Periodontal Scaling and Root Planing (Deep Cleaning)
This procedure is similar to a typical cleaning 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 access of the tooth root structure for proper cleaning with brushing and flossing. Small scaling devices (either manual or ultrasonic) are carefully placed into the gum pockets, 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. Local anesthetic (numbing) of the areas being treated may or may not be needed, depending on each patient's sensitivity. Medicated rinses and/or antibiotics may be used in addition. In cases of early periodontal disease, where home care is good, this procedure and more frequent cleanings may be the only needed treatment. Possible adverse outcomes include but are not limited to:
1. Your gums and teeth may be slightly uncomfortable for a few days, but usually they will gradually feel normal again. Once the gums have healed for a few days, you should be able to maintain better oral hygiene than in the past.
2. The most common problem is tooth sensitivity, but there is desensitizing medication, if need be.
3. Your gum tissue may shrink somewhat as it heals. This is desirable because it reduces the depth of the pockets and allows you to clean the area under the gums. However, it will expose tooth surfaces that were previously covered by inflamed gum tissue.
Periodontal tooth scaling is the most conservative method used to treat periodontal disease. Many patients, are able to slow or stop the progression of the disease with this procedure. Regular check-up visits are essential in order to monitor your progress and suggest future intervention if needed. Smoking is also extremely bad for your oral tissues. Smokers tend to have more periodontal disease and often heal more slowly. Smoking is a substantial risk factor with any periodontal procedure. If you smoke and wish to stop, you can be referred to a smoking cessation program.
1. Your gums and teeth may be slightly uncomfortable for a few days, but usually they will gradually feel normal again. Once the gums have healed for a few days, you should be able to maintain better oral hygiene than in the past.
2. The most common problem is tooth sensitivity, but there is desensitizing medication, if need be.
3. Your gum tissue may shrink somewhat as it heals. This is desirable because it reduces the depth of the pockets and allows you to clean the area under the gums. However, it will expose tooth surfaces that were previously covered by inflamed gum tissue.
Periodontal tooth scaling is the most conservative method used to treat periodontal disease. Many patients, are able to slow or stop the progression of the disease with this procedure. Regular check-up visits are essential in order to monitor your progress and suggest future intervention if needed. Smoking is also extremely bad for your oral tissues. Smokers tend to have more periodontal disease and often heal more slowly. Smoking is a substantial risk factor with any periodontal procedure. If you smoke and wish to stop, you can be referred to a smoking cessation program.
Arestin (Minocycline HCL 1 mg)
Periodontal (gum) disease is the bacterial infection of the gums and can result in bleeding, recession, and sensitivity. It is currently the number one factor for tooth loss in Americans. To prevent this, your gums need to be cleaned of bacteria. In addition to a thorough cleaning of the gums (deep cleaning), this antibiotic kills the bacteria that the deep cleaning can't reach and helps keep it from returning. Arestin, with a deep cleaning, is nearly 3x more likely to result in successful treatment than a deep cleaning alone. The dentist will place Arestin in infected gum pockets below your gumline. This may happen with the deep cleaning or a separate appointment. Arestin contains microspheres, tiny bead-like particles, that are smaller than grains of sand and not visible to the naked eye. These spheres contain minocycline hydrochloride, which release the antibiotic over time, killing bacteria so your gums can heal better than with a deep cleaning alone. It is painless and dissolves on its own. It is different than an antibiotic pill, because it's placed right where you need it. A pill can't give the same result. After treatment, avoid chewing hard, crunchy, or sticky foods for 7 days. These include pretzels, popcorn, and caramels. Avoid using floss in the area for 10 days.
Endodontic Therapy (Root Canals)
Inside of all normal teeth is a cavity containing nerves, blood vessels, and live soft tissue called the dental pulp. If the pulp tissue is traumatized by physical force, decay, large fillings, crowns, or other factors, the pulp tissue may be irreversibly damaged. Usually, the result to you is pain and/or bone destruction visible on dental x-rays. Treating a damaged pulp is a delicate procedure requiring the following steps:
1. A small opening is made in the chewing surface of the tooth to allow access to the damaged pulp tissue.
2. Using a series of small instruments, the damaged tissue is removed from the internal portion of the tooth.
3. Once, the internal portion of the tooth is totally cleaned, 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.
Possible adverse outcomes with root canal therapy include:
1. Temporary discomfort: May be mild to severe and linger for a few weeks.
2. Broken root: Instruments used to clean out the root may inadvertently puncture the side of the root or the root may split as it is being hollowed out.
3. Tooth fracture and other natural events: Since teeth with root canals are more brittle than other teeth, a crown is recommended to prevent future damage. This is especially important with molar and bicuspid teeth. Teeth treated with root canals can still decay, and are subject to periodontal (gum) disease, but since the nerve is gone, there may be no pain.
With some teeth, conventional root therapy alone may not be sufficient. For example, if the canal(s) are severely bent or calcified, if there is substantial or long standing infection in the bone around the roots, or an instrument becomes separated within a canal, the tooth may remain sensitive and a surgical procedure may be necessary to solve the problem. Root canal therapy is about 95% successful.
1. A small opening is made in the chewing surface of the tooth to allow access to the damaged pulp tissue.
2. Using a series of small instruments, the damaged tissue is removed from the internal portion of the tooth.
3. Once, the internal portion of the tooth is totally cleaned, 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.
Possible adverse outcomes with root canal therapy include:
1. Temporary discomfort: May be mild to severe and linger for a few weeks.
2. Broken root: Instruments used to clean out the root may inadvertently puncture the side of the root or the root may split as it is being hollowed out.
3. Tooth fracture and other natural events: Since teeth with root canals are more brittle than other teeth, a crown is recommended to prevent future damage. This is especially important with molar and bicuspid teeth. Teeth treated with root canals can still decay, and are subject to periodontal (gum) disease, but since the nerve is gone, there may be no pain.
With some teeth, conventional root therapy alone may not be sufficient. For example, if the canal(s) are severely bent or calcified, if there is substantial or long standing infection in the bone around the roots, or an instrument becomes separated within a canal, the tooth may remain sensitive and a surgical procedure may be necessary to solve the problem. Root canal therapy is about 95% successful.
Cracked-Tooth Syndrome
You may have a very commonly occurring dental problem. Teeth may crack subjected to the stress of chewing hard foods or objects. Sometimes a very small hard object (bone, stone) is mixed in with soft food. This concentrates all of the biting force on a very small area and will sometimes break a natural tooth. Teeth, with or without restorations, may exhibit this problem, but the larger the silver alloy or tooth-colored restoration, the more susceptible they are. Older persons tend to have more cracked teeth than younger people. Symptoms and signs include the following:
1. Sharp pain of short duration on chewing
2. Pain on cold-air application
3. Pain with no apparent cause (leakage of sugar into the tooth cracks)
4. Usually cannot see crack on the x-ray
5. Dental decay may not be present.
6. The dentist may be able to see the crack when the tooth is prepared for restoration.
Treatment of cracked teeth:
1. Simple crack: The majority of cracked teeth (about 9 or 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.
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 before the crown is placed. However, if the crack extends vertically down the root the tooth will likely need to be extracted.
1. Sharp pain of short duration on chewing
2. Pain on cold-air application
3. Pain with no apparent cause (leakage of sugar into the tooth cracks)
4. Usually cannot see crack on the x-ray
5. Dental decay may not be present.
6. The dentist may be able to see the crack when the tooth is prepared for restoration.
Treatment of cracked teeth:
1. Simple crack: The majority of cracked teeth (about 9 or 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.
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 before the crown is placed. However, if the crack extends vertically down the root the tooth will likely need to be extracted.
Post and Core For Heavily Damaged Teeth
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 root canal therapy and previous restorations, it may need internal reinforcement to ensure that the root and crown portions of the tooth are connected together adequately. Various types of posts are used to connect the root and crown. A post is cemented into the tooth root, and a core, or replacement of the missing portion of the crown is placed on top of the post. Although post and cores are common, in rare cases, the procedure is unsuccessful. Reasons for failure include, but are not limited to:
1. The tooth may split or break below the gums
2. The instruments used to prepare the tooth for the post may inadvertently puncture the side of the tooth.
3. The procedure may have to be terminated prior to completion due to an unforeseen complication.
In the event of an adverse or unforeseen outcome, procedures needed to restore or replace the tooth may include, but are not limited to: gum surgery around the tooth or extraction and replacement with fixed bridgework or implants. A post and core may allow optimum potential for this tooth to continue to serve in your mouth for many years. Teeth having posts and/or crowns may still decay, especially if your oral hygiene is not optimal.
1. The tooth may split or break below the gums
2. The instruments used to prepare the tooth for the post may inadvertently puncture the side of the tooth.
3. The procedure may have to be terminated prior to completion due to an unforeseen complication.
In the event of an adverse or unforeseen outcome, procedures needed to restore or replace the tooth may include, but are not limited to: gum surgery around the tooth or extraction and replacement with fixed bridgework or implants. A post and core may allow optimum potential for this tooth to continue to serve in your mouth for many years. Teeth having posts and/or crowns may still decay, especially if your oral hygiene is not optimal.
Extraction (Removal of a tooth)
Post-op instructions:
1.The initial healing period usually takes 1-2 weeks, and you'll likely experience some swelling for the first 24 hours.
2.Before the procedure began, you were given anesthetic to ensure your comfort. This anesthetic typically leaves your lips, teeth, and tongue feeling numb after the appointment. For this reason, you should avoid chewing for 2 hours following surgery, or until the numbness has completely worn off.
3.Some discomfort after the extraction is normal. An over-the-counter pain reliever, such as Ibuprofen or Acetaminophen, is usually sufficient. We can also give you a prescription for a stronger pain reliever, if needed.
4.To avoid nausea, do not take pain medication on an empty stomach.
5.You can also decrease pain and swelling by applying an ice pack-20 minutes on, 20 minutes off-for the first 6 hours following the extraction.
6.A blood clot will form on the extraction site, and this clot is vital to the healing process.
7.Blowing your nose or sneezing violently can also dislodge the blood clot and impair healing, so if you have an upper respiratory infection or suffer from allergies, be sure to have the appropriate sinus medication on hand.
8.Do not rinse your mouth the day of the surgery.
9.Smoking, or allowing food particles to pack into the tooth's socket should be avoided, as both will significantly affect the healing process.
10.24 hours following the procedure, you can rinse gently with mouthwash or a warm salt-water solution (dissolve one teaspoon of salt with one cup of warm water); gently swish the solution around the affected area, and spit carefully. You should do this 2-3 times each day for the week, following the extraction.
11.If antibiotics were prescribed, continue to take them for the indicated length of time, even if all symptoms and signs of infection are gone.
12.Relax as much as possible and avoid all strenuous activities for the first 24 hours following surgery.
13.Once the numbness has worn off, you should eat, as nourishment is important to the healing process. Limit your diet to soft foods like yogurt, soft soups, ice cream, or soft-cooked eggs for the first 48 hours.
14.Drink at least 8 glasses of water or fruit juice each day.
15.Keep your head elevated with pillows to control bleeding. We will give you a supply of gauze sponges to place over the bleeding area. Change the pad as necessary, and use them until the bleeding stops completely. You can also bite gently, but firmly, on a moist tea bag for 20 minutes. Be sure to call our office if bleeding persists or increases.
Be sure to brush and floss the other areas of your mouth as you would normally. The space left by the tooth will feel a bit strange to you at first. Eventually, new bone and gum tissue will grow into the gap left by the extraction.
1.The initial healing period usually takes 1-2 weeks, and you'll likely experience some swelling for the first 24 hours.
2.Before the procedure began, you were given anesthetic to ensure your comfort. This anesthetic typically leaves your lips, teeth, and tongue feeling numb after the appointment. For this reason, you should avoid chewing for 2 hours following surgery, or until the numbness has completely worn off.
3.Some discomfort after the extraction is normal. An over-the-counter pain reliever, such as Ibuprofen or Acetaminophen, is usually sufficient. We can also give you a prescription for a stronger pain reliever, if needed.
4.To avoid nausea, do not take pain medication on an empty stomach.
5.You can also decrease pain and swelling by applying an ice pack-20 minutes on, 20 minutes off-for the first 6 hours following the extraction.
6.A blood clot will form on the extraction site, and this clot is vital to the healing process.
7.Blowing your nose or sneezing violently can also dislodge the blood clot and impair healing, so if you have an upper respiratory infection or suffer from allergies, be sure to have the appropriate sinus medication on hand.
8.Do not rinse your mouth the day of the surgery.
9.Smoking, or allowing food particles to pack into the tooth's socket should be avoided, as both will significantly affect the healing process.
10.24 hours following the procedure, you can rinse gently with mouthwash or a warm salt-water solution (dissolve one teaspoon of salt with one cup of warm water); gently swish the solution around the affected area, and spit carefully. You should do this 2-3 times each day for the week, following the extraction.
11.If antibiotics were prescribed, continue to take them for the indicated length of time, even if all symptoms and signs of infection are gone.
12.Relax as much as possible and avoid all strenuous activities for the first 24 hours following surgery.
13.Once the numbness has worn off, you should eat, as nourishment is important to the healing process. Limit your diet to soft foods like yogurt, soft soups, ice cream, or soft-cooked eggs for the first 48 hours.
14.Drink at least 8 glasses of water or fruit juice each day.
15.Keep your head elevated with pillows to control bleeding. We will give you a supply of gauze sponges to place over the bleeding area. Change the pad as necessary, and use them until the bleeding stops completely. You can also bite gently, but firmly, on a moist tea bag for 20 minutes. Be sure to call our office if bleeding persists or increases.
Be sure to brush and floss the other areas of your mouth as you would normally. The space left by the tooth will feel a bit strange to you at first. Eventually, new bone and gum tissue will grow into the gap left by the extraction.
