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Exams

Our dental exams include the following initial questions:

  • List of medications you are currently taking.
  • List of vitamins and natural healing remedies you are currently taking.
  • Smoking and alcohol consumption.
  • Allergy list.
  • Previous experience with anesthesia.
  • Adverse reactions to anesthesia.
  • Family member reactions to anesthesia.
  • Any medical conditions you are currently being treated for.
  • Previous surgeries or hospitalizations.

The second step of any oral health exam involves a thorough examination of your teeth and supporting structures. While this may seem like a straightforward objective, it is its own process that involves the incorporation of various techniques, technologies and therapies.

  • We explore every surface of every tooth to uncover new cavities and examine the quality of existing fillings with a crown horn or fishhook, two commonly used dental instruments. Over time, fillings can break down and require replacement. They may also be replaced for improved esthetics. In fact, many people today opt to remove their older silver amalgam fillings and replace them with natural-looking composite fillings.
  • We use a pigtail tool to check for calculus deposits.
  • If X-rays are necessary, we take full-mouth X-rays or bitewings (molars and premolars) to detect abnormalities not visible to the naked eye.
  • Healthy gums adhere tightly to the teeth. If they don't, then periodontal disease may be present or bone loss may be occurring. We typically perform periodontal probing to measure the circumference of each tooth and the strength of the supporting bone structure. A calibrated probe is inserted between the teeth and gums to measure (in millimeters) the level of "gum adherence" to the teeth. We then record a millimeter number for every tooth. The goal is to record a number of one, two or three. A number of four or more indicates periodontal disease and potential bone loss. If the gums do not tighten after the cleaning, you will be scheduled for a scaling or root planing appointment. For more severe cases, you will be referred to a periodontist for additional treatment.
  • Using scalers (scraping tools), curets (scoop-shaped instruments) and sometimes additional high-frequency ultrasonic scalers, we clean each tooth.
  • Cleaning is performed below the gum and between the teeth as well.
  • The teeth are gently polished to ensure that the enamel is not disturbed.
  • Toothpaste or a combination of baking soda and water may be used to complete the polishing.
  • Fluoride treatment is the last step.
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Cleanings

Teeth cleaning (prophylaxis) by a dental hygienist removes tartar (mineralized plaque) that may develop even with careful brushing and flossing, especially in areas that are difficult to reach in routine toothbrushing. Professional cleaning includes tooth scaling and tooth polishing and debridement if too much tartar has accumulated. This involves the use of various instruments or devices to loosen and remove deposits from the teeth.

Most dental hygienists recommend having the teeth professionally cleaned at least once every year or two.[4] More frequent cleaning and examination may be necessary during treatment of dental and other oral disorders. Routine examination of the teeth is recommended at least every year. This may include yearly, select dental X-rays. See also dental plaque identification procedure and removal.

Between cleanings by a dental hygienist, good oral hygiene helps to prevent cavities, tartar build-up, and gum disease.

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X-rays

Dental radiographs, commonly referred to as X-ray films, or informally, X-rays, are pictures of the teeth, bones, and surrounding soft tissues to screen for and help identify problems with the teeth, mouth, and jaw. X-ray pictures can show cavities, cancerous or benign masses, hidden dental structures (such as wisdom teeth), and bone loss that cannot be seen during a visual examination. Dental X-rays may also be done as follow-up after dental treatments.

A radiographic image is formed by a controlled burst of X-ray radiation which penetrates oral structures at different levels, depending on varying anatomical densities, before striking the film or sensor. Teeth appear lighter because less radiation penetrates them to reach the film. Dental caries, infections and other changes in the bone density, and the periodontal ligament, appear darker because X-rays readily penetrate these less dense structures. Dental restorations (fillings, crowns) may appear lighter or darker, depending on the density of the material.

 

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Fillings

A dental restoration or dental filling is a dental restorative material used to restore the function, integrity and morphology of missing tooth structure. The structural loss typically results from caries or external trauma. It is also lost intentionally during tooth preparation to improve the aesthetics or the physical integrity of the intended restorative material. Dental restoration also refers to the replacement of missing tooth structure that is supported by dental implants.

Dental restorations can be divided into two broad types: direct restorations and indirect restorations. All dental restorations can be further classified by their location and size. A root canal filling is a restorative technique used to fill the space where the dental pulp normally resides.

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Crowns

A crown is a type of dental restoration which completely caps or encircles a tooth or dental implant. Crowns are often needed when a large cavity threatens the ongoing health of a tooth[1]. They are typically bonded to the tooth using a dental cement. Crowns can be made from many materials, which are usually fabricated using indirect methods. Crowns are often used to improve the strength or appearance of teeth. While unarguably beneficial to dental health, the procedure and materials can be relatively expensive.
The most common method of crowning a tooth involves using a dental impression of a prepared tooth by a dentist to fabricate the crown outside of the mouth. The crown can then be inserted at a subsequent dental appointment. Using this indirect method of tooth restoration allows use of strong restorative materials requiring time consuming fabrication methods requiring intense heat, such as casting metal or firing porcelain which would not be possible to complete inside the mouth. Because of the expansion properties, the relatively similar material costs, and the aesthetic benefits, many patients choose to have their crown fabricated with gold.

As new technology and materials science has evolved, computers are increasingly becoming a part of crown and bridge fabrication, such as in CAD/CAM Dentistry.

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Bridges

A bridge, also known as a fixed partial denture, is a dental restoration used to replace a missing tooth by joining permanently to adjacent teeth or dental implants.

There are different types of bridges, depending on how they are fabricated and the way they anchor to the adjacent teeth. Conventionally, bridges are made using the indirect method of restoration however, bridges can be fabricated directly in the mouth using such materials as composite resin.

A bridge is fabricated by reducing the teeth on either side of the missing tooth or teeth by a preparation pattern determined by the location of the teeth and by the material from which the bridge is fabricated. In other words, the abutment teeth are reduced in size to accommodate the material to be used to restore the size and shape of the original teeth in a correct alignment and contact with the opposing teeth. The dimensions of the bridge are defined by Ante's Law: "The root surface area of the abutment teeth has to equal or surpass that of the teeth being replaced with pontics".

The materials used for the bridges include gold, porcelain fused to metal, or in the correct situation porcelain alone. The amount and type of reduction done to the abutment teeth varies slightly with the different materials used. The recipient of such a bridge must be careful to clean well under this prosthesis.

When restoring an edentulous space with a fixed partial denture that will crown the teeth adjacent to the space and bridge the gap with a pontic, or "dummy tooth", the restoration is referred to as a bridge. Besides all of the preceding information that concerns single-unit crowns, bridges possess a few additional considerations when it comes to case selection and treatment planning, tooth preparation and restoration fabrication.

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Root Canals

A root canal is a treatment used to repair and save a tooth that is badly decayed or becomes infected. During a root canal procedure, the nerve and pulp are removed and the inside of the tooth is cleaned and sealed. Without treatment, the tissue surrounding the tooth will become infected and abscesses may form.

"Root canal" is the term used to describe the natural cavity within the center of the tooth. The pulp or pulp chamber is the soft area within the root canal. The tooth's nerve lies within the root canal.

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Partials

A removable partial denture (RPD) is for a partially edentulous dental patient who desires to have replacement teeth for functional or aesthetic reasons, and who cannot have a bridge (a fixed partial denture) for any number of reasons, such as a lack of required teeth to serve as support for a bridge (i.e. distal abutments) or due to financial limitations.

The reason why this type of prosthesis is referred to as a removable partial denture is because patients can remove and reinsert them when required without professional help. Conversely, a "fixed" prosthesis can and should be removed only by a dental professional.

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Dentures

Dentures are prosthetic devices constructed to replace missing teeth, and which are supported by surrounding soft and hard tissues of the oral cavity.

Conventional dentures are removable, however there are many different denture designs, some which rely on bonding or clasping onto teeth or dental implants. There are two main categories of dentures, depending on whether they are used to replace missing teeth on the mandibular arch or the maxillary arch.

Dentures can help patients in a number of ways:

  • Mastication - chewing ability is improved by replacing edentulous areas with denture teeth.
  • Aesthetics - the presence of teeth provide a natural facial appearance, and wearing a denture to replace missing teeth provides support for the lips and cheeks and corrects the collapsed appearance that occurs after losing teeth.
  • Phonetics - by replacing missing teeth, especially the anteriors, patients are better able to speak by improving pronunciation of those words containing sibilants or fricatives.
  • Self-Esteem - Patients feel better about themselves.
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Extractions

A dental extraction (also referred to as exodontia) is the removal of a tooth from the mouth. Extractions are performed for a wide variety of reasons, including tooth decay that has destroyed enough tooth structure to prevent restoration. Extractions of impacted or problematic wisdom teeth are routinely performed, as are extractions of some permanent teeth to make space for orthodontic treatment.

The most common reason for extraction is tooth damage due to breakage or decay. There are additional reasons for tooth extraction:

  • Severe tooth decay or infection. Despite the reduction in worldwide prevalence of dental caries, still it is the most common reason for extraction of (non-third molar) teeth with up to two thirds of extractions.
  • Extra teeth which are blocking other teeth from coming in.
  • Severe gum disease which may affect the supporting tissues and bone structures of teeth.
  • In preparation for orthodontic treatment (braces)
  • Teeth in the fracture line
  • Fractured teeth
  • Insufficient space for wisdom teeth (impacted third molars). Although many dentists remove asymptomatic impacted third molars, American as well as British Health Authorities recommended against this routine procedure, unless there are evidences for disease in the impacted tooth or the near environment. The American Public Health Association, for example, adopted a policy, Opposition to Prophylactic Removal of Third Molars (Wisdom Teeth) because of the large number of injuries resulting from unnecessary extractions.
  • Receiving radiation to the head and neck may require extraction of teeth in the field of radiation.
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Bleaching

Dental bleaching, also known as tooth whitening, is a common procedure in general dentistry but most especially in the field of cosmetic dentistry. A child's deciduous teeth are generally whiter than the adult teeth that follow. As a person ages the adult teeth often become darker due to changes in the mineral structure of the tooth, as the enamel becomes less porous Template:Citation is needed. Teeth can also become stained by bacterial pigments, foodstuffs and tobacco. Certain antibiotic medications (like tetracycline) can also cause teeth stains or a reduction in the brilliance of the enamel.

There are many methods to whiten teeth: bleaching strips, bleaching pen, bleaching gel, laser bleaching, and natural bleaching. Traditionally, at-home whitening involves applying bleaching gel to the teeth using thin guard trays. At-home whitening can also be done by applying small strips that go over the front teeth. Oxidizing agents such as hydrogen peroxide or carbamide peroxide are used to lighten the shade of the tooth. The oxidizing agent penetrates the porosities in the rod-like crystal structure of enamel and oxidizes interprismatic stain deposits; over a period of time, the dentin layer, lying underneath the enamel, is also bleached. Power bleaching uses light energy to accelerate the process of bleaching in a dental office. The effects of bleaching can last for several months, but may vary depending on the lifestyle of the patient. Factors that decrease whitening include smoking and the ingestion of dark colored liquids like coffee, tea and red wine.

Internal staining of dentine can discolor the teeth from inside out. Internal bleaching can remedy this. If heavy staining or tetracycline damage is present on a patient's teeth, and whitening is ineffective, there are other methods of whitening teeth. Bonding, when a thin coating of composite material is applied to the front of a person's teeth and then cured with a blue light can be performed to mask the staining. A veneer can also mask tooth discoloration.

What We Do

Dr. Pfau and his staff perform a variety of different dental services.

Click these links to jump to the different services:

If there's a service that you're interested in, but don't see listed here, contact us to see if we offer it.