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General Dentistry

Dental Exam and Cleanings

Dental Exam

A comprehensive dental exam will be performed by your dentist at your initial dental visit.  At regular check-up exams, your dentist and hygienist will perform the following:

  • Examination of diagnostic X-rays (radiographs):Essential for detection of decay, tumors, cysts, and bone loss.  X-rays also help determine tooth and root positions.
  • Oral cancer screening: Check the face, neck, lips, tongue, throat, tissues, and gums for any signs of oral cancer.
  • Gum disease evaluation:Check the gums and bone around the teeth for any signs of periodontal disease.
  • Examination of tooth decay: All tooth surfaces will be checked for decay with special dental instruments.
  • Examination of existing restorations:Check current fillings, crowns, etc.

Professional Dental Cleaning

Professional dental cleanings (dental prophylaxis) are usually performed by Registered Dental Hygienists.  Your cleaning appointment will include a dental exam and the following:

  • Removal of calculus (tartar): Calculus is hardened plaque that has been left on the tooth for some time and is now firmly attached to the tooth surface.  Calculus forms above and below the gum line and can only be removed with special dental instruments.
  • Removal of plaque:Plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (poisons) that inflame the gums.  This inflammation is the start of periodontal disease!
  • Teeth polishing:Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.
  • Removal of calculus (tartar): Calculus is hardened plaque that has been left on the tooth for some time and is now firmly attached to the tooth surface.  Calculus forms above and below the gum line and can only be removed with special dental instruments.
  • Removal of plaque: Plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (poisons) that inflame the gums.  This inflammation is the start of periodontal disease!
  • Teeth polishing: Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.

Oral Cancer Exam

According to research conducted by the American Cancer Society, more than 30,000 cases of oral cancer are diagnosed each year.  More than 7,000 of these cases result in the death of the patient.  The good news is that oral cancer can easily be diagnosed with an annual oral cancer exam, and effectively treated when caught in its earliest stages.

Oral cancer is a pathologic process which begins with an asymptomatic stage during which the usual cancer signs may not be readily noticeable.  This makes the oral cancer examinations performed by the dentist critically important.  Oral cancers can be of varied histologic types such as teratoma, adenocarcinoma and melanoma.  The most common type of oral cancer is the malignant squamous cell carcinoma.  This oral cancer type usually originates in lip and mouth tissues.

There are many different places in the oral cavity and maxillofacial region in which oral cancers commonly occur, including:

  • Lips
  • Mouth
  • Tongue
  • Salivary Glands
  • Oropharyngeal Region (throat)
  • Gums
  • Face

Reasons for oral cancer examinations

It is important to note that around 75 percent of oral cancers are linked with modifiable behaviors such as smoking, tobacco use and excessive alcohol consumption.  Your dentist can provide literature and education on making lifestyle changes and smoking cessation.

When oral cancer is diagnosed in its earliest stages, treatment is generally very effective.  Any noticeable abnormalities in the tongue, gums, mouth or surrounding area should be evaluated by a health professional as quickly as possible.  During the oral cancer exam, the dentist and dental hygienist will be scrutinizing the maxillofacial and oral regions carefully for signs of pathologic changes.

The following signs will be investigated during a routine oral cancer exam:

  • Red patches and sores– Red patches on the floor of the mouth, the front and sides of the tongue, white or pink patches which fail to heal and slow healing sores that bleed easily can be indicative of pathologic (cancerous) changes.
  • Leukoplakia– This is a hardened white or gray, slightly raised lesion that can appear anywhere inside the mouth. Leukoplakia can be cancerous, or may become cancerous if treatment is not sought.
  • Lumps– Soreness, lumps or the general thickening of tissue anywhere in the throat or mouth can signal pathological problems.

Oral cancer exams, diagnosis and treatment

The oral cancer examination is a completely painless process.  During the visual part of the examination, the dentist will look for abnormality and feel the face, glands and neck for unusual bumps.  Lasers which can highlight pathologic changes are also a wonderful tool for oral cancer checks.  The laser can “look” below the surface for abnormal signs and lesions which would be invisible to the naked eye.

If abnormalities, lesions, leukoplakia or lumps are apparent, the dentist will implement a diagnostic impression and treatment plan.  In the event that the initial treatment plan is ineffective, a biopsy of the area will be performed.  The biopsy includes a clinical evaluation which will identify the precise stage and grade of the oral lesion.

Oral cancer is deemed to be present when the basement membrane of the epithelium has been broken.  Malignant types of cancer can readily spread to other places in the oral and maxillofacial regions, posing additional secondary threats.  Treatment methods vary according to the precise diagnosis, but may include excision, radiation therapy and chemotherapy.

During bi-annual check-ups, the dentist and hygienist will thoroughly look for changes and lesions in the mouth, but a dedicated comprehensive oral cancer screening should be performed at least once each year.

If you have any questions or concerns about oral cancer, please contact our practice.

Digital Dental X-rays

Dental radiographs (X-rays) are essential, preventative, diagnostic tools that provide valuable information not visible during a regular dental exam.  Dentists and dental hygienists use this information to safely and accurately detect hidden dental abnormalities and complete an accurate treatment plan.  Without X-rays, problem areas may go undetected.

Dental X-rays may reveal:

  • Abscesses or cysts.
  • Bone loss.
  • Cancerous and non-cancerous tumors.
  • Decay between the teeth.
  • Developmental abnormalities.
  • Poor tooth and root positions.
  • Problems inside a tooth or below the gum line.

Detecting and treating dental problems at an early stage can save you time, money, unnecessary discomfort, and your teeth!

Are dental X-rays safe?

We are all exposed to natural radiation in our environment.  The amount of radiation exposure from a full mouth series of X-rays is equal to the amount a person receives in a single day from natural sources.

Dental X-rays produce a low level of radiation and are considered safe.  Dentists take necessary precautions to limit the patient’s exposure to radiation when taking dental X-rays.  These precautions include using lead apron shields to protect the body and using modern, fast film that cuts down the exposure time of each X-ray.

How often should dental X-rays be taken?

The need for dental X-rays depends on each patient’s individual dental health needs.  Your dentist and dental hygienist will recommend necessary x-rays based on the review of your medical and dental history, dental exam, signs and symptoms, age consideration, and risk for disease.

full mouth series of dental X-rays is recommended for new patients.  A full series is usually good for three to five years.  Bite-wing X-rays (X-rays of top and bottom teeth biting together) are taken at recall (check-up) visits and are recommended once or twice a year to detect new dental problems.

Vatech 3D Imaging

Physicians have relied on computerized axial tomography scans (CAT) for many years.  CAT scans are an X-ray procedure that uses many different X-ray images with the help of computers to generate cross-sectional or even 3D views of internal organs and structures within the body.  A knee replacement surgery, for example, would never be performed without first examining 3D imaging.

More recently however, dentists have begun to rely on 3D imaging techniques and i-CAT® scans to provide them with a detailed view of the mouth and skull.  The advantage that 3D imaging holds over regular dental x-rays is that bone structure, bone density, tissues, and nerves can be viewed clearly.

i-CAT® scans can be completed in less than half a minute.  This means that far less radiation enters the body than if a regular set of bitewing X-rays were taken.  The main use for i-CAT® scans is as an aid to plan dental implant treatment and other oral surgery.

Dental implants are the most sophisticated replacement for missing teeth, but have historically proven to be time-consuming to place.  i-CAT® scans vastly reduce the time it takes to place implants. It is thought that in the near future implants will be placed in a single visit because of this unique type of imaging.

How are i-CAT® scans used?

i-CAT® scans are advantageous because they allow the dentist to magnify specific areas of the face.  In addition, the dentist can easily view cross-sectional “slices” of the jaw, which makes planning treatment easier and faster.

Here are some of the main ways in which i-CAT® scans are used in dentistry:

  • Assess the quality of the jawbone where the implant will be placed.
  • Determine where nerves are located.
  • Diagnose tumors and disease in the early stages.
  • Measure the density of the jawbone where the implant will be placed.
  • Pinpoint the most effective placement for implants, including the angle of best fit.
  • Plan the complete surgical procedure in advance, from start to finish.
  • Precisely decide on the appropriate size and type of implants.
  • View exact orientation and position of each tooth.
  • View impacted teeth.

How are i-CAT® scans performed?

i-CAT® scans are quick and simple to perform.  A Cone Beam Imaging System is at the heart of the i-CAT® scanner.  During the scan, the patient sits stationary on a designated seat.  The cone beams are used to take literally hundreds of pictures of the face.  These pictures are used to compile an exact 3D image of the inner mechanisms of the face and jaw.  The dentist is able to zoom in on specific areas and view them from alternate angles.

Previous patients report the i-CAT® scanner is comfortable because they remain in a sitting position at all times.  Additionally, the scanner provides an open environment, meaning that claustrophobic feelings are eliminated.  The i-CAT® scan is an incredible tool that is minimizing the cost of dental treatment, reducing treatment time and enhancing the end results of dental surgery.

If you have questions or concerns about i-CAT® scans or 3D imaging, please contact our office.

Sealants

A sealant is a thin, plastic coating applied to the chewing surface of molars, premolars and any deep grooves (called pits and fissures) of teeth.  More than 75% of dental decay begins in these deep grooves.  Teeth with these conditions are hard to clean and are very susceptible to decay.  A sealant protects the tooth by sealing deep grooves, creating a smooth, easy to clean surface.

Sealants can protect teeth from decay for many years, but need to be checked for wear and chipping at regular dental visits.

Reasons for sealants:

  • Children and teenagers– As soon as the six-year molars (the first permanent back teeth) appear or any time throughout the cavity prone years of 6-16.
  • Adults– Tooth surfaces without decay that have deep grooves or depressions.
  • Baby teeth– Occasionally done if teeth have deep grooves or depressions and child is cavity prone.

What do sealants involve?

Sealants are easily applied by your dentist or dental hygienist and the process takes only a couple of minutes per tooth.

The teeth to be sealed are thoroughly cleaned and then surrounded with cotton to keep the area dry.  A special solution is applied to the enamel surface to help the sealant bond to the teeth.  The teeth are then rinsed and dried.  Sealant material is carefully painted onto the enamel surface to cover the deep grooves or depressions.  Depending on the type of sealant used, the material will either harden automatically or with a special curing light.

Proper home care, a balanced diet, and regular dental visits will aid in the life of your new sealants.

Fluoride Treatment

Fluoride is the most effective agent available to help prevent tooth decay.  It is a mineral that is naturally present in varying amounts in almost all foods and water supplies.  The benefits of fluoride have been well known for over 50 years and are supported by many health and professional organizations.

Fluoride works in two ways:

Topical fluoride strengthens the teeth once they have erupted by seeping into the outer surface of the tooth enamel, making the teeth more resistant to decay.  We gain topical fluoride by using fluoride containing dental products such as toothpaste, mouth rinses, and gels.  Dentists and dental hygienists generally recommend that children have a professional application of fluoride twice a year during dental check-ups.

Systemic fluoride strengthens the teeth that have erupted as well as those that are developing under the gums.  We gain systemic fluoride from most foods and our community water supplies.  It is also available as a supplement in drop or gel form and can be prescribed by your dentist or physician.  Generally, fluoride drops are recommended for infants, and tablets are best suited for children up through the teen years.  It is very important to monitor the amounts of fluoride a child ingests.  If too much fluoride is consumed while the teeth are developing, a condition called fluorosis (white spots on the teeth) may result.

Although most people receive fluoride from food and water, sometimes it is not enough to help prevent decay.  Your dentist or dental hygienist may recommend the use of home and/or professional fluoride treatments for the following reasons:

  • Deep pits and fissures on the chewing surfaces of teeth.
  • Exposed and sensitive root surfaces.
  • Fair to poor oral hygiene habits.
  • Frequent sugar and carbohydrate intake.
  • Inadequate exposure to fluorides.
  • Inadequate saliva flow due to medical conditions, medical treatments or medications.
  • Recent history of dental decay.

Remember, fluoride alone will not prevent tooth decay!  It is important to brush at least twice a day, floss regularly, eat balanced meals, reduce sugary snacks, and visit your dentist on a regular basis.

How to Properly Brush and Floss

Brushing and flossing are of paramount importance to oral hygiene.  Though bi-annual professional dental cleanings remove plaque, tartar, and debris, excellent homecare methods are equally valuable.  Proper brushing and flossing can enhance the health of the mouth, make the smile sparkle, and prevent serious diseases.

Reasons why proper brushing and flossing are essential:

  • Prevention of tooth decay – Tooth decay is one of the leading causes of tooth loss, and its treatment often requires complex dental procedures.  Tooth decay occurs when the acids found in plaque erode the natural enamel found on the teeth.  This phenomenon can easily be prevented by using proper home hygiene methods.
  • Prevention of periodontal disease – Periodontal disease is a serious, progressive condition which can cause tooth loss, gum recession, and jawbone recession. Periodontal disease is caused by the toxins found in plaque and can lead to serious health problems in other parts of the body. Removing plaque and calculus (tartar) from the surface of the tooth using a toothbrush and from the interdental areas using dental floss, is an excellent way to stave off periodontal problems. 
  • Prevention of halitosis – Bad breath or halitosis is usually caused by old food particles on or between the teeth.  These food particles can be removed with regular brushing and flossing, leaving the mouth healthier, and breath smelling fresher.
  • Prevention of staining – Staining, or yellowing, of teeth can be caused by a wide variety of factors such as smoking, coffee, and tea.  The more regularly these staining agents are removed from the teeth using brushing and flossing techniques, the less likely it is that the stains will become permanent.

The Proper Way to Brush

The teeth should be brushed at least twice a day, ideally in the morning and before bed.  The perfect toothbrush is small in size with soft, rounded-end bristles, and is no more than three months old. The head of the brush needs to be small enough to access all areas of the mouth, and the bristles should be soft enough so as not to cause undue damage to the gum tissue.  The American Dental Association (ADA) has given electric toothbrushes their seal of approval, stating that those with rotating or oscillating heads are more effective than other toothbrushes. 

Here is a basic guide to proper brushing:

  1. Place the toothbrush at a 45-degree angle where the gums and teeth meet.
  2. Use small circular motions to gently brush the gumline and teeth. 
  3. Do not scrub or apply too much pressure to the teeth, as this can damage the gums and tooth enamel.
  4. Brush every surface of every tooth, cheek-side, tongue-side, and chewing surfaces. Place special emphasis on the surfaces of the back teeth.
  5. Use back and forth strokes to brush the chewing surfaces.
  6. Brush the tongue to remove fungi, food, and debris. 

The Proper Way to Floss

Flossing is a great way to remove plaque from the interdental regions (between the teeth).  Flossing is an especially important tool for preventing periodontal disease and limiting the depth of the gum pockets.  The interdental regions are difficult to reach with a toothbrush and should be cleansed with dental floss on a daily basis.  The flavor and type of floss are unimportant; choose floss that will be easy and pleasant to use.

Here is a basic guide to proper flossing:

  1. Cut a piece of floss to around 18 inches long.
  2. Wrap one end of the floss around the middle finger of the left hand and the other end around the middle finger of the right hand until the hands are 2-3 inches apart.
  3. Work the floss gently between the teeth toward the gum line.
  4. Curve the floss in a U-shape around each individual tooth and carefully slide it beneath the gum line.
  5. Carefully move the floss up and down several times to remove interdental plaque and debris.
  6. Do not pop the floss in and out between the teeth as this will inflame and cut the gums.

If you have any questions about the correct way to brush or floss, please contact our office.

Composite Fillings

A composite (tooth colored) filling is used to repair a tooth that is affected by decay, cracks, fractures, etc.  The decayed or affected portion of the tooth will be removed and then filled with a composite filling.

There are many types of filling materials available, each with their own advantages and disadvantages.  You and your dentist can discuss the best options for restoring your teeth.  Composite fillings, along with silver amalgam fillings, are the most widely used today.  Because composite fillings are tooth colored, they can be closely matched to the color of existing teeth, and are more aesthetically suited for use in front teeth or more visible areas of the mouth.

As with most dental restorations, composite fillings are not permanent and may someday have to be replaced.  They are very durable and will last many years, giving you a long lasting, beautiful smile.

Reasons for composite fillings:

  • Chipped teeth.
  • Closing space between two teeth.
  • Cracked or broken teeth.
  • Decayed teeth.
  • Worn teeth.

How are composite fillings placed?

Composite fillings are usually placed in one appointment.  While the tooth is numb, your dentist will remove decay as needed.  The space will then be thoroughly cleaned and carefully prepared before the new filling is placed.  If the decay was near the nerve of the tooth, a special medication will be applied for added protection.  The composite filling will then be precisely placed, shaped, and polished, restoring your tooth to its original shape and function.

It is normal to experience sensitivity to hot and cold when composite fillings are first placed, however this will subside shortly after your tooth acclimates to the new filling.

You will be given care instructions at the conclusion of your treatment.  Good oral hygiene practices, eating habits, and regular dental visits will aid in the life of your new fillings.

Porcelain Crowns

A crown (or cap) is a covering that encases the entire tooth surface restoring it to its original shape and size.  A crown protects and strengthens tooth structure that cannot be restored with fillings or other types of restorations.

Although there are several types of crowns, porcelain (tooth colored crown) are the most popular, because they resemble your natural teeth.  They are highly durable and will last many years, but like most dental restorations, they may eventually need to be replaced.  Porcelain crowns are made to match the shape, size, and color or your teeth giving you a natural, long-lasting beautiful smile.

Reasons for crowns:

  • Broken or fractured teeth.
  • Cosmetic enhancement.
  • Decayed teeth.
  • Fractured fillings.
  • Large fillings.
  • Tooth has a root canal.

What does getting a crown involve?

A crown procedure usually requires two appointments.  Your first appointment will include taking several highly accurate molds (or impressions) that will be used to create your custom crown.  A mold will also be used to create a temporary crown which will stay on your tooth for approximately two weeks until your new crown is fabricated by a dental laboratory.

While the tooth is numb, the dentist will prepare the tooth by removing any decay and shaping the surface to properly fit the crown.  Once these details are accomplished, your temporary crown will be placed with temporary cement and your bite will be checked to ensure you are biting properly.

At your second appointment your temporary crown will be removed, the tooth will be cleaned, and your new crown will be carefully placed to ensure the spacing and bite are accurate.

You will be given care instructions and encouraged to have regular dental visits to check your new crown.

Fixed Bridges

A dental bridge is a fixed (non-removable) appliance and is an excellent way to replace missing teeth.

There are several types of bridges.  You and your dentist will discuss the best options for your particular case.  The “traditional bridge” is the most popular type and is usually made of porcelain fused to metal.  This type of bridge consists of two crowns that go over two anchoring teeth (abutment teeth) and are attached to pontics (artificial teeth), filling the gap created by one or more missing teeth. 

Dental bridges are highly durable and will last many years; however, they may need replacement or need to be re-cemented due to normal wear.

Reasons for a fixed bridge:

  • Fill space of missing teeth.
  • Maintain facial shape.
  • Prevent remaining teeth from drifting out of position.
  • Restore chewing and speaking ability.
  • Restore your smile.
  • Upgrade from a removable partial denture to a permanent dental appliance.

What does getting a fixed bridge involve?

Getting a bridge usually requires two or more visits.  While the teeth are numb, the two anchoring teeth are prepared by removing a portion of enamel to allow for a crown.  Next, a highly accurate impression (mold) is made which will be sent to a dental laboratory where the bridge will be fabricated.  In addition, a temporary bridge will be made and worn for several weeks until your next appointment.

At the second visit, your permanent bridge will be carefully checked, adjusted, and cemented to achieve a proper fit.  Occasionally your dentist may only temporarily cement the bridge, allowing your teeth and tissue time to get used to the new bridge.  The new bridge will be permanently cemented at a later time.

You will receive care instructions at the conclusion of the procedure.  Proper brushing, flossing, and regular dental visits will aid in the life of your new, permanent bridge.

Dentures and Partial Dentures

A denture is a removable dental appliance and a replacement for missing teeth and surrounding tissue.  They are made to closely resemble your natural teeth and may even enhance your smile.

There are two types of dentures – complete and partial dentures.  Complete dentures are used when all of the teeth are missing, while partial dentures are used when some natural teeth remain.  A partial denture not only fills in the spaces created by missing teeth, it prevents other teeth from shifting.

A complete denture can be either “conventional” or “immediate.”  A conventional type is made after the teeth have been removed and the gum tissue has healed (usually takes 4 to 6 weeks).  During this time, the patient will go without teeth.  Immediate dentures are made in advance and immediately placed after the teeth are removed, thus preventing the patient from having to be without teeth during the healing process.  Once the tissues shrink and heal, adjustments will have to be made.

Dentures are very durable appliances and will last many years but may have to be remade, repaired, or readjusted due to normal wear.

Reasons for dentures:

  • Complete Denture – Loss of all teeth in an arch.
  • Partial Denture – Loss of several teeth in an arch.
  • Enhancing smile and facial tissues.
  • Improving chewing, speech, and digestion.

What does getting dentures involve?

The process of getting dentures requires several appointments, usually over a period of several weeks.  Highly accurate impressions (molds) and measurements are taken and used to create your custom denture.  Several “try-in” appointments may be necessary to ensure proper shape, color, and fit.  At the final appointment, your dentist will precisely adjust and place the completed denture, ensuring a natural and comfortable fit.

It is normal to experience increased saliva flow, some soreness, and possible speech and chewing difficulty, however this will subside as your muscles and tissues get used to the new dentures.

You will be given care instructions for your new dentures.  Proper cleaning of your new dental appliance, good oral hygiene, and regular dental visits will aid in the life of your new dentures.

TMJ

Temporomandibular Joint Dysfunction Syndrome (TMJ) is a common condition affecting a wide variety of people. TMJ is characterized by severe headaches, jaw pain of varying degrees, grinding teeth, and an intermittent ringing in the ears. The vast majority of TMJ sufferers are unaware that the root cause of these problems is something that a dentist can effectively treat.

The symptoms of TMJ are debilitating and can greatly interfere with every day life. The comfort and general well being of the patient is at the heart of the dental practice, so pain relief is the first consideration of the dentist. The dentist is able to test, diagnose, and devise an immediate plan to treat the underlying causes of the TMJ disorder.

Reasons for treating TMJ

TMJ sufferers report that their symptoms generally worsen during periods of prolonged or unexpected stress, and that intense outbreaks of the condition can lead to neck pain and dizziness.

The most common cause of TMJ is the misalignment of the teeth, often called “bad bite.” It is possible for the dentist to realign or adjust the teeth without the need for painful or expensive surgeries. The realignment/adjustment will stop the pounding headaches, the jaw pain, and the dizziness.

The grinding teeth symptom is particularly common and usually occurs at night. The grinding will eventually erode the structure of the teeth and lead to much more severe dental problems in the future. Untreated TMJ is one of the prime underlying factors in eroded jawbones and loose teeth.

It is important for anyone experiencing the symptoms of TMJ to visit the dentist for an exact diagnosis.

What does treating TMJ involve?

TMJ could be a result of several different problems. Bad bite is the most common, but an injury resulting from a blow to the meniscus cartilage is also a possibility. Initially, the dentist will thoroughly examine the jaw area, the patient’s bite, take X-rays, and review the patient’s history in order to make an accurate diagnosis and recommend necessary treatment.

Once a firm diagnosis is attained, there are several ways in which relief can be provided. A specially molded bite guard can be created to stop teeth grinding during the night. A bite relationship analysis may be recommended by the dentist. The dentist can also provide advice on relaxation techniques which will lessen the effects of stress. As a last alternative, the dentist is also able to prescribe muscle relaxants.

A better option is to change the shape of the teeth and get rid of the bad bite completely, often called “realignment.” This is especially useful because it alleviates TMJ symptoms and may improve the aesthetic appearance of the teeth as well. Realignment involves adjusting the relationship between how the upper teeth come together with the lower teeth. This may require new restorations and/or adjusting the natural teeth as well. It is not a painful procedure, and it is one the dentist has performed with great success numerous times. As with any procedure, the dentist will be happy to answer questions and discuss symptoms, options, and treatments.

If you are experiencing any symptoms of TMJ, we encourage you to contact our office today to schedule an appointment.

Sleep Apnea

Sleep apnea is a potentially life-threatening sleep disorder characterized by repeated pauses in breathing during sleep.  The term sleep apnea is derived from the Greek etymology meaning “without breath”.  Breathing pauses can last anywhere from several seconds to minutes, and happen as often as 30 times or more per hour.  Ongoing disrupted breathing causes an imbalance between the carbon dioxide and oxygen levels in the bloodstream, as not enough carbon dioxide is exiting and not enough oxygen is entering the body.

Sensing this imbalance, the brain sends a message to the body, telling it to wake up to restart the breathing process.  People with sleep apnea will partially awake as they struggle to breathe, and this is often accompanied by loud snoring or choking sensations.  Because people with sleep apnea don’t always completely awake during the episodes, they are often unaware they have a sleeping disorder and it can remain undiagnosed.

There are two main types of this disorder; central sleep apnea which occurs when the brain fails to send important signals to the breathing muscles, and obstructive sleep apnea which occurs when air cannot flow through the nose or mouth even though the body is still trying to breathe.  Obstructive sleep apnea is far more prevalent and easily treatable by the dentist.

Common signs of obstructive sleep apnea can include severe early morning headaches, sleepiness in the daytime, and insomnia. Fortunately, the dentist is equipped with the necessary technology and expertise to treat sleep apnea in several different ways.

Reason for treating sleep apnea

It is very important to seek medical attention if sleep apnea is suspected. A sufferer can completely stop breathing numerous times per hour, and this can quickly turn into a deadly situation. Obstructive sleep apnea occurs when the soft tissue lying at the back of the patient’s throat collapses into the airway. The tongue then falls towards the back of the throat which tightens the blockage and prevents oxygen from entering the lungs.

The problem worsens when the chest region, diaphragm, and abdomen fight for air. The efforts they make to obtain vital oxygen only cause a further tightening of the blockage. The patient must arouse from deep sleep to tense the tongue and remove the soft tissue from the airway.

Because sleep apnea causes carbon dioxide levels to skyrocket in the blood and oxygen levels to decrease, the heart has to pump harder and faster to compensate for the lack of oxygen. Sleep apnea patients can technically “die” many times each night. Sleep apnea has been linked to a series of serious heart-related conditions, and should be investigated by the dentist at the earliest opportunity.

What does sleep apnea treatment involve?

Initially, the dentist will want to conduct tests in order to investigate, diagnose, and pinpoint a suitable treatment. The dentist can offer many different treatment options which depend largely on the exact diagnosis and the health of the patient. The dentist may advise the patient to halt some habits that aggravate sleep apnea such as smoking, alcohol consumption, and tranquilizer use.

Sleeping masks were traditionally used to keep the patient’s airways open while they slept, but nowadays there are some less intrusive options. Dental devices that gently tease the lower jaw forward are very effective in preventing the tongue from blocking the main air passage. These dental devices are gentle, easy to wear, and often help patients avoid unwanted surgeries.

A more permanent solution is to have surgery that sections the lower jaw and helps pull the bone holding the tongue forward slightly. This surgery has an impressive success rate and is simple for the dentist or oral surgeon to perform. The dentist needs to formally make a diagnosis of each individual case before recommending the best course of action.

If you feel you may benefit from sleep apnea treatment, contact our practice today.

Sleep Apnea Appliances

Sleep apnea is a serious, sometimes fatal medical disorder that affects around 10% of American men over the age of 40, and 6% of American women of the same age.  Sleep apnea sufferers completely stop breathing during sleep, sometimes hundreds of times in a single night.  Normal breathing ceases because the airway becomes obstructed, causing a serious reduction of airflow to the lungs.

There are a number of dental devices that can be used to alleviate this condition. The goal of most of these devices is to separate the jaws and push them forward slightly.  This slight repositioning opens up the airway, and allows oxygen to flow freely again.  Wearers of sleep apnea dental devices report that they stop loud snoring, feel more rested in the daytime, and are much more comfortable going to sleep.  Sleep apnea appliances work best on patients who are not significantly overweight. They offer a viable alternative to Continuous Positive Airway Pressure (CPAP).

Sleep apnea appliances fall into two categories: fixed and adjustable.  Here are brief descriptions of some commonly used sleep apnea dental appliances:

TAP® 3 (Thornton Adjustable Positioner)

The TAP® 3 is the smallest, most comfortable member of the TAP family.  It is a two-part custom-created sleep apnea appliance that fits over the teeth in much the same way as a sports mouthguard.  The TAP® 3 projects the jaw forward to prevent the tongue and soft tissues from impeding the airway.  The lower jaw positioner is adjustable, which means that it can be altered to suit the comfort level of the wearer.  The TAP® 3 appliance can accommodate the three main types of malocclusion, and allows the lips to fully close.

OASYS Appliance

The OASYS appliance is designed to move the base of the tongue toward the front of the mouth by gently repositioning the jawbone (mandible).  This shift opens the oropharynx and strengthens the upper airway.  An extension of the upper shield projects toward the nose, creating a larger nasal opening and less resistance to normal airflow.  This adjustable appliance is comfortable to wear and extremely patient friendly.

KlearwayTM Appliance

The KlearwayTM Appliance is generally used to alleviate obstructive sleep disorder and eliminate snoring.  The patient or dentist can project the jaw forwards in increments of .25mm at a time.  This ensures maximum comfort for the sleeper.  The KlearwayTM appliance is made from VariflexTM heat softening acrylic, which makes it easier to insert.  Running warm water over the appliance makes it pliable, but once placed in the desired position, the acrylic hardens again.

Herbst Telescopic Appliance

The Herbst appliance is held in the mouth by clasps and friction grips.  It is made of acrylic, and contains adjustable metal wiring.  The advantage of this appliance is that the wearer is able to move vertically and laterally without dislodging the appliance.  The Herbst appliance is usually used in mild and moderate cases of sleep apnea, and can also alleviate loud snoring effectively.

If you have questions or concerns about sleep apnea appliances, please ask your dentist.

Bruxism

Bruxism refers to an oral parafunctional activity that occurs in most humans at some point in their lives.   Grinding of the teeth and clenching of the jaw are the two main characteristics of this condition, which can occur during the day or at night.

Bruxism is one of the most common known sleep disorders and causes most of its damage during sleeping hours.  The clenching and grinding which accompanies bruxism is symptomatic of a malfunctioning chewing reflex, which is turned off in non-sufferers when sleeping.  For sufferers, deep sleep or even naps cause the reflex nerve control center in the brain to turn off and the reflex pathways to become active.

Typically, the incisors and canines (front 6 upper and lower teeth) of opposing arches grind against each other laterally.  This side to side action puts undue strain on the medial pterygoid muscles and the temporomandibular joints.  Earache, depression, headaches, eating disorders, and anxiety are among the most common symptoms of bruxism; these symptoms also accompany health issues such as chronic stress, Alzheimer’s disease, and alcohol abuse.

Bruxism is frequently misdiagnosed or not diagnosed at all, because it is only one of several potential causes of tooth wear.  Only a trained professional can tell the difference between bruxing wear and wear caused by overly aggressive brushing, acidic soft drinks, and abrasive foods.

A BiteStrip® is an economical device used to diagnose bruxism at home.  The device itself is a small electromyography which senses and monitors any activity in the jaw muscles during sleep.  The frequency and severity of the condition can then be assessed and the best treatment plan can be formulated.

Reasons for the treatment of bruxism

Here are some of the main reasons why bruxism should be promptly treated:

  • Gum recession and tooth loss – Bruxism is one of the leading causes of gum recession and tooth loss. It damages the soft tissue directly and leads to loose teeth and deep pockets, where bacteria can colonize and destroy the supporting bone. 
  • Occlusal trauma– The abnormal wear patterns on the occlusal (chewing) surfaces can lead to fractures in the teeth, which may require restorative treatment.
  • Arthritis– In severe and chronic cases, bruxing can eventually lead to painful arthritis in the temporomandibular (TMJ) joints (the joints that allow the jaw to open smoothly).
  • Myofascial pain – The grinding associated with bruxism can eventually shorten and blunt the teeth.  This can lead to debilitating headaches and muscle pain in the myofascial region.

Treatment options for bruxism

There is no single cure for bruxism, though a variety of helpful devices and tools are available.  Here are some common ways in which bruxism is treated:

  • Mouthguards– An acrylic mouthguard can be designed from tooth impressions to minimize the abrasive action of tooth surfaces during normal sleep.  Mouthguards should be worn on a long-term basis to help to stabilize the occlusion as well as prevent damage to teeth and to the temporomandibular joint.
  • NTI-tss device – This device is fitted by a health professional and only covers the front teeth.  The goal of the NTI-tss is to prevent the grinding of the rear molars by limiting the contraction of the temporalis muscle.
  • Botox®– Botox® can be injected into the muscles to relax and weaken them.  Botox® is an excellent treatment for bruxism because it weakens the muscles enough to prevent grinding but not enough to interfere with everyday functions like chewing and speaking.

Other methods of treatment include relaxation exercises, stress management education, and biofeedback mechanisms.  When the bruxing is under control, there are a variety of dental procedures such as crowns, gum grafts, and crown lengthening that can restore a pleasant aesthetic appearance to the smile.

If you have questions or concerns about bruxism, please contact our office.

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