Believe it or not, dentists are trained in evaluating not only your mouth, but your face, head and neck as well! At your initial exam, the doctor will look at and record information about your jaw, lips, nodes, cheeks, palate, throat, tongue, gums, teeth and floor of mouth. Any unusual findings will be discussed, as well as any recommended treatment. Patients have the opportunity to discuss alternatives and work with the doctor to determine a treatment plan that meets their needs. At subsequent check ups, the doctor performs a "periodic" exam, which covers the same areas, but is usually shorter, since continuing care patients are (hopefully!) fairly stable.
At the first visit (and every five years after) patients have a full mouth series of x-rays taken. These 18 images show all the areas between the teeth as well as their roots and the bone levels surrounding them. Subsequent visits typically require bitewing x-rays, which are annual pictures taken to look primarily between the teeth. Although some people feel that avoiding x-rays and the resultant radiation is a good idea, most radiologists agree that even the radiation from a full set of dental x-rays is roughly equivalent to a person's radiation exposure while flying coast to coast on an airplane.
Performed by dental hygienists, cleanings serve to remove plaque and tartar (which is calcified plaque) from around the teeth and gums, so as to prevent gum disease. The hygienist also assesses the health of the gums and offers suggestions on the latest and best techniques for patients to customize their own home care regimen. Lastly, they polish the teeth to give patients that "nice clean just-from-the-dentist feeling!"
Sometimes, due to periodontal disease, patients require a deeper cleaning to remove long-standing tartar from below the gumline. Typically, these cleanings, also performed by the hygienist, are done with anesthetic to ensure the patient's comfort. Once this cleaning is finished, patients may be placed on a more frequent continuing care schedule to maintain the results of the cleaning.
Most people, at some point in their life, develop decay on one or more teeth. Sometimes this is the result of neglect, but other times it's simply a matter of difficult cleaning access, diet or even side effects of medication. The dentist can remove the decay and restore the missing tooth structure with a filling. Some fillings are very simple and require no anesthetic and take only five minutes to complete. Others are more complicated. Fillings can be done in both amalgam ("silver") or composite ("tooth-colored"). If you have dental decay, the dentist will discuss what kind of fillings will be best, as it often depends on the age of the patient, the area of the mouth and the nature and location of the decay.
CROWNS AND BRIDGES
If a tooth fractures, has had a root canal, or has a very large filling with decay underneath, a patient may require a crown, also known as a "cap." This procedure involves shaping a tooth in a precise and specific way and taking an impression (or "mold") of the preparation. The impression is sent to a dental lab where the crown is manufactured. Usually, the patient is sent home with a temporary crown, and returns a week or two later for the permanent restoration. Crowns are available in metal alloys, ceramics or porcelain/metal hybrids, depending on esthetic and functional concerns. The white crowns can be used for esthetic reconstruction, as well.
A bridge is basically three or more crowns fused together. If a patient is missing a tooth, the dentist can prepare the teeth next to the space, and cement a bridge that looks, feels and chews like natural teeth.
A veneer is similar to a crown, but only the front surface of the tooth is affected. While crowns are done for functional purposes, veneers are typically cosmetic in nature. They can be used to whiten a smile, straighten slightly crooked teeth or close gaps between teeth.
A dental implant is an alternative to a bridge. If a patient is missing a tooth, an implant allows it to be replaced in a very permanent way without affecting the other teeth in the mouth. This procedure involves a titanium appliance that is surgically implanted in a patient's jaw bone. At successive visits, a post is fitted into the implant and a crown placed over the post. Often, the general dentist collaborates with an oral surgeon or periodontist during this procedure.
Sometimes a tooth is unrestorable and no treatment can save it. Other times, patients are unable or unwilling to save teeth due to financial or time constraints. In these cases, a broken, mobile or painful tooth can be removed. A general dentist can remove most teeth, but other times the patient is referred to an oral surgeon, due to the number or complexity of the teeth involved. While many patients are fairly comfortable with local anesthetic for an extraction, the oral surgeon can administer more advanced sedation techniques as needed.
If a patient is missing all of their upper and/or lower teeth, the dentist can make a denture or "plate" to replace them. Ideally, the denture will help the patient chew most foods as well as look like a natural smile. Many patients are dissatisfied with dentures, however, and technology now exists to stabilize the dentures with implants. Additionally, patients should consider retaining as many natural teeth as possible so as to facilitate the use of a Partial Denture.
A partial denture is a removable appliance that replaces missing teeth. The partial denture is sometimes used as a temporary or economical alternative to bridges or implants. Partials can be made with both plastic or metal frames and involve a wide variety of clasping techniques, depending on functional and esthetic concerns.
Root canal therapy involves removing infected or compromised nerve tissue from a tooth and sealing that space with a non-reactive material to prevent future infections. Some root canals are performed by general dentists, while others are referred to a specialist called an endodontist. A root canal often results in a back tooth being weaker and needing a crown. Front teeth treated by root canals often darken or turn gray, so many patients later have veneers (hyperlink) placed. Despite their bad reputation, most patients experience no more discomfort with this procedure than they would with a filling.
NIGHT GUARDS/BITE APPLIANCES
Some patients grind their teeth while they sleep, or even during the day. The dentist can provide an acrylic appliance to protect the teeth from further damage. These appliances can also be used to treat TMJ disorders. Typically a night guard or bite appliance can be made after some simple impressions of the patient's mouth.
While many whitening products are available over-the-counter, only a dental office can provide patients with a customized personal tray and the strongest available whitening gels. Many patients have darker or more yellow teeth due to aging, tobacco use, or beverages such as red wine, coffee or tea. A whitening tray can dramatically brighten a smile, although some patients who have visible white fillings on their front teeth may need to consider veneers to complement whitening treatments.