You are going to have an apicoectomy performed on a tooth.

The following information will assist you in understanding the procedure and aid the healing response:

1. A small incision is made in the gums near the deepest end of the tooth root. This allows access for the dentist to the infected area. Through this incision, the infected material at the end of the tooth root is removed. The tooth root is sealed to prevent the occurrence of further infection. The gum tissue is sutured to aid in the healing process. The stitches will dissolve by themselves, unless we tell you differently.
2. You will be given a prescription for an antibiotic. Take this medication as directed until it is gone.
3. You will be given a prescription for an analgesic to reduce any discomfort you may experience after the apicoetomy.
4. Slight bloody discharge may come from the site for a few days. It will gradually stop.
5. As soon as it is convenient, place some ice cubes in a plastic bag, wrap the bag in thin towel, and place the bag on the external of your face over the site of the apicoectomy.
6. Within several days, you will recover from this procedure. Statistics show that the involved tooth will continue to serve as a functional part of your dentition.

You are in need of root canal therapy. The following will help you to understand the procedure.

Inside of all normal teeth is a cavity containing nerves, blood vessels, and live soft tissue called the pulp. Occasionally the pulp tissue is abused by trauma, deep decay, large fillngs, crowns, or other factors, and the pulp tissue becomes necrotic (dead). Usually, the result to you is pain or bone destruction visible on dental x-rays.

Treating necrotic (dead) pulp is a delicate procedure requiring the following steps.

1. A small hole is made in the chewing surface of the tooth to allow access to the dead pulp tissue.

2. Using a series of small files, the dead tissue is removed from the internal of the tooth.

3. Once, the internal portion of the tooth is hollow and cleared, this area is filled with a “rubber like” material called “gutta-percha.”

4. If the tooth has been severely weakened, it may need a supportive post placed internally, and a subsequent crown (cap) for strength.

Root canal therapy is about 95% effective in restoring the tooth back to normal function. However, occasionally mild discomfort lingers for a few weeks before the tooth feels normal.

We expect that your tooth that will receive root canal therapy will return to a healthy, strong, non-painful portion of your dentition.

Root canal therapy requires the removal of a significant amount of the internal portion of a tooth to gain access to the root canals and to remove infected materials. If the tooth has had previous restorations (fillings), or has to support a fixed bridge, it may need internal reinforcement to ensure that root and crown. A post is cemented in connected together adequately. Various types of posts are used to connect the root and crown. A post is cemented in to the tooth root, and a core, or replacement of the crown is placed on the top of the post.

We plan to place a post in your tooth. The root end of the tooth will remain filled with the root canal filling. The post will be cemented with a strong epoxy-like material that bonds the post and the tooth together.

The “post and core” provided for you allows optimum potential for this tooth to continue to serve in your mouth for many years.

Bleaching teeth that are discolored internally can be a very effective procedure, but you should know some important information before deciding to have this procedure accomplished on your teeth:

1. Bleaching in the dental office occurs slowly and requires one 1-hr appointment.

2. Bleaching may be somewhat uncomfortable during and for a short time after the procedure.

3. Slight to moderate discolorations can usually be removed successfully.

4. If discoloration is severe, crowns or veneers are usual more acceptable.

5. Bleached teeth may require retreatment occasionally to maintain acceptable color.

6. Some teeth bleach easily, but others do not bleach well: the only way to determine the bleaching potential of your teeth is to try it.

7. Bleaching is the most conservative and least expensive procedure available for internally stained teeth.

8. Bleaching teeth at home is an alternative to in-office bleaching and should be considered.

The Procedure Follows:

1. A minimum of one 1-hr appointment is required.

2. Anesthetic is not used.

3. A tooth isolation plastic is placed each time to isolate your teeth.

4. Bleaching solution (concentrated hydrogen peroxide) is placed on the isolated teeth.

5. Bleaching is accomplished by the action of the concentrated hydrogen peroxide over a short period of time.

6. Bleaching solution (concentrated hydrogen peroxide) will be applied several times during the 1-hrs appointment.

7. The plastic guard is removed and your appointment is finished.

After The Procedure:

1. Immediately after each bleaching appointment, your teeth will be lighter than they will be 24 hrs later. The color will return to somewhere between their dehydrated, bleached color and their original, darker color.

2. The teeth may be sensitive for a few days because of the heat and bleach application. We have not experienced any long-term damage to teeth from bleaching. If you experience sensitivity call 724-869-0446.

3. In some cases, we may suggest more appointments for an optimum result.

4. If slight color returns after a period of months, rebleaching may be needed.

Hydrogen peroxide has been used for many years to lighten the color of teeth. Originally, it was applied by dentists in their offices. In recent years, new techniques have allowed patients to apply bleaching gels to their teeth at home using custom fitted trays. Although tooth bleaching compounds can be purchased in pharmacies or grocery stores, more effective bleaching techniques may be obtained only from dentists. It is preferable for dentists or dental auxiliaries to supervise this type of bleach. Bleaching teeth with peroxide in custom-fitted trays outside the dental office is the most popular method to achieve this desirable lightening of teeth.

Potential Side Effects: A Few Side Effects Can Occur When Bleaching Teeth At Home.

1. Tooth Sensitivity: This condition can be minimized if bleaching times are deduced, or it is eliminated if bleaching is discontinued for days. Post-bleaching application of fluoride as described below reduces sensitivity.

2. Gum Tenderness: Occasionally, gum tissue become irritated, and sometimes a mild sloughing of the superficial layers of the gums occurs. Reduction of bleaching time or elimination of bleach stops the sloughing.

3. Discomfort of Jaw Joints: If bleaching trays are worn too long during any given day, discomfort in jaw joints may occur. It is reversible when the bleaching trays are removed.

4. Sore Throat: may occur if you swallow too much of the bleaching solution.

Patient Instructions:

1. Brush and floss teeth. Rinse your mouth well.

2. Place a small amount of bleaching gel into each space in the provided trays for every tooth to be lightened.

3. Insert the trays into your mouth over the teeth, wipe excess gel off gum tissue with your finger or a towel, expectorate (spit out) the excess gel froam, and wear the loaded trays for 1 hour.

4. Remove the trays, wash the gel out and wipe the trays dry with tissue paper, reload the trays, replace them, and wear them for another hour.

5. Place several drops of 1.1% fluoride gel into washed and dried trays and place the trays into your mouth for 5 min.

6. Rinse the trays with tap water after use, and tip them upside down to allow drying before the next use.

7. Discontinue bleaching if tooth sensitivity, gum irritation, or any other negative event occurs. Notify us of the problem immediately, and we will advise you concerning further bleaching.

You have absorbed, and we have recorded the color of your teeth at the initiation of bleaching. We will monitor the color changes with you when the desired color changes with you and will advise you when the desired color change is completed. The average time for optimum color change to occur is 1-3 weeks. Brown, orange, and yellow stains bleach faster and easier than blue or gray stains. Observation appointments are necessary every 7-10 days to check the progress of the bleaching. As frequently as once per year, a few additional touch-up bleaching sessions may be needed. We will advise you of tis need at your regular check-up appointments.

Patient Instructions (Accelerated Bleaching Sequence):

If you want to bleach your teeth faster, you may apply bleaching gel more than 2 hours per day. Any convenient time during the day is acceptable.

How long will porcelain veneers last?
There are no hard and fast rules about how long you can expect your porcelain veneers (porcelain laminates) to last. You can certainly expect that they will remain cosmetically pleasing and structurally sound for many years, but it is unrealistic to expect that they will last forever. With good home care and by exercising good judgment, it seems likely that a porcelain veneer could last well in excess of ten years.

What should you do to take good care of your porcelain veneers?
The expected lifespan of your porcelain veneers can be heavily influenced by the way you use and take care of them. Here are some suggestions:

Practice good oral home care
Just as with any tooth, your veneered tooth should be brushed and flossed thoroughly on a daily basis. Ask your dentist for specific recommendations but in general any non-abrasive toothpaste which contains fluoride should be suitable. By practicing good oral home care you can help to minimize the chance that decay will for m on those aspects of your tooth that are not covered by the veneer. Additionally, thorough plaque removal will help to ensure that the level of the gum line on your tooth will not recede in response to gum inflammation (gingivitis or periodontitis) that has been caused by dental plaque. Since in most cases the edge of a porcelain veneer will end right at the gum line, if you allow any gum recession to occur the cosmetic appearance of the veneered tooth can be spoiled.

Avoid exposing your porcelain veneers to excessive forces
Porcelain veneers are not intended to have to withstand heavy forces or sharp impacts. You should avoid biting your fingernails or biting on hairpins, bottles, ice, or any other hard items because doing so can break or dislodge a veneer. If you engage in sporting events you should wear an athletic mouthguard.

Avoid clenching and grinding your teeth
People who clench and grind their teeth (dentists use the term "bruxism" to refer to this activity) can easily chip or break their porcelain veneers because of the heavy forces generated by these actions. If you know that you do brux, or if your dentist finds evidence of your bruxing behavior in the appearance of your teeth, you must control this activity during your waking hours. For protection when you are sleeping, your dentist should fabricate a plastic night guard for you to wear.

Minimize staining influences
Porcelain veneers are a great improvement over other types of cosmetic bonding by the fact that their surface is very resistant to staining. The Achilles heal of porcelain veneer technique, however, is that the veneer is bonded onto your tooth using cement which is capable of picking up stain over time. It is possible that a veneer itself will still have a nice appearance but at its edges, where the cement holding the veneer in place exists, staining will have occurred, thus spoiling the overall cosmetic appearance of the tooth. Good home care, meaning keeping plaque and debris from accumulating in the area of the edged of your porcelain veneer, can help to minimize the potential that the veneer’s cement will stain. Also, avoid an excessive exposure to tea, coffee, red wine, colas, and tobacco products.

How do dentists bond porcelain veneers to teeth?

The pre-cementation evaluation of the porcelain veneer
Before your dentist can bond your new porcelain veneer ( porcelain laminate ) into place they will need to evaluate how accurately it fits on your tooth. To do so, your dentist will place the veneer on your tooth, inspect it, remove the veneer and trim it, repeatedly, until they are satisfied with its fit. In most cases anesthetic is not needed for this step or any of the other steps we describe on this page.

Evaluating the porcelain veneer's overall shape
When you porcelain veneer is fabricated it will be made so it has the "ideal" shape. Even so, you and your dentist may come to the conclusion that certain aspects of the veneer need to be shortened, squared off, or rounded so to make the veneer's appearance even more pleasing.

It will be difficult for you and your dentist to determine that the shape of the porcelain veneer is exactly right. This is because the veneer has not been bonded to the tooth yet, so its exact final positioning on the tooth isn't known. At this stage your dentist will need to error on the side of leaving the porcelain veneer slightly oversized. Then after the veneer has been cemented into place it can be trimmed to precise proportions.

Evaluating the porcelain veneer's color.
Your dentist will have chosen the shade of the porcelain that was used to fabricate your porcelain veneer because they felt it came closest to matching the shade of your tooth's neighboring teeth. However, because porcelain veneers are translucent, the precise color a veneer will possess can be adjusted by changing the shade of the cement that is used to bond the veneer into place.
Your dentist will choose a cement that they feel will provide the best color match for the veneer as compared to its neighboring teeth. Once a cement shade has been selected your dentist will place some of the cement's corresponding "trial paste" into the veneer. Trial pastes have the same color properties as their corresponding cement. Once the trial paste has been placed into the veneer the veneer can be placed on its tooth so both you and your dentist can see how the shade of the cement will affect the veneer's overall coloration. If you do not feel that the color of the veneer is a good match with your other teeth your dentist can repeat this same type of evaluation using other shades trial pastes, until the right color of cement is found.

It is important for you to realize that you must be happy with the veneer's shade before your dentist proceeds with the cementation process. After a porcelain veneer has been bonded into place it cannot be removed.

Bonding the porcelain veneer into place.

Once you and your dentist have determined that the shape and shade of your porcelain veneer are appropriate it can be bonded into place. First the porcelain veneer will be cleaned and prepared for the cementation process. Your tooth will also be cleaned, usually by polishing it with a rubber cup or brush. The enamel surface of your tooth will be etched with an acidacidic etching gel surface roughness allows the cement to create a very strong bond with the tooth's surface, and it is a hallmark of dental bonding technique.

At this point cement will be placed into the porcelain veneer and the veneer will in turn be seated on your tooth. Once your dentist has ensured that the veneer is in its proper position they will cure the cement by way of shining a special light on your tooth. This light (which is usually blue in color) passes through the translucent veneer to the cement which lies underneath. The light activates a catalyst in the cement, causing it to cure in just a few moments.

At this point, the porcelain veneer is securely bonded into place on your tooth. There will probably be at least some excess cement present at the edges of the veneer that your dentist will need to trim off and polish down. You and your dentist will also need to evaluate the veneer's precise contours and trim or reshape them as you feel is needed. Your dentist will also spend time evaluating your bite and making sure that the veneer doesn't interfere with it.

The porcelain veneer post-cementation appointment
Most dentists will ask that you return to their office about one week after your porcelain veneer has been bonded into place. Your dentist will want to evaluate how your gums have responded to the presence of your new veneer. If you feel that the overall shape of your veneer needs to be adjusted, your dentist can perform that task during this appointment also.

Since that time when your porcelain veneer was bonded into place, you may have noticed that your tooth has some persistent hot and cold sensitivity. If you do let your dentist know during this follow-up visit. While it is possible that this thermal sensitivity will resolve on its own, your dentist may have some suggestions or solutions that can speed up the process.

How long will porcelain veneers last?
There are no hard and fast rules about how long you can expect your porcelain veneers (porcelain laminates) to last. You can certainly expect that they will remain cosmetically pleasing and structurally sound for many years, but it is unrealistic to expect that they will last forever. With good home care and by exercising good judgment, it seems likely that a porcelain veneer could last well in excess of ten years.

What should you do to take good care of your porcelain veneers?
The expected lifespan of your porcelain veneers can be heavily influenced by the way you use and take care of them. Here are some suggestions:

A) Practice good oral home care.
Just as with any tooth, your veneered tooth should be brushed and flossed thoroughly on a daily basis. Ask your dentist for specific recommendations but, in general, any non abrasive toothpaste which contains fluoride should be suitable.
By practicing good oral home care you can help to minimize the chance that decay will form on those aspects of your tooth that are not covered by the veneer. Additionally, thorough plaque removal will help to ensure that the level of the gum line on your tooth will not recede in response to gum inflammation (gingivitis or periodontitis) that has been caused by dental plaque. Since in most cases the edge of a porcelain veneer will end right at the gum line, if you allow any gum recession to occur the cosmetic appearance of the veneered tooth can be spoiled.

B) Avoid exposing your porcelain veneers to excessive forces.
Porcelain veneers are not intended to have to withstand heavy forces or sharp impacts. You should avoid biting your fingernails or biting on hair pins, bottles, ice, or any other hard items because doing so can break or dislodge a veneer. If you engage in sporting events you should wear an athletic mouthguard.

C) Avoid clenching and grinding your teeth.
People who clench and grind their teeth ( dentists use the term "bruxism" to refer to this activity) can easily chip or break their porcelain veneers because of the heavy forces generated by these actions. If you know that you do brux, or if your dentist finds evidence of your bruxing behavior in the appearance of your teeth, you must control this activity during your waking hours. For protection when you are sleeping, your dentist should fabricate a plastic night guard for you to wear.

D) Minimize staining influences.
Porcelain veneers are a great improvement over other types of cosmetic dental bonding by the fact that their surface is very resistant to staining. The Achilles heal of porcelain veneer technique, however, is that the veneer is bonded onto your tooth using cement which is capable of picking up stain over time. It is possible that a veneer itself will still have a nice appearance but at its edges, where the cement holding the veneer in place exists, staining will have occurred, thus spoiling the overall cosmetic appearance of the tooth.

Good home care, meaning keeping plaque and debris from accumulating in the area of the edged of your porcelain veneer, can help to minimize the potential that the veneer's cement will stain. Also, avoid an excessive exposure to tea, coffee, red wine, colas, and tobacco products.

Source: www.animated-teeth.com

There are numerous causes of superficial white, brown, gray or orange spots on the surfaces of teeth.  If the appearance of the tooth discolorations is unacceptable to you, they may be removed in one or more ways:

• Microabrasion: The most conservative method is removal of small amount of the discolored tooth structure using an abrasive solution. This technique is usually fast and relatively inexpensive, and it produces a permanent result. We will tell you if this procedure is appropriate for your teeth.

• Tooth-Colored Restorations (fillings): If the discolored spots are too deep for microabrasion, they may be removed by standard rotary abrasion and restored by placement of small, tooth-colored plastic restorations.  Usually, these restorations match the color of the tooth structure very well, and they serve for several years.

• Veneers: If your teeth have multiple, deep discolorations, veneers, which are thin, custom-made pieces of plastic or porcelain, can be bonded to the surfaces of the teeth to cover the spots.  Veneers provide an excellent appearance and serve well for several years.

If possible, we suggest beginning with conservation microabrasion. If it is successful, further treatment is not necessary. If the spots are too deep, small resorations may be needed in addition to microabrasion. If the spots or discolorations are very deep, veneers will usually be suggested as the only treatment possibility.

Please ask us if you have questions.

You have just had some teeth prepared for porcelain veneers.  The teeth have received plastic temporary restorations to cover the prepared tooth structure while the new veneers are made.  The following information will help you to understand the procedure:

• Temporary veneers do not resemble the final restorations in any way.

• Temporary veneers are attached only slightly to the underlying teeth so they can be removed easily.  Be careful to chew only on teeth without temporary veneers on them.

• Prepared teeth may be sensitive to hot, cold, and sweets.  When the final restorations are placed, the teeth will not have these sensations.

• Prepared teeth may be sensitive to hot, cold, and sweets.  When the final restorations are placed, the teeth will not have these sensations.

• Your gums will be slightly irritated for a few days.  Avoid heavy brushing of the temporary veneers.  Do not use floss between the temporary veneers because you may pull them off.
  • Your final porcelain veneers will be as close to the beauty and function of natural teeth as possible.  We will have them for you in a few days.

This instruction sheet will help you to understand the dental implant placement procedure.

• Please have a good night’s rest before the day of implant placement, and eat a moderate breakfast or lunch.

• A local anesthetic will be used to block sensation in the area where the implant is to be placed.

• Sterile covers will be placed over your clothing and hair, and our work surfaces to reduce the presence of bacteria.

•  We will wear sterile outer clothing to eliminate any contamination.

• A small incision will be made in your gums to obtain access to the location where the implant will be placed.

• Several sizes of small drills will be used to make precise, painless, preparations in the locations where the implants will be placed.

• Implants will be placed into the prepared sites.

• Your gum tissue will be stitched together to isolate the newly implants from oral fluids and foods.  The stitches will dissolve, or come out by themselves, unless we advise you differently.

• You will be asked to bite on gauze sponges for at least on half-hour to stabilize the site and stop any slight blood flow.

• You will be given at least 2 prescriptions which you should have filled and begin to use immediately:

• An antibiotic to control any potential infection.  Please take this              medication as directed until the tablets are gone.
• A pain relieving medication to control discomfort. Take this medication only until you do not need it anymore.

• Anesthesia should remain in your mouth for at least 1 hour after we are finished.

• As soon a possible after treatment, place ice in a plastic bag and put it on the outside of your face for a few hours over the sites where the implants were placed.  This reduces the potential swelling and bruising.  However, you may still have some swelling and bruising for a few days.

• There may be a felling of numbness caused by the surgery that lingers for a time.  Usually this goes away within a few days.  In a very few cases it does not go away totally.

• Eat and drink only soft foods for a few days.  The less force you put on the implants at this time, the better the chance of their optimum healing.  Over 95% of implants are accepted well by the body, but about one out of 20 is rejected and must be replaced.
  • We anticipate that these implants will serve you well for many years.

We have done are best to provide you with-fitted, functional, and esthetic implant prosthesis.  WE feel confident that adjustment to these artificial teeth will be fast and that you have many years of satisfaction from them.

• Your First Few Weeks:  For several days, please chew more carefully on these restorations than on natural teeth.  We will adjust the bite (occlusion) on future appointments until the teeth are well balances.  After you have adjusted the prosthesis, it should function in a similar manner to natural teeth.
• Cleaning the Implants and Prosthesis:  The continuing success of the implant and prosthesis is up to you.  Please do the following (items are checked):
• Visit us for examination, scaling, and polishing at least once every _______ months.
• Clean the implant(s) and prostheses daily, especially before bedtime using:

_____ Floss
_____ Bridge cleaner
_____ Toothbrush
_____ Mechanical toothbrush
_____ Water Pik
_____ Peridex

Please ask us about anything that is unclear relative to proper cleaning.

• The Future:  Your examination and professional cleaning appointments are very important to the long-term success of you prosthesis.  If your personal and professional cleanings and you examination appointments are accomplished routinely, you restorations should serve many yours.

Please contact us if any of the conditions below occur:
Feeling of looseness
Peculiar taste
Clicking or metallic snap while eating
Breakage of a piece of the prosthesis
Redness in the gum tissue around the implant
Feeling of the bite being different
Pain

We look forwar to helping you enjoy your new implant supported prosthesis.

Normal sized dental implants appear to be too large for the amount of bone you have available.  You need more stability for your prostheses, and there are only three choices for a situation such as yours:

• Stay “as you are”
• Have bone grafted into our mouth from some other part of your body to provide enough bone for conventional implants. Usually, this operation requires:
• A surgical procedure to transfer the bone to your mouth
• A healing period
• Placement of conventional-sized implants
• Another healing period
• Placement of the teeth onto the implants

Placement of “mini” implants.  These small titanium-alloy implants are only 1.8 mm in diameter.  Regular implants are 3.25 – 6.0 mm in diameter.  “Mini” implants are not as strong as conventional-sized implants and the research on them as been in progress for only a few years with good results.  However, they are at least an interim “fix” for your problem, if not a long-term one. Please ask us about the feasibility of “mini” implants for your situation.

In the past few generations, a significant negative health condition has become common in our affluent society.  Rather than hunger, we suffer from an over abundance of food and the subsequent effect-overweight people of those who think they are overweight.

Bulimia is common among young women and a few men.  Often, these people are not overweight, but they perceive themselves to be “fat.”  As a result, they eat what they want, and then they stimulate themselves to vomit.  When the resultant high-acid content vomitus is present on tooth structure several times per day, a significant demineralization and dissolution of tooth structure occurs.  The locations in the mouth where bulimia is noticed first are back surfaces of the upper front teeth and the upper molars.  The enamel (outer surface) of the teeth is dissolved and may be entirely destroyed on those surfaces.  The patient feels sensitivity to sweet, cold, and heat, and has considerable discomfort from the result of the dissolved tooth surfaces.

Those persons with bulimia should receive extensive psychological counseling and perhaps in-part confinement for an appropriate period of time to stop the problem.  Serious systemic challenges, including circulatory and reproductive dysfunction occur with advanced bulimia.  Many patients never recover.  Recovery should be started as soon as possible!

In relation to the overall health challenges, bulimic patients need counseling about the destructive dental problems caused by bulimia.  They need fluoride gel applied to the teeth in trays daily.  They should wash their mouths with a dilute solution of baking soda (sodium bicarbonate) each time they vomit until the condition is under control.  Advanced cases of bulimia required extensive oral rehabilitation including crowns, bridges, and subsequent preventive care.

Don’t avoid treating bulimia, it can be fatal.

You may have a very commonly occurring dental problem.

Teeth may crack when subjected to the stress of chewing hard foods, ice, or hard objects.  Teeth with or without restorations (fillings) may exhibit this problem, but teeth restored with typical silver alloy silver alloy or tooth-colored restorations are most susceptible.  Older persons have more cracked teeth than younger people.

Symptoms and Signs Include The Following:

• Pain or chewing.

• Pain on cold-air application.

• Unsolicited pain (This is usually leakage of sugar into the tooth cracks).

• No x-ray evidence of the problem.

• Dental decay is not present.

• Easy verification of the crack by the dentist when the tooth is prepared for restoration.

Treatment of Cracked Teeth:

• Simple Crack:  The majority of cracked teeth (about 9 out of 10) can be treated by placement of a simple crown (cap) on the tooth.  When the tooth is prepared for the crown and a temporary restoration is placed, the pain usually leaves immediately.  If this is the case with your tooth, we will place the final crown without a problem on you next appointment. The condition should then be solved.

2. Complex Crack:  Occasionally, (about 1 in 10) the tooth cracks into the pulp (nerve) of the tooth.  If pain persists after placement of the temporary crown, you may have a crack into the pulp of the affected tooth.  Please call us.  This tooth may require endodontics (root canal therapy) before the crown is placed.  This procedure requires about two additional appointments before the crown is placed.

Thanks for your cooperation.

Tongue Piercing & Its Dental Effects

Body piercing is popular among adolescents and young adults. Included in this phenomenon is piercing of the tongue and placement of a metal bar through the tongue. This ornament rests in the mouth at all times and unavoidably moves as the person eats or talks.

If you have a metal bar in your tongue, you should be very careful to avoid having the metal hit your teeth as you move your tongue. Gently touching the teeth with the bar is not a problem. However, letting the bar move as the tongue makes its normal eating and speaking movements causes racks in the teeth and even breaks off pieces of enamel. Microcracks are created in teeth by hitting them with the bar. The result of the microcracks will be future fractures of tooth enamel, necessitating extensive and expensive dental crowns.

Tongue piercing may cause mild to severe infection upon placement or throughout the life of the piercing. Consult your dentist as soon as any soreness or draining occurs.

The best tongue piercing is none at all, but if you must have one, be very gentle in the movements of your tongue or dental damage is inevitable.

Modifying The Chewing Surfaces Of Teeth

• Purpose: Often, teeth and jaws do not occlude (come together) in an acceptable position the result is called malocclusion and has been related to muscle pain and other maladies.  Some reasons for malocclusion are fillings or bridges that have been placed piecemeal over a period of years, orthodontics, developmental defects, oral surgery, trauma, natural occurring malocclusion, bruxism, and clenching.

• Occlusal Equilibration: Occlusal equilibration is the mechanical adjustment   of your teeth, dentures, bridges, fillings, or other oral appliances allow your lower jaw to function in a natural hinge in relation to your upper jaw without improper influence from teeth.

• Is Occlusal Equilibration Harmful?  When malocclusion is presented, teeth are equilibrated because some problem exists: pain, abnormal wear, breaking of restorations (crowns), or other conditions.  The problem is usually present because the teeth and/or restorations do not meet in harmony with yur lower jaw at the proper position, the teeth and fillings have not “worn in” properly.  Occlusal equilibration “wears” some areas mechanically and allows the teeth to meet harmoniously.   It is not harmful.

• The Future:  A simple occlusal equilibration can make the teeth and restorations meet harmoniously.  However, slight changes in y our occlusion (bite) occur over a period of time, because of small movements of teeth in the jaw bones.  More complex equilibrations may require several appointments, and the teeth may shift significantly between appointments.  When your symptoms are gone, and your occlusion is relatively stable, your occlusal equilibration will be finished.  Placement of any new fillings in your mouth will change the way the teeth contact.  The dentist accomplishing this future treatment should be advised of your past occlusion problem.

• How Your Teeth Feel:  After occlusal equilibration, your occlusion (bite) will feel different to you.  This is to be expected.  You will gradually accept this location as your new chewing position.

Occlusal Splints for Temporomandibular Disorders (TMD), Bruxism, or Clenching

1. Purpose: The purpose of splint therapy is to allow your lower and upper jaw to come together without tooth contact, and to reduce muscle pain.  Many situations cause the malfunction of your lower jaw.  Examples are accidents, surgery, developmental defects, peculiar oral habits, many fillings placed over numerous years, naturally occurring malocclusion (poor bite), orthodontics, psychological stress. Clenching or bruxing (grinding teeth), and other conditions.

2. Rational for Splint Use: you will receive a plastic bite splint (occlusal splint).  This treatment has been used for many years to keep the teeth from contacting during chewing and to allow the lower jaw to return to a comfortable hinge position without interference and guidance from the teeth.  When the splint has worn for a few days the jaw functions freely.

3. Wearing Splint:

Temoromandibular Disorders: If your condition is temporomandibular disorder, you should wear the splint at all times including while eating, unless directed otherwise.  If you remove the splint to eat, your treatment will not be as effective.  Many fillings placed into your mouth over the years or other conditions have caused your teeth to meet in a position your jaws cannot tolerate.  The splint eliminates tooth-to-tooth contact.  Your symptoms will gradually disappear while you are wearing the splint; and your natural teeth, bridges, and/or fillings will be adjusted to the new bite by us.  This procedure is called occlusal equilibration.  After equilibration, you will wear your splint only at night.  After a period of time, you will not wear the splint at all.  The described treatment usually requires a few weeks to several months.

Bruxism and Clenching:  If your condition is bruxism (grinding of teeth) or clenching, you should wear your splint at night when you cannot control your jaw movements or during time of psychological stress.  During the daytime, make sure your splint is placed in water to avoid warping.

4. Cleaning the Splint and Teeth:  Food will accumulate around and under the splint.  At least one time each day, brush and floss your teeth very thoroughly.  Brush and rinse the inside and outside of the splint, and then return it to your mouth.  Dental decay will initiate if you are not careful about cleanliness of your mouth and splint.  If you have a high dental decay potential, fluoride-containing rinses of gels are useful when placed into your splint once per day.

5. When the Splint Is Out of the Mouth:  If the splint is out of your mouth for any reason, your teeth may not meet in harmony.  This situation is to be expected because of muscle and jaw relaxation while you were wearing the splint.  Occlusal equilibration will eliminate this improper meeting of the teeth (malocclusion).  If the splint is out of your mouth, place it in a container of water to prevent it from warping.  You may desire to soak it occasionally in a commercially available denture cleanser.  As an alternative, you may soak it in a solution made by adding a few drops of Clorox to a cup of water.

Selecting Materials Used for Tooth Restorations

This information is provided to help you make decisions about selection of materials as tooth restorations in your mouth.  Many types of metals are used in dentistry for the replacement and rehabilitation of oral structures.  Most of these metals are considered to be inert when placed in the body, while others have been criticized as potential toxins or allergens.  Plastics and ceramics are used commonly as tooth restoratives, and these have not been shown to have adverse biologic responses.  Te following information will help you to make decisions about the type of tooth restorations you prefer to be placed in your mouth.

Restoration Of Missing Parts Of Single Teeth (Fillings):

Silver amalgam has been used for about 160 years for tooth restoration.  This alloy contains silver, tin, cooper, zinc, and about 50 percent mercury.  It has been a highly successful, but unsightly material.  Use of mercury in the body has been criticized since its inception, but amalgam use is still supported strongly by the American Dental Association and other health groups worldwide.  A few people in the overall population may be allergic to the elements in silver amalgam.  However, you have several other options for restorations (fillings).

Your Choices For Restoration Of Missing Parts Of Single Teeth (Feelings):

• Silver amalgam.  Average longevity about 15 years, silver colored, low-moderate initial cost.  Best used in small-to medium-sized restorations of posterior teeth (premolars and molars).

• Gold inlays and onlays.  Average longevity 20 years to life, silver colored, low-moderate initial cost.  May be used in most locations where metal is not displayed to an objectionable level.

• Resin (plastic) – direct (one-day appointment placement).  Average longevity 10-15 years, tooth colored, moderate cost.  Best used in small-to medium-sized restorations for any teeth.  Considered at this time to be comparable to silver amalgam’s service potential.

• Resin (plastic) – direct (two-appointment placement).  Average longevity (expected) 10-15 years, tooth colored, moderate to high initial cost.  Best used in medium to large restorations for posterior teeth (premolars and molars).

• Ceramic – indirect (two-appointment placement).  Average longevity 10-15 years, tooth colored, moderate to high initial cost.  Best used in moderate to large restorations for any teeth.

Crowns or Fixed Prostheses (Bridges)

Gold alloys have been used for many years for the construction of crowns or fixed prostheses.  Gold alloys provide excellent, strong, long-lasting service.  Other alloys are used as well.  Three major types of alloys are now available:

• High-noble metal.  Mostly gold, but also palladium, silver, and occasionally platinum, zinc, and copper.

• Noble metal.  Mostly palladium, but also silver, gold, and other trace metals.

• Base metal.  Mostly nickel, but also chrome or cobalt and other base materials.

All of the above alloys are used either as the sole constituent of a crown or as a thimble on which porcelain is fired (baked).  Most people have no biologic response to any of these categories of metals, but some people, especially females, have adverse tissue responses to base metals.  If you know of allergies you have to metals, please tell us.  We usually use noble or high-noble metals.  The cost of these is somewhat higher than base metals.  Fixed prostheses are strongest when metal is used with or without porcelain on it; but, in certain limited situations, all-ceramic or polymer fixed prostheses may be used as described below.

Your Choices For Crowns (Caps) or Fixed Prostheses (Bridges):

• High-noble metal.  High-noble, noble, or base metal.  Average longevity 20 years to life, gold or “silver” color, moderate to high initial cost.  May be used in any area where metal display is not objectionable.

• Porcelain fused-to-metal.   Average longevity 10-20 years, tooth colored, moderate to high initial cost.  May be used in any area where extreme biting stress in snot present, and patient does not have severe tooth grinding habit.

• Ceramic, non-metal.  These restorations are constructed from ceramic alone.  Average longevity is 10 plus years, moderate to high initial cost.  May be used when extreme stress or grinding habits are not present.  All ceramic fixed prostheses may be used in a few clinical situations, but they are improving constantly.

• Polymer (plastic).  These restorations may be single crowns or bridges.  Average longevity is currently unknown, since they are relatively new, but success has been reported up to 5 years.

We sill inform you about the best type of tooth restoration for your mouth, and we welcome your questions.  Thanks for helping us to make these important decisions.

We have just placed some silver amalgam restorations in your teeth.  These well proven restorations should provide you with many years of service.  You should be aware of the following information about your new restoration:

Chewing:  Amalgam restorations do not develop their maximum strength for 24 hours. Chew only soft foods on the new restorations until that time.

Sensitivity: Metal conducts heat and cold faster than tooth structure.  Therefore, you may experience mild sensitivity to hot and cold foods for a few days.  This sensitivity should disappear soon.  If it does not do so, please contact us.

Recall Visits:  Professional examinations at regular six-month recall periods are necessary.  Developing problems can be found at an early and corrected easily, while waiting for a longer time may require redoing the entire restoration.  We sill contact you when it is time for your recall.

 Preventive Procedures:  Use the following preventive procedures that are checked:

_____ a. Brush with a fluoride-containing tooth paste, and clean your teeth with floss at least once a day.

_____ b. Swish vigorously for 30 seconds daily with one of the following fluoride containing rinses: (1) Colgate Fluorigard; or (2) Johnson & Johnson       
ACT.  The best time is immediately before bedtime.

_____ c. Use a Water Pik as directed

_____ d. Use 1.1 percent neutral sodium fluoride as a brush-on material.  These products require a prescription from us.

_____ e. Use a mechanical toothbrush.

The Future:  Small silver amalgam restorations will serve for many years in your mouth.  However, large restorations may break, or the tooth structure around them may break in the future.  If breakage occurs, the involved tooth or teeth may require a crown (cap) for optimum strength.  The restorations we just placed in your moth were:

_____ a. Small with optimum longevity potential.

_____ b. Moderate to large with good longevity potential.

_____ c. Very large and with questionable longevity potential.

Aggressive Chewing:  As wit natural unrestored teeth, do not chew ice or other hard objects.  Avoid chewing sticky “hard tack” candy or caramels because they can remove restorations. 

Problems:  If one or more of the following conditions occur, contact us immediately to avoid further problems:

• A feeling of movement or looseness in the restoration.

• Sensitivity to sweet foods.

• A peculiar taste from the restoration site.

• Breakage of a piece of material from the restoration.

We have done our best to provide ou with the finest quality oral restorations available today.  However, you must practice excellent oral hygiene to ensure optimum service longevity.

Tooth-Colored Restorations

We have restored one or more of your teeth with tooth-colored materials.  The resin (plastic) material used contains small “filler” particles of glass-like material for strength and wear resistance.  These restorations will serve you well for several years.  They contain the finest and most up-to-date materials available today.  Please be aware of the following information about your new restorations:

Chewing:  Avoid chewing excessively hard foods such as hard candy, corn nuts, ice, bones, etc., because the resin material can be broken from the tooth with extreme force.  If breakage occurs, replacement of the restoration is not difficult.

Recall Visits:  Professional six-month examinations are necessary.  Developing problems can be detected at an early stage and repaired easily.  Waiting for a longer time may require redoing the entire restoration.  We will contact you when it is time for your recall appointment.

Preventive procedures:  To provide optimum longevity for your restorations and to prevent future dental decay and supporting tissue breakdown, please use the following checked preventive procedures:

_____ a. Brush with a fluoride-containing toothpaste after meals. And clean your teeth with floss at least once a day.

_____ b. Swish vigorously for 30 seconds daily with one of the following fluoride containg rinses: (1) Colgate Fluorigard or (2) Johnson & ACT.  The best time is immediately before bedtime.

_____ c. Use a Water Pik as directed

_____ d. Use 1.1% neutral sodium fluoride as a brush-on-material.  These products require a prescription from us.

_____ e. Use a mechanical toothbrush.

The Future:  We expect several years of service from these restorations.  However, after a service period of years, we have seen the following situations occur.

• Slight stains may occur at locations around juncture of the tooth restoration.  Often, we can remove these stains.

• Slight chipping at the juncture of the tooth and restorations.  Usually these chips can be smoothed by us.

• The gums (gingival) may shrink from the restorations, displaying an unfavorable appearance underneath.  This condition may require remaking the restoration or modifying the gums.

Tooth-Colored Restorations

We have restored one or more of your teeth with tooth-colored materials.  The resin (plastic) material used contains small “filler” particles of glass-like material for strength and wear resistance.  These restorations will serve you well for several years.  They contain the finest and most up-to-date materials available today.  Please be aware of the following information about your new restorations:

Chewing:  Avoid chewing excessively hard foods such as hard candy, corn nuts, ice, bones, etc., because the resin material can be broken from the tooth with extreme force.  If breakage occurs, replacement of the restoration is not difficult.

Recall Visits:  Professional six-month examinations are necessary.  Developing problems can be detected at an early stage and repaired easily.  Waiting for a longer time may require redoing the entire restoration.  We will contact you when it is time for your recall appointment.

Preventive procedures:  To provide optimum longevity for your restorations and to prevent future dental decay and supporting tissue breakdown, please use the following checked preventive procedures:

_____ a. Brush with a fluoride-containing toothpaste after meals. And clean your teeth with floss at least once a day.

_____ b. Swish vigorously for 30 seconds daily with one of the following fluoride containg rinses: (1) Colgate Fluorigard or (2) Johnson & ACT.  The best time is immediately before bedtime.

_____ c. Use a Water Pik as directed

_____ d. Use 1.1% neutral sodium fluoride as a brush-on-material.  These products require a prescription from us.

_____ e. Use a mechanical toothbrush.

The Future:  We expect several years of service from these restorations.  However, after a service period of years, we have seen the following situations occur.

• Slight stains may occur at locations around juncture of the tooth restoration.  Often, we can remove these stains.

• Slight chipping at the juncture of the tooth and restorations.  Usually these chips can be smoothed by us.
  • The gums (gingival) may shrink from the restorations, displaying an unfavorable appearance underneath.  This condition may require remaking the restoration or modifying the gums.

Ceramic Crowns

Crowns made entirely of ceramic materials are available.  There are numerous types and brand names of these crowns.

The Advantages of Ceramic Crowns Are:

1.They can be constructed to a highly acceptable esthetic level.  Usually, ceramic crowns are the most beautiful crowns in dentistry.

2. Ceramic crowns do not have a metal undercoping, as do porcelain-fused-to-metal crowns. Therefore, these crowns are biologically compatible and have extremely low allergenicity or toxicity.

The Disadvantages of Ceramic Crowns are:

• Ceramic crowns are not as strong as metal crowns or porcelain-fused-to-metal crowns.  If your bite is especially abusive, ceramic crowns may not have adequate strength for you.  During service, some all-ceramic crowns break and must be replaced.

• Some brands of ceramic crowns can be made into fixed prostheses (bridges), but they may not as strong as metal or porcelain-fused-to-metal crowns.

If you have a need for an optimum esthetic result or you have allergies to metals used in dentistry, you may want to consider ceramic crowns.  If not, porcelain-fused-to-metal crowns or metal crowns are better choices.

Bridges

You have just had some crowns or fixed bridges cemented onto your teeth. They will replace your missing tooth structure or missing teeth very well, and they should provide you with years of service, if you will observe the following suggestions:

1. Chewing: do not chew hard foods on the restorations for 24 hours from the time they were cemented. The cement must mature for up to 24 hours to have optimum strength.
2. Sensitivity: don’t worry about mild sensitivity to hot or cold foods. It will disappear gradually over a few weeks. Infrequently, sensitivity last longer than six weeks. Please tell us if this occurs.
3. Aggressive chewing: do not chew ice or other hard objects. Avoid chewing very sticky foods such as ‘hard tack’ candies and caramels because they can remove restorations.
4. Preventive procedures: to provide optimum longevity for your restorations and prevent future dental decay and supporting tissue breakdown, please use the following preventive procedures that are checked:
1. Brush and floss your teeth after eating and before bedtime.
2. Swish vigorously for at least 30 seconds daily with one of the following fluoride rinse products:

1.) Colgate Fluorigard or 2.) Johnson & Johnson Act. The best time is immediately before bedtime.

3. Use mechanical toothbrush
4. Use fluoride gel such as Colgate PreviDent as you would use toothpaste. (This product requires a prescription from us.)
5. Use the provided fluoride gel in the provided trays for 5 minutes per day. You should have been provided with another information sheet for this technique.
4. Recalls: visit us for regular six month examinations often, small problems that are developing around the restorations can be found at an early stage and corrected easily, but waiting for a longer time may require redoing the entire restoration. Inadequate return for professional examinations is the most significant reason for restoration failure. We will contact you when it is time for your recall appointment. If that does not occur, please call us.
5. Problems: if any of the following conditions occur, contact us immediately to avoid further problems.
1. Movement or looseness in the restoration.
2. Sensitivity to sweet foods.
3. A peculiar taste from the restoration site.
4. Breakage of a piece of material from the restoration.
5. Sensitivity to pressure.

We have done our best to provide you with the finest quality of oral restoration available today. However, only your continuing excellent oral hygiene and professional recalls can ensure optimum service longevity.

Temporary Crowns or Bridges (Fixed Prostheses)

You have just received a temporary plastic restoration that will serve you for a short period of time until the final restoration is made by the laboratory.  A few comments about this temporary restoration will be helpful to you.
Chewing:

• The temporary cement requires about one-half to set.  Please do not chew during that period of time.  
• Temporary restorations are not strong.  They may break or come off occasionally.  If so, call us and we will replace them.   If you are where you cannot contact us, go to a pharmacy and get some Fixodent.  Replace the temporary on you tooth with some Fixodent holing it in place.  This denture adhesive will retain the temporary restoration until you can see us.  Please do not leave the temporary resotation out of you mouth, because the teeth will move and the final restoration swill not fit.
• Certain foods will stick to the temporary restoration.  This will not happen with the final restoration to be cemented soon.

Color:  The color of the plastic temporary does not resemble the color of the final restoration.
Shape, Size:  The shape and size of the plastic temporary does not resemble the final restoration.
Tooth Sensitivity:  Temporary restorations may leas saliva or food into the tooth.  Sensitivity to cold, hot, or sweet is not uncommon.  This sensitivity will not be present with your final restorations.

Immediate Dentures
You have just had an immediate denture place in your mouth.  The following information will assist you to understand the sequence of events during the healing period:

Tooth Restorations (Fillings) for Children

Your child has need of decay removal from teeth and placement of some form of tooth restoration.  There are  few alternatives for this procedure that you may consider:

• Silver amalgam is the most commonly used restorative material for children.  It has been used since the beginning of modern dentistry; however, it is metallic in color and does not match tooth color.  Also, silver amalgam can be used only in small to moderate sized cavities.

There have been some objections raised by numerous individuals and groups about the potential for the mercury in silver amalgam to be harmful to patients.  Most health organizations deny this allegation.

• Various tooth-colored restorative materials can be used for restoration of your child’s teeth.  Most of these materials contain decay-preventive materials that have very small amounts of fluoride in them.  In many countries these relatively new tooth-colored materials are very popular.  Their use has now been shown to be as acceptable in longevity for children’s teeth as silver amalgam.

• Stainless steel crowns can be placed if the decay is extensive.  Although unsightly, these crowns serve well.  Some groups object to the nickel content of these crowns, but that objection has little scientific support.

• Various types of tooth-colored crowns are available for children with extensive decay.  Ask your dentist about the type he or she uses.

Frenectomy – What and Why

Occasionally, a thick piece of soft tissue grows between the front surfaces of the upper central incisor teeth up to the maxilla (upper jaw).  This tissue is attached strongly to the bone.  The result of this excessive frenum attachment is the inability for the upper front teeth to come together.  The resultant space is unsightly and causes the back teeth to come together in an improper position (malocclusion). 

Treatment for this excessive frenum is a simple surgical procedure called a frenectomy.  The excess tissue attachment is gently trimmed away and the gingival site heals rapidly (few days), allowing the two front teeth to eventually come together and the remainder of the teeth to meet (occlude)  in a proper relationship.

Do no wait.  As soon as an excessive frenum is diagnosed, have it removed.

Periodontal Scaling

You have need of periodontal tooth scaling.  This procedure is similar to typical tooth scaling during a routine oral hygiene visit, but it is different in the following ways:

• Deep pockets existing around your teeth require deeper than normal scaling.  The deep gum pockets block vision of the tooth root structure.  Small scaling devices (either manual or ultrasonic) will be carefully placed into the gum pocket, and systematic smoothing of the tooth root surfaces will be accomplished.  Debris that has collected on tooth surfaces will be removed along with diseased soft tissue.

• Deep tooth scaling and gum curettage requires significant time and expertise.  Usually only one or two segments of your mouth will be treated on one appointment.  Other appointments will be needed to complete the therapy.

• Your gums and teeth will be slightly uncomfortable for a few days after the deep scaling, but they will gradually feel normal again.  After the gums have healed a few days, you will be able to maintain good oral hygiene much getter that in the past.

• Your gum tissue may shrink somewhat as it heals.  This condition is desirable because it reduces the depth of the pockets and allows you to clean the areas under the gums.

• Periodontal tooth scaling is the most conservative method to treat periodontal disease.  We look forward to slowing or stopping the disease with this procedure, and we will keep you advised of the status your of periodontal condition as it heals.

Periodontal Treatment

The following information describes the various treatments for periodontal disease.  They are listed from least to most aggressive:

• No Treatment.  If you elect to do nothing to treat your periodontal disease, it will continue to progress slowly until you lose the involved teeth.  Tooth loss can require a few months to years.  Routine dental hygiene appointments can increase the possibility of increased tooth longevity.

• Increased frequency of oral hygiene appointments.  Although normally tooth cleanings or scalings are performed once every 6 months, patients with minimal periodontal disease can often control its progress by increasing the frequency of scalings and exams to once every two to four months.

• Deep scaling, soft tissue curettage (removal of inflamed tissue) and increased frequency of oral hygiene appointments.  Removal of tartar from the deepest areas of the periodontal pockets and removal of the diseased soft tissue by scaling, usually decreases pocket depth and slows or stops periodontal disease.  Routine oral hygiene scaling, polishing, and examination is increased to once every two to four months.  Systemic and local antibiotics and rinses may be included in the therapy.

• Periodontal surgery.  In advanced cases it may be necessary to gently reflect the gums from the underlying bone tissue, clean out the infection, sometimes add artificial bone fill in deficient areas, and replace the gums to allow healing.

In addition to the above treatments, patients should improve their hygiene procedures and diet.
Smoking is also an extremely negative factor related to periodontal disease, and it should be reduced or stopped.

Periodontal Treatment – Conservative

You have periodontal disease, which is a slowly progressing condition that eventually weakens the bone support of the teeth, causing the need for their extraction.  Treatment of this condition can be surgical, in which the diseased gum and bone tissue are removed and/or reshaped to allow proper cleaning or conservative, which is explained in this informational piece.  Surgical therapy is faster and somewhat more predictable, but conservative therapy is effective as well.

If you elect conservative periodontal therapy, you must have an active role in carrying out the necessary procedures.  The following are procedures necessary for conservative periodontal therapy:

• Education providing enough information for you to understand the disease.

• Oral Hygiene instruction and upgrading of your oral cleaning habits.

• Institution of tongue cleaning.

• Professional scaling, planning, and polishing of your teeth on a routine schedule.

• Low level systemic antibiotic therapy to control the organisms causing periodontal disease.

• Antimicrobiologic rinses on a daily routine.

• Local antibiotics delivered to the most effected areas of your mouth.

Both surgical and conservative periodontal therapy work.  You and your dentist must decide which is the best for you.

Perio Protect
Revolutionary Painless Gum Treatment

Perio Protect is a revolutionary new method to treat most gum disease (also known as periodontal disease, gingivitis or periodontitis) using an FDA – cleared medical device to deliver dentist- prescribed medications directly to the source of the infection. 

It is painless and easy, with years of reliable and proven clinical results.rotect.com/

Rinse to Reduce Gum Inflammation before, during, and after Restorative treatment.

(Chlorhexidene Gluconate)

To reduce inflammation in your gums, we recommend you use an antibiotic mouth rinse for the next few weeks.  This practice will make your treatment easier by making your gums healthier.

Please use the mouth rinse Peridex or other bands of chlorhexidine gluconate one time per day just before bedtime after cleaning your mouth and rinsing thoroughly.  Swish a half-capful of 15 seconds, spit, and swish with the second half of the capful for 15 seconds and spit again.

You should use this mouth rinse for two weeks before treatment begins, during the time you wear the temporary restorations, and for about two weeks after we place the new crowns.

Biphosphonates 

Having been treated previously with Bisphosphonate drugs you should know that there is a significant risk of future complications associated with dental treatment.  Bisphosphonate drugs appear to adversely affect the ability of bone to break down or remodel itself thereby reducing or eliminating its ordinary excellent healing capacity.  This risk is increased after surgery, especially from extraction; implant placement or other "invasive " procedures that might cause even mild trauma to bone.  Osteonecrosis may result.  This is a smoldering, long-term, destructive process in the jawbone that is often very difficult or impossible to eliminate.

Your medical/dental history is very important.  We must know the medications and drugs that you have received or taken or are currently receiving or taking. An accurate medical history, including names of physicians is important.

_____1.     Antibiotic therapy may be used to help control possible post-operative infection.  For some patients, such therapy may cause allergic responses or have
                undesirable side effects such as gastric discomfort, diarrhea, colitis, etc.

_____2.     Despite all precautions, there may be delayed healing, osteonecrosis, loss of bony and soft tissues, pathologic fracture of the jaw, oral-cutaneous fistula, or
                other significant complications.

_____3.     If osteonecrosis should occur, treatment may be prolonged and difficult, involving ongoing intensive therapy including hospitalization, long-term antibiotics
                and debridement to remove non-vital bone.  Reconstructive surgery may be required, including bone grafting, metal plates and screws, and/or flaps and
                grafts.

_____4.     Even if there are no immediate complications from the proposed dental treatment, the area is always subject to spontaneous breakdown and infection.
                Even minimal trauma from a toothbrush, chewing hard food, or denture sores may trigger a complication.

_____5.     Long-term post-operative monitoring may be required and cooperation in keeping scheduled appointments is important.  Regular and frequent dental check-ups with your dentist are important to monitor and attempt to prevent breakdown in your oral health.

Bisphosphonates medicines may include among others:

1.    Residronate  (Actonel)*
2.    Etidronate    (Didronel)
3.    Tiludronate  (Skelid)
4.    Alendronate (Fosamax)*
5.    Pamidronate (Aredia)*
6.    Zoledronate  (Zometa)*
* Nitrogen containing

Fluoride as Preventive Therapy

• Use of small amounts of fluoride (one part per million) in community water supplies has been shown to significantly reduce dental decay.

• Where fluoride in water supplies is not available, addition of fluoride to the diet of children has been shown to similarly reduce the development of dental decay.  About 1mg per day is the optimal dosage, with lesser amounts of young children.

• Placement of fluoride on teeth in the form of rinses can reduce or totally prevent new dental decay, depending on the concentration of fluorides are used in patients who have high decay potential, such as those receiving chemotherapy or radiation therapy.

•  Application of fluoride on the tooth-cleaning appointment has a decay reducing influence.

As a group, dentists and physicians, as well as global health organizations favor use of fluoride in all of the previously describe methods.  Fluoride for reduction of dental decay has had more legitimate worldwide research than any other health related subject.  Nevertheless, there are some groups that oppose fluoride use for various political and alleged health reasons.

The decision to use fluoride for you and your family is up to you.  For almost all dentists and physicians, “anti-fluoride” arguments make no sense at all.

Tooth Sealants

Why Seal Teeth?  Over the past many years, numerous materials and techniques have been developed to seal the chewing (occusal) surfaces of teeth.  Often, these procedures are necessary because some teeth have defective occlusal surfaces when they erupt into the mouth, and food debris and microorganisms penetrate into the grooves on the teeth during eating.  Patients cannot clean these areas effectively, and dental decay (caries) occurs frequently.

Do All Teeth Need to Be Sealed?  Usually only the back (posterior) teeth require sealing.  We cannot tell which individual teeth require sealing, because incomplete fusion of the teeth often leaves a nearly microscopic entry from the enamel outside the tooth into the softer dentin inside.  Therefore, we suggest that all suspect posterior teeth and selected anterior teeth be sealed.  A few teeth that do not require sealing may be inadvertently sealed because it is impossible to select defective from non-defective teeth at an early age.

Will All Decay Be Prevented?  Sealants placed as close to the eruption time of the teeth as possible prevent the majority of decay on the chewing (occlusal) surfaces of the teeth.  However, flossing, brushing, and routine fluoride therapy are required to prevent decay on other surfaces of the teeth.  In the presence of poor oral hygiene, decay may begin between to teeth, since sealants cannot be placed on these surfaces.

Cost  The cost of sealing a tooth with plastic is about one-third the cost of filling (restoring) the tooth in the event of decay.  Sealants do not require anesthetic or cutting away tooth structure.

How Long Do Sealants Last?  Studies show sealants last many years.  However, occasional resealing may be required.

What Is It?
Debridement is the removal of excessive amounts of plaque and from your teeth.

What It's Used For
Debridement is done on people who have heavy plaque and tartar (calculus) build-up, usually because they haven't visited a dentist in several years. The plaque and tartar accumulation on the teeth is so heavy that your dentist can't see the teeth to examine them. Before he or she can do an exam, the plaque and tartar must be removed through debridement.

Preparation
Some people who are very sensitive to pain might need local anesthesia for this procedure. Others might require some form of sedation, such as. Often, people who avoid the dentist .

have some form of dental phobia, so anesthesia or sedation may be necessary to make them comfortable.
How It's Done
Debridement is done with a combination of hand instruments and an ultrasonic device. This device uses water and high-frequency vibrations to dislodge plaque and tartar from the teeth.
Follow-Up
Debridement is usually the first phase of comprehensive periodontal treatment. After completing the debridement, your dentist will re-evaluate your teeth to determine the appropriate course of therapy, which may involve scaling and root planing or periodontal surgery.
Risks
If your gums are inflamed they can bleed during the procedure. In some cases, you may notice that your teeth are sensitive to temperature (hot and/or cold) after debridement. This occurs when the roots of the teeth are exposed following the removal of plaque and tartar.
Infection is possible after debridement, but it is very rare.
When To Call a Professional
Call your dentist if:

• You have bleeding that doesn't stop
• You think the area might be infected
• You have excessive swelling or discharge from the area

Lymph nodes beneath your lower jaw or in your neck become swollen.

Concerned about the dangers of Radiation? Don't Be!!!
Now Digital Radiography offers computerized x-rays with up to 90% reduction in radiation compared to conventional x-rays.