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A veneer is a thin shell that covers the front part of the tooth. Veneers are custom made for each patient and are fabricated from ceramic or composite resin material. After they are fitted in the mouth, they are permanently bonded in place. Veneers can improve a person’s smile by correcting a wide range of dental problems: chipped or broken teeth, discolored teeth that can’t be whitened by bleaching, teeth with gaps or spaces between them, and crooked or misshapen teeth.

If your teeth are discolored, teeth whitening may help to give you a brighter and whiter smile. Over time, tooth enamel can change color. Some of the factors that contribute to tooth discoloration are foods like coffee and tea, medications taken in childhood such as tetracycline, tobacco, trauma to the tooth, and ingesting too much fluoride while teeth are developing. Whitening may be safely done in the dental office or in the home. Typically, the active ingredient in whitening kits is either carbamide peroxide or hydrogen peroxide. The whitening product used by the dental professional is stronger than the over-the-counter material and consequently works more effectively.

A crown is a dental restoration that covers your tooth. A crown is placed on a tooth when there isn’t enough natural tooth structure left to support a conventional filling. A crown can restore a tooth’s shape, size and function. A crown can strengthen the tooth by protecting a weak tooth or a fractured tooth. A crown can also improve the appearance of a tooth by covering discolorations on the tooth and by reestablishing the proper dimensions of a badly shaped tooth.

A crown can be fabricated from one material or a combination of materials. These materials are metal alloys, porcelain and composite resins. There are mechanical and esthetic factors that determine which material(s) are used.

There are multiple steps involved in the preparation of a crown. The tooth is prepared; its outer layer is removed and shaped by the dentist to accommodate the thickness of the crown. An impression is taken of the prepared tooth to provide an exact replica, which is called a model, of the prepared tooth. The laboratory technician, as instructed by the dentist, will use the model to fabricate the crown.

While the laboratory is fabricating the crown, the dentist will make and place a temporary crown which the patient wears until the permanent crown returns from the laboratory. The temporary crown protects the tooth from fracture, decreases sensitivity by covering the exposed tooth, and maintains the space for the permanent crown.

On the final visit, the dentist will fit the new crown, make all the necessary adjustments and check the esthetics. The crown will be permanently cemented to your tooth.

When a tooth or multiple teeth are missing, one option for replacement is a dental implant. A dental implant is a metal post that gets placed below the gum and into the bone. It fuses to the bone and acts in a similar fashion as the root of a tooth. The placement of the post(s) is a surgical procedure. One of the advantages of an implant is that it feels more like your own tooth. Another advantage is that adjacent teeth do not have to be involved in the replacement procedure.

In order to have the surgery, a patient needs to be in good health and there needs to be adequate bone to support the implant. If there is not enough adequate bone to support an implant, there are other surgical procedures that can create an adequate foundation to support an implant.

After the implant is placed in the jaw bone, up to six months may be required for the bone to grow around the implant. This waiting period allows the implant to be firmly attached to the bone. In some instances, an immediate implant may be placed.

When the healing process is completed, a post is attached to the implant and a replacement tooth is fitted to the post portion of the implant.

Another alternate for tooth or teeth replacement is a fixed bridge. A fixed bridge is attached to your natural teeth. A bridge requires that teeth adjacent to the space with the missing tooth/teeth are prepared. An artificial tooth called a pontic is attached to the crowns placed on the prepared adjacent teeth. The whole unit is cemented to the natural teeth.

The mechanics and steps involved in a fixed bridge are similar to those of a crown. Please see Crown Section for details.

A partial bridge, sometimes call a partial denture, as its name describes, is a removable appliance that replaces missing teeth. Partial bridges are generally less expensive and are not as comfortable as a fixed bridge.

A partial bridge is constructed of gum colored acrylic on its base and tooth colored acrylic teeth. Beneath and embedded in the acrylic is a metal substructure which strengthens the appliance. The partial denture may attach to the natural teeth with metal clasps, acrylic clasps or precision attachments.

A full denture is an appliance that replaces all the natural teeth, helps provides support for the facial muscles and lips, and aids in eating and speaking.

The base of the denture is made out of gum colored acrylic to which tooth colored acrylic teeth are attached. The denture rests on the bone that is left in the mouth after all the teeth are removed and the overlying soft tissue. The denture is held in the mouth by the gums and the bone. A full denture may be attached to implants to aid in its stability and retention in the mouth.

A full denture is less expensive than fixed bridges and implants.

The pulp is the soft tissue inside the tooth that contains blood vessels and nerves. When the pulp is diseased or injured, it dies. Some factors that cause the pulp to die are deep cavities, cracked teeth, trauma and problems with large fillings. All of these can allow bacteria to enter the pulp. Consequently, the pulp can become inflamed and the tissues around the tooth can become infected. Pain and swelling can occur. Sometimes, teeth that need root canal treatment are asymptomatic because even if there is no pain, bacteria can damage the bone.

Root canal treatment is the process whereby the nerve is removed from inside the tooth, and the canal(s) of the tooth are shaped and cleaned. After the tooth is free of infection, the canals are filled with an inert material called gutta percha.

Typically, when tooth structure is lost from decay or trauma, a dentist will place a filling. The dentist will remove the decay, remove unsupported tooth structure and replace the missing tooth structure with a dental restorative material. This reestablishes the structural integrity and the function of the tooth.

Composite restorations are often referred to as white fillings. A composite filling is made of a resin matrix and a filler component. The filler component consists of glass ceramic plus other materials. After the decay is removed and the interior of the filling is shaped, the tooth is conditioned. A bonding agent is placed on the conditioned surface of the tooth. The composite material is layered on top of the bonding agent and is hardened with a special curing light that emits a full spectrum of light.

Composite fillings were developed as an alternative to dental amalgams (silver fillings) for their esthetic properties because they are colored to look like a natural tooth. Composites come in a wide variety of colors and can be mixed together which allows the dentist to match the remaining tooth.

Bonding is a term commonly used when adding composite to tooth structure in order to close spaces between teeth, repair cracks and chips, and to change the shape of existing teeth. The technique of conditioning the tooth, applying a bonding agent, and layering in the composite resin is the same one used in placing a white filling.

The main advantage of a white filling is its esthetic quality. Composite resins are more costly and don’t last as long as silver fillings.

Dental amalgam fillings (silver fillings) have been used for over a hundred years. They are composed of liquid mercury and a powdered alloy that consists of silver, tin, copper, and other metallic elements. When the powder is mixed with the liquid, the material is in a softened state. It is condensed into the prepared tooth where it hardens.

Dental amalgams are less expensive, more durable, and less esthetic than composite resins.

Dental amalgams are approved by the FDA and the ADA.

Sealants are a preventative dental restoration that protects the chewing surface of the tooth. They are most often placed in children and teenagers.

The chewing surfaces of the teeth can have deep pits and grooves that trap plaque, bacteria and food. The bacteria in our mouth can convert the sugar from the food we eat into acids that erode the tooth enamel and cause tooth decay. Sealants act as a barrier and function by flowing into these pits and grooves. When these grooves are sealed off, the bacteria cannot reach these areas to create decay.

The technique of applying a sealant is similar to that of a white filling without the tooth preparation phase.

Nighttime grinding/clenching is a common problem. Some of the contributing factors are stress, sleep disorders and an abnormal bite.

Some of the symptoms associated with grinding/clenching are:

• Worn teeth
• Headaches
• Sore jaw and facial muscles
• Toothaches
• Earache
• Cracked fillings

For patients who consistently grind/clench at night, a night guard is recommended to prevent further damage to your teeth and to the temporomandibular joints, and to reduce the above symptoms.

Night guards are custom made plastic or acrylic appliances that cover either the upper or lower teeth. Dentists recommend them for patients who consistently grind or clench their teeth. Other treatments recommended for people who grind/clench are:

• Soft diet
• Avoiding chewing gum and nail biting
• Biofeedback and relaxation techniques
• Heat packs muscle relaxants, anti-inflammatory, and analgesic medications