Author: Adam R. Pershing, DMD

Same-Day Crowns

Written by Adam R. Pershing, DMD on April 1, 2023. Posted in Technology. No Comments on Same-Day Crowns

A tooth that has been structurally damaged by decay or trauma sometimes needs to be crowned or “capped” so that it can look good and function properly again. A crown is a durable covering that is custom-made to fit over the entire tooth from the gum line up.

Getting a crown used to mean multiple office visits and weeks of waiting time, but now there is a much more convenient option—same-day crowns. Same-day crowns and other tooth restorations can be made in the dentist’s office and often in minutes using technology known as Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM).

Benefits of Same-Day Crowns

Saves you time and money

Traditional crowns require you to get temporary crowns while you wait for the permanent crown to be made. Same-day crowns eliminate the expense of the temporary crown, and the expense of the multiple appointments that traditional crowns require.

Restores function to your mouth and teeth immediately

With temporary crowns, you have to be careful how you eat so that the temporary crown doesn’t fall out. With same-day crowns, you will have full functioning of your teeth again.

Same-Day Crown Process

Your dentist will remove any decay or debris from the affected area, and then shape the tooth or teeth so it will fit with the crown.
With the help of a small scanning wand, your dentist will take digital pictures of your mouth that will assist in generating a 3D model of your teeth.
The CAD/CAM software uses this 3D model to create your crown. It can even use a mirror-image twin of the other side of your mouth to create the most natural-looking crown possible.
A block of ceramic material is chosen to match the color of your teeth, and the computer’s digital design is transmitted to a milling machine that carves the crown from the ceramic block in about five minutes.
The crown is then bonded to your tooth.

Caring for your crown is very similar to caring for your natural teeth. As always, you need to regularly brush and floss. With crowns, it’s even more important to maintain a regular schedule of professional cleanings at the dental office. If you have a grinding habit, talk to your dentist about a mouthguard to protect your teeth and crowns.

Laser Dentistry

Written by Adam R. Pershing, DMD on April 1, 2023. Posted in Technology. No Comments on Laser Dentistry

Lasers direct a controlled force of energy that can remove or alter bone and tissue. By applying varying wavelengths of energy, dental lasers are used to detect and treat a myriad of oral health issues, including detecting oral cancer and treating small cavities.

Types of Dental Lasers

There are two different types of dental lasers: hard tissue lasers and soft tissue lasers.

With unparalleled precision, hard tissue lasers emit a wavelength that can cut through bone, or more specifically, the calcium phosphate that make up our bones and teeth. The hard tissue laser eliminates the need for a dental drill, which is often associated with uncomfortable noise and vibrations.

Hard tissue lasers are typically used for:

Removing decay to a tooth for a filling
Detecting cavities under the gum line
Treating tooth sensitivity

Soft tissue lasers emit a wavelength that is easily absorbed by water and hemoglobin, a molecule found in the blood. Soft tissue lasers cut through soft tissue and seal exposed blood vessels at the same time, which is why laser treatments often have little bleeding and heal quickly.

Soft tissue lasers are typically used for:

Reshaping gums to lengthen crowns, or for cosmetic purposes, like treating a “gummy” smile
Making changes to soft tissue, like treating limited tongue movement or removing soft tissue that causes sleep apnea
Detecting abnormal tissue, like oral cancers
Treating infection in the root canal or gums

Lasers sterilize what they touch and seal any blood vessels they cut, which means dental lasers:

Reduce the need for sutures
Reduce the need for anesthesia
Reduce risk of infection
Reduce healing time significantly
Reduce blood loss during treatments

Laser Decay Diagnostics

Written by Adam R. Pershing, DMD on April 1, 2023. Posted in Technology. No Comments on Laser Decay Diagnostics

Using lasers, dentists can detect tooth decay that is not yet visible and would otherwise be undiagnosed using traditional methods.

Laser cavity detection is based on the fact that healthy tooth structure reflects light, or “fluoresces,” differently than does decayed tooth structure. Teeth with decay will display a higher level of fluorescence, and the higher the fluorescence, the more advanced the tooth decay. Laser decay technology also puts out an audio signal when it finds areas of decay.

Prior to using a laser scanner, dentists depended upon X-rays and using fine picks to identify cavities. Not only is this process uncomfortable, it’s also harder to diagnose decay in areas with limited visibility, like underneath the gum line. Laser technology provides about a 90% accuracy rate for identifying suspicious areas and cavities.

If tooth decay is caught early enough, you might not even need a filling at all, meaning laser technology not only improves early cavity detection, but reduces the size and number of fillings you might need over time. This means that you will be better able to preserve your natural teeth and avoid the need for expensive dental treatments.

Educational Videos

Written by Adam R. Pershing, DMD on April 1, 2023. Posted in Educational Videos. No Comments on Educational Videos

Veneers

Written by Adam R. Pershing, DMD on April 1, 2023. Posted in Cosmetic & General Dentistry. No Comments on Veneers

A dental veneer is a thin, durable porcelain shell that is custom-fabricated to cover the front of a tooth. Veneers can restore the appearance of teeth with chips, cracks, and stains, can close small gaps between the teeth, and can reshape misshapen or slightly misaligned teeth.

5 Steps of the Veneer Process

Veneers are a popular choice for cosmetic enhancement because they are a straightforward and natural-looking way to create a brighter and more uniform smile. The veneer process is completed over several appointments:

Consultation

You and your dentist discuss your goals for your smile and whether you’re a good candidate for veneers.

Examination

Your teeth and gums are examined. Measurements, photographs, X-rays, and impressions are taken as needed.

Preparation

A small amount of enamel is removed from the front of the tooth so that the veneer will fit flush with the tooth surface. An impression is taken of the prepared tooth and the teeth around it, and a color is chosen for the porcelain.

Fabrication

The veneers are lab-fabricated to the desired shape and size, using the dental impression and the dentist’s detailed instructions for a precise fit and tint.

Application

When the veneers are ready, they are placed at a final appointment. After checking for shape, color, and fit, and making adjustments if necessary, your dentist will clean the teeth and use dental cement to bond the veneers in place.

Are veneers right for you?

Before deciding on veneers, discuss with your dentist whether they’re the right choice for you:

Veneers Are Permanent

Prepping for a veneer requires the removal of a small amount of tooth enamel, so veneers will need to be replaced if they are damaged or dislodged. Proper care keeps veneers their best and brightest.

Veneers Aren’t for Everyone

Teeth and gums must be healthy before beginning the procedure. More serious orthodontic misalignments and habitual conditions such as tooth grinding and jaw clenching make veneers impractical.

The Advantages of Veneers

While there are less expensive options for cosmetic restorations, veneers offer benefits that whitening and bonding treatments don’t.

- Veneers cover staining which whitening treatments alone can’t eliminate.
- The porcelain used is semi-translucent, like actual enamel, so the veneers will look more natural than bonding. Veneers are more stain resistant, too.
- Veneers are less vulnerable to chipping or other damage than bonding, and have a longer lifespan, typically lasting from ten to 15 years with proper care.

While the cost of veneers is comparable to the cost of crowns, veneers preserve more of the tooth’s underlying structure than crowns do.

If chips, gaps, stains, cracks, misshapen teeth, or other small imperfections in your smile are causing an outsized impact on your confidence, talk to your dentist to discover how veneers could be the right choice to restore and enhance your smile.

Fillings

Written by Adam R. Pershing, DMD on April 1, 2023. Posted in Cosmetic & General Dentistry. No Comments on Fillings

The bacteria in plaque produce acids that erode tooth enamel, eventually creating a hole, or cavity, in the tooth surface. Left untreated, this decay can spread to the interior of the tooth, and might lead to the need for a crown, a root canal, or even extraction. When caught early, your dentist can treat your cavity conservatively by restoring your tooth’s function and appearance with a filling.

What kind of filling do you need? Your choice of restoration will depend on the location of the cavity and how much of the tooth structure is affected.

Direct Filling

For most small to moderate cavities, direct fillings can be bonded to the tooth immediately after removing decay and cleaning and shaping the tooth.

Composite resin, dental amalgam, and glass ionomer fillings are typically used for this type of single visit restoration.

Indirect Filling

An indirect filling is the right choice for molars and premolars with larger areas of decay or damage. Indirect fillings fit more securely, last longer than direct fillings, and can even strengthen the remaining tooth structure. An inlay fills the tooth surface inside the cusps, while an onlay typically covers the center of the tooth and one or more cusps.

Indirect fillings can be made of composite resin, gold, or porcelain, and are created from a mold taken after the tooth is cleaned and prepped. The finished filling is bonded to the tooth at a second visit.

Filling Options

Once you know what type of filing you need, you and your dentist can choose the best filling material for your tooth based on durability, aesthetics, longevity, and cost considerations:

Composite Resin

Made of acrylic resin mixed with powdered quartz, glass, or other ceramic particles, composite resin can be used for both direct and indirect fillings.

Composite resin fillings are popular, especially for fillings in the front teeth, because they are color-matched to blend with natural enamel. These fillings generally preserve more of the tooth structure and are quite durable, although gold or porcelain might be a stronger choice for chewing surfaces. Composite resin fillings are more expensive than amalgams, and, unlike porcelain fillings, are more prone to staining.

Dental Amalgam

An amalgam, or silver-colored, filling is composed of several different metals, including silver, tin, copper, and mercury.

Because this filling is very durable, it’s often the filling of choice for biting surfaces. It’s also one of the most cost-effective options. Amalgam fillings sometimes require the removal of more tooth structure than composite resin fillings, and won’t blend in with natural enamel. If you are concerned about the metals used in amalgams, discuss alternatives with your dentist.

Glass Ionomer

Glass ionomer fillings use a flexible cement paste made with silicate glass powder. This filling material bonds to the tooth itself and hardens quickly. Resin-modified ionomers harden even more quickly under a curing light.

Many glass ionomer fillings contain fluoride that is released over time, helping to prevent new cavities. These fillings don’t blend as well with enamel as other tooth-colored options, and, because they are quite a bit less durable than other filling materials, they’re more suitable for baby teeth, cavities along the gum line or other non-biting surfaces, and temporary fillings.

Gold

A gold filling is an alloy of gold, copper, and other metals. Gold is typically used in indirect fillings, and is extremely durable, lasting 20 years or more. Gold fillings are a more expensive option than composite resin, and, like silver amalgams, these fillings are visible.

Porcelain

A porcelain filling is made from specially formulated ceramic materials and is used in indirect fillings.

Because porcelain fillings are both color-matched to the tooth and translucent, they are the most natural looking filling available. They are resistant to staining and cracking and are quite durable. Porcelain is a more expensive choice than composite resin, more comparable to the cost of a gold filling.

If you have a small or moderate cavity, there are a variety of filling choices available to address your functional, aesthetic, and cost concerns. Discuss these options with your dentist to discover which filling is best suited to restore and protect your healthy, attractive smile.

Root Canal Treatment

Written by Adam R. Pershing, DMD on April 1, 2023. Posted in Endodontics. No Comments on Root Canal Treatment

Every tooth has two sections: a crown, the visible part of the tooth above the gum line, and one or more roots, which anchor the teeth within the jaw. Each tooth has three basic layers: an outer layer of hard enamel (which protects the crown) or cementum (which covers the root), a middle layer of softer dentin, and inside the center of the tooth, the pulp.

Pulp is living tissue containing nerves, blood vessels, and connective tissue. It’s found in the pulp chamber within the crown and in the root canals that lead from the pulp chamber to the tip of each root.

When tooth pulp is infected or dying, it can’t be restored. Without prompt treatment, tooth extraction is often necessary. Moreover, an infection in the pulp can spread to the gum tissue, the jawbone, and other parts of the body. A root canal procedure can prevent tooth loss and more widespread infection by removing infected pulp tissue and restoring the integrity of the tooth structure.

What can make root canal treatment necessary?

Even with the protective layers surrounding it, tooth pulp is vulnerable to infection and injury:

A deep cavity can extend to the pulp chamber, permitting bacteria to reach the pulp and cause infection.
Similarly, a broken or cracked tooth can allow bacteria access to the pulp chamber.
With serious gum disease, infection can spread from the gums to the pulp inside the roots.
Tooth trauma can critically damage the nerves or the blood vessels inside the tooth, leading to pulp death.

The Root Canal Procedure

A root canal procedure is relatively straightforward. If you are anxious about the procedure, your dentist can recommend sedations options.

First, the area around the tooth is numbed. A dental dam is often placed around the tooth to isolate the area.
An opening in the crown is made to allow access to the pulp inside.
Small, precise instruments are used to clean the inner pulp chamber and root canals and to remove dead or dying tissue.
The area is thoroughly disinfected.
The inside of the tooth is shaped to hold a filling.
The roots and pulp chamber are filled with gutta-percha or a dental composite and sealed.

A crown is typically used to protect and reinforce the tooth after treatment. A temporary filling or crown will be placed on the tooth to prevent bacteria and food from entering the site while a permanent crown is created. This permanent crown will be placed at a later visit. The entire process usually takes from one to three appointments.

Symptoms of Pulp Infection

A tooth that needs root canal treatment might be symptom-free, but any of these symptoms are strong indications that the pulp has suffered infection or injury:

Persistent tooth pain, which can be dull or sharp and severe
Pain when chewing or when any pressure is placed on the tooth
Prolonged sensitivity to heat or cold
A cracked, broken, darkened, or discolored tooth
Gum tissue near the tooth which is sore, red, or swollen
A pimple-like bump on the gums that persists or keeps recurring. This is the sign of an abscess, an infection in the gum or bone near the root of the tooth.

A root canal should be performed by an endodontist or a dentist who has special training in treating the interior of the tooth. Call your dentist immediately if you have any symptoms of pulp infection or injury. Prompt endodontic treatment can relieve tooth pain and prevent further infection. And, with proper dental care and regular checkups, your restored tooth can last a lifetime.

Tooth Decay Prevention

Written by Adam R. Pershing, DMD on April 1, 2023. Posted in Cosmetic & General Dentistry. No Comments on Tooth Decay Prevention

What is tooth decay?

Tooth decay begins with the Streptococcus mutans bacteria. These bacteria join with food particles and fluids in the mouth to create plaque, a constantly forming biofilm which sticks to the surface of tooth enamel.

The bacteria in plaque convert the sugars in our foods into lactic acid. When plaque remains on the tooth, these acids erode the calcium phosphate minerals which make enamel the hardest substance in the body. This process, called demineralization, creates weak spots in the tooth surface.

Over time, a weak spot will become larger and deeper until a hole, or cavity, forms in the enamel.

Treating Tooth Decay and Cavities

Because tooth enamel isn’t living tissue, it can’t regenerate or grow back. Once bacteria and acids have created a deep enough cavity, only a dentist can repair it by removing the decayed area of the tooth and restoring the tooth’s structure.

Without treatment, a cavity will continue to grow until it erodes the enamel and spreads into the interior of the tooth. Treatment for tooth decay will depend on how far the decay has progressed.

Demineralization—Early tooth decay

Early signs of demineralization can show up as white spots where minerals have been stripped from the enamel. Demineralization is sometimes reversible with a professional fluoride treatment that remineralizes and strengthens tooth enamel.

Enamel Decay

For small cavities in the enamel, a filling is generally recommended. The dentist will remove any decay, clean the area, and fill the tooth. Filling options include color-matched composite, silver dental amalgam, and gold fillings.

Dentin Decay

Dentin lies just below tooth enamel. When decay reaches the dentin, it spreads more quickly because dentin is much softer than enamel. More extensive decay might require a larger filling or a crown.

Pulp Decay

Left untreated, a cavity can grow until it reaches the living pulp inside the dentin. The pulp contains blood vessels and nerves, and, once damaged or infected, will require a root canal procedure and a crown to save the tooth.

Extraction

When decay is so extensive that a tooth cannot be saved, extraction becomes necessary. A dental implant is often the best choice to replace a lost tooth because it prevents shifting in the remaining teeth and helps maintain jawbone density.

Preventing Tooth Decay

While there are many options for treating cavities, prevention is always best. Working together with your dental team, you can help prevent cavities with healthy dental habits and proactive treatments:

Regular checkups can catch and treat early tooth decay before a cavity forms.
Professional cleanings remove tartar and plaque you might have missed.
Brush at least twice a day, for at least two minutes each time, to clean plaque from tooth surfaces.
Floss at least once each day to remove plaque between the teeth and along the gum line.
Use fluoride toothpaste, a proven way to strengthen and remineralize enamel.
Consider professional fluoride treatments if you have a higher risk of tooth decay.
Ask your dentist about sealants to protect molars from decay.
Make sure your tooth-healthy diet is rich in nutrients like calcium, phosphorus, and vitamin D and low in sugars and acids.