General Treatment
    My practice can provide a wide range of dental services. I can typically provide every type of dental service without having to refer you to other specialties. This flexibility saves you time & keeps your total dental care within one practice. My emphasis is on total preventive care for my patients. Total care begins with regular hygiene visits, regular checkups & continued home oral health routines.

    My practice also provides the highest-quality services for restoring mouths that have been damaged by dental disease, injury & common problems that require cosmetic dentistry. My primary goal for my patients is to achieve & maintain optimum oral health through advances in techniques, technologies & by maintaining their scheduled dental check-ups.
    Cavity Fillings
    The concept of a “filling” is replacing & restoring tooth structure that is damaged due to decay or fracture with an artificial material. For over a century, dentists have been using mercury amalgam as fillings for cavities. As a result of the ongoing health controversy surrounding the use of mercury, I also use white fillings. The controversy is ongoing, sometimes bitter, & confusing to many. It was once believed that if a tooth was filled with amalgam, the mercury in the amalgam would harden & become inert. Now we know that's not true, & that low levels of mercury vapor are released over time.

    Mercury is a poison that in large doses can cause brain damage, kidney malfunction, memory loss, & depression. I do not recommend replacing existing mercury amalgam fillings, because the levels of mercury vapor released have not been shown to be a health hazzard. Tooth coloured composite fillings offer many benefits other than the abscence of mercury. They are much more natural looking, & never discolor neighboring teeth or tissues as mercury fillings are prone to do. Their durability has greatly improved in recent years.

    Comparing Tooth Coloured Fillings Versus Silver Amalgam Fillings:
    • Tooth coloured fillings bond to the tooth; they strengthen the tooth by restoring most of its original shape. Silver amalgams, on the other hand, weaken the teeth & make them more susceptible to breaking. Broken teeth can be very expensive to replace.
    • Tooth coloured filling composites are preferred by most patients. This is due to the natural color, strength & overall appearance & feel. Composites are naturally more comfortable.
    • Hot & cold sensitivity is greatly reduced with composite material compared to the silver/mercury amalgams.
    • Restorations with composites require less removal of tooth, less structure to place than those with amalgams & especially with new cavities. Dramatically smaller holes are needed with a composite.
    • Tooth coloured fillings are healthier because no traces of mercury are used, unlike silver amalgams.
    Root Canal Treatment (RCT)
    A root canal is a procedure in which decayed pulp is removed from the central part of the tooth, the canal reshaped & is replaced with strengthening filler.

    The cavity is the result of superficial decay of the enamel of the tooth. Left long enough, this decay can burrow into the deeper reaches of the tooth, causing extensive damage to tooth structure. When the damage goes beyond what can be treated with a filling, dentists can perform a root canal (or endodontics), preserving the tooth & retaining its original integrity; thereby, saving a tooth that in the past would have to have been pulled.

    Root Canal Treatment

    Procedure:
    • The patient undergoes anesthesia.
    • The tooth is opened to allow for removal of infected or dead dental pulp.
    • The tooth is comprehensively cleaned, including any cracks & canals.
    • With special tools, the doctor reshapes the canals.
    • Medication is placed in the canals,  a temporay filling is placed, & the patient is dismissed.
    • At a second appointment, the tooth is again opened & cleaned.
    • The canals of the tooth are then filled with a biocompatible filling material.
    • A temporary covering is used to cover the access opening.
    Teeth that have undergone root canal therapy are usually brittle & susceptible to fracture. Most all teeth treated with root canal therapy require posts & crowns to restore them to proper strength & function.
    Ultrasonic Scaling
    To fight periodontal disease, there is a need to reduce plaque, tartar, & the number of bacteria in the pockets in your mouth. One device used to remove calculus from teeth is an ultrasonic scaler. It consists of a wand with a small scaling tip that produces a soft ultrasonic vibration. The small, quick vibrations in combination with a water flow give us a whole new level of effectiveness in calculus removal. The benefits of ultrasonic scaling include removing of calculus & reducing the number of harmful bacteria below the gum line. It is an important tool in the prevention & treatment of periodontal disease.
    Root Planing
    Routine scaling procedure removes plaque & tartar that exist on your teeth above the gum line, but sometimes, especially if you don't floss regularly, plaque, tartar & bacterial toxins can develop below the gum line. The goal of scaling & root planing is to remove this source of periodontal infection from below the gum line on the surfaces of the roots.

    Normally, the scaling & root planing spread over several appointments. This will maximize your comfort & allows the dentist to check on the healing & the help you fine-tune your home-care efforts. To keep you comfortable, dentist may give you local anesthetic before the procedure begins. Then dentist may either use a small scaling instrument or an ultrasonic scaler to carefully & meticulously remove plaque & tartar from the top of your tooth all the way down to the bottom of the pocket.

    Next step is to plane or smooth the root surfaces so that your gums can heal & re-attach to your teeth. If it appears to be necessary, an antibiotic or alternative medication will be placed in the pocket after it's been scaled & planed to control infection & promote healing. Oral antibiotics might also be prescribed to further combat the infection. Once the source of infection has been removed, your gums will begin to heal, & will once again tighten around your teeth.

    Home-care is the key to continuing the healing process. Since brushing & flossing only removes plaque about three millimeters below the gum line, you'll need special tools to clean the affected areas. As part of your treatment, dentist may provide you with the tools & techniques you'll need to thoroughly clean & maintain these areas.
    Complete & Partial Dentures

Denture

    A denture is a removable replacement for missing teeth & surrounding tissues. Two types of dentures are available viz. complete & partial dentures. Complete dentures are used when all the teeth are missing, while partial dentures are used when some natural teeth remain.

    Complete dentures can be either "conventional" or "immediate." Made after the teeth have been removed & the gum tissue has begun to heal, a conventional denture is ready for placement in the mouth about 8 to 12 weeks after the teeth have been removed. Unlike conventional dentures, immediate dentures are made in advance & can be positioned as soon as the teeth are removed. As a result, the wearer does not have to be without teeth during the healing period. However, bones & gums shrink over time, especially during the healing period following tooth removal. Therefore, a disadvantage of immediate dentures compared with conventional dentures is that they require more adjustments to fit properly during the healing process & generally should only be considered a temporary solution until conventional dentures can be made.

    A removable partial denture or bridge usually consists of replacement teeth attached to a pink or gum-colored plastic base, which is connected by metal framework that holds the denture in place in the mouth. Partial dentures are used when one or more natural teeth remain in the upper or lower jaw. A fixed (permanent) bridge replaces one or more teeth by placing crowns on the teeth on either side of the space & attaching artificial teeth to them. This "bridge" is then cemented into place. Not only does a partial denture fill in the spaces created by missing teeth, it prevents other teeth from changing position. A precision partial denture is removable & has internal attachments rather than clasps that attach to the adjacent crowns. This is a more natural-looking appliance.
    Tooth Extraction
    Tooth extraction involves having one or more teeth completely removed from your mouth by a dentist. This can be carried out at one appointment or over a few sessions. Depending on the reason, you may or may not need to have the teeth replaced. I will be able to advise you about what this will involve.

    There are a number of ways in which your teeth can be damaged resulting in the need for an extraction. Some of the most common include:
    • having bad gum disease (periodontal disease) - if bacteria build up on your teeth, they will start to damage the ligaments & bone that hold them in place & a tooth may become loose.
    • having a decayed tooth - if the decay is very advanced, it can cause the nerve & blood vessels (tooth pulp) to become infected & eventually this may lead to a painful abscess.
    • breaking a tooth.
    • having crowding - if you have a small jaw or lost your milk (baby) teeth early, causing your second teeth to come through before your mouth had grown big enough - this means your teeth may be crooked & you may need to have one or more removed so the rest can be straightened.
    • not having enough space in your mouth for your wisdom teeth - they may become impacted (stuck behind the tooth in front) & need to be removed.
Cosmetic Treatment
    Crowns, Veneers & Bridges
    A Crown is a permanent covering that fits over an original tooth that is either decayed, damaged or cracked. Crowns are made of a variety of different materials such as porcelain, gold, acrylic resin or a mix of these materials. Porcelain generally has the most natural appearance, although it is often less durable.

    The treatment plan for a patient receiving a crown involves:
    1. Numbing the tooth to remove the decay in or around it.
    2. Re-sculpturing the tooth to provide an ideal fit for the crown.
    3. Making an impression of your teeth in order to create a custom-made crown (usually takes one to two weeks).
    4. Making a temporary crown out of acrylic resin & fitting it onto the tooth during the interim period when the permanent custom-made crown is being created.
    5. Applying the permanent crown (when received from the lab) by removing the temporary crown & fitting the permanent one onto the tooth.
    6. After ensuring that the crown has the proper look & fit, the dentist cements it into place.

    Crowns

    This process generally consists of a minimum of 2-3 visits over a three to four week period. Once the procedure is completed, proper dental hygiene, including daily brushing & flossing, is required to maintain healthy, bacteria-free teeth, gums & crowns. This helps in the prevention of gum disease. Given proper care, your crowns can last a lifetime.

    Veneers are thin, semi-translucent “shells” typically attached to your front teeth. Veneers are customized from porcelain material & permanently bonded to your teeth. Veneers are a great alternative to otherwise painful dental procedures to improve the appearance of your smile.

    Common problems that veneers are used for:
    • Spaces between the teeth
    • Broken or chipped teeth
    • Unsightly, stained or discolored teeth
    • Permanently stained or discolored teeth
    • Crooked or misshapen teeth
    Veneers are a great aesthetic solution to your smile that may even help you avoid orthodontic treatment. Subtle changes to your smile can be achieved with veneers, & in most cases, veneer application is completed in only two office visits. Please contact me if you have any further questions on veneers.

    A Bridge is a dental device that fills a space that a tooth previously occupied. A bridge may be necessary to prevent:
    • Shifting of the teeth that can lead to bite problems (occlusion) &/or jaw problems & resultant periodontal disease.
    • Bridges safeguard the integrity of existing teeth & help maintain a healthy, vibrant smile.
    There are three main types of bridges, namely:
    • Fixed bridge- this is the most popular & consists of a filler tooth that is attached to two crowns, which fit over the existing teeth & hold the bridge in place.
    • The “Maryland” bridge is commonly used to replace missing front teeth & consists of a filler that is attached to metal bands that are bonded to the abutment teeth. The metal bands consist of a white-colored composite resin that matches existing tooth color.
    • The Cantilever bridge is often used when there are teeth on only one side of the span. A typical three-unit cantilever bridge consists of two crowned teeth positioned next to each other on the same side of the missing tooth space. The filler tooth is then connected to the two crowned teeth, which extend into the missing tooth space or end.
    Teeth Whitening / Bleaching
    Your teeth will darken over time. Changes in the color of your teeth can be caused by such factors as the food & beverages consumed (like coffee, tea & soda). Other known factors for discoloration may include childhood medications or illnesses, tobacco use or improper oral hygiene.

    Dental bleaching, also known as tooth whitening, is a common procedure in general dentistry but most especially in the field of cosmetic dentistry. This process used to be called bleaching, even though bleach was never used. All the processes utilize carbimide peroxide in some different delivery systems & concentrations. Teeth are either shades of yellow, brown, or grey. These are surface stains which are removed with appropriate hygiene visits. In one visit I can whiten (lighten) your teeth up to 12 shades & create a "wow" visit.

    All the whitening procedures begin with an in-office chairside procedure. The process takes 1-1/2 to 2 hours. You will sit in a comfortable reclined chair while I gently place different products & utilize a special light to create that whiter smile. After your visit, you will need to maintain that beautiful smile at different intervals. In order to do this easily, I will make custom trays for you to use as needed. This is a cosmetic procedure & your teeth will darken a little bit each year. With trays, the touch up procedure is easy a little whitening product placed in the tray for an hour per day. In a few days you will be back where you were.

    A very common question is "will this damage my teeth?" The answer is an absolute "no." Research has been done testing these products for daily use of one year without one long-term problem occurring. The most common is a temporary tooth sensitivity that occurs in less than 5% of cases. The sensitivity can last for 30 minutes to 24 hours & at this point goes away.
    Orthodontic Treatment

Orthodontic Braces

    Orthodontic treatment is a way of straightening or moving teeth, to improve the appearance of the teeth & how they work. It can also help to look after the long-term health of the teeth, gums & jaw joints, by spreading the biting pressure over all the teeth.

    Many people have crowded or crooked teeth. Orthodontic treatment will straighten the teeth or move them into a better position. This can not only improve their appearance but also the way the teeth bite together, while also making them easier to clean. In some patients, the upper front teeth can stick out & look unsightly. These ‘prominent’ teeth are more likely to be damaged, but orthodontic treatment can move them back into line. In others, the way the upper & lower jaws meet can cause teeth to look unsightly & lead to an incorrect bite. Orthodontic treatment may be able to correct both.

    When the teeth don’t meet correctly, this can put strain on the muscles of the jaw, causing jaw & joint problems & in some cases headaches. Orthodontic treatment can help you to bite more evenly & reduce the strain. Orthodontic treatment is generally best carried out in children, but adults can have orthodontic treatment too & more & more are doing. Age is less important than having the proper number of teeth. In children, it may be necessary to wait for enough teeth to come through before starting treatment.
© Dr. Swati Agarwal 2009-2015. All Rights Reserved.
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