway under gentle pressure, keeping it open and allowing the person to sleep and breathe normally.
• Surgery may be able to correct physical abnormalities that cause sleep apnea. However, there is no easy surgical solution. Considering the invasiveness of surgical solution, a failure can be devastating to the patient. Surgical success ranges between 50%-70%.
• Dental appliance therapy. An effective way of treating snoring and obstructive sleep apnea for many patients.

QUICK FACTS ABOUT OBSTRUCTIVE SLEEP APNEA
98.5% of snorers exhibit apnic tendencies.
24% of males and 18% of females suffer from snoring.
60% of males and 40% of females over the age of 60 snore (female snoring increases after menopause)
Loudness of snoring may reach as high as 90db (workman's compensation requires ear protection in workplace at 90 db
Hypertension is present during wakefulness in approximately 50% of people with sleep apnea.
Over long periods, sleep apnea results in intellectual and memory deterioration.

THE FOLLOWING IS A SLEEP QUIZ TO HELP YOU RATE THE QUALITY OF YOUR SLEEP PATTERNS

If you checked three or more boxes, you should ask your doctor or dentist about sleep apnea.