COMMON DENTAL PROCEDURES

	Fillings

A filling is a way to restore a tooth damaged by decay back to its normal function and shape. When a dentist gives you a filling, he or she first removes the decayed tooth material, cleans the affected area, and then fills the cleaned out cavity with a filling material. A filling also helps prevent further decay by closing off spaces where bacteria can enter the tooth. Materials used for fillings include gold, porcelain, a composite resin for tooth colored fillings, and amalgam, an alloy of mercury, silver, copper, tin and sometimes zinc. The material used will be determined by the extent of the repair, whether you have allergies to certain materials, where the filling is needed and the cost involved.

Only your dentist can detect whether you have a cavity that needs to be filled. During a checkup, your dentist will use a small mirror to examine the surfaces of each tooth.

Anything that looks abnormal will then be closely checked with special instruments. Your dentist may also X-ray your entire mouth or a section of it. The type of treatment your dentist chooses will depend on the extent of damage caused by decay.

	Crowns and Bridges

Crowns, and most bridges, are fixed prosthetic devices. Unlike removable devices such as dentures, which you can take out and clean daily, crowns and bridges are cemented onto existing teeth or implants, and can only be removed by a dentist.

A crown is used to entirely cover or "cap" a damaged tooth. Besides strengthening a damaged tooth, a crown can be used to improve its appearance, shape or alignment. A crown can also be placed on top of an implant to provide a tooth-like shape and structure for function. Porcelain or ceramic crowns can be matched to the color of your natural teeth. Other materials include gold and metal alloys, acrylic and ceramic. These alloys are generally stronger than porcelain and may be recommended for back teeth. Porcelain bonded to a metal shell is often used because it is both strong and attractive.

A bridge may be recommended if you're missing one or more teeth. Gaps left by missing teeth eventually cause the remaining teeth to rotate or shift into the empty spaces, resulting in a bad bite. The imbalance caused by missing teeth can also lead to gum disease and temporomandibular joint (TMJ) disorders. Bridges span the space where the teeth are missing. Bridges are cemented to the natural teeth or implants surrounding the empty space. These teeth, called abutments, serve as anchors for the bridge. A replacement tooth, called a pontic, is attached to the crowns that cover the abutments. As with crowns, you have a choice of materials for bridges. Your dentist can help you decide which to use, based on the location of the missing tooth (or teeth), its function, aesthetic considerations and cost. Porcelain or ceramic bridges can be matched to the color of your natural teeth.

Crowns and bridges can last a lifetime, however, they do sometimes come loose or fall out. The most important step you can take to ensure the longevity of your crown or bridge is to practice good oral hygiene.

	Root Canal Treatment

Root canal treatment is the removal of the tooth's pulp, a small, thread-like tissue in the center of the tooth. Once the damaged, diseased or dead pulp is removed, the remaining space is cleaned, shaped and filled. This procedure seals off the root canal. Years ago, teeth with diseased or injured pulps were removed. Today, root canal treatment saves many teeth that would otherwise be lost.

The most common causes of pulp damage or death are a cracked tooth, a deep cavity, or injury to a tooth, such as a severe knock to the tooth.

Once the pulp is infected or dead, if left untreated, pus can build up at the root tip in the jawbone, forming an abscess. An abscess can destroy the bone surrounding the tooth and cause pain.

Your treated and restored tooth/teeth can last a lifetime with proper care. Because tooth decay can still occur in treated teeth, good oral hygiene and regular dental exams are necessary to prevent further problems.

	Dental Implants

Dental implants are metal posts or frames that are surgically positioned into the jawbone beneath your gums. Once in place, they allow your dentist to mount replacement teeth onto them.

Because implants fuse to your jawbone, they provide stable support for artificial teeth. This secure fit helps dentures and bridges - as well as individual crowns placed over implants - feel more natural than conventional bridges or dentures.

For some people, ordinary bridges and dentures are simply not comfortable or even possible, due to sore spots, poor ridges or gagging. In addition, ordinary bridges must be attached to teeth on either side of the space left by the missing tooth. An advantage of implants is that no adjacent teeth need to be prepared or ground down to hold your new replacement tooth/teeth in place.

In order to receive implants, you need to have healthy gums and adequate bone to support the implant. You must also commit to keeping these structures healthy. Meticulous oral hygiene and regular dental visits are critical to the long-term success of dental implants.

Implants generally last 10-20 years, depending on the location of the implant and patient compliance with oral hygiene and dental visits. Because molars receive more stress and wear and tear, these implants typically do not last as long as implants located at the front of your mouth.

	Dentures

Dentures are replacements for missing teeth that can be taken out and put back into your mouth. There are two main types of dentures: full and partial. Your dentist will help you choose the type of denture that's best for you based on whether some or all of your teeth are going to be replaced and the cost involved.

With full dentures, a flesh-colored acrylic base fits over your gums. The base of the upper denture covers the palate (the roof of your mouth), while that of the lower denture is shaped like a horseshoe to accommodate your tongue.

Dentures are custom-made in a dental laboratory from impressions taken of your mouth. Your dentist will determine which of the three types of dentures described below is best for you.
Conventional Full Denture
A conventional full denture is placed in your mouth after any remaining teeth are removed and tissues have healed. Healing may take several months, during which time you are without teeth.
Immediate Full Denture
An immediate full denture is inserted immediately after the remaining teeth are removed. (Your dentist takes measurements and makes models of your jaw during a prior visit.) While immediate dentures offer the benefit of never having to be without your teeth, they must be relined several months after being inserted. The reason is that the bone supporting the teeth reshapes as it heals, causing the denture to become loose.
Partial Denture
A partial denture rests on a metal framework that attaches to your natural teeth. Sometimes crowns are placed on some of your natural teeth and serve as anchors for the denture. Partial dentures offer a removable alternative to bridges.

New dentures may feel awkward or uncomfortable for the first few weeks or even months. Eating and speaking with dentures might take a little practice. A bulky or loose feeling is not uncommon, while the muscles of your cheeks and tongue learn to hold your dentures in place. Excessive saliva flow, a feeling that the tongue does not have adequate room, and minor irritation or soreness are also not unusual. If you experience irritation, see your dentist.

	Tooth Extraction

Teeth are extracted for a variety of reasons:
Decay has reached deep into the tooth
Infection has destroyed a large portion of the tooth or surrounding bone
There is not enough room for all the teeth in your mouth

Many dentists recommend extracting impacted teeth that are only partially erupted, because bacteria can enter around the tooth and cause an infection, which can extend into the surrounding bone and become an extremely serious issue. Impacted teeth continue trying to break through the gum tissue even if there is not enough room to accommodate them; the continued pressure caused by this attempted eruption can eventually damage the roots of nearby teeth. Removing a tooth that is impacted can often prevent infection, damage to adjacent teeth and bone, and save pain in the years to come.

Before removal, the area around your tooth will be anesthetized. Dentists use a local anesthetic to numb the area of the mouth where the extraction will take place.

For a simple extraction, once the area is anesthetized, the tooth is loosened with the help of a tool called an elevator, then extracted with dental forceps. Your dentist may also want to smooth and re-contour the underlying bone. When he or she is finished, they may choose to close the area with a stitch.

It is critical to keep the area clean and prevent infection immediately following the removal of a tooth. Your dentist will ask you to bite down gently on a piece of dry, sterile gauze, which you must keep in place for up to 30 to 45 minutes to limit bleeding while clotting takes place. For the next 24 hours, you shouldn't smoke, rinse your mouth vigorously, or clean the teeth next to the extraction site.

A certain amount of pain and discomfort is to be expected following an extraction, however, there are some ways to limit the pain. In some cases, your dentist will recommend a pain killer or prescribe one for you. It may help to apply an ice pack to the face for 15 minutes at a time. You may also want to drink through a straw, limit strenuous activity, and avoid hot liquids. The day after the extraction, your dentist may suggest that you begin gently rinsing your mouth with warm salt water (do not swallow the water). Under normal circumstances, discomfort should lessen within three days to two weeks. If you have prolonged or severe pain, swelling, bleeding or fever, call your dentist at once.