Advances in modern dental materials and techniques have provided new ways to create more pleasing, natural-looking smiles. As a result, dentists and patients have several choices when it comes to selecting materials used to repair missing, worn, damaged, or decayed teeth.

Silver amalgam was used for about 160 years for the restoration of teeth. This alloy contains silver, tin, copper, zinc and about 50 percent mercury. For years it was highly successful but an unsightly material. The use of mercury in the body has been criticized since its inception, but groups worldwide are still supporting the material.

Our practice no longer works with silver amalgam in favor of more superior composite resins (white fillings). Below is a summary of the reasoning for this recommendation:

In addition to moving to the use of composite resins for new fillings, we also recommend the replacement of silver with white fillings as soon as is feasible for the patient. Below is a summary of the reasons for this recommendation:

A sealant is essentially the simplest form of a filling. It is a plastic material applied to the chewing surfaces of the back teeth (premolars & molars). The sealant resin bonds into the depression and grooves (pits and fissures) on the chewing surfaces of back teeth. The sealant acts as a barrier protecting enamel from plaque and acids.

Sealants work well for all ages – but because the likelihood of developing pit and fissure decay begins early in life, children and teenagers are obvious candidates. However, many adults can benefit from sealants as well.

Sealants are relatively easy to apply. First, the tooth grooves of the teeth are opened with a bur ensuring all food or decay are removed from the tooth’s small crevices. The tooth is then cleaned, primed, bonded and the sealant is ‘painted’ onto the tooth enamel, where it bonds directly to the tooth and is cured with a special light.

Any tooth surface containing sealant will be protected from decay for as long as the sealant remains intact. Sealants hold up well under the force of normal chewing and usually last several years before reapplication is needed. We check the condition of sealants, reapplying them when necessary as part of the regular check-up and oral exam in all patients who have teeth containing sealants.

People with a small chip can have their tooth restored with bonding. Bonding is acrylic that matches your tooth color, adhered to the tooth, and then shaped and polished all in one office visit.

People with a more significant chip in a front tooth may need to have it repaired with a porcelain veneer. Porcelain veneers are made in a lab and cemented to your natural tooth. Some of the most common reasons we place veneers include:

Placing a veneer takes 2-3 office visits and may also include custom shading at our lab. Veneers can also be used as a cosmetic procedure to simply improve the overall look of a tooth. See Cosmetic for further details.

Unlike a filling which resides inside the tooth, a crown covers a tooth and restores it to its normal shape and size. A crown can make a tooth stronger and improve its overall appearance. It may be made of gold, porcelain or a combination of the two. A crown is made to fit the tooth precisely and is cemented directly onto the prepared tooth.

A crown is used to cover and support a tooth that has a large filling. They are also commonly used to prevent a weak or brittle tooth from breaking, or restore one that is already broken. Crowns are also used to attach a bridge or to cover a dental implant. Finally, a crown is also an excellent way to cover a discolored, badly shaped, or out of position tooth.

Crowns generally require two or more visits. During the first visit, we prepare the tooth and make an impression of the area to be restored. The impression is sent to a dental laboratory, which creates the dental restoration. We place a temporary crown over the prepared tooth while the permanent restoration is being created. At the next appointment we cement the permanent restoration (crown) onto the prepared tooth and make adjustments as needed.

Crowns can also be used as a cosmetic procedure to simply improve the overall look of a tooth. See Cosmetic for further details.

In cases where we determine a traditional filling will not fix the problem and a crown is too invasive, an onlay may be the treatment of choice. These procedures require two office visits. First, we prepare the tooth and create a mold. Between office visits a lab then uses the mold to create the onlay. On the second office visit, we place it in, or on, the tooth.

If you're missing one or more teeth, you may notice a difference in chewing and speaking. In these cases, a bridge may be used to replace missing teeth, help maintain the shape of your face, and alleviate the stress in your bite.

A fixed bridge replaces missing teeth with artificial teeth, looks great, and literally bridges the gap where one or more teeth may have been. The restoration can be made from gold, alloys, porcelain or a combination of these materials and is bonded onto surrounding teeth for support. Neighboring teeth on each side of the space are prepared for crowns and attached between the two is an artificial tooth called a pontic.

Similar to crowns, bridges require multiple office visits to ensure proper fit.

An alternative to the traditional fixed bridge is a dental implant. An implant attaches artificial teeth directly to the jaw under the gum tissue. A small titanium fixture is used to surgically place the implant in the upper or lower jawbone to replace the root of your missing tooth and provide an anchor for a crown.

One of the biggest advantages of an implant over a bridge is that, like a crown, an implant does not require treatment of the neighboring teeth. It is a free-standing restoration similar to the missing natural tooth.

Dentures replace missing teeth and their adjacent tissues with a removable dental appliance made of acrylic resin and, in some cases, a combination of metals. A complete denture replaces the full arch of teeth. A partial denture can replace a single tooth or several missing teeth. Unlike their permanent counterparts (bridges and implants), dentures are removable.

Similar to crowns and bridges, the creation of a denture requires multiple office visits to ensure proper fit.

Although we work toward making it a rare occurrence, there are times when it is necessary to remove a tooth. Sometimes a tooth has so much decay or bone loss that it puts the surrounding teeth and jaw at risk of decay and periodontal disease. If this occurs, we may recommend removal and replacement with a bridge or implant. Infection, orthodontic correction, or problems with a wisdom tooth may also require removal of a tooth.

When it is determined that a tooth needs to be removed, we will discuss whether it should be treated in our office or best treated by one of our specialists. When a determination for extraction has been made, it is important to share any concerns or preferences for anesthesia and sedation that you may have.

In the past, a tooth with a diseased nerve usually resulted in a lost tooth. Today, a special dental procedure called root canal treatment has dramatically reduced the need for tooth extraction.

The center of a tooth is hollow and contains soft tissue including a nerve and blood vessel. The nerve is the vestige of the tissue that originally formed the tooth. Once the tooth has been in the mouth for a time, the functioning of the nerve is no longer necessary.

When a tooth is cracked or has a deep cavity, bacteria can enter the pulp. Germs can cause an infection inside the tooth. Left without treatment, pus builds up at the root tip, in the jawbone, forming a "pus-pocket" called an abscess. An abscess can cause the pulp tissue to die. When the infected pulp is not removed, pain and swelling can result. Certain byproducts of the infection can injure your jawbones and your overall health. Without treatment, the tooth may have to be removed.

Treatment often involves from one to two visits. During treatment, the endodontist (a dentist who specializes in problems of the pulp) removes the diseased pulp. The pulp chamber and root canal(s) of the tooth are then cleaned and sealed. Posterior teeth that have endodontic treatment should have a cast crown placed in order to strengthen the remaining structure. Then as long as you continue to care for your teeth and gums with regular brushing, flossing, and checkups so that the root(s) of the restored tooth are nourished by the surrounding tissues, your restored tooth can last a lifetime.

Most often, a root canal is a relatively simple procedure with little or no discomfort involving one to two visits. Best of all, it can save your tooth and your smile!

The following are the other treatment areas to which we refer patients on a regular basis: