Once a dentist has finished a comprehensive dental examination, he must come up with a treatment plan to help meet the patient’s dental goals.These usually are:Comfort, function, stability and esthetics.More plainly: Look good, feel good, chew well and last a long time.
To reach these goals, we often divide dental treatment in to two phases.Phase one treatment involves the treatment of active disease.Phase two treatment involves repair of damage caused by the previous disease.In some cases, phase one treatment will be all that is required, in other situations, phase one and phase two treatment can be accomplished at the same time.Sometimes, phase one treatment must be completed prior to phase two treatment.
Phase one treatment…stopping disease.
Creating healthy gums.This usually involves gum treatment.The goal is to have healthy gums that do not bleed.This usually means a trip to the dental hygienist for a deep cleaning.If the gums are still inflamed after initial gum therapy, laser gum therapy, chemical gum therapy or surgical gum therapy may be needed.
Creating healthy teeth.This involves fixing any cavities that have formed.These can be new cavities, or cavities under and around old fillings.Worn teeth must be examined and the cause of the wear determined.If it looks like the wear is due to grinding the bite must be stabilized.If the damage is caused by acids, the source of the acids that dissolve the teeth must be found and eliminated or reduced if possible.
Creating a healthy bite.This part of dental treatment is not as familiar to the general public.In order to function properly and to reduce wear, the bite must be checked to ensure that the lower teeth move into the upper teeth in a way that maximizes the biting forces and reduces the strain on the muscles and jaw joint.Many times the phase one treatment for this problem may be an appliance that is worn at night to help relax the muscles and prevent wear.Phase one bite therapy may involve balancing the bite by selective tooth adjustment.
After the disease is halted phase one treatment is either completed, or the final part of the phase one treatment may be to move the teeth.This is done to allow the bite to be as good as it can be.Teeth are moved with braces.
Following phase one dentistry, the teeth and gums should be in a state where they are not infected or inflamed and the teeth are where they need to be. At this point, all treatment is either completed and only regular check ups and maintenance is required or it is time to start restoring the teeth to their ideal form and function…phase two treatment.
I will discuss more about phase two dentistry in our next segment.
Since graduating in 1981 I have seen some incredible changes in the delivery of dental services.I thought it would be a good idea to share some of the changes with you, as a lot of the changes in dentistry are not readily apparent to the general public.
When we were in dental school, esthetic dentistry was not even discussed except when we were setting up a denture.When we were restoring teeth, the goal was to make the front teeth acceptable in appearance, and little or no consideration was given to the appearance of the back teeth.
At that time, it wasn’t that dentists were unconcerned about the appearance of our patients; it was that the materials and techniques available to us were limited.Back fillings were either silver amalgam or gold.Front fillings were available in tooth coloured material, however, the material was not that great and a limited number of tooth shades were manufactured.
The goal when placing a restoration in a tooth is to have a seal that will prevent leakage of the oral fluids.Gold restorations could be constructed to have a mechanical seal; gold is malleable and can be burnished to obtain the excellent fit required.Silver amalgam restorations seal the filling by corroding.The corrosion layer between the filling and the tooth has enough thickness to seal the cavity.Both of these restorations have a great track record and still function as acceptable restorative materials, however they are not always acceptable in appearance especially in front teeth.
White fillings were made of composite resins filled with finely ground glass particles.The problem with these fillings was that they did not stick to the tooth, therefore there was limited usage and the fillings did not last very long.
Things were changing quickly.
To create a long lasting restoration that did not leak and create sensitivity, there needed to be a way to glue the filling to the tooth.It is very difficult to glue to a tooth.This is good for you as this keeps things from sticking to your teeth (except spinach), but creates a problem for a dentist who wants to stick a dental restoration on your tooth.While it was discovered as early as 1955, that application of a mild acid solution to a tooth created a surface that could be bonded etching and bonding of teeth did not become routine until the late 70’s.In the 80’s great advances were made in the science of bonding to tooth structure.With these advances came new tooth coloured resins with greater colour matching and strength.Light cured resins were developed to allow for greater control of placement by allowing the dentist to cure the resin on demand.(That is what the blue light does, for those of you who have had bonded restorations.)The advances in dental bonding are ongoing.We are currently in the seventh generation of dental bonding resins.
Today, we can predictably bond to tooth material.This allows for placement of restorations that are not only acceptable, but also invisible.The modern dentist can make front and back tooth restorations out of composite resin or bonded porcelain, that not only look great but also function like a normal tooth.
Dental bonding has dramatically changed the way dentists practice dentistry.It has opened a whole new field of esthetic or cosmetic dentistry.Today, if you would like to change your smile to make it look better you have that option.A dentist trained in smile design and current in the state of the art esthetic procedures can easily create for you a smile that you love.
For more information about esthetic dental restorations ask Dr. Saby
Previously, I have discussed dental goals, for the most part everyone has the same goals:teeth that look good, feel good, chew well and last a long time.
The first phase of treatment is phase one treatment, where the object is to stabilize the existing teeth and gums.This is achieved by placing fillings where there is decay, treating gum disease and stabilizing the bite.
After phase one treatment, it is time to move to phase two treatment.This is where, missing teeth are replaced, damaged teeth are restored to optimum function and any esthetic improvements are made.
To maintain proper function and stability, it is important to replace any teeth that are missing.While it is true that many people are missing teeth and get along quite fine, this is more to do with the adaptive nature of the human body than the fact that the teeth are not necessary.The teeth are arranged in an arch, disruption of the continuity of the arch results in aberrant biting which must be compensated for.Loss of an opposing tooth will result in the opposite tooth drifting down.If you have a tooth that has lost the tooth in front of it, this will result in tipping forward of the back tooth.Over time this changes the bite and may result in excessive wear, TMJ symptoms or further tooth loss.
Teeth can be replaced with either dental implant supported crowns, fixed bridgework or removable bridgework.The rule is, fixed is better than removable, an implant is better than a bridge.
Teeth that have been badly broken down by decay or wear, or teeth that have excessively large fillings can be restored with crowns.A crown is much like an outside filling.It is cast and becomes a solid unit that fits over the damaged tooth, it is shaped and acts like a tooth.A crown can be either gold, porcelain fused to gold, milled ceramic or cast ceramic.What material is used depends upon the situation.
Esthetics can be improved by using whitening, bonding, veneers or crowns, again depending on the situation.
While sometimes simple and sometimes complex, there are very few dental conditions that modern dentistry cannot improve.If you want to enjoy a comfortable, functional mouth that also looks great, ask your dentist for more information.
Once a dentist has finished a comprehensive dental examination, he must come up with a treatment plan to help meet the patient’s dental goals.These usually are:Comfort, function, stability and esthetics.More plainly: Look good, feel good, chew well and last a long time.
To reach these goals, we often divide dental treatment in to two phases.Phase one treatment involves the treatment of active disease.Phase two treatment involves repair of damage caused by the previous disease.In some cases, phase one treatment will be all that is required, in other situations, phase one and phase two treatment can be accomplished at the same time.Sometimes, phase one treatment must be completed prior to phase two treatment.
Phase one treatment…stopping disease.
Creating healthy gums.This usually involves gum treatment.The goal is to have healthy gums that do not bleed.This usually means a trip to the dental hygienist for a deep cleaning.If the gums are still inflamed after initial gum therapy, laser gum therapy, chemical gum therapy or surgical gum therapy may be needed.
After the disease is halted phase one treatment is either completed, or the final part of the phase one treatment may be to move the teeth.This is done to allow the bite to be as good as it can be.Teeth are moved with braces.
Following phase one dentistry, the teeth and gums should be in a state where they are not infected or inflamed and the teeth are where they need to be. At this point, all treatment is either completed and only regular check ups and maintenance is required or it is time to start restoring the teeth to their ideal form and function…phase two treatment.
I will discuss more about phase two dentistry in our next segment.
