When a tooth has extensive decay and/or has an existing big filling that needs replacing, the restoration of choice is either a bigger filling or a crown. If there is enough tooth structure to hold a filling (existing cusps), then placing a filling that can withstand the forces of chewing would be better than grinding the entire tooth down to crown it. Placing a filling that lays on the tooth or onlay would be more conservative, less traumatic, and buy the tooth more time before it needs a crown 10, 15, 20 years later. As a crown is considered to be the end-treatment for a tooth, an onlay allows the dentist to restore the tooth to its normal function by filling in what is missing. Usually the bite is not altered since remaining cusps are left in contact with opposing teeth, existing walls with adjacent teeth are retained for normal flossing (unless weak), and the front wall of a tooth is unaltered if it blends well with the other teeth. Materials for onlays are two-fold. Gold or porcelain can be used. Nowadays porcelain is gaining in popularity and is becoming the material of choice. Porcelain is esthetic, strong and has the same properties as the enamel of the tooth. Restoring the tooth with porcelain is almost like re-enameling the tooth.

Filling a tooth or placing an onlay involves removing the decayed portion and/or old filling from the tooth. Weak tooth structure is also removed when it can no longer withstand the force of chewing. Ordinarily, these procedures result in no pain or post-operative sensitivity. In some instances, however, cold– or air–sensitivity may occur. Sensitivity is transient and goes away with time, generally within a week of the procedure. In some instances, sensitivity can last as long as 6 months; this is more likely when root exposure is present. In cases of prolonged sensitivity, tooth recovery can be facilitated with the application of a desensitizing solution.

Partial tooth removal traumatizes the tooth. Trauma is related to the amount of tooth removed, and proximity of decay to the pulp. Trauma may cause inflammation in the immediate area. In rare cases, trauma can result in the death of the tooth. Presence of cracks or decay near or in the pulp may cause further risks to the tooth. In these rare cases, a root canal procedure may be required. If the doctor determines that you may need a root canal, he will notify you immediately and explain your options. Root canals are often done in the office. A minority of cases are referred to an endodontist.

The longevity of a composite (white) filling is 2–7 years; that of a porcelain onlay is 15 years or more. The difference has to do with the materials, and how they behave in a wet acidic environment with frequent temperature changes and the constant pounding our teeth must tolerate. Metals and composites expand when exposed to heat, and shrink when exposed to cold. With years of thermal cycling, the material pulls away from the enamel of the tooth, and allows bacterial infiltration and decay. Porcelain has the unique property of expanding and contracting with changes in temperatures to the same degree as enamel. In fact, clinical studies have shown that porcelain looks the same in the mouth 15 years after it has been placed. In recent years, porcelain has become even stronger, and bonding materials and techniques have improved significantly. For these reasons, many doctors consider onlays a one-time fix.

For both procedures, the longevity of materials is increased by several factors, including frequent brushing, flossing, regular exams and cleanings, and a low-sugar diet. A diet high in sugar, untreated cavities, smoking, poor oral hygiene, and a weakened immune system are some factors that can shorten the longevity of a filling or onlay. Fillings are not guaranteed to last, and onlays cannot be guaranteed to last for any patient with these risk factors. The best way to protect your investment is to see your regular dentist every 4–6 months for oral exams and cleanings.

There are two forms of tooth whitening: in office and take home trays. The in-office whitening will work while in the chair, but reverses back within days. Following the in-office whitening with take home trays is the recommended path if office whitening is what you are looking for.
Take home trays work just as well but whitening occurs within a period of a week to two weeks. Prices are $400.00 for bleaching trays. We offer them at $250 for patient of records. In-office bleaching (takes about 1 hour) with take home trays cost $500 due to chair time.

A bridge and a denture a two different ways of restoring a missing tooth. A bridge consists of at least three crowns fused together. It involves crowning both teeth around the missing one, and fusing a crown to the other two where the one is missing. A bridge is cemented or bonded and never comes off.
Disadvantages of a bridge: Crowning a tooth means that enough tooth structure is removed to allow a crown to fit over it. That is an irreversible procedure and is traumatic to the tooth. Another disadvantage is the inability to floss between crowns on a bridge since they are fused together. Special floss has to be woven underneath the bridge for flossing. Once teeth are linked by a bridge, recurrent decay to a tooth means that the bridge has to be replaced. Another disadvantage is a higher cost compared to a partial denture. Advantages are that it feels natural, smooth, very esthetic, and lasts on average 15 years or more.

A partial denture is a denture replacing some teeth missing (one or more but not all teeth). It is bulky, occupies a big portion of the palate, and infringes on the tongue space. It takes time to get used to it, time to learn how to speak with it, and constantly traps food. The bite is not as strong as with a regular tooth or bridge, since there is some give involved. Since it has to be removed and cleaned, there is potential for it breaking or getting lost. It is more affordable than a bridge and involves little or no tooth alteration. It could potentially be ready in a day depending on the chosen type of partial.

We don't want to promise a cleaning because we need to assess your dental needs at your first visit. You will have a comprehensive exam, and a cancer screening check. Visual aids will be used to illustrate dental conditions, X-rays will be taken, and an assessment of periodontal disease will be done. If you happen to have a simple case of gingivitis and there is still time, we will be start the prophylaxis.

Sure we do! We would like to have you in for a consultation, review your medical history and brief you on what to expect with sedation. You will be given a pill (a cousin of Valium) to relax you and allow you to be very comfortable during the procedure. You may even go to sleep. You will remember nothing of your appointment the next day. The appointment will be longer than usual, since we make sure that you are very comfortable before starting (by allowing more drug to take effect if needed); there will be someone to monitor your oxygen saturation and blood pressure at all times during your visit. To compensate for chair time and monitoring your vital signs, as well as the education and setup involved, we ask for a conscious sedation fee of $250 for our services. We also ask that someone brings you to our office and drives you back home the day you have work done.

As a courtesy to patients, we offer to file all types of dental insurance. We collect 60% of the total in addition to any deductible at time of service for dental work. 10% will be collected for hygiene. If you chose to pay your balance in full at time of service, we will reward you with a 10% courtesy adjustment. We will still file your insurance and reimburse you promptly if we get paid in excess.

When faced with the decision to save or extract a tooth, it is always better to save your natural tooth. A root canal procedure allows the tooth to remain in the mouth for a very long time. It involves cleaning, disinfecting, and sealing the tooth from within so no bacteria can penetrate it and cause an infection. A crown is usually prescribed after a root canal to restore the strength of the compromised tooth. When you have a tooth extracted, it usually costs more to replace it. If the space between the teeth is not restored in a timely manner by a bridge or partial (see above), teeth start shifting toward the gap (unopposed tooth moves towards the gap, back tooth tilts forward and front tooth moves back.)

Crowning a tooth involves removing about 1.2 mm of tooth structure all around the gum level, and providing 2 mm of space from the biting surface of the tooth to the opposing one. Trauma from this procedure may cause inflammation in the immediate area. In rare cases, the tooth dies as a result of the trauma associated with this procedure. If there are cracks or decay that extend near or to the pulp, there is further risk to the tooth. In these rare cases, a root canal procedure may be required to save the tooth. If the doctor determines that you may need a root canal, he will notify you immediately and explain your options. A referral to an endodontist may follow.

The longevity of a crown is increased by several factors, such as frequent brushing, flossing, regular exams and cleanings, and a low-sugar diet. A diet high in sugar, untreated cavities, smoking, poor oral hygiene, and a weakened immune system are some factors that can shorten a crown’s longevity. Crowns and bridges cannot be guaranteed to last for any patient with these risk factors. The best way to protect your investment is to see your regular dentist every 4-6 months for exams and cleanings.

There are three types of crowns: gold, porcelain fused to metal (PFM) and all--porcelain.
The traditional crown or gold standard is gold itself! It requires little tooth preparation compared to other crowns, does not break, tarnish, and is biocompatible.
The porcelain fused to metal (PFM) is another choice. This crown has a base or skeleton of either gold or non-precious metal (Nickel Chromium), and porcelain is lapped over it. These crowns are esthetic, show no metal, and can be used anywhere in the mouth. Drawbacks involve more tooth preparation than gold, and porcelain can chip under excessive biting forces (bruxism, clenching). In general non-precious metals are used for a lesser fee, and should not be used if you are allergic to Nickel (skin reaction to cheap jewelry!). With metal allergies, gold, porcelain fused to gold (PFG) or an all-porcelain crown would be the best choices. PFG crowns are healthier to the tissues than PFM base metal. They accumulate less bacteria at the gum line and do not discolor the tissues with time. There is also a lesser incidence of a dark line or halo at the gum line, an unpleasing look for crowns, due to tissue recession exposing the crown margin. If esthetic is a major concern, as for an anterior tooth, the all-porcelain crown would be your preference. It allows light properties to reflect true tooth colors through porcelain. All-porcelain crowns can be used anywhere in the mouth since they can be as strong as PFM or gold crowns. They do however involve more tooth preparation on the biting surface than gold or PFM crowns for clearance between opposing teeth. Anterior all-porcelain crowns are also not as strong in compression as PFM crowns or gold, but are a fine balance of esthetic and strength where needed.

A veneer is a nail thick sheet of porcelain that is used to fix or reshape a front tooth and make it more beautiful. Veneers are used to close spaces between teeth, whiten, widen, straighten, lengthen them, fix chips, etc... Once the porcelain is bonded to the tooth, it is unbreakable and can last 10-15 years or more. See our cosmetic section for examples of veneers.

A dental exam is incomplete without a full set of X-rays. X-rays are used to determine whether or not there is decay between teeth, to get an idea of bone loss, visualize abscesses beyond root tips, check for cancer, determine depth of decay relative to the pulp of a tooth, etc... Changes in dental structures can become noticeable on an X-ray as early as 3 months from the time the first film is taken. The radiation involved is so minimal, that it is considered negligible. With digital radiography, less than 50% of the original radiation is used per film making it even safer for you. X-rays should be taken at the hygiene visit once every 6 months if a lot of decay is present, and once a year to a year and a half in a healthy individual. X-rays are only taken in for emergency purposes in the first trimester of pregnancy.