Our Dental Services

At Dr. Victor’s Springfield Smiles office, we offer a variety of dental services for the entire family.  We begin with accurate and honest diagnostic services.  We use careful exams, a variety of tests, and when necessary, low dose digital x-rays to identify potential problems.  We can even take intra-oral pictures, which Dr. Victor will go over with you to help you understand what is going on inside your mouth.   In many cases, all that is necessary is regular cleanings or other preventative measures.  When intervention is required, Dr. Victor offers a variety of Restorative and Cosmetic services.

Diagnostic

Dental Exams

image16Dental exams are an important part of proper diagnosis, and include evaluation of both hard and soft tissue inside the mouth.  They include the evaluation of patients’ teeth for cavities and other dental concerns such as fracturing and abrasion.  When necessary, dental x-rays may be a critical part of the diagnostic process.  Be aware that Dr. Victor only takes x-rays that are necessary for proper diagnosis.  Also know that we have implemented low dose rate digital x-rays here at Springfield Smiles.  This allows us to reduce patient radiation exposure by up to 90% compared to traditional film based x-rays.

During cleaning and comprehensive exams, Dr. Victor also thoroughly evaluates the oral cavity for the identification of benign and cancerous lesions   If necessary, appropriate treatments (such as antibiotics, antifungals, biopsies, etc…) may be prescribed.  For more information on common mouth sores such as cankers and cold sores, visit the American Dental Association’s website on mouth sores.

When necessary, Dr. Victor discusses potential restorative and preventative procedures with the patient to ensure they have a thorough understanding of the options, and then together they decide on appropriate treatment.

When is it appropriate to bring in your child for an exam and cleaning?   The ADA recommends regular dental check-ups, including a visit to the dentist within six months of the eruption of the first tooth, and no later than the child’s first birthday. Dr. Victor endorses this policy, and as the child grow, he encourages you to bring your child with you to your exams in order for them to get used to the Dentist’s office.  Dr. Victor offers free exams for children under 5, or until a treatment need is identified, whichever is sooner.

Preventive care such as cleanings and fluoride treatments provide your child with “smile” insurance. Routine dental exams uncover problems that can be treated in the early stages, when damage is minimal and restorations may be small. Our low dose digital dental radiographs (X-rays)  are taken only when necessary, in order to see how the teeth are developing and to spot hidden decay.

Oral Cancer Screenings

image17At Springfield Smiles, we routinely perform oral cancer screenings as a part of our dental examination. Regular check-ups, including an examination of the entire mouth, are essential in the early detection of cancerous and pre-cancerous conditions. Oral Cancer often starts as a tiny, unnoticed white or red spot or sore, and can affect any area of the oral cavity including the lips, gum tissue, cheek lining, tongue and the hard or soft palate.

Other signs can include an unexplained sore that bleeds easily or does not heal within 2 weeks, or a color change of the oral tissues.  It may also present as a pain or numbness anywhere in the mouth or on the lips, or manifest itself as a change in the way the teeth fit together.  Although many of the lesions that present themselves like this are harmless, some are not.   Typically over 30,000 Americans get oral cancers every year, and since early detection of these lesions greatly improves patient outcome, it is important to have your dentist regularly screen for these lesions.

If you notice something different about your mouth and aren’t sure what it is, we encourage you to come see Dr. Victor for an exam.  For more information, visit the American Dental Association’s website on oral cancers.

Cleanings

Prophy

iStock_000010743287_MediumProper oral care begins with a clean mouth.  That’s why the staff here at Springfield Smiles is very meticulous in ensuring that your teeth are as clean as possible.  We remove the plaque and tartar buildup from your teeth, floss them, and polish each tooth.  Plus we are committed to making each patient as comfortable as possible.  We take extra time with children and walk them through each and every step to help ensure they are as relaxed as possible.

When is it appropriate to bring in your child for an exam and cleaning?   The ADA recommends regular dental check-ups, including a visit to the dentist within six months of the eruption of the first tooth, and no later than the child’s first birthday. Dr. Victor endorses this policy, and as the child grow, he encourages you to bring your child with you to your exams in order for them to get used to the Dentist’s office.  Dr. Victor offers free exams for children under 5, or until a treatment need is identified, whichever is sooner.  At Springfield Smiles, we are happy to start cleanings for your child as soon as you and your child are comfortable to do so.

Preventive care such as cleanings and fluoride treatments provide your child with “smile” insurance. Routine dental exams uncover problems that can be treated in the early stages, when damage is minimal and restorations may be small. Our low dose digital dental radiographs (X-rays) are taken only when necessary, in order to see how the teeth are developing and to spot hidden decay.

Scaling and Root Planing

image19Periodontal treatment methods depend upon the type and severity of the disease.  If the disease is caught in the early Gingivitis stage, and no damage has been done, a good professional cleaning and improved daily oral hygiene can typically resolve the issue.

However, in more advanced stages, such as Mild Periodontitis and Advanced Periodontitis, a special cleaning called scaling and root planning is required in order to debride the diseased tissue.  When the plaque and tartar build up goes beyond 3mm (1/8 inch) of the exposed crown of the tooth, it is necessary to perform a deeper cleaning of the root surface.  Scaling and root planing allow us to clean this buildup away from the root surface and reduce the bacterial load in the gingival sulcus (the space between the tooth and the gum tissue).   Once cleaned, the body has a chance to heal, and ideally reduce the depth of the gingival sulcus.  Scaling and root planning is sometimes referred to as “periodontal” or “deep cleaning” and may take more than one visit.

During scaling and root planning, a local anesthetic may be given to reduce any discomfort.  Dr. Victor’s team will use special instruments called scalers and an ultrasonic cleaner to carefully remove plaque and tartar from the periodontal pockets.  The tooth’s root surfaces are then smoothed or “planed”.  Sometimes, special medications may be used in order to help resolve the infection.

At the next visit, Dr. Victor will evaluate the periodontal response to the treatments.  Ideally, the disease progression will have stopped, and pocket depths reduced back to healthy, maintainable levels.  If this is the case, it will be important to continue good daily oral hygiene and regular professional cleanings.

However, in some cases the disease progression will be far enough along that the periodontal pockets remain deep and do not heal completely after scaling and root planing. In these instances, additional procedures such as periodontal surgery may be needed to reduce the pocket depth and make the teeth easier to keep clean.  Surgery allows access to areas that are otherwise inaccessible for the removal of tartar and plaque.  It may also include modification of the diseased tissue or bone grafts in order to reshape or rebuild bone structure destroyed by periodontal disease. In advanced cases like these, Dr. Victor refers his patients to specially trained and board certified Periodontists in order to ensure the best treatment is provided.

For more information, visit our educational page on periodontal disease.

Fillings

Fillings are the most common form of dental restoration for decayed or chipped teeth. Fillings are direct restorations that are placed immediately into a prepared cavity in a single visit. They include Composite (tooth colored) fillingsglass and resin ionomers, and dental amalgam.

Thanks to advances in modern dental materials and techniques, we have more ways to create pleasing, natural-looking smiles. As a result, there are several choices when it comes to selecting materials to repair worn, damaged or decayed teeth. However, these new materials have not eliminated the usefulness of more traditional dental materials, such as gold, base metal alloys and dental amalgam. That’s because the strength and durability of traditional dental materials continue to make them useful for certain situations, such as fillings in the back teeth where chewing forces are greatest.

Composite (Tooth Colored) Fillings

image20Composite fillings are the most esthetic direct restoration filling option, however are not always appropriate for use everywhere.  Composites are a mixture of glass or quartz filler in a resin medium that produces a tooth-colored filling. Composite fillings provide good durability and resistance to fracture in small-to-mid size restorations that need to withstand moderate chewing pressure. Often less tooth structure is removed when preparing the tooth, and this may result in a smaller filling than that of an amalgam. As a result, composites often allow a more conservative repair to the tooth.

However, composite fillings require a cavity that can be kept clean and dry during filling and it should be noted that they are subject to stain and discoloration over time.  Furthermore, studies show that composite fillings do not last as long as traditional dental amalgam fillings, particularly in high stress areas of the mouth such as posterior biting surfaces.

Because of the limitations to the use of composite fillings, some patients consider other restorative measures when necessary.  If esthetics are an issue, options include porcelain inlays and onlays , and crowns.  If esthetics is not a concern, patients often select a less expensive restorative option such as traditional amalgam fillings.

Dr. Victor can discuss the appropriateness of composites and their alternatives with you for each of your restorative needs.

Glass and Resin Ionomers

image21Glass ionomers are translucent, tooth-colored materials made of a mixture of acrylic acids and fine glass powders that are used to fill cavities, particularly those on the root surfaces of teeth. One of the benefits of glass ionomers is that they can release a small amount of fluoride that may be particularly helpful for patients who are at high risk for decay. Like composite fillings, it is often possible to conserve tooth structure by using a glass ionomer filling as compared to amalgam fillings.

However, Glass ionomers have a low resistance to fracture.  Therefore, they are primarily used in areas not subject to heavy chewing pressure, such as  mostly used in small non-load bearing fillings or on the roots of teeth.

Resin ionomers are made from glass filler with acrylic acids and acrylic resin. They also are used for very small, non-load bearing fillings (between the teeth), on the root surfaces of teeth, and they have low to moderate resistance to fracture.

Ionomers experience high wear when placed on chewing surfaces. Both glass and resin ionomers mimic natural tooth color but lack the natural translucency of enamel. Both types are well tolerated by patients with only rare occurrences of allergic response.

Amalgam Fillings

image22When esthetics is not a concern, traditional dental amalgam fillings can be an excellent restorative choice.  Used by dentists for more than a century, it is the most thoroughly researched and tested restorative material among all those in use. It is durable, easy to use, highly resistant to wear and relatively inexpensive in comparison to other materials. For those reasons, it remains a valued treatment option for patients.

Dental amalgam is a stable alloy made by combining elemental mercury, silver, tin, copper and possibly other metallic elements. Although dental amalgam continues to be a safe, commonly used restorative material, some concern has been raised because of its mercury content. However, the mercury in amalgam combines with other metals to render it stable and safe for use in filling teeth.

While questions have arisen about the safety of dental amalgam relating to its mercury content, the major U.S. and international scientific and health bodies, including the National Institutes of Health, the U.S. Public Health Service, the Centers for Disease Control and Prevention, the Food and Drug Administration and the World Health Organization, among others have been satisfied that dental amalgam is a safe, reliable and effective restorative material.

Because amalgam fillings can withstand very high chewing loads, they are particularly useful for restoring molars in the back of the mouth where chewing load is the greatest. They are also useful in areas where a cavity preparation is difficult to keep dry during the filling replacement, such as in deep fillings below the gum line. Amalgam fillings, like other filling materials, are considered biocompatible—they are well tolerated by patients with only rare occurrences of allergic response.

Disadvantages of amalgam include possible short-term sensitivity to hot or cold after the filling is placed. The silver-colored filling is not as natural looking as one that is tooth-colored, especially when the restoration is near the front of the mouth, and may showswhen the patient laughs or speaks. And to prepare the tooth, the dentist may need to remove more tooth structure to accommodate an amalgam filling than for other types of fillings.

Because of the concern about dental amalgams, much of the content of this page came directly from the American Dental Association’s website on amalgam fillings.

Children's Dentistry

At Dr. Victor’s Springfield Smiles, we know how important children are.  Dr. Victor has four wonderful children of his own!  That’s why we take the extra time and effort to make your child comfortable in our office.  We have an area for kids to play in the reception area, and encourage them to come back and observe their parent’s cleanings.

Your child’s first dental exam

image23The ADA recommends regular dental check-ups, including a visit to the dentist within six months of the eruption of the first tooth, and no later than the child’s first birthday. Dr. Victor endorses this policy, and as the child grows, he encourages you to bring your child with you to your exams in order for them to get used to the Dentist’s office.  Dr. Victor offers free exams for children under 5, or until a treatment need is identified, whichever is sooner.

Preventive care such as cleanings and fluoride treatments provide your child with “smile” insurance. Routine dental exams uncover problems that can be treated in the early stages, when damage is minimal and restorations may be small. Our low dose digital dental radiographs (X-rays) are taken only when necessary, in order to see how the teeth are developing and to spot hidden decay.

Teeth Whitening

Coffee, tea, wine, dark foods, and age are the main causes of reversible teeth staining. They can cause everything from a slight yellowing of the teeth to dark spots. For many patients, these stains can be removed or lightened by whitening them, a process often called “bleaching”.

The current methods of whitening teeth include store-bought kits, in-office procedures, and custom-made take home kits. While store-bought whitening kits are popular, they are rarely effective enough to change your smile for longer than a few weeks at a time. Studies indicate that professional strength take-home kits worn as prescribed provide the most sustainable whitening over time. That’s why Dr. Victor recommends custom take home trays and whitening systems.

Some people indicate that they notice tooth and gum sensitivity when using whitening products. However, recent developments have made dramatic improvements in desensitization. Dr. Victor prescribes professional strength Nite White ACP and Day White ACP. Both products contain 3 desensitizers: Potassium Nitrate, Fluoride and Amorphous Calcium Phosphate (ACP). No other whiteners have these 3 leading ingredients.

ACP also provides benefits beyond desensitization. It is a chemical precursor to natural hydroxyapatite minerals that are found in teeth. ACP is clinically proven to rebuild tooth enamel and reduce the fade-back often experienced after a whitening treatment. ACP also adds luster to teeth by filling in tooth-surface defects.

Night White ACP is worn overnight for 10-14 days. Alternatively, Day White ACP has a twice-a-day wear protocol of only 30 minutes.

Talk to Dr. Victor about whether Night White ACP or Day White ACP is appropriate for you.

Crowns

A crown is a tooth-shaped cap placed over a tooth that has been badly damaged or decayed, and is used to protect the tooth from further deterioration.

Crowns may be placed for a number of reasons. Usually the tooth has been broken or damaged a great deal by decay. As a result, a filling alone can’t replace enough of the tooth or make the tooth strong enough. Often times, a crown will be used on top of a root canal treated  tooth in order to give it strength.  A crown can also be used to hold together parts of a cracked tooth with the goal of stopping the crack from progressing. Another use of crowns is where they are used to hold a bridge  in place. Furthermore, crowns can be used to improve appearance as well. They may be placed to cover misshapen or badly discolored teeth.

image24Crowns can be made of various combinations of metals and ceramics.  They can be all ceramic, all metal, or porcelain fused to metal (PFM). The metals used to fabricate crowns include gold alloy, other alloys (palladium) or a base-metal alloy (nickel or chromium). PFM and all-ceramic crowns are fabricated to be the same color as your natural teeth, and they can look just like normal teeth.  Today’s ceramics are far superior to those a few years ago, and make an excellent choice for crown restorations.

In certain situations, prefabricated crowns may be appropriate. Prefabricated crowns are made of plastic or stainless steel. Prefabricated crowns are typically used in pediatric situations, where a short term, low cost alternative can be utilized until the child has completed growing.  In certain situations, they can also be used on a temporary basis until a permanent crown is made.

Preparing the Tooth

Before placing a crown, Dr. Victor ensures there is a firm foundation for it.  This may include x-rays and a special filling called a “crown build-up”. A build-up is needed if large areas of the tooth are decayed, damaged or missing. If you are receiving the crown after root canal treatment, Dr. Victor may also insert a post-and-core as part of this foundation.  The post-and-core provides strength to the tooth by spreading the load out over the root as well as the crown.

image25Once this is done, Dr. Victor will refine the tooth to make room for the new crown. The goal here is to allow the new crown to be the same size as the original tooth.  Once the tooth is prepared, Dr. Victor will make a special impression (copy) of the prepared tooth as well as those around it.  The impression is then sent to a lab, where the crown is made.

Temporary Crowns

Since it may take several weeks for the lab to make the final crown, you will have a temporary crown placed at the time of the crown prep. This temporary crown is made of plastic, and is not as strong as the final crown, so care must be exercised by the patient to not chew hard substances such as ice or nuts. The temporary crown is also seated with temporary cement, which is designed to be weak. This allows us to easily remove the temporary crown when we go to seat your permanent crown.  If by chance the crown comes uncemented, re-seat the crown using toothpaste (this creates a suction to help hold the crown in place) and contact Dr. Victor.

Seating the Permanent Crown

image26At a second visit, Dr. Victor will remove the temporary crown and test the permanent one. Sometimes crowns need additional polishing or glazing or some other adjustment before they are placed. Once the crown is ready, it’s cemented to your tooth, typically with permanent cement.  In certain situations, like when there is a concern that a root canal may be needed in the future, Dr. Victor may seat the crown with temporary cement.

Inlays / Onlays

Inlays and onlays are special types of restorations that combine the conservative aspects of regular fillings with the superior strength and esthetics of crowns.  Both inlays and onlays are considered indirect restorations, in as much as they are fabricated by a lab to Dr. Victor’s specifications.  The difference is that an onlay covers part of the facial or tongue side of the tooth in addition to the more central part, whereas an inlay does not extend as far.

Inlays and onlays are excellent choices when sufficient tooth structure remains to support them. If not, crowns (which cover the entire tooth) are typically better choices. Often, inlays will be considered when a more esthetic restoration is desired for a deep posterior restoration that does not meet the requirements for a composite filling.

Like crowns, inlays and onlays require two visits.  During the first visit, the tooth will be prepared for the inlay/onlay, an impression taken, and a temporary placed.  The impression will then be sent to a dental laboratory, which will fabricate the restoration to Dr. Victor’s specifications.  At the second appointment, the temporary will be removed and the inlay/onlay will be permanently cemented into location.

Talk to Dr. Victor about inlays and onlays as an option for you.

Veneers

image28Veneers are wafer thin porcelain covers that are bonded or cemented onto the front of teeth to create a new cosmetic appearance. If teeth are discolored, worn, slightly chipped or misaligned, a dental veneer inlay could be the next step towards having a picture perfect smile. Thanks to the new technology in cements and bonding agents, porcelain veneers can be firmly bonded to teeth creating a durable and strong restoration. In addition, porcelain veneers are stain resistant, providing a longer lasting white smile that looks and feels natural.

Similar to crowns, it will usually take two visits to get cosmetic porcelain veneers in place. During the first visit, the tooth will be prepared for the veneer, an impression taken, and a temporary placed.  The impression will then be sent to a dental laboratory, which will fabricate the restoration to Dr. Victor’s specifications.  At the second appointment, the temporary will be removed and the veneer will be permanently cemented into location.

image27If well taken care of, veneers can be a long lasting restoration. However, biting hard items, not maintaining good oral hygiene, as well as exposing dental veneers to excessive forces may result in them coming loose or breaking. Although porcelain veneers themselves resist staining, the cement on the edges can still take in stains, so be careful when drinking staining agents and brush and floss properly to help keep this from happening.

Implants

Dental implants are the closest alternative to natural teeth developed so far.  They consist of a metal post that is inserted beneath the gum tissue and into the bone.  Over time, it fuses to the bone in your jaw and acts like the root of a tooth.  Typically a crown is then fabricated to match your existing teeth and is attached to the implant post.   Alternatively, implants can be used to support dentures, in which case a complete denture is fabricated as the final restoration to be attached to the implant posts.

Most patients find that implants are a good replacement for lost teeth.  However, implants are not an option for everyone.  Because implants require surgery, patients should be in good health overall and have healthy gums.  Furthermore, patients either must have adequate bone to support the implant body, or be good candidates for surgery to build up the area needing the implant.

Implant candidates must also be committed to excellent oral hygiene as well.  Some people think that once they have implants, they do not need to worry about their hygiene.  This is not true!  Even though the implant and crown replace a tooth, the bone surrounding the implant is still susceptible to diseases such as peri-implantitis, a disease that affects the implant in much the same way that periodontitis affects natural teeth.

Advantages

Reasons to consider an implant include:

  • Most similar to the look, feel, and function of natural teeth
  • Stops the movement of teeth adjacent to the area associated with the missing toot
  • Adjacent teeth do not have to be involved in the placement procedure
  • Can help prevent the absorption (shrinkage) of the jawbone typically associated with tooth loss
  • Permanently secured into place, so it does not come loose with chewing
  • Cleans the same way as natural teeth

Disadvantages

The disadvantages of implants include:

  • More expensive than removable partial dentures and fixed bridges
  • May not be covered by your insurance
  • Requires the patient to be in good health
  • The implant placement and healing period takes longer and requires more visits than alternatives

Options to Consider

Other options to consider for the restoration of missing teeth include fixed bridges and removable partial dentures

Talk to Dr. Victor to see if implants are a good option for you.

Bridges

image31Bridges are a special series of crowns joined together in order to span the space associated with a missing tooth.  An artificial tooth (called a pontic) replaces the lost natural tooth, and restores its function. This pontic is attached to crowns on either side of it, which serve as retainers to support the fixed bridge.  The fixed bridge is permanently cemented into place, and therefore does not come loose.

Advantages

Reasons to consider a bridge include:

  • Similar look, feel, and function to natural teeth
  • Stops the movement of teeth adjacent to the area associated with the missing tooth
  • Permanently cemented into place, so it does not come loose with chewing
  • No need to remove it from your mouth in order to clean

Disadvantages

The disadvantages of fixed bridges include:

  • More expensive than removable partial dentures
  • Requires significant tooth structure to be removed from the adjacent teeth
  • Harder to clean around than natural teeth (requires a special proxy brush)

Options to Consider

Other options to consider for the restoration of missing teeth include implants and removable partial dentures. Talk to Dr. Victor to see if a fixed bridge is a good option for you.

Root Canals / Endodontics

image32Removing the pulp tissue of a tooth is called endodontic treatment, but it is often referred to as root canal treatment or root canal therapy.  Root canal therapy (RCT) is necessary when the nerve and blood supply to the tooth have been damaged beyond repair.  In healthy teeth the pulp tissue, which includes connective tissue, nerves and blood vessels, nourishes the tooth.  The goal of root canal treatment is to save the tooth by removing the infected or damaged pulp, treating any infection, and filling the empty root canals with a material called gutta percha. When a root canal is necessary, Dr. Victor will refer you to an Endodontist (root canal specialist) for the necessary treatment.

Why are Root Canals Needed?

Root canal treatment is needed for two main reasons, the primary of which is infection. An untreated cavity is a common cause of pulpal infection. The decay erodes the enamel and dentin of the tooth until it reaches a root canal. This allows bacteria to infect the pulp, which becomes a source of irritation and infection until treated.

The second reason for a root canal is damage to the pulp that can’t be fixed. Examples include trauma or a fractured tooth. Sometimes dental work such as fillings or crowns that are close to the pulp can irritate it enough as well.  Then the tooth might need a root canal. However, when the pulp is inflamed but not infected, it may heal on its own. Dr. Victor will exam the tooth and run several tests to see if this might be the case before doing root canal treatment.

Signs and Symptoms

If you have an infection of the pulp, you may not feel any pain at first. But if it is not treated, the infection will cause pain and swelling. In some cases, an abscess will form.

Your tooth might need a root canal if:  

  • It hurts when you bite down on it, touch it or push on it
  • It is sensitive to heat
  • It is sensitive to cold for more than a couple of seconds
  • There is swelling near the tooth
  • It is discolored (whether it hurts or not)
  • It is broken

To determine whether your tooth needs root canal treatment, Dr. Victor will perform several tests to see if it is more or less sensitive than a normal tooth.  Dr. Victor will also take an X-ray to determine if there is a widening of the ligament that holds the tooth in place or a dark spot at the tip of the root, which are signs of infection and inflammation. If either of these is present, you are likely to need a root canal procedure.

What can happen if left untreated?

An infection in the pulp can be very painful, and if left untreated it can spread throughout the body.  Typically the first place infected is the bone around the tooth. The localized infection can cause an abscess, which is an area of pus that forms as part of the body’s effort to fight a bacterial infection. If the abscess does not find a path of drainage, it can cause severe swelling, and may even block off the patient’s airway in a process called Ludwig’s angina.  If such swelling occurs, the patient should seek emergency medical treatment immediately.

An untreated infection of the pulp can also allow the bacteria to spread systemically, allowing it to lodge in other areas of the body, including the brain.

In general, any infection, including dental infections, should not be left untreated.

Alternatives to Root Canals

If you ignore an infected or injured tooth, the infection can spread to other parts of your body, and may even be life threatening. Therefore, it is important to remove the source of infection by either treating the tooth via root canal therapy or extracting  the tooth.

In general, it is better to keep your natural teeth if you can.  If a tooth is missing, neighboring teeth can drift out of line and opposing teeth may super-erupt. Remaining teeth also can be overstressed from chewing. Keeping your natural teeth also helps you to avoid other treatments, such as implants or bridges.

Other options to consider for the restoration of missing teeth include implants, bridges , and removable partial dentures.

Talk to Dr. Victor to determine the most appropriate treatment for you.

After Root Canal Treatment

The pulp that was removed during root canal treatment is the part that responds to temperature. Your tooth will no longer be sensitive to hot or cold after the root canal is treated. There still are tissues and nerves around the tooth, however, so it will respond to pressure and touch.

Immediately after root canal treatment, your tooth may be sore for two to three days, until your body has had a chance to heal from the infection and trauma. The worse the infection and inflammation were, the more sensitive the tooth will be after treatment. Avoid chewing on the affected side. Assuming no medical contraindications, you can take over-the-counter pain relievers. A pain reliever that also reduces inflammation is likely to be most helpful. Examples include ibuprofen and aspirin.

After the tooth has been allowed to heal, the temporary filling will be replaced by a permanent one.  In many cases, a root canal treated tooth will need a crown. Since the pulp tissue has been removed during the root canal, the tooth’s nutritional supply has been dramatically decreased, and the tooth will be weaker.  A crown will help to restore the tooth’s strength and protect it from cracking. If a crown is indicated it should be placed soon after having root canal treatment.

Pulpotomy (Baby Root Canal)

image33When the nerve of a primary (or “baby”) tooth becomes infected or abscessed, a pulpotomy or pulpectomy is necessary to save the tooth. During a pulpotomy, only the top portion of pulpal area is removed, and then a sedative medication is placed inside the tooth to prevent sensitivity and to promote healing. A pulpectomy requires the total removal of the nerve. In permanent teeth the total removal of the nerve is referred to as root canal therapy.

A tooth may become abscessed from deep decay, a cracked or broken tooth, or trauma. The only alternative to pulp therapy is an extraction.

After the primary tooth has undergone pulp therapy it is more brittle and often must be covered with special, prefabricated crowns in order to give it the strength to resist chewing pressure.  Fortunately, these prefabricated crowns are significantly less expensive than adult crowns.

Dentures

Dentures are false teeth, made mostly of plastic, that replace missing or lost teeth. There are several different types of dentures, including Complete Dentures, Implant Supported Dentures, Removable Partial Dentures, and Flipper Dentures.  Many people assume that they will need dentures as they age, but losing teeth is not a normal part of the aging process. If you care for your teeth well and guard against cavities and periodontal disease, you should be able to keep your teeth for a lifetime.

Saving even a few natural teeth is often better than losing them all. Natural teeth or even parts of natural teeth can help you retain bone in your jaw. Implants can also help with this.  Natural teeth and implants can act as stable supports for bridges or removable partial dentures. Dr. Victor will try to save as many of your natural teeth as possible.

Complete Dentures

image35Complete dentures are made for people who have lost all of their teeth.  They cover the entire jaw, either upper or lower. Some people call them “plates.” Complete dentures typically rest directly on the gum that covers the bone, but can be made to be supported by natural teeth or implants.

Dr. Victor has complete dentures custom made for you. The process involves multiple appointments. At the first appointment, he takes a series of impressions of your mouth. At later visits, Dr. Victor works with you to select the size, shape and color of the artificial teeth. If you liked the way your natural teeth looked, bring in a photograph of you smiling with your natural teeth. This will help Dr. Victor and the dental laboratory that will make your dentures.

Once the denture is made, you’ll have a trial fitting. You’ll be able to see how the denture looks and feels in your mouth. At this appointment, we make sure that the denture will fit and function correctly, and we verify that it harmonizes with the rest of your face. This is your denture preview, or “try-in.”  If the try-in goes well, you will receive the completed denture at the next visit. After this initial seat of your denture, there will be a series of follow-up appointments to check the fit and comfort of your denture.  Typically, Dr. Victor likes to follow-up 24 hours and 72 hours after the initial seat.

Although dentures may look like your natural teeth, they cannot work like them. Simple actions such as speaking and eating may feel different. You will have to learn how to use and adjust to your dentures. For some people, this can take up to several months. Learning to chew food with complete dentures takes patience and practice. You might have to cut your food into smaller pieces than you did in the past when you had your natural teeth.  Additionally, you will have to learn to chew on both sides evenly at the same time in order to keep the dentures from rocking.

Denture problems still can occur, of course. The teeth can wear down, and problems such as clicking, slipping, frequent gum irritation and odor may be signs that your dentures don’t fit well. They may need to be adjusted, relined or remade.  Dr. Victor recommends at least yearly checkups, even if you don’t have any teeth, to verify how your dentures are working and perform soft tissue exams and cancer screenings.

For more information, visit the American Dental Association’s website on dentures.

Implant Supported Dentures

Supporting dentures with implants has several advantages:  

  • Implants help preserve bone.
  • They bear some of the chewing pressure. This reduces pressure on other areas of the jaw.
  • They stabilize the denture and make it less likely to shift in your mouth.

image36Lower dentures tend to be more difficult to keep in your mouth than upper dentures. Therefore, an implant supported denture can be particularly helpful for the lower jaw. However, it is an option for both the upper and lower arches. It is interesting to note that implants originally were developed to give people “artificial roots” for bridges or dentures in the lower jaw. The denture can fit onto the implants directly, or onto a metal bar between implants.

Removable Partial Dentures

image37Removable partial dentures consist of a metal framework with plastic teeth and gum areas. The framework includes metal clasps or acrylic attachments that hold the denture in place. Depending on the remaining teeth present and the partial design, the partial can be supported by adjacent teeth and/or the gum tissue.  Partial dentures are easily removed for cleaning. They are often used to fill the void of multiple missing teeth.

Removable partial dentures should not be confused with Fixed Partial Dentures, which most people call bridges.  Fixed partial dentures are cemented onto nearby healthy teeth rather than being retained in place by clasps. However, bridges do tend to look and feel more like natural teeth.

For more information, visit the American Dental Association’s website on removable partial dentures.

Flipper Dentures

image39A flipper denture is a relatively inexpensive esthetic option made entirely of acrylic and replaces only a few teeth in an arch.  It is a temporary option as it is not tough enough to withstand regular use. It replaces one or more teeth until a more permanent form of treatment such as a bridge, implant, or removable partial denture can be made or decided upon. Such a denture can be placed immediately or soon after a tooth is extracted. However, it is not meant to be a permanent solution.

Immediate Dentures

If you have teeth extracted, there will be bony changes going on as the body heals and adapts.  The bulk of these changes will occur within 3 months, but bony changes continue throughout our lifetimes. Since dentures are supported by both bone and gum tissue, these changes impact the fit and function of dentures.  Subsequently, your mouth will need to heal for at least three months before a complete denture can be made that will fit well for any substantial amount of time.

Some patients choose to go without teeth during this time period.  However, an alternative you can consider is an interim or temporary denture called an immediate denture. This will be made and inserted at the time of extraction. The immediate denture will allow you to eat and speak with minimal problems while we wait for the body to heal and while the complete denture is made. As your mouth heals, the gums and bones will shrink. Therefore, the immediate denture will need to be relined to adjust the fit.

Discuss immediate dentures with Dr. Victor to see if they are an option for you.

Care of Your Dentures

In addition to the need to brush and floss your natural teeth regularly, it is also necessary to keep your dentures very clean.  Accumulations on it can lead to sore gums, tooth decay, and other problems with your mouth and the denture itself.  Any denture should be removed after every meal and rinsed thoroughly.  At least once per 24 hour period (usually just before bedtime) dentures should be cleaned thoroughly by scrubbing with a soft toothbrush (dedicated only to cleaning your denture) and mild hand soap.  Do not use toothpaste as abrasives found in toothpaste can unnecessarily wear away the acrylic teeth and denture base. The use of most commercial denture cleansers is generally not necessary and is of limited value.  The primary reason to use a commercial denture cleanser is to give the denture a better flavor when it is inserted. While cleaning your dentures, always hold them over a sink half-filled with water so if one is dropped, the water will break the fall of the denture and possibly prevent it from breaking.  After thoroughly cleaning your dentures, you should brush your gums and any remaining teeth with a separate soft toothbrush dedicated for that purpose.

Always remove your dentures and leave them out for at least six to eight hours per 24-hour period.  This permits the denture-bearing tissue to have the normal stimulation from the tongue and cheeks that it cannot receive while the dentures are being worn. Furthermore, this allows good circulation of oxygen to the tissue area normally covered by the dentures.  Without regular exposure to oxygen, some of the good bacteria in the area can die off and allow a yeast infection to take over.  Signs of this can include swollen, inflamed, reddish gum tissue.  It may also include an itching or burning sensation.  If you are concerned that you may have some of these symptoms, contact Dr. Victor’s office to set up an appointment to evaluate the area.  Frequently, short doses of anti-fungal medications and regular removal of the dentures are sufficient to cure these infections.

Periodic examinations (at least once per year) are also necessary for adequate care of your denture(s) and the tissue on which it rests.  Periodic x-rays, even when complete dentures are being worn, may be necessary for a thorough examination.  Remember, the acrylic teeth in dentures will wear over time and the denture-bearing tissues do change continuously.  Thus, dentures cannot be expected to fit as well after they have been used for any extended length of time.  Areas that become sore or irritated on your gums are typically due to changes occurring in your tissues, not changes in the dentures.  When these issues develop, please contact Dr. Victor for evaluation and/or adjustments.

Extractions

image40While most dentists will do anything possible to save a tooth, it is not always possible. Extractions are sometimes the only treatment that can be done for a tooth that has a deep stress fracture, a substantial amount of decay, or is severely broken.  Wisdom teeth that do not erupt correctly are also often removed in order to avoid future problems.  When a tooth must come out, Dr. Victor may remove the tooth or refer the patient to an Oral Surgeon, depending on the medical and dental conditions of the patient.

Emergency

If you face a dental emergency, you may need to seek dental or medical care immediately, depending on the severity of the emergency.  If you are an established patient, call Dr. Victor’s Springfield Smiles office at (937) 390-3077. If necessary, you can call our emergency number, which is listed on the answering message.  If you or your loved ones feel that an emergency is life threatening, such as in ludwig’s angina  (when an infection begins to restrict a person’s ability to breathe), do not hesitate to call 911 or visit an emergency room. Your health is the most important thing.

Once the source of pain is identified, Dr. Victor will present to you the best course of treatment to get your pain under control as quickly and easily as possible. If your emergency cannot be resolved over the phone, Dr. Victor may ask that you come in for an evaluation and/or treatment.

Below are tips on dealing with urgent dental situations; you may want to display this list on your refrigerator or store it near your emergency phone numbers for easy reference.

  • Broken, chipped, or fractured tooth
  • Infected tooth
  • Knocked-out tooth (dental avulsion)
  • Lateral displacement of a tooth
  • Tooth pushed up (dental intrusion)
  • Tooth was hit but appears fine
  • Object caught in teeth
  • Avoiding Injury

Broken, chipped, or fractured tooth

A broken or chipped tooth can occur for a variety of reasons.  Some fractures occur from trauma, others from grinding you teeth, and others may be the result of chewing something.  A crown fracture is classified based on the location of the fracture in relation to the enamel, dentin, or pulp tissue of the tooth:

  • Fracture of enamel only (outer portion of the tooth).  It is rarely painful, and is not a true emergency.  Often this can be resolved with a filling or just smoothing the roughened surface.
  • Fracture of enamel as well as dentin.  They are recognized by the yellow to pink color of the dentin.  Depending on the amount of pain or trauma the patient has, this may or may not require emergent treatment.
  • Fracture exposing the nerve, requires immediate care. The fracture site will have a reddish tinge or will show bleeding. In an Ellis class III dental fracture, exposure of the pulp’s nerve endings can cause extreme pain – even if exposed only to air. Exposure of the pulp in this type of fracture will eventually lead to pulpal necrosis from bacterial infection, if left untreated.

 Infected Tooth

An infected tooth can be a severe source of pain and discomfort, and should be addressed as soon as possible.  In order to rule out other potential issues, you may want to rinse with warm water and inspect the teeth to be sure there is nothing caught between them. If pain continues, use a cold compress to ease the pain. Do not apply heat or any kind of aspirin or topical pain reliever directly to the affected area, as this can cause damage to the gums. Consider taking oral pain relievers, and contact our office immediately by calling (937) 390-3077.

If left untreated, the infection can spread throughout the body.  Typically the first place infected is the bone around the tooth. The localized infection can cause an abscess, which is an area of pus that forms as part of the body’s effort to fight a bacterial infection. If the abscess does not find a path of drainage, it can cause severe swelling, and may even block off the patient’s airway in a process called Ludwig’s angina.  If such swelling occurs, do not hesitate to call 911 or visit an emergency room.

An untreated infection of the pulp can also allow the bacteria to spread systemically, allowing it to lodge in other areas of the body, including the brain.    In general, any infection, including dental infections, should not be left untreated.

Knocked-out tooth (dental avulsion)

A dental avulsion occurs when a tooth is completely displaced or knocked out of its socket.  Emergency care for avulsed teeth depends on whether or not the tooth is a permanent tooth or a baby tooth.

Baby teeth should not be re-implanted.  This is due to a high probability of infection that can impact the development of the permanent adult tooth.

Adult teeth should be considered for immediate re-implantation in order to enhance the tooth’s long-term prognosis.  Follow this emergency response procedure for best results.  Note that time is of the essence, as teeth left out for longer than15 minutes begin to have a much poorer prognosis.

  • Do not touch the root of the tooth. Handle the tooth by the crown only.
  • Rinse the tooth off only if there is dirt covering it. Do not scrub or scrape the tooth.
  • Attempt to reimplant the tooth into the socket with gentle pressure, and hold it in position.

If unable to reimplant the tooth, place it in a protective transport solution, such as Hank’s Balanced Salt Solution, milk, or saline. This will hydrate and nourish the periodontal ligament cells which are still attached to the root. You may want to consider getting a small container of Hank’s Balanced Salt Solution for your home, school, or sports team.  It can be purchased in dental emergency kit form at many drug stores and online. Contact lens solution is not an acceptable storage medium.  The tooth should not be wrapped in tissue or cloth. The tooth should never be allowed to dry.

Contact Dr. Victor or take the patient to the nearest hospital emergency room for evaluation and treatment.

Radiographs may need to be taken of the airway, stomach, and mouth if the tooth cannot be found .

Tetanus prophylaxis should be considered if the dental socket is contaminated with debris.

Lateral displacement of a tooth

Lateral displacement of a tooth occurs when the tooth is dislocated in a side-to-side direction. If the displacement is less than 5 mm, the tooth will remain vital in about 50% of the cases.  There is usually an associated fracture of the supporting bone.

If a tooth is laterally displaced, have the patient rinse with cold water, and keep an ice pack over the lip and mouth to reduce swelling. Give Tylenol for pain relief, assuming no medical contraindications. Try to reposition the luxated tooth back to its normal position using gentle to moderate finger pressure. The patient is then instructed to gently hold the tooth in position.  Contact Dr. Victor for definitive dental care as soon as possible.

Tooth pushed up (dental intrusion)

An intrusion injury is the most severe type of luxation injury. The intruded tooth is impacted into the alveolar bone, and the alveolar socket is fractured. The forces that drive the tooth into the socket wall crush the periodontal ligament, and rupture the blood and nerve supply to the teeth. The tooth may not be visible, and can be mistaken for an avulsion.   If a dental intrusion injury occurs, rinse with cold water, and keep an ice pack over the lip and mouth to reduce swelling. Give Tylenol for pain relief, if not medically contraindicated.  Contact Dr. Victor for definitive dental care as soon as possible.

Tooth was hit but appears fine

Teeth that are hit but appear fine may have experienced what is termed a dental concussion.  This results in mild injury to the periodontal ligament without tooth mobility or displacement. In some cases, minor movement of the tooth may be noticeable.  In any situation, the tooth may be tender for a week or two.  In general, have the patient rinse with cold water, and keep an ice pack over the lip and mouth to reduce swelling. Give Tylenol for pain relief, if not medically contraindicated.

In some instances, an impacted tooth may change color after being subjected to trauma.   Dental trauma affects the blood supply to the tooth, and therefore its health and color.  It should be noted that color changes may take months to occur.

Different color changes suggest specific problems with traumatized teeth:

  • Yellow or yellow-brown discoloration indicates calcification and obliteration of the dental pulp (nerve canal). No treatment is usually needed with this type of discoloration.
  • Grey or black discoloration indicates necrosis (death) of the dental pulp in 98% of cases. Such teeth will usually require root canal treatment or extraction.
  • Pink indicates either internal resorption, or the presence of blood pigments in the dentinal tubules of the tooth. The pink tooth needs to be monitored closely.

Object caught in teeth

If something is caught between your teeth, use dental floss to gently remove it. Never use a metal, plastic, or sharp tool to remove a stuck object. If you are unable to remove the item with dental floss, give Dr. Victor a call.

Avoiding injury

There are a number of things you can do to help you and your child avoid dental emergencies. Child-poof your house to avoid falls. Don’t chew on ice, popcorn kernels, or other hard foods. Always use car seats for young children and require seat belts for older children. A mouthguard should be worn for all contact sports. Finally, prevent toothaches with regular brushing, flossing, and exams.