Periodontal (Gum) Treatment
Periodontal treatment is primarily necessary for two reasons: (1)Periodontitis, damage caused by disease to the soft tissue and bone supporting the roots of the teeth; and (2)gingival (gum) recession. Treating periodontitis initially involves removing pathogens from the roots of the teeth called calculus (sometimes called “tartar”), and teaching the patient how to remove dental plaque so additional pathogens will not be deposited on the roots of the teeth. Sometimes gum surgery is needed to remove pathogens not removed in the initial therapy and to establish architecture that the patient can maintain better. Patients who don’t get periodontitis treated can eventually lose their teeth when the bone supporting the roots atrophies away. Loose teeth are often sore and painful. Sometimes a loose tooth can come out when a patient merely bites into an apple. Losing teeth due to periodontitis in this modern era is a by product of neglect.The x-ray you see below has projections coming off of the roots. This is calculus, the accumulation of pathogens that causes the bone to atrophy that holds the teeth.The x-rays below of both upper and lower teeth show how the calculus has been removed, which is part of the initial therapy of periodontal treatment.Gum recession is sometimes treated by doing gingival grafts as shown in the before and after pictures.
If you want your natural teeth to be whiter, then you should consider bleaching. Our office offers two options: (1)in-office bleaching, or (2)bleaching trays to be used at home. Bleaching will not affect the color of porcelain crowns or the bonding material in white fillings. It can only whiten natural teeth.Look at the before and after pictures to see the dramatic changes that can occur with bleaching.
Nothing speaks better about cosmetic bonding than before and after pictures.
Crowns are indicated when teeth have been broken by injuries, trauma, large amounts of decay, or prior root canal therapy. A crown covers all sides of the tooth.Can you identify the porcelain crown in the photograph? We can—if we look at the patient record.
Missing teeth can be replaced by fixed bridges when there are sufficient teeth on each side to anchor the bridge. The bridge covers the teeth that anchor the bridge just like a crown covers a single tooth. A bridge has all of its teeth connected to each other.
While the permanent bridge is being fabricated in the dental lab, a plastic temporary bridge is temporarily cemented in place.
The permanent fixed bridge feels like natural teeth to the patient.
This patient was born without both upper lateral incisors. Dr. Daniel cemented two different bridges to replace both missing teeth. Each bridge was cemented to a tooth on both sides of the missing tooth.
These bridges looked the same when Dr. Daniel attended this patient’s wedding 13 years later.
This patient was in a near fatal accident and had three teeth knocked out. The patient was embarrassed to be seen in public.
Dr. Daniel fabricated a plastic temporary bridge immediately after the patient arrived at his office.
Dr. Daniel cemented the temporary bridge in. With the lower lip in a normal position, it was not obvious the patient had experienced trauma or had a temporary bridge inserted.
After the oral tissues had healed, Dr. Daniel permanently cemented in this beautiful porcelain fixed bridge. The new teeth were more beautiful than the originals.
Root canals are finished more quickly today than they were just a few years ago thanks to advanced technology such as surgical microscopes, digital radiography, and nickel titanium files. Dr. Daniel has embraced these technologies for many years.
Inside every tooth is a pulp chamber which houses connective tissue with small arteries, small veins, and nerve tissue.
When this tissue is injured by trauma, dental decay, or fracture, the only way to save the tooth is with a root canal.
An opening is made into the pulp chamber and the connective tissue is removed (nerves and all).
The canals of the root are shaped in a concentric fashion with endodontic files before being filled with an isoprene rubber called gutta percha.
Dr. Daniel has been replacing missing teeth with dental implants in Henry County since 1987. Patients sometimes desire implants instead of fixed bridges. With a fixed bridge, the adjacent teeth which would hold the bridge have to be prepared in the same manner as a single crown. With an implant, the adjacent teeth aren’t touched.Another indication for implant placement is when the missing tooth is the last tooth in the arch. Notice the model of lower teeth with a missing second molar marked by a red X. Note the same model with a barium sulfate splint fabricated for the patient’s CT scan. This will enable a potential treatment plan for an implant to replace this missing tooth.
In this instance, there is nothing to bridge to on one end. In some instances, an adjacent tooth that would hold a bridge is too weak to serve as an anchor for a bridge.So will implants replace fixed bridges?
Not anytime soon. Here’s why: For an implant to succeed, it has to be accommodated in an adequate amount of jaw bone. Dental diseases such as periodontitis and pulpal abscesses caused by tooth decay destroy bone. Also, the bone of the jaw tends to recede when a tooth is removed.Do dental x-rays show if there is enough bone for an implant?
Since x-rays show just two- dimensions, only potential length is shown, and then it may not be entirely accurate.Then how do you know if there’s enough bone?
CT scans, giving three dimensional topography or pictures, have been used in the medical field for some time. Advances in technology and software in the past decade along with more imaging centers have made three dimensional technology available at reasonable fees to prospective dental implant patients.
Oral Surgery can entail many procedures, but the most common one is extraction of teeth.
Extractions can be necessary for three reasons:
Decay may have destroyed a tooth to such an extent that it cannot be saved.
There may not be room in the jaw for all of the teeth a patient has, which is often the case with wisdom teeth.
Orthodontic treatment may dictate removal of selected teeth in order for the remaining teeth to be properly aligned.
Dr. Daniel performs hundreds of extractions each year.
A patient presented with the obvious decay on tooth number 13. The tooth was restored with Herculite Ultra by Dr. Daniel. Notice how Dr. Daniel also contoured the existing fillings on adjacent teeth numbers 12 and 14 for a more natural look.
Whereas all fillings for front teeth today are done with different shades of white composite resin materials, fillings for back teeth can be done with either white composite resins, gold, or silver amalgam.The fees for white fillings on back or posterior teeth are usually more than for silver fillings because white fillings generally take longer to complete. But the white fillings look so natural that the untrained eye cannot detect a filling is there.The American Dental Association has determined that silver fillings are safe, economical, and long lasting restorations that enable patients to keep their back teeth. It’s not uncommon to see silver fillings to still be in place after 50 years! However, the silver filling is not as esthetic as a white one.In the photographs above, the two teeth have fillings. In the photograph below, the silver is quite noticeable, but the tooth colored composite resin filling in the photographs above is not detectable. The two fillings touch each other. The silver filling is made of an excellent amalgam called Tytin. The white filling is made of Herculite Ultra. Both are products of the Kerr Corporation.
Intravenous Sedation (Twilight Sleep)
Since 1989, many patients have been referred by other dentists to Dr. Daniel for treatment under IV Sedation for three reasons:
- Severe phobias or fears of dental treatment that they have put off treatment for years.
- Inability to get sufficient results from local anesthesia (numbness) for various reasons.
- Severe gag reflexes that only sedation can enable them to complete dental procedures successfully.
Besides being relaxed, pain free, and dozing during procedures, most patients report some amnesia during the time of treatment.
Dr. Daniel prefers Intravenous Sedation over oral sedation because it is more predictable and the drugs can be immediately reversed if necessary.
The patient pictured to the left, Don C. says, “My first time under sedation at Dr. Daniel’s office I thought I was being asked to change chairs before the procedure began, but I was shocked when they told me I was done already and could go home. I couldn’t believe it, I didn’t remember a thing and what a restful sleep. Sedation is the way to go. You sleep and it’s over. No drill sounds, no pain, just restful sleep and it’s over.”
The vital signs that are monitored when Dr. Daniel does Sedation are pulse oximetry, capnography, EKG, pulse rate, and blood pressure. Pulse oximetry measures the percent of hemoglobin in the blood that is oxygenated. Capnography shows that CO2 is being expelled by the patient.
In the photograph to the left is the CSI 8100 monitor that Dr. Daniel uses.
You can see the EKG waves in green. The amount of blood hemoglobin saturated with oxygen as a percent (pulse oximetry) is 98 and represented by the yellow graph. The white graph (capnography) shows that carbon dioxide is being expelled by the patient. The blood pressure, automatically taken at pre-set intervals, is 120/80. The heart rate is 60.
A patient whose health is too fragile to be treated in a private dental office can be treated under general anesthesia at Piedmont Henry Medical Center in Stockbridge by Dr. Daniel. Special needs patients, whose disabilities often include severe mental disabilities, can be treated under general anesthesia by Dr. Daniel at Piedmont Henry Medical Center. Dr. Daniel has never refused treatment to a mentally handicapped patient due to inability to pay.All patients obtaining treatment at Piedmont Henry Medical by Dr. Daniel must have a History and Physical performed by a physician who is a member of the Medical Staff at Piedmont Henry Medical.Prior to obtaining privileges at Piedmont Henry Medical, Dr. Daniel was on the Medical Staff at Georgia Baptist Hospital in Atlanta.
Copyright 2015 Dr. Randy Daniel, D.D.S.
All photographs shown are cases completed by Dr. Randy Daniel and are copyrighted.
Content may only be used with prior written permission from Dr. Randy Daniel.