Cable Car Dentistry

Composite fillings (tooth colored fillings): see below under restroative dentistry

Your mouth is a chemical factory filled with bacteria. The bacteria in the dental plaque that forms on your teeth are the chief culprits in producing dental decay (cavities) and gum disease. What you eat and swallow affects your teeth, your gums and eventually your body in terms of the nutrition it provides you. Saliva also plays a very important role in protecting your teeth and gums.

What is the worst food for your teeth?

Foods sweetened with either table sugar (sucrose) or fruit sugar (fructose) are extremely bad.
The bacteria in your mouth grow by feeding on these sugars thus creating an acid that can
dissolve the enamel. How often we eat the sugary foods and how long they stay in the mouth is more important than their total amount (i.e., the worst foods are long lasting hard candies and sticky foods such as raisins, caramel and breath mints). Chewable vitamin C is also hard on teeth.

Typical soda drinks like colas are probably the biggest contributors to tooth decay and gum disease. Diet sodas are less harmful than the sugary sodas and do not significantly contribute to the formation of plaque, but all carbonated drinks are acidic and will contribute to the breakdown of enamel.

The same diet that protects against heart disease, cancer and osteoporosis, will also contribute to dental health. Calcium and vitamin D are the two most important nutrients for your teeth as well as for your bones although other vitamins and minerals count too. Fruits, vegetables, lean meats, fish and poultry are all recommended. Cheese is also a good snack item, at least for dental health. It provides calcium, promotes saliva production, and lowers the level of acid in the mouth. Tea is rich in fluoride and therefore very good for your teeth.

All kinds of fresh fruits are good for your teeth because you chew and swallow them quickly. They also provide many beneficial nutrients (such as phosphates) for your teeth as well as for your body. However because dried fruits are sticky and likely to stick to your teeth, they may tend to promote cavities.

Saliva acts as a lubricant for your teeth and plays an important protective role in keeping your mouth clean and healthy as well as being an aid in chewing and swallowing. It promotes the absorption of calcium and fluoride into your teeth and this "re-mineralization" process helps keeps your teeth healthy. It also aids in clearing food and bacteria away from your teeth.

In general bottled water does not contain fluoride which is a well known factor in preventing cavities. It is therefore often not as good as tap water which is generally fluoridated.

Many people experience anxiety about visiting the dentist and particularly the possibility of being exposed to AIDS or other infections. We practice stringent "universal safety precautions" as established by the U.S. Centers for Disease Control (CDC) which requires sterilization of all instruments. We also use disposable items whenever possible and continually decontaminate all surfaces.

Universal precautions are safety procedures established by CDC and ADA (American Dental Association). They are used after every patient in order to prevent transmission of diseases including AIDS. We also adhere strictly to all work place regulations specified by The Federal Occupational Safety and Health Administration (OSHA).

Do you sterilize all instruments after each patient, including the dental drill?

Yes. All instruments, including the dental drill, are sterilized after each patient. Disposable items are discarded into a special container after each patient to be disposed of in a special manner. We employ use of an autoclave (steam under pressure), and special chemical solutions, to sterilize and disinfect all instruments.

While bad breath might be a symptom of other diseases, it most likely stems from dental decay, gum disease (periodontitis), or bacterial build-up on the tongue. Simply by brushing the tongue a person can often eliminate bad breath by up to 70 %.

Food stuck between the teeth, around the gums, and on the tongue, can cause bad breath as it decays. Dentures that are not cleaned properly can also harbor odor-causing food and bacteria. Certain diseases or drugs can also contribute to bad breath. By performing a thorough dental exam, we can help you identify the cause of bad breath and help you eliminate it.

Practicing good oral hygiene at home, brushing after each meal, flossing daily and brushing your tongue thoroughly. If you continue to suffer from bad breath you may need to use special antimicrobial mouthwash, fluoride rinses and/or products that help stimulate the flow of saliva. Some people suck on sugar-free candies to increase the amount of saliva. Under normal conditions saliva clears many particles and bacteria that might cause unpleasant odors, but when people suffer from dry mouth, they lose some of the cleaning feature of their saliva.

Dry mouth or xerostomia results from inadequate flow of saliva. People need saliva to help lubricate and clean their mouth. When they suffer from inadequate amount of saliva in their mouth, they are susceptible to tooth decay, gum disease, bad breath and oral infections among other health problems.

Medications are the most common cause of dry mouth. These include antihistamines, decongestants, painkillers, diuretics, anti-hypertensives and antidepressants. It can also result from diseases such as diabetes and sjogren's syndrome. (see the section below on diabetes).

If you experience dry mouth, you can use various remedies to increase the salivary flow such as sugar-free candies and artificial saliva to keep the mouth moist. Regular check-ups are especially important because patients with dry mouth are more prone to suffering from gum disease and rampant tooth decay.

If a taste of ice cream or a sip of coffee makes you wince, you may have a common problem called "sensitive teeth."

Enamel, which is the outermost layer of the tooth, normally acts as a protective covering. But when the roots of the teeth are exposed as a result of receding gums, or the enamel is lost as a result of decay, wear, or fracture, the teeth can become hypersensitive and painful to temperature and to brushing.

Desensitizing toothpastes and fluoride gels used over a period of a few months can often help by blocking the sensation from traveling from the tooth surface to the roots. For the more severe cases, gum grafts or bonded fillings may be necessary.

Millions of Americans suffer from diabetes which can lower their resistance to infection and also compromise their body's healing capability. Diabetes can also cause problems with various organs such as the heart, kidneys and eyes, as well as lead to tooth decay and gum disease.

When diabetes is not controlled properly the glucose level in the saliva rises causing greater amounts of bacteria in the mouth. This leads to more tooth decay, more frequent and more severe gum disease, and lead to eventually greater teeth loss than people who have better control of their diabetes.

Proper control of diabetes is outside the realm of dentistry and is properly a matter between the patient and his or her physician. However, professional dental cleanings, and conscientious home care can be instrumental in preventing dental cavities and gum disease associated with diabetes. Special toothpastes and mouth-rinses that contain greater amounts of fluoride will also make the teeth more resistant to decay. Sugar-free candies can also reduce dental disease by stimulating salivary flow and therefore enhancing the body's natural ability to maintain a clean mouth.

The best way to keep healthy teeth and gums is to prevent disease from occurring. Some 70 % of Americans suffer from gum disease to some degree. There is now growing evidence that gum disease may contribute to heart disease and strokes. Gum disease is caused by plaque and tartar build-ups that tend to accumulate around the teeth and gums on a daily basis. While good oral hygiene is crucial, regular professional cleaning is also essential in removing the buildup of undesirable plaque and tartar.

Gum disease (periodontal disease) is an infection of the gums and the bones that hold teeth in place. It is responsible for approximately 70 % of tooth loss today. It is usually painless and patients are often not aware that they have the disease until the gums and the bone are seriously damaged. If gum disease is suspected, X-rays can help determine how much of the supporting bone has been destroyed.

Plaque, which is a sticky film consisting of food debris and bacteria, that later turns into tartar. It adheres to the teeth and, when not removed daily, hardens into tartar (or calculus) and becomes difficult to remove. The bacteria in the tartar can then eat away at the surrounding gums and bone leading to chronic infection and inflammation in the mouth. This process is analogous to rain washing away the soil from around the trunk and the roots of a tree. As more and more soil is eroded away, more roots will be exposed and weakened, thus often causing the tree to eventually collapse.

Regular dental check-ups are important for evaluating oral health and for treating problems in the early stage. Preventive home care (such as brushing and flossing 2-3 times daily) and regular professional dental cleanings (2-4 times per year) are important in preventing gum disease.

The first step in treating gum disease involves a special deep cleaning called "scaling and root planing." This process cleans away all the disease causing plaque and tartar from the teeth, their roots and their gums. Occasionally a substance will be placed directly into the pockets between the teeth and the gums after the deep cleaning along with dental antibiotics and special mouth-rinses for you to use.

In cases of more severe gum disease surgery may be needed to better treat the inflamed gums and reduce the damage to the bone around the teeth. Occasionally bone grafts and bone stimulating proteins are placed inside the bone to help the body's natural ability to regenerate bone and gums.

In cases of severe gum recession soft tissue grafts can help cover exposed roots. This can help in straightening your gum line, improving your smile, and also in reducing tooth sensitivity.

After periodontal treatment it is important to practice good oral hygiene at home and to see your dentist for professional cleanings at regular intervals. If plaque and tartar is not cleaned scrupulously on a regular basis, periodontal disease will very likely recur.

A beautiful, bright smile can increase your self-confidence and over-all life satisfaction. With dentistry's many advances, you no longer have to settle for stained, chipped or misshapen teeth. We now have many ceramic and plastic compounds that mimic the appearance of natural teeth. Even the most subtle changes can make a dramatic difference in how you look.

Enamel shaping involves modifying tooth enamel to create a more ideal tooth shape. The procedure is quick, comfortable and results can be seen immediately.

Enamel shaping is quick and comfortable and the results can be seen immediately.

None. However in cases of teeth that are severely worn or chipped, it may need to be combined with bonding.

Bonding or veneers (see below) may be needed in cases of teeth that are severely chipped, worn, misshapen, or crooked. Orthodontics (or braces) may also be advised.

Teeth whitening is a cosmetic procedure that whitens and brightens the teeth using a bleaching solution, teeth whitening can dramatically improve a person's smile. We make a soft mouth guard customized to fit your teeth. The mouth guard is then filled with a bleaching gel which is worn from a few hours per day to overnight. The bleaching gel contains peroxide which bleaches the tooth enamel.

This is an easy way to whiten and brighten your smile. Most whitening products are safe and effective and by utilizing them we can help you create that "twinkling" effect.

Occasionally teeth can become mildly sensitive but this isusually very temporary and ceases when you stop bleaching your teeth.

There are over the counter "whitening" toothpastes that may lighten your teeth but the effect is usually very slight when compared to the bleaching gel we can provide you. For severely discolored teeth bleaching is not as effective as bonding or veneering which have a more dramatic improvement.

Preferred when there are
· Chipped, broken or cracked teeth
· Stained or discolored teeth
· Crooked teeth
· Gaps between the teeth

Bonding is a cosmetic procedure that uses a tooth colored resin material (called composites) that are glued (or bonded) to the tooth surface to change its color and shape. Composites of various colors are blended to match the tooth color, then applied, shaped and polished to the proper gloss and shape. The final product is a beautiful, natural looking tooth.

Bonding can improve your overall smile and the appearance of teeth that are chipped, broken, stained and/or have spaces between them. Bonding can often be completed in one visit.

For severely broken down teeth, veneers or crowns are more durable than bonding and will last longer. Also, veneers or crowns are made of porcelain which will not stain or change color over the years.

Preferred when there are:
· Chipped, broken or cracked teeth
· Permanently stained or discolored teeth
· Gaps between the teeth

Veneers are thin custom-made shells (think of them as artificial fingernails) designed to cover the front of the teeth. Veneers can be made of beautiful, tooth colored ceramic or porcelain, and are used to treat gaps between teeth and teeth that are chipped, worn, permanently stained, poorly shaped or crooked. They can mask defects such as chips, cracks, discoloration and malformed teeth. By making each tooth more uniform in color and shape veneers can create a truly beautiful smile.

Although veneers are quite strong they can break where there are heavy chewing forces present such as in the back of the mouth. In those cases, crowns are more durable and preferable.

For teeth with excessive decay or subject to heavy biting forces, porcelain crowns are better alternatives because they are stronger than the thinner porcelain veneers.

Pits or fissures on the teeth that are difficult to clean and therefore more susceptible to decay

Dental sealants are a type of plastic overlays. Our teeth are constantly being covered with a sticky film of bacteria called plaque. When we eat or drink anything containing sugar or starch, bacteria turn the sugar and starch into acids that attack the tooth enamel and eventually create a cavity. For deep pits or fissures that are difficult to clean we can install dental sealants. Dental sealants are plastic materials that, when applied over the tooth, can act as a barrier against plaque and acid, protecting the tooth from decay.

Dental sealants are simple, fast and cost-effective. Properly applied, sealants are extremely helpful in preventing cavities. When it comes to your health, prevention is always better than treatment.

Sealants are especially helpful in children who are more susceptible to developing cavities than adults with clean, healthy mouths. However, sealants may not be necessary on adult teeth that have been exposed to fluoride and on teeth that are not particularly susceptible to decay.

· Small to medium size cavities
· Decayed teeth that are subject to heavy chewing pressure

Amalgam (or silver) fillings are mixtures of metals containing mostly silver and mercury (see safety features below). After tooth decay is removed, an amalgam (gray color) is packed into the tooth. It hardens into a very hard and strong filling within a few hours.

Dental amalgams, used for over 100 years, are the most thoroughly researched and tested material among all those in use. They are durable, very strong, resistant to wear, and inexpensive.

Concerns have arisen regarding the safety of mercury in amalgam fillings but many studies have concluded that mercury in amalgam chemically combines with silver to make it safe and stable in the mouth. However amalgam fillings are gray colored and are not therefore very attractive.

Composite (white fillings) are an excellent and prettier alternative. We offer both traditional amalgam fillings and the prettier cosmetic fillings depending on what is deemed best for that particular tooth and what is most desired by the patient. Both types of fillings are very strong and able to stand the test of time.

· Small to medium size cavities
· Desire to replace amalgam (silver) fillings
· Desire for a more natural, pleasant smile

Composite fillings (also called white fillings) are made from tooth colored resins that restore the natural appearance of a decayed or previously filled tooth. Composite fillings are glued (or bonded) to the prepared tooth surface and hardened with an intense blue light. They are a more pleasing and prettier alternative to the traditional dark, silver amalgam fillings.

Composite fillings can generally be completed in one visit. Because of the composite fillings' ability to bond to the tooth, we can preserve more tooth structure as compared to other kinds of fillings. They are also generally considered more attractive since they blend so well with the natural tooth structure., Composites are also environmentally non-toxic since they contain no mercury.

If the cavity is large, or the tooth is subject to heavy chewing pressure, a composite (white) filling might not prove to be the most appropriately durable approach and a crown or an inlay/onlay may be a more durable alternative.

For large cavities, a severely broken down tooth, or a tooth subject to heavy chewing pressure, inlays/onlays and crowns are more durable alternatives.

A crown or cap is a custom made restoration that covers the entire chewing surface of the tooth and restores it to its original shape. For teeth that are weak, a crown (both the traditional gold or the more tooth-like porcelain) can help to prevent the tooth from further disintegration.

Crowns are very strong and can protect the remaining tooth structure. Porcelain crowns are very realistic looking because of their white natural tooth color. Gold crowns exhibit high strength and can withstand heavy chewing forces.

Crowns require two or more visits because they have to be custom fabricated in a special dental laboratory.

For badly decayed teeth there are no alternatives, although a tooth can be removed and replaced with a bridge or an implant.

Bridges are replacements for missing teeth. When a tooth is missing the gap between the teeth can be filled by creating a "bridge" in which an artificial tooth is attached to the adjacent teeth by making two crowns that are then connected by the artificial tooth.

Fixed bridges are cemented to the abutting (adjacent) teeth and therefore cannot come loose or be removed from the mouth like removable partials (see section below on removable partials). They are very stable and they look and function very much like your natural teeth.

Two or more visits are required to fabricate the fixed bridge since they have to be custom made in a special dental laboratory.

· One or more missing teeth
· Desire for a more permanent alternative to a removable partial or to improve the sunken face look associated with missing teeth
· Badly decayed teeth

Implants are specifically designed surgical screws that are anchored into the jaw-bone. They act as very stable anchors (artificial roots) for artificial replacement teeth called dental implant crowns. The replacement implant crowns look and function very much like your natural teeth. Implants can help prevent the deterioration of the bone that accompanies the loss of a tooth. This is especially important where multiple teeth may be missing and the accompanying bone loss may cause the lower one third of the face to shrink and develop a sunken look. Implants can prevent this kind of bone loss and help maintain the proper facial structure. In addition, they can provide the foundation and support needed for proper chewing. Crowns placed on top of the implants are very natural looking and can function very comfortably.

They are very stable, comfortable and attractive. In short, they are the closest thing to natural teeth. They can be used to replace missing teeth and to support partials and dentures. However, unlike partials or dentures, implants are fixed into the jaw and are not removed for cleaning or overnight soaking. They can also help to fill out a face that looks sunken because of missing teeth.

Implants are excellent state-of-the art restorations but the treatment process is a three part process that can take several months and is considerably is more expensive than bridges or partials.

Bridges and partials are alternatives. See the previous section on bridges and following section on removable partials.

A removable partial is a dental appliance consisting of replacement teeth attached to gum-colored plastic retainers connected by a metal framework. A denture (sometimes knownas "false teeth") is an appliance used to replace teeth when the patient has no teeth.

They can improve the sunken look associated with multiple missing teeth, improve the chewing efficiency and are inexpensive.

Initially they may feel bulky and awkward but most people get accustomed to them. Inserting and removing a partial also requires some practice.

Fixed bridges and implants are more comfortable and more esthetic. see the previous section bridges and implants.

Inside each tooth is a chamber filled with nerves and blood vessels called the pulp. When the pulp becomes damaged through injury or disease, the pulp becomes necrotic (i.e., dead) and an infection can develop around the tooth causing severe pain. Root canal therapy consists of removing the diseased pulp and sealing the roots to prevent the tooth from becoming re-infected. Without root canal treatment the tooth may very likely need to be extracted.

Root canal therapy can help a patient save a tooth that, in the past, would have required an extraction.

The only alternative is to extract the tooth and replace it with a fixed bridge or an implant. However, preserving one's own tooth with root canal therapy is a much more preferable alternative.