Spokane District Dental Society
23403 E Mission Ave
Liberty Lake, WA 99019
(509) 838-0436
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Patient Education

Best Dental Care

Prevention is the foundation of all dental care. Dentists focus on treating the cause of oral disease, not just the results of oral disease. Preventing disease and trauma is the dental professions first task and its other task is providing care when prevention fails.

The goal of the dental profession is to eliminate oral disease by preventing infection (caries, gingivitis, periodontitis, and pulpitis). Dentists attain this goal by teaching their patients about the destruction oral bio-films, or plague, can cause if left to organize.

Dentists seek to discover and diagnose their patients' individual risks for oral disease and develop a preventive treatment plan that their patients can learn and then implement.

When a dental restoration or dental filling, is required, a dentist chooses a dental restorative material to artificially restore the function, integrity and morphology of missing tooth structure. The missing tooth structure typically results from caries or external trauma. Dental restorations may be fabricated out of a variety of materials.

Learn more about dental restorations.

Dental Restorations

Sealants
Sealants are highly effective in preventing decay on the biting surfaces of your chewing teeth, sealants are a simple procedure in which a "coating", typically tooth-colored, is painted onto the surface of the tooth. This effectively "seals" the deep grooves acting as a barrier, protecting enamel from plaque and acids.

Sealants are made from a variety of materials and are made to protect the depressions and grooves of your teeth from food particles and plaque that brushing and flossing can't reach.

Easy to apply, sealants take only a few minutes to seal each tooth. Sealants hold up well under the force of normal chewing and can last several years before a reapplication is needed.

Children and adults can benefit from sealants in the fight against tooth decay.

Dental composites
Composite resin fillings are the most common alternative to dental amalgam. They are sometimes called "tooth-colored" or "white" fillings because of their color. Composite resin fillings are made of a type of plastic (an acrylic resin) reinforced with powdered glass. The color (shade) of composite resins can be customized to closely match surrounding teeth.

Dental Amalgam
Dental amalgam has been used for more than 150 years in hundreds of millions of patients.

Dental amalgam is a mixture of metals, consisting of liquid mercury and a powdered alloy composed of silver, tin, and copper. Approximately 50% of dental amalgam is elemental mercury by weight.

Dental amalgam fillings are also known as "silver fillings" because of their silver-like appearance.

There are circumstances in which composite (white fillings) serves better than amalgam; when amalgam is not indicated, or when a more conservative preparation would be beneficial.

The American Dental Association Council on Scientific Affairs has concluded that both amalgam and composite materials are considered safe and effective for tooth restoration.

Veneers
Porcelain veneers are thin shells of material that bond directly to the front and top surfaces of the teeth. They are an ideal choice for improving your smile and have become increasingly popular due to their simplicity and versatility. A veneer can correct gaps between your teeth, teeth that are stained, badly shaped or crooked and help you achieve a beautiful smile.

When bonded to the teeth, the ultra-thin veneers are virtually undetectable and highly resistant to coffee, tea, or even cigarette stains.

Bleaching
Having a beautiful smile may be even easier than you think. Many people achieve the look they've been dreaming of with professional "bleaching" procedures.

Professional dental bleaching can be used to correct many tooth discolorations. These discolorations may have been caused by staining, aging, or chemical damage to teeth. Using the latest in bleaching technology, dentists offer a safe method for creating a beautiful, "brilliant" smile. In cases of extreme tooth discoloration, crowns or veneers may be the only choice and because of the conservation of tooth structure and lower cost as compared to restorative treatment, bleaching is often recommended before restorative options are considered.

Inlays / Onlay
Inlays and onlays are made from a variety of dental materials. These materials are bonded in the place of the missing or removed area of the once diseased or damaged tooth. An inlay, which is similar to a filling, is used inside the cusp tips of the tooth; an onlay is a more substantial reconstruction, similar to the inlay but extending over one or more of the cusps of the tooth.

Traditionally, gold has been the material of choice for inlays and onlays. In recent years, however, porcelain and other dental materials have become increasingly popular due to their strength and color, which can potentially match the natural color of your teeth.

Crowns
If damage to a tooth is extreme your dentist may recommend the use of a full coverage crown. A crown is a restorative option for the most severe loss of tooth structure and is available in many types of dental materials.

Many people have unexplained pain from filled back teeth, which may be due to cracks in the tooth. Placing crowns on these teeth is an option to potentially relieve the pain and return of full dental function for these teeth. In front teeth, older fillings can both weaken the teeth and cause "appearance" problems due to staining or chipping. Tooth colored crowns are suitable in cases where veneers are not. In teeth with root canal fillings, crowns can prevent breakage and may be the best treatment option.

CAD/CAM
Cad Cam Dentistry consists of dental restorations, including crowns, onlays, inlays and veneers that are both designed and manufactured with the aid of a computer.

CAD / CAM dentistry utilizes a machine many dentists use to create tooth colored restorations for teeth in one appointment. The CAD / CAM software takes a digital picture and converts it into a 3-dimensional virtual model on the computer screen that a dentist uses to design the restoration. The restoration design data is sent to a separate milling machine in the office. A ceramic block that matches your tooth shade is placed in the milling machine and a customized tooth-colored restoration comes out.

Extractions

You and your dentist may determine that you need a tooth extraction for any number of reasons. Some teeth are extracted because they are severely decayed; others may have advanced periodontal disease, or have broken in a way that cannot be repaired. Other teeth may need removal because they are poorly positioned in the mouth (such as impacted teeth), or in preparation for orthodontic treatment.

The removal of a single tooth can lead to problems related to your chewing ability, problems with your jaw joint, and result in shifting teeth, which can have a major impact on your dental health.

To avoid these complications, your dentist will discuss alternatives to extractions as well as replacement of the extracted tooth.

Missing Tooth Solutions

Dental Implants
Dental implants are designed to provide a foundation for replacement teeth that look, feel, and function like natural teeth. The person who has lost teeth regains the ability to eat virtually anything and can smile with confidence, knowing that teeth appear natural and that facial contours will be preserved. The implants themselves are tiny titanium posts that are placed into the jawbone where teeth are missing. The bone bonds with the titanium, creating a strong foundation for artificial teeth. In addition, implants can help preserve facial structure, preventing the bone deterioration that occurs when teeth are missing.

Dental implants are changing the way people live! With them, people are rediscovering the comfort and confidence to eat, speak, laugh and enjoy life.

If you feel implant dentistry is the choice for you, your dentist will ask that you undergo a dental/radiographic examination and health history. During these consultation visits, your specific needs and considerations will be addressed by your dentist and possibly by a dental specialist that your dentist has recommended.

Bridges
All of your teeth play an important role in speaking, chewing and in maintaining proper alignment of other teeth. Tooth loss doesn't necessarily have to occur as you age, but if you do lose teeth, a bridge is one option to maintain proper function of your mouth.

A bridge — a device used to replace missing teeth — attaches artificial teeth to adjacent natural teeth, called abutment teeth. Bridges are either permanently attached (fixed bridges), or they can be removable.

Fixed bridges are applied by either placing crowns on the abutment teeth or by bonding the artificial teeth directly to the abutment teeth. Removable bridges are attached to the teeth with metal clasps or by precision attachments.

Oral functionality and appearance are important reasons for wearing a bridge. A bridge helps support your lips and cheeks. The loss of a back tooth may cause your mouth to sink and your face to look older.

Dentures
A denture is an appliance that is inserted in the mouth to replaces natural teeth and provides support for the cheeks and lips. Most dentures are made of acrylic and can be fabricated in different ways. The teeth are made of plastic, porcelain or a combination thereof.

A conventional denture is made after all teeth have been extracted and the tissues (gums) have healed.

An immediate denture is fabricated and inserted immediately after the teeth are extracted and the tissues are allowed to heal under the denture.

Dentures can be fabricated to fit over endodontically treated teeth or dental implants to allow for a more secure fit of the appliance.

An upper denture is acrylic and covers the palate (roof of the mouth).

A lower denture is shaped like a horseshoe to leave room for the tongue.

Dentures, over a normal course of time, will wear and need to be replaced or relined in order to keep the jaw alignment normal. The alignment will slowly change as the bone and gum ridges recede or shrink which naturally occurs after the extraction of the teeth. Regular dental examinations are still important for the denture wearer so that the oral tissues can be checked for disease or change and adjustments can be made to the dentures as needed.

Patient Comfort

Analgesia
Analgesia refers to the relief of pain that is often included in most dental procedures and sedation techniques.

For most types of dental care a patient will receive a drug called an anesthetic.

Anesthetics reduce or prevent pain. There are three main types used in dental care.
•  Local: numbs one small area of the body. You stay awake and alert.
•  Conscious or intravenous (IV) sedation: uses a mild sedative to relax you and pain medicine to relieve pain. You stay awake but may not remember the procedure afterwards.
•  General anesthesia: affects your whole body. You go to sleep and feel nothing. You have no memory of the procedure afterwards.

The type of anesthesia your dentist chooses depends on many factors. These include the procedure you are having, your ability to cope and your current health.

Nitrous Oxide
Nitrous Oxide is a sweet smelling, non irritating, colorless gas which you can breathe.

Nitrous Oxide has been the primary means of minimal to moderate sedation in dentistry for many years and it helps reduce pain. A local anesthetic is still required for most dental procedures while using nitrous Oxide.

Patients are able to breathe on their own and remain in control of all bodily functions. A patient may experience mild amnesia and may choose to fall asleep.

Avoid using nitrous oxide if you have emphysema, take bleomycin, are pregnant, suffer from an acute ear infection or have a severe breathing problem.

Sedation Dentistry
Sedation is a management technique some dentists use to assist anxious, fearful and/or special needs patients. Sedation allows patients to safely and effectively receive dental treatment because it reduces or eliminates uncooperative behavior which results from anxiety and fear.

Many different medications can be used for sedation and these medications can be delivered in a number of different ways, such as swallowing, injection, inhaled gas or mist, or intravenously. Your dentist will discuss with you the medication(s) and the delivery option he or she recommends and give you further information and instructions.

Sedation is best described in terms of "stages" – as part of a scale – sedation usually is divided into three categories:
•  Minimal sedation, or anxiolysis (relieves anxiety)
•  Moderate sedation
•  Deep sedation

During minimal sedation, you will feel relaxed and you may be awake. You can understand and answer questions and will be able to follow instructions.

When receiving moderate sedation, you will feel drowsy and may even sleep through much of the procedure, but will be easily awakened when spoken to or touched. You may or may not remember being in the procedure room.

During deep sedation, you will sleep through the procedure with little or no memory of the procedure room. Your breathing can slow, and you might be sleeping until the medications wear off. With deep sedation, supplemental oxygen is often given.

With any of the three levels of sedation, you may receive an injection of local anesthetic to numb the surgical site. You may or may not feel some discomfort as this medication is injected, depending on how sedated you are.

Sedation can provide pain relief as well as relief of anxiety that may accompany some treatments or diagnostic tests. It involves using medications for many types of procedures without using general anesthesia, which causes complete unconsciousness.

When given appropriately, sedation is safe and effective for many procedures done in hospitals, ambulatory surgical centers and doctors' or dentists' offices. Ask the dentist performing your diagnostic or therapeutic procedure about which level of sedation is appropriate for you.

Administering the Analgesia
A dentist may administer the sedation or he or she may work with an anesthesiologist, dental anesthesiologist, or a nurse anesthetist. You should know who will be providing your sedation analgesia, what their level of training is, and who will be there to handle any medical situation that arises during the procedure.

Monitoring and Safety
As with any type of anesthesia, you will be monitored when receiving sedation analgesia. These monitors are very important to ensure your safety. They are used to monitor your heart rate and rhythm, blood pressure and the oxygen levels of your blood. During moderate and deep sedation, someone will be solely responsible for monitoring your vital signs and controlling your level of consciousness.

After the Procedure
If you have received minimal sedation only, you may be able to go home once the procedure is finished. If you have received moderate or deep sedation, you will probably require more time to recover. Often this may be within an hour. In the recovery room, you will be monitored until the effects of the medication wear off.

Any after-effects of the medication must be minimal or gone before you will be discharged from the facility. You will not be allowed to drive yourself, so arrangements should be made for a responsible adult to provide you with transportation. If you think you may need some assistance, you might consider having someone stay with you on the day of surgery.

Checklist: Questions to Ask Before Sedation Analgesia
Here are a few questions that you may want to ask prior to receiving sedation analgesia:

1.  Who will be responsible for the administration of sedative medications?
2.  What are his or her qualifications?
3.  How will I be monitored during my procedure?
4.  Will I have an IV (intravenous catheter)?
5.  Will I be receiving local anesthesia in addition to sedation?
6.  Will the level of sedation I receive be sufficient to make me comfortable during the procedure as well as the recovery period immediately afterward?
7.  Who will be monitoring my recovery after the procedure?
8.  In case of an emergency, what equipment and personnel will be available?
9.  Who will decide when I am ready to go home?
10.  Whom can I call if I have any problems or questions once I get home?

Recognized Dental Specialties

Approved by the Council on Dental Education and Licensure, American Dental Association

1.  Dental Public Health: Dental public health is the science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice which serves the community as a patient rather than the individual. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis. (Adopted May 1976)
2.  Endodontics: Endodontics is the branch of dentistry which is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. (Adopted December 1983)
3.  Oral and Maxillofacial Pathology: Oral pathology is the specialty of dentistry and discipline of pathology that deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes, and effects of these diseases. The practice of oral pathology includes research and diagnosis of diseases using clinical, radiographic, microscopic, biochemical, or other examinations. (Adopted May 1991)
4.  Oral and Maxillofacial Radiology: Oral and maxillofacial radiology is the specialty of dentistry and discipline of radiology concerned with the production and interpretation of images and data produced by all modalities of radiant energy that are used for the diagnosis and management of diseases, disorders and conditions of the oral and maxillofacial region. (Adopted April 2001)
5.  Oral and Maxillofacial Surgery: Oral and maxillofacial surgery is the specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. (Adopted October 1990)
6.  Orthodontics and Dentofacial Orthopedics: Orthodontics and dentofacial orthopedics is the dental specialty that includes the diagnosis, prevention, interception, and correction of malocclusion, as well as neuromuscular and skeletal abnormalities of the developing or mature orofacial structures. (Adopted April 2003)
7.  Pediatric Dentistry: Pediatric Dentistry is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. (Adopted 1995)
8.  Periodontics: Periodontics is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. (Adopted December 1992)
9.  Prosthodontics: Prosthodontics is the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth and/or oral and maxillofacial tissues using biocompatible substitutes. (Adopted April 2003)

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23403 E Mission Ave, Suite 218
Liberty Lake, WA, 99019
Phone: 509-838-0436
Fax: 509-838-5040



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