• Procedures performed using soft tissue dental lasers may not require sutures (stitches).
• Certain laser dentistry procedures do not require anesthesia.
• Laser dentistry minimizes bleeding because the high-energy light beam aids in the clotting (coagulation) of exposed blood vessels, thus inhibiting blood loss.
• Bacterial infections are minimized because the high-energy beam sterilizes the area being worked on.
• Damage to surrounding tissue is minimized.
• Wounds heal faster and tissues can be regenerated.

Hard Tissue (Tooth) Laser Dentistry Procedures

• Cavity Detector: Low intensity soft tissue dental lasers may be used for the early detection of cavities by providing a reading of the by-products produced by tooth decay.
• Dental Fillings/Tooth Preparation: Hard tissue dental lasers may eliminate the need for a local anesthetic injection and the traditional turbine dental drill. Lasers used in dental filling procedures are capable of killing bacteria located in a cavity, potentially leading to improved long term tooth restorations. However, dental lasers are not appropriate for the replacement of amalgam fillings, onlays or crowns.
• Tooth Sensitivity: Dental lasers may be used to seal tubules (located on the root of the tooth) that are responsible for hot and cold tooth sensitivity.

Soft Tissue (Gum) Laser Dentistry Procedures

• Crown Lengthening: Dental lasers can reshape gum tissue (soft tissue laser) and bone (hard tissue laser) to expose healthier tooth structure. Referred to as crown lengthening, such reshaping provides a stronger foundation for the placement of restorations.
• Gummy Smile: Dental lasers can reshape gum tissue to expose healthy tooth structure and improve the appearance of a gummy smile.
• Muscle Attachment (Frenula): A laser frenectomy is an ideal treatment option for children who are tongue tied (restricted or tight frenulum) and babies unable to breast feed adequately due to limited tongue movement. A laser frenectomy may also help to eliminate speech impediments.
• Soft Tissue Folds (Epulis): Dental lasers may be used for the painless and suture-free removal of soft tissue folds often caused by ill-fitting dentures.

Other Laser Dentistry Applications

• Viewing Tooth and Gum Tissues: Optical Coherence Tomography is a safer way to see inside tooth and gums in real time.
• Benign Tumors: Dental lasers may be used for the painless and suture-free removal of benign tumors from the gums, palate, sides of cheeks and lips.
• Cold Sores: Low intensity dental lasers reduce pain associated with cold sores and minimize healing time.
• Nerve Regeneration: Photobiomodulation can be used to regenerate damaged nerves, blood vessels and scars.
• Sleep Apnea: In cases where sleep apnea is a result of a tissue overgrowth in areas of the throat (which sometimes occurs with age), a laser assisted uvuloplasty or laser assisted uvula palatoplasty (LAUP) procedure can be performed to reshape the throat and relieve the correlating breathing problems associated with sleep apnea.
• Teeth Whitening: Low intensity soft tissue dental lasers may be used to speed up the bleaching process associated with teeth whitening.
• Temporomandibular Joint Treatment: Dental lasers may be used to quickly reduce pain and inflammation of the temporomandibular jaw joint.

• Advantages of dental bonding:
  Esthetics is the big advantage over silver fillings. As silver does not stick to teeth, entirely healthy tooth structure is usually removed to keep a silver filling in place. Composites permit your cosmetic dentist to remove only the decayed area of your tooth. Unlike silver fillings, composite bonding expand just like your teeth and are much less likely to cause cracks in your tooth. Composites bond directly to the tooth providing support. Composites can be used to fill in cracks, chips and gaps - and will match the color of your other teeth.
• Disadvantages of the dental bonding procedures:
  Bonding with composites simply costs more in material and time.

• Removable partial dentures are for patients who are missing some of their teeth on a particular arch.
• Fixed partial dentures, better known as permanent bridges, are made from crowns that are fitted on the remaining teeth to act as abutments and pontics made from materials to resemble the missing teeth. Fixed bridges are more expensive than removable appliances but are more stable. One type of fixed bridge, a cantilever bridge uses only a tooth or teeth to support the entire bridge and should be used only when the span is not more than the supporting teeth.
• Conversely, complete dentures or full dentures are worn in patients who are missing all their teeth in an arch (i.e the maxillary or mandibular arch).

• Surgical planning
  Prior to commencement of surgery, careful and detailed planning is required to identify vital structures such as the inferior alveolar nerve or the sinus and to properly orientate the implants for the most predictable outcome. Two dimensional radiographs, such as orthopantomographs or periapicals are taken prior to the surgery.
• Basic procedure In its most basic form the placement of an implant requires a preparation into the bone using either hand osteotomes or precision drills with highly regulated speed [16] to prevent burning or pressure necrosis of the bone. After a variable amount of time to allow the bone to grow onto the surface of the implant (osseointegration) a tooth or teeth can be placed on the implant. The amount of time required to place an implant will vary depending on the experience of the practitioner and difficulty of the individual situation.
• Surgical incisions Traditionally, an incision is made over the crest of the site where the implant is to be placed. This is referred to as a 'flap'. Some systems allow for 'flapless' surgery where a piece of mucosa is punched-out from over the implant site. Proponents of 'flapless' surgery believe that it decreases recovery time while its detractors believe it increases complication rates because the edge of bone cannot be visualized. Because of these visualization problems flapless surgery is often carried out using a surgical guide constructed following computerized 3D planning of a pre-operative CT scan.

Considerations

For dental implant procedure to work, there must be enough bone in the jaw, and the bone has to be strong enough to hold and support the implant. If there is not enough bone, more may need to be added with a bone graft procedure discussed earlier. Sometimes, this procedure is called bone augmentation. In addition, natural teeth and supporting tissues near where the implant will be placed must be in good health.

Success rates

Dental implant success is related to operator skill, quality and quantity of the bone available at the site, and also to the patient's oral hygiene. The general consensus of opinion is that implants carry a success rate of around 95%.

• Teeth grinding or clenching, which may be loud enough to wake your sleep partner
• Teeth that are worn down, flattened or chipped
• Worn tooth enamel, exposing the inside of your tooth
• Increased tooth sensitivity
• Jaw pain or tightness in your jaw muscles
• Ear ache — because of violent jaw muscle contractions, not a problem with your ear
• Dull morning headache
• Chronic facial pain
• Chewed tissue on the inside of your cheek

Causes

In some adults, abnormal alignment of upper and lower teeth (malocclusion) may contribute to the problem.
More often, psychological factors cause bruxism, including:

• Anxiety, stress or tension
• Suppressed anger or frustration
• Aggressive, competitive or hyperactive personality type

In children, bruxism may be related to growth and development. Some researchers think children brux because their top and bottom teeth don't fit together comfortably. Others believe that children grind their teeth because of tension, anger, allergy problems, or as a response to pain from an earache or teething. Bruxism occurs in up to 30 percent of children, often around the ages of 5 and 6. It's particularly common in children with cerebral palsy or severe mental retardation. But most children outgrow bruxism before they get their adult teeth. In some cases, bruxism isn't caused by stress or dental problems. It can be a complication of another disorder, such as Huntington's disease or Parkinson's disease. It can also be an uncommon side effect of some psychiatric medications including antidepressants.

Risk factors

These factors increase your risk of bruxism:
Stress. Increased anxiety or stress can lead to teeth grinding. So can anger and frustration. Bruxism is common in young children, but usually goes away by age 10. In adults, the condition is common between the late teen years and the 40s. It tends to decrease with older age.
Caffeine, nicotine and other drugs. Using caffeine, tobacco, cocaine or amphetamines seems to increase the risk of bruxism.

When to seek medical advice

Because bruxism often goes unnoticed, be aware of its signs and symptoms. See your doctor or dentist if you have worn teeth or pain in your jaw, face or ear. Also consult your doctor or dentist if your bed partner complains that you make a grinding noise while you sleep.
If you notice that your child is grinding his or her teeth — or has other signs or symptoms of this condition — be sure to mention it at your child's next dentist appointment.

Complications

In most cases, bruxism doesn't cause serious complications. But severe bruxism may lead to:

• Damage to your teeth or jaw
• Tension-type headaches
• Facial pain
• Temporomandibular disorders — which occur in the temporomandibular joints (TMJs), located just in front of your ears and felt when opening and closing your mouth

Treatment

In many cases, no treatment is necessary. Many kids outgrow bruxism without special treatment, and many adults don't brux badly enough to require therapy. However, if the problem is severe, treatment options include:

Stress management: If you grind your teeth because of stress, you may be able to prevent the problem with professional counseling or strategies that promote relaxation, such as exercise and meditation. If your child grinds his or her teeth because of tension or fear, it may help to talk about your child's fears just before bed or to help your child relax with a warm bath or a favorite book.

Dental approaches: If you or your child has bruxism, your doctor may suggest a mouth guard or protective dental appliance (splint) to prevent damage to your teeth. Your dentist can make a custom mouth guard to fit your mouth.

Behavior therapy: Once you discover that you have bruxism, you may be able to change the behavior by practicing proper mouth and jaw position. Concentrate on resting your tongue upward with your teeth apart and your lips closed. This should keep your teeth from grinding and your jaw from clenching.

Medications: In general, medications aren't very effective for treatment of bruxism. If you develop bruxism as a side effect of an antidepressant medication, your doctor may change your medication or prescribe another medication to counteract your bruxism. Botulinum toxin (Botox) injections may help some people with severe bruxism that hasn't responded to other treatments.

Self-care

These self-care steps may prevent or help treat bruxism:

• Limit alcohol, tobacco and caffeine. Cutting down on your daily intake of alcohol, tobacco and caffeine — or giving up these substances entirely — may help, because they seem to make bruxism worse.
• Reduce stress. Keeping your life stresses to a minimum can reduce your risk of developing bruxism. The less anxiety and tension you feel, the better chance you have of avoiding bruxism.
• Consult your sleep partner. If you have a roommate or bed partner, ask him or her to be aware of any grinding or clicking sounds that you might make while sleeping. Your sleep partner can then let you know if he or she notices any teeth-grinding sounds in the night.
• Have regular dental exams. Dental exams are the best way to screen against bruxism, especially if you live alone or don't have a sleep partner who can observe bruxism at night.

Advantages

• Durability – lasts at least 10 to 15 years, usually longer; doesn't corrode
• Strength – can withstand chewing forces
• 3. Aesthetics – some patients find gold more pleasing to the eye than silver, amalgam fillings

Disadvantages

• Expense – more than other materials; up to 10 times higher than cost of amalgam filings
• Additional office visits – requires at least two office visits to place
• Galvanic shock – a gold filling placed immediately next to a silver, amalgam filling can cause a sharp pain (galvanic shock) to occur. The interaction between the metals and saliva causes an electric current to occur – it's a rare occurrence, however
• Aesthetics – most patients don't find any "colored" fillings to be an "eye-pleasing" advantage

Silver-fillings (Amalgams)

Advantages

• Durability – lasts at least 10 to 15 years and usually outlasts composite fillings
• Strength – can withstand chewing forces
• Expense – is less expensive than composite fillings

Disadvantages

• Poor aesthetics – fillings don't match the color of your natural teeth
• Destruction of more tooth structure – healthy parts of the tooth must often be removed to make a space large enough to hold the amalgam filling
• Discoloration – amalgam fillings can create a grayish hue to the surrounding tooth structure
• Cracks and fractures – although all teeth expand and contract in the presence of hot and cold liquids, which ultimately can cause the tooth to crack or fracture, amalgam material – in comparison with other filling materials–may experience a wider degree of expansion and contraction and lead to a higher incidence of cracks and fractures
• Allergic reactions – a small percentage of people, approximately 1%, are allergic to the mercury present in amalgam restorations

Tooth-colored composite fillings

Advantages

• Aesthetics – the shade/color of the composites can be closely matched to the color of existing teeth; is particularly well suited for use in front teeth or visible parts of teeth
• Bonding to tooth structure – composite fillings actually chemically bond to tooth structure, providing further support to the tooth
• Versatility in uses – in addition to use as a filling material for decay, composite fillings can also be used to repair chipped, broken or worn teeth
• Tooth-sparing preparation – sometimes less tooth structure needs to be removed compared with amalgams when removing decay and preparing for the filling

Disadvantages

• Lack of durability – composite fillings wear out sooner than amalgams (lasting at least 5 years compared with at least 10 to 15 for amalgams); in addition, they may not last as long as amalgams under the pressure of chewing and particularly if used as the filling material for large cavities
• Increased chair time – because of the process to apply the composite material, these fillings can take up to 20 minutes longer than amalgams to place
• Additional visits – if composites are used for inlays or onlays, more than one office visit may be required
• Chipping – depending on location, composite materials can chip off the tooth
• Expense – composite fillings can cost up to twice the cost of amalgams

In addition to tooth-colored, composite resin fillings, two other tooth-colored fillings exist–ceramics and glass ionomer.

Other

• Ceramics, which are made most often of porcelain, are more resistant to staining than composite resin material but are also more abrasive. This material generally lasts more than 15 years and can cost as much as gold.
• Glass ionomer is made of acrylic and a specific type of glass material. This material is most commonly used for fillings below the gum line and for fillings in young children (drilling is still required). Glass ionomers release fluoride, which can help protect the tooth from further decay. However, this material is weaker than composite resin and is more susceptible to wear and prone to fracture. Glass ionomer generally lasts 5 years or less with costs comparable to composite resin.

What Are Indirect Fillings?

Indirect fillings are similar to composite or tooth-colored fillings except that they are made in a dental laboratory and require two visits before being placed. Indirect fillings are considered when not enough tooth structure remains to support a filling but the tooth is not so severely damaged that it needs a crown.

During the first visit, decay or an old filling is removed. An impression is taken to record the shape of the tooth being repaired and the teeth around it. The impression is sent to a dental laboratory that will make the indirect filling. A temporary filling (described below) is placed to protect the tooth while your restoration is being made. During the second visit, the temporary filling is removed, and the dentist will check the fit of the indirect restoration. Provided the fit is acceptable, it will be permanently cemented into place

There are two types of indirect fillings – inlays and onlays.

• Inlays are similar to fillings but the entire work lies within the cusps (bumps) on the chewing surface of the tooth.
• Onlays are more extensive than inlays, covering one or more cusps. Onlays are sometimes called partial crowns.

Inlays and onlays are more durable and last much longer than traditional fillings – up to 30 years. They can be made of tooth-colored composite resin, porcelain or gold. Inlays and onlays weaken the tooth structure, but do so to a much lower extent than traditional fillings.

What's a Temporary Filling and Why Would I Need One?

Temporary fillings are used under the following circumstances:

• For fillings that require more than one appointment – for example, before placement of gold fillings and for certain filling procedures (called indirect fillings) that use composite materials
• Following a root canal
• To allow a tooth's nerve to "settle down" if the pulp became irritated
• If emergency dental treatment is needed (such as to address a toothache)

Temporary fillings are just that; they are not meant to last. They usually fall out, fracture, or wear out within 1 month. Be sure to contact your dentist to have your temporary filling replaced with a permanent one. If you don't, your tooth could become infected or you could have other complications.

• Gum disease: Most people are aware of the pain experienced during the eruption of these teeth. This generally happens because these partly erupted teeth are difficult to keep clean, and the accumulated food particles cause the gums around the tooth to get infected. Such an infection is felt as swelling and pain around the area. Sometimes the tooth is trying to erupt, but has not yet broken through the gums. When the upper tooth bites down onto this gum, pain can be caused.
• Impacted: It sometimes happens that there is not enough space in the mouth for these teeth to erupt. In such cases they may try to erupt in an abnormal direction, or may get locked into the jaw. This locking is known as impaction.
• Decay: A wisdom tooth may decay unnoticed, as they are the most difficult teeth to keep clean, being so far back into the mouth.
• Crowding: An impacted or erupting wisdom tooth can push on adjacent teeth, causing them to become crooked or even damaging them structurally.
• Cyst: If the sac that holds the crown of the wisdom tooth remains in the bone, it can fill with fluid, forming a cyst that can destroy surrounding bone.

Types of Tooth Bonding Procedures

There are two types of bonding. What type is indicated in your situation depends upon whether you have a small area or a larger area that requires correction.

The picture above shows an impacted wisdom tooth. The swollen gums are depicted in red, while the decayed portions are shown in black. It also shows the erupting wisdom tooth putting pressure on the adjacent tooth in front, which if allowed to continue for a longer time, could result in crowding. The position of the wisdom tooth also makes it difficult to keep that area clean, leading to decay and gum infection.

Your dental evaluation will consist of oral examination and x-rays. Your dentist may also need to know your medical history, as extraction of an impacted tooth usually is a minor surgical procedure. But the surgery is a minor one and the patient is back to work in a day or two. The x-rays show the type of impaction and thus helps the dentist plan your treatment.

Positions of Impaction:

Due to unavailability of space in the jaws, the impacted wisdom teeth grow in many different directions, commonly at an angle. The complexity of surgery depends on the type of impaction, as explained below.

A wisdom tooth may grow at an angle towards your other teeth. This type of impaction is called as a Mesio-angular impaction.

A wisdom tooth which erupts at an angle away from your other teeth is said to be Disto-angularly impacted.

A wisdom tooth facing your other teeth horizontally is said to be Horizontally impacted.

A tooth which is in normal direction but still unable to erupt due to lack of space is said to be Vertically impacted.

Once your wisdom teeth have been removed, you can take steps to keep your mouth healthy. Floss and brush daily to ward off tooth decay and gum disease, and make sure you get regular dental checkups.

The Cause - There are many reasons for irregular teeth:

• Heredity
• Thumb-sucking
• Lip and tongue habits
• Mouth breathing, nail biting, etc.
• Incompetent lips
• Injury / accidents

Why Teeth Sometimes Need to be Extracted

In cases of severe crowding of teeth, there may not be any space available to align the teeth. Then it becomes necessary to extract some teeth to create enough space for the other teeth to get aligned correctly.

Whether Spaces created by Extracting Teeth will get filled

As the teeth are moved for aligning them correctly, they move into the spaces created by the extraction. Hence the spaces created by extraction are completely filled once the teeth are aligned.

Will Teeth Move Back to their Original Positions after Treatment

About 15-20% relapse is bound to occur over a period of time. Hence Orthodontists sometimes over-correct the alignment, anticipating the rebound. This can be minimized by following the instructions given to the patient during the maintenance phase of treatment.

The Treatment

This is commonly done by fixing braces to your teeth and using a thin guiding wire to straighten them out. The treatment does involve a certain amount of pain, which may be mild to moderate and lasts for upto a week after treatment begins. After that there is generally no pain. However, each time the wire is adjusted or changed, expect to have some pain.

You will be required to eat soft food, food that is cut into small pieces, or well-cooked. Anything sticky or hard is best avoided during treatment.

Brushing will require an extra effort on your part. You may use a soft brush twice a day in gentle circular motions, making sure to dislodge any accumulated food particles and plaque.

Another area of concern is sports. Be careful to take care of your braces during any sporting activity to prevent damage to teeth and lips.

Having undergone treatment, get ready to receive compliments on your new look!

Fillings can help save your teeth! Although some might dread the experience of a dentist repairing the decay caused by a cavity, fillings are a modern marvel. Without dental fillings, we would be left to live through the pain of a dieing tooth as well as the eventual extraction of that tooth.
Cavities begin with the decay of the hard-mineralized outer layer of the tooth (enamel). Cavities progress as the decay reaches the more sensitive areas of the tooth (first the cementum then the dentin and finally the dental pulp). After the cavity has decayed to the dental pulp the tooth can and will eventually die, leading to root canal treatment.

Microabrasion is a method that can be used to remove the stain and surface discoloration from your teeth. It uses a pressurised stream of a non-toxic aluminium oxide powder to rapidly remove the surface marks. This method does not require a local anaesthetic.

• Cosmetic Reshaping of Gums -- The laser can actually adjust the gum line and improve your smile.
• Gum Disease Treatment -- Removes diseased tissue and as an added benefit of gum reshaping, allows you better access to the gum for improved oral hygiene.
• Reduction of Hyperplastic Tissue -- Patients who wear dental braces, or are taking certain medicines, are prone to the overgrowth of gum tissue.
• Access to Gum-Covered Decay -- In elderly patients, the gums can grow over decayed teeth.

If the cleft does not affect the palate structure of the mouth it is referred to as cleft lip. Cleft lip is formed in the top of the lip as either a small gap or an indentation in the lip (partial or incomplete cleft) or it continues into the nose (complete cleft). Lip cleft can occur as a one sided (unilateral) or two sided (bilateral). It is due to the failure of fusion of the maxillary and medial nasal processes (formation of the primary palate).

Unilateral incomplete

Unilateral incomplete

Unilateral incomplete

3 month old boy before going into surgery to have his unilateral incomplete cleft lip repaired.

The same boy, 1 month after the surgery.

Again the same boy, 18 months old. Note how the scar gets less visible with age.

6 month old girl before going into surgery to have her unilateral complete cleft lip repaired.

The same girl, 1 month after the surgery.

Again the same girl, age 5 years old. Note how the scar gets less visible with age.

Incomplete cleft palate

Unilateral complete lip and palate.

Bilateral complete lip and palate

The blue lines indicate incisions.

Movement of the flaps; flap A is moved between B and C. C is rotated slightly while B is pushed down.

Pre-operation

Post-operation, the lip is swollen from surgery and will get a more natural look within a couple of weeks. See photos in the section above.

Cleft palate treatment

A baby being fed using a customized bottle. The upright sitting position allows gravity to help the baby swallow the milk more easily
Cleft may cause problems with feeding, ear disease, speech and socialization.

• Swollen gums
• Mouth sores
• Bright-red, or purple gums
• Shiny gums
• Swollen gums that emit pus
• Severe oral odor
• Gums that are tender, or painful to the touch.
• Gums that bleed easily, even with gentle brushing, and especially when flossing.
• Gums that itch with varying degrees of severity.

Prevention

Gingivitis can be prevented through regular oral hygiene that includes daily brushing and flossing. Mouthwash is optional, usually using a saline solution (water and salt) or chlorhexidine

Complications

• Recurrence of gingivitis
• Periodontitis
• Infection or abscess of the gingiva or the jaw bones
• Trench mouth (bacterial infection and ulceration of the gums)

• Headaches / migraines
• Facial pain
• Back, neck and shoulder pain
• Tinnitus (Ringing in the ears)
• Vertigo (dizziness)
• Trigeminal neuralgia (Tic douloureux), a neuropathic pain disorder unrelated to TMD
• Bell's Palsy, a nerve disorder unrelated to TMD
• Sensitive and sore teeth
• Jaw pain
• Limited jaw movement or locking jaw
• Numbness in the fingers and arms (related to the cervical musculature and nerves, not to TMD)
• Worn or cracked teeth
• Clicking or popping in the jaw joints
• Jaw Joint pain
• Clenching/bruxing
• Tender sensitive teeth
• A limited opening or inability to open the mouth comfortably
• Deviation of the jaw to one side
• The jaw locking open or closed
• Postural problems (forward head posture)
• Pain in the joint(s) or face when opening or closing the mouth, yawning, or chewing
• Pain in the muscles surrounding the temporomandibular joints
• Pain in the occipital (back), temporal (side), frontal (front), or infra-orbital (below the eyes) portions of the head
• Pain behind the eyes
• Swelling on the side of the face and/or mouth
• A bite that feels uncomfortable, "off," or as if it is continually changing
• Older Bells palsy

• Whitening, or "tooth bleaching", is the most common cosmetic dental procedure. While many whitening options are now available, dentist-supervised treatments remain the recommended procedures for lightening discolored teeth.[citation needed]
• Enamel shaping removes parts of the contouring enamel to improve the appearance of the tooth. It may be used to correct a very small chip. The removed enamel is irreplaceable, and may sometimes expose dentin. It is also known as enameloplasty, odontoplasty, recontouring, reshaping, slenderizing and stripping.
• Contouring, also known as tooth reshaping, is one of few instant treatments now available in cosmetic dentistry. Dental reshaping and contouring is a procedure to correct crooked teeth, chipped teeth, cracked teeth or even overlapping teeth in just one session. The dental contouring procedure can even be a substitute for braces under certain circumstances. It is also a procedure of subtle changes. A few millimeters of reduction and a few millimeters of tooth-colored laminate is involved. Tooth reshaping, or dental contouring, is commonly used to alter the length, shape or position of teeth.[citation needed]
• Bonding is a process in which an enamel-like dental composite material is applied to a tooth's surface, sculpted into shape, hardened and then polished.
• Dental bridges are false teeth, known as a pontics, which are fused between two porcelain crowns to fill in the area left by a missing tooth. The two crowns holding it in place that are attached onto your teeth on each side of the false tooth. This is known as a fixed bridge. This procedure is used to replace one or more missing teeth. Fixed bridges cannot be taken out of your mouth as you might do with removable partial dentures. In areas of your mouth that are under less stress, such as your front teeth, a cantilever bridge may be used. Cantilever bridges are used when there are teeth on only one side of the open space. Bridges can reduce your risk of gum disease, help correct some bite issues and even improve your speech. Bridges require your commitment to serious oral hygiene, but will last as many ten years or more.
• Veneers are ultra-thin, custom-made laminates that are bonded directly to the teeth. They are an option for closing gaps or disguising discolored teeth that do not respond well to whitening procedures.
• Gum lift is a cosmetic dental procedure that raises and sculpts the gum line. The procedure involves reshaping the tissue and/or underlying bones to create the appearance of longer or more symmetrical teeth. >

• Spontaneous pain or throbbing.
• Pain while biting or chewing.
• Sensitivity to hot and cold.
• Severe decay or injury that causes an abscess (infection) in the bone surrounding the tooth.

Treatment Procedure

Step 1
After the tooth is anesthetized, an opening is made through the crown into the pulp chamber.

Step 2
The lengths of the roots' canals are determined.

Step 3
Unhealthy pulp is removed. Canals are cleaned, enlarged and shaped using progressively larger endodontic files.

Step 4
Canals are filled and sealed. A metal post may be added for structural support or to retain restorative materials.

Step 5
The tooth is sealed with a tempory filling. Usually a gold or porcelain crown adds further protection.

A dental malocclusion occurs when the teeth are not lined up properly as they are crooked, crowded and/or turned. In this your bite is otherwise fine due to the jaws being properly aligned, your top teeth line up with your bottom teeth.

Skeletal malocclusion Class III Malocclusion

A skeletal malocclusion where your lower jaw protrudes. Your lower teeth stick out past your upper teeth. This is also called an "underbite".

Proper Occlusion

A beautiful smile where all of your teeth are straight and your top teeth line up with your bottom teeth.

Causes

A common cause of malocclusion is disproportion between jaw size and tooth size or between the size of the upper and lower jaws. These differences can result in the overcrowding of teeth and in an abnormal bite. Another cause is loss of one or more teeth: When a tooth is lost, nearby teeth tend to drift into the newly available space, moving them out of alignment. If missing permanent teeth are not replaced with implants, a bridge, or a partial denture, the adjacent teeth can "tip" into the empty space and the opposing teeth can "super-erupt" meaning they grow longer than is natural. Malocclusion may have a hereditary component.

Bad Habits

The teeth are not as fixed in place as one might think! A strong, constant breeze can cause a tree to grow at an angle, instead of allowing straight and upright growth. The few bad habits or repetitive forces on your teeth can also cause them to become "out of alignment."

• Thumbsucking can lead to an Open Bite.
• Tongue thrusting (pushing your tongue against the back of your teeth) can slowly, but surely, move your teeth out of alignment.
• Fingernail biting, or habitually biting or chewing on most objects, due to psychological reasons can cause worn teeth.
• Mouth breathing: Breathing primarily through your mouth instead of your nose habitually or prolonged, unattended nasal problems can dry out the tissues of your mouth leading to swollen and irritated gums. Also, the unnatural jaw alignment of mouth breathing creates and imbalance that can lead to a malocclusion.

Grinding Teeth (Bruxism)

Severe cases of grinding teeth (bruxism) can also change the occlusion. Most people who grind their teeth do so in their sleep and therefore may be quite unaware of the growing problem. The muscles that move the jaw are very powerful and can do major damage to the teeth when the biting surfaces don't fit together properly. This can lead to even more severe wear or it may crack off a cusp or split the tooth or create a microscopic chipping away close to the gum line to form a deep groove in the tooth. This is called an abfraction.

Missing Teeth

Another cause is loss of one or more teeth: When primary (baby) teeth that are prematurely lost due to decay or injury, nearby teeth tend to drift into the newly available space, moving them out of alignment. Less common causes of malocclusion include misalignment of a jaw fracture, tumors of the mouth or jaw, etc. and improper fitting of crowns, fillings, retainers, or braces.

Correcting a malocclusion

Of course, more than one of the above factors may be involved, so it is important to obtain a professional evaluation. Left untreated, a malocclusion not only affects the patient's appearance, it can also lead to TMJ problems and an increased risk of decay and gum disease. Occasionally, when an orthodontic appliance alone is not sufficient, jaw surgery may be necessary. Other methods of treating malocclusion include selective grinding of some teeth or building them up with the use of crowns or other dental restorations.

The specialists on our panel will evaluate each individual case to determine the best course of action to prevent or cure the malocclusion. Visit our Orthodontics and Braces pages to learn more about how early detection of malocclusions in children and the use of arch expanders can reduce and sometimes eliminate the need for braces!

This is about cancers that occur in the mouth (oral cavity) and the part of the throat at the back of the mouth (oropharynx). The oral cavity and oropharynx have many parts:

• Lips
• Lining of your cheeks
• Salivary glands (glands that make saliva)
• Roof of your mouth (hard palate)
• Back of your mouth (soft palate and uvula)
• Floor of your mouth (area under the tongue)
• Gums and teeth
• Tongue
• Tonsils

This picture shows the parts of the mouth and throat.

This picture shows the area under the tongue.

Oral cancer is part of a group of cancers called head and neck cancers. Oral cancer can develop in any part of the oral cavity or oropharynx. Most oral cancers begin in the tongue and in the floor of the mouth. Almost all oral cancers begin in the flat cells (squamous cells) that cover the surfaces of the mouth, tongue, and lips. These cancers are called squamous cell carcinomas.

When oral cancer spreads (metastasizes), it usually travels through the lymphatic system. Cancer cells that enter the lymphatic system are carried along by lymph, a clear, watery fluid. The cancer cells often appear first in nearby lymph nodes in the neck.

Cancer cells can also spread to other parts of the neck, the lungs, and other parts of the body. When this happens, the new tumor has the same kind of abnormal cells as the primary tumor.

Oral Cancer: Who's at Risk?

Doctors cannot always explain why one person develops oral cancer and another does not. However, we do know that this disease is not contagious. You cannot "catch" oral cancer from another person.
Research has shown that people with certain risk factors are more likely than others to develop oral cancer. A risk factor is anything that increases your chance of developing a disease.

The following are risk factors for oral cancer:

• Tobacco: Tobacco use accounts for most oral cancers. Smoking cigarettes, cigars, or pipes; using chewing tobacco; and dipping snuff are all linked to oral cancer. The use of other tobacco products (such as bidis and kreteks) may also increase the risk of oral cancer. Heavy smokers who use tobacco for a long time are most at risk. The risk is even higher for tobacco users who drink alcohol heavily. In fact, three out of four oral cancers occur in people who use alcohol, tobacco, or both alcohol and tobacco.
• Alcohol: People who drink alcohol are more likely to develop oral cancer than people who don't drink. The risk increases with the amount of alcohol that a person consumes. The risk increases even more if the person both drinks alcohol and uses tobacco.
• Sun: Cancer of the lip can be caused by exposure to the sun. Using a lotion or lip balm that has a sunscreen can reduce the risk. Wearing a hat with a brim can also block the sun's harmful rays. The risk of cancer of the lip increases if the person also smokes.
• A personal history of head and neck cancer: People who have had head and neck cancer are at increased risk of developing another primary head and neck cancer. Smoking increases this risk.

Early Detection

Your regular checkup is a good time for your dentist or doctor to check your entire mouth for signs of cancer. Regular checkups can detect the early stages of oral cancer or conditions that may lead to oral cancer. Ask your doctor or dentist about checking the tissues in your mouth as part of your routine exam.

Symptoms

• Patches inside your mouth or on your lips that are white, a mixture of red and white, or red.
• White patches (leukoplakia) are the most common. White patches sometimes become malignant.
• Mixed red and white patches (erythroleukoplakia) are more likely than white patches to become malignant.
• Red patches (erythroplakia) are brightly colored, smooth areas that often become malignant.
• A sore on your lip or in your mouth that won't heal
• Bleeding in your mouth
• Loose teeth
• Difficulty or pain when swallowing
• Difficulty wearing dentures
• A lump in your neck
• An earache

Anyone with these symptoms should see a doctor or dentist so that any problem can be diagnosed and treated as early as possible. Most often, these symptoms do not mean cancer. An infection or another problem can cause the same symptoms

Diagnosis

If you have symptoms that suggest oral cancer, the doctor or dentist checks your mouth and throat for red or white patches, lumps, swelling, or other problems. This exam includes looking carefully at the roof of the mouth, back of the throat, and insides of the cheeks and lips. The doctor or dentist also gently pulls out your tongue so it can be checked on the sides and underneath. The floor of your mouth and lymph nodes in your neck also are checked.
If an exam shows an abnormal area, a small sample of tissue may be removed. Removing tissue to look for cancer cells is called a biopsy. Usually, a biopsy is done with local anesthesia. Sometimes, it is done under general anesthesia. A pathologist then looks at the tissue under a microscope to check for cancer cells. A biopsy is the only sure way to know if the abnormal area is cancerous. If an exam shows an abnormal area, a small sample of tissue may be removed. Removing tissue to look for cancer cells is called a biopsy. Usually, a biopsy is done with local anesthesia. Sometimes, it is done under general anesthesia. A pathologist then looks at the tissue under a microscope to check for cancer cells. A biopsy is the only sure way to know if the abnormal area is cancerous.

Treatment

Many people with oral cancer want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and your treatment choices. However, shock and stress after the diagnosis can make it hard to think of everything you want to ask the doctor. It often helps to make a list of questions before an appointment. To help remember what the doctor says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to the doctor—to take part in the discussion, to take notes, or just to listen.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat oral cancer include oral and maxillofacial surgeons, otolaryngologists (ear, nose, and throat doctors), medical oncologists, radiation oncologists, and plastic surgeons. You may be referred to a team that includes specialists in surgery, radiation therapy, or chemotherapy. Other health care professionals who may work with the specialists as a team include a dentist, speech pathologist, nutritionist, and mental health counselor.

Getting a Second Opinion

Before starting treatment, you might want a second opinion about the diagnosis and the treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if you or your doctor requests it.

Methods of Treatment

Oral cancer treatment may include surgery, radiation therapy, or chemotherapy. Some patients have a combination of treatments.

At any stage of disease, people with oral cancer may have treatment to control pain and other symptoms, to relieve the side effects of therapy, and to ease emotional and practical problems. This kind of treatment is called supportive care, symptom management, or palliative care.

Surgery

Surgery to remove the tumor in the mouth or throat is a common treatment for oral cancer. Sometimes the surgeon also removes lymph nodes in the neck. Other tissues in the mouth and neck may be removed as well. Patients may have surgery alone or in combination with radiation therapy.

Radiation Therapy

Radiation therapy (also called radiotherapy) is a type of local therapy. It affects cells only in the treated area. Radiation therapy is used alone for small tumors or for patients who cannot have surgery. It may be used before surgery to kill cancer cells and shrink the tumor. It also may be used after surgery to destroy cancer cells that may remain in the area.

Radiation therapy uses high-energy rays to kill cancer cells. Doctors use two types of radiation therapy to treat oral cancer:

• External radiation: The radiation comes from a machine. Patients go to the hospital or clinic once or twice a day, generally 5 days a week for several weeks.
• Internal radiation (implant radiation): The radiation comes from radioactive material placed in seeds, needles, or thin plastic tubes put directly in the tissue. The patient stays in the hospital. The implants remain in place for several days. Usually they are removed before the patient goes home.

Chemotherapy

Chemotherapy uses anticancer drugs to kill cancer cells. It is called systemic therapy because it enters the bloodstream and can affect cancer cells throughout the body.

Chemotherapy is usually given by injection. It may be given in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, a hospital stay may be needed.

• In-office bleaching;
• At-home bleaching;
• Whitening toothpastes

How teeth whitening bleach works?

Teeth whitening bleach contains peroxide. Dentists use bleach that contains higher levels of peroxide to make your teeth whiter. In office bleaching done by a dentist on your teeth, at the most will take 2-3 hours. If you are undergoing laser teeth whitening bleach procedure, this is even more effective for lightening the stain in your teeth.

Teeth whitening bleach designed to be used at home, requires the person to wear trays filled with the bleaching agent. The individual may be required to wear the tray for a considerable length of time. The entire process can turn out to be very messy and time consuming as well. In office whitening procedure is the best bet for anyone who wants to have shining white teeth.

Bleaching

What is Tooth Whitening?

Tooth Whitening is actually a mild bleaching process that restores stained or discolored teeth to a healthy, natural color. Don't be misled by unproven and ineffective over-the-counter whitening solutions. Our office uses an advanced procedure that is only available from your dentist.

What Causes Tooth Discoloration?

Teeth become discolored for different reasons:

• Frequently drinking coffee, tea, or colas.
• Some antibiotics may darken developing teeth in children.
• Aging - The dentin underneath the enamel of a tooth gradually darkens
• Use of tobacco products.
• Accidents - If a tooth has been traumatized, sometimes the nerve will gradually "die," and the tooth becomes dark.
• After Root Canal Therapy, a tooth will generally darken.

Is Bleaching Safe?

Bleaching is very safe. We use a product that has been proven safe when used under the direction of a dentist.

What Is The At-Home Bleaching Process?

First, we will make impressions of your teeth so that our lab can create custom bleaching trays to fit your mouth. These trays will guide the bleaching agent to the areas of your teeth that need to be bleached. We will record the current color of your teeth to help you monitor your progress.

Next, we will fit your custom trays in your mouth to ensure they feel comfortable. We will instruct you on how to apply the bleaching agent to your trays and how to insert them into your mouth. You will take the custom trays and bleaching agent home with you. Most patients wear the bleaching trays at night while they sleep, but they may be worn during the day since the clear, custom-fitted trays are barely visible and do not interfere with your ability to speak.

When Will I See Results?

Immediately! Most patients see results after the first night. It will typically take from 2 to 6 weeks to restore your teeth to a beautiful white. The time it will take depends on the original color of your teeth, how discolored they were, and how frequently the treatment is applied.

How Long Will The Results Last?

The effects typically last several years. Many patients choose to "touch-up" their teeth every 6 to 12 months by applying the treatment for 1 or 2 nights. "Touch-ups" are especially useful for patients that drink beverages that stain teeth, like coffee, tea, and colas.

Are There Any Side-Effects?

Some patients may experience heightened tooth sensitivity to cold, or mild tooth or gum sensitivity during treatment, but these symptoms are only temporary and disappear within a few days.