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Dental Treatment: Before and After

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S: Dental Treatment: Before and After by Dr. Christopher R. Morris

BC: 7720 S. Broadway, Suite 430 Littleton, CO 80122 (303) 795-1443 | CHRISTOPHER R. MORRIS, DMD, FAGD | Scan here to call our office. | Scan here to visit our website. | Scan here to save our contact information.

FC: Before and After | Dental Treatment

1: Dr. Morris completed his pre-dental education in his hometown of St. George, Utah at Dixie State College. He graduated from dental school at the University of Louisville School of Dentistry. After dental school he completed a one-year residency in Advanced Education in General Dentistry where he learned specialist-level treatment in many disciplines of dentistry. His education and honors continued with: - Fellowship in the Academy of General Dentistry (FAGD), - Advanced surgical and prosthetic dental implant training with the Misch International Implant Institute, - and IV sedation training at Duquesne University. Dr. Morris has been a lecturer for other dentists and medical professionals. Dr. Morris has enjoyed participating in humanitarian projects and public service including pediatric dentistry in Honduras, missionary service in Brazil, Give Kids a Smile pediatric dentistry, and four years of active duty service in the U.S. Army, including a 15-month deployment to Iraq where he was the only dentist for 10,000 military personnel. | CHRISTOPHER R. MORRIS, DMD, FAGD | This book will show before and after photos of dental treatment provided by Dr. Morris.

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3: Cosmetic dentistry. . . . . . . . . . 4-23 Teeth whitening. . . . . . . . . . . 6 Orthodontics. . . . . . . . . . . . 8 Periodontal surgery. . . . . . . . . 10-13 Gingivectomy. . . . . . . . . . . 10 Gingival graft. . . . . . . . . . . 12 Restoration. . . . . . . . . . . 14-23 Veneers. . . . . . . . . . . . . 14 Porcelain crowns. . . . . . . . . . 16 Fillings and Sealants. . . . . . . . 18-21 Dentistry for missing teeth. . . . . . . 24-43 Bone loss in the jaws. . . . . . . . . . 26 Dental implants. . . . . . . . . . 28-37 Bridges. . . . . . . . . . . . . . 38 Dentures. . . . . . . . . . . . 40-43 | 3 | Periodontal health. . . . . . . . . . 44-49 Dental cleaning. . . . . . . . . . . 46 Deep cleaning. . . . . . . . . . . 48 Biteguards. . . . . . . . . . . . 50-56 TMJ / TMD biteguard. . . . . . . . . 52 Sleep apnea biteguard / Snore guard. . . . 54 Sports mouthguard. . . . . . . . . . 56 Other common procedures. . . . . . . 58-67 Root canal therapy. . . . . . . . . . 60 IV sedation. . . . . . . . . . . . 62 Wisdom tooth extraction. . . . . . . . 64 Emergency dental trauma. . . . . . . 66 Conclusion. . . . . . . . . . . . . 68 | Table of Contents

4: Cosmetic Dentistry | 4

5: 5 | Cosmetic dentistry can provide you with the most attractive smile possible. A smile makeover may include stages for teeth whitening, orthodontics to straighten the teeth, periodontal surgery to adjust the level of the gums, and finally restoring the teeth with veneers, porcelain crowns, or bonded fillings. This process is represented in the dental cosmetic pyramid: While some patients may benefit from all stages of treatment, other patients may require only one or two stages to achieve a perfect smile.

6: Teeth Whitening | Teeth whitening brightens teeth to a whiter, more attractive smile. The most effective method of teeth whitening is with take-home trays that are used daily for about two weeks. The average patient can expect teeth to lighten two to three shades. Results from whitening last from months to years, depending on your food habits. | Before you whiten it is important to have a current dental exam with your dentist. Areas of decay can be extremely sensitive to whitening and should be treated before whitening. Previous porcelain crowns and composite fillings will not lighten with the natural teeth. Old dental work may need to be updated after whitening. | 6 | Before | After

7: Internal bleaching | In some cases a single tooth will darken - in this photo the front tooth on the left has turned gray. Internal bleaching will lighten a single tooth. Peroxide is placed inside the back of the tooth and covered with a temporary filling. Each week fresh peroxide is placed in the tooth until it is brightened to the match the shade of the other teeth. Then the temporary filling is replaced with a permanent filling. | 7 | Before | After

8: Orthodontics | Orthodontics is the practice of straightening crooked teeth. This is accomplished by light, continuous pressure applied by a wire or clear aligners like Invisalign. As the teeth shift position the bone supporting the roots reforms to allow the teeth to assume their new position. Traditional brackets and wires are the standard of care in orthodontics and can correct the widest variety of crooked teeth and alignment issues. | 8 | Clear aligners are a series of removable, thin, clear, plastic trays that fit over the teeth. The trays are less noticeable to wear than metal brackets and wires. Each aligner will push the teeth a small distance – just a millimeter or two. Each set will push the teeth a little further until they reach their final position. The aligners should be worn at all times other than when eating and drinking. The more you wear them, the better they'll work. Once the teeth are straight, a retainer is worn day and night for a year. After the first year, the retainers should be worn at night.

9: 9 | Before | After

10: Gingivectomy | A gingivectomy is the removal of excess gum tissue. A gingivectomy corrects the problem of a "gummy smile," or a smile that shows too much of the gums. Too much gum tissue can make the teeth look short and stubby, or make the smile uneven. Once the area is numbed, some of the gum tissue is removed to uncover more of the natural enamel of the tooth. When this procedure is done by laser, the healing time is several days quicker. After a gingivectomy the teeth appear longer, straighter, and more slender. The teeth then fill up more of the smile as less of the gums is showing. | 10 | Before | After

11: 11 | Immediately after laser gingivectomy | After | Before | One week of healing

12: Gingival Graft | Recession is a loss of gum tissue that should cover the tooth root. The most common cause of recession is scrubbing too aggressively when using a toothbrush. Recession can lead to sensitivity of the teeth and an unaesthetic, long-toothed smile. Gingival grafting can correct recession and restore the height of gum tissue. In the photo below notice the yellow exposed root at the top of several front teeth. A graft from the palate or a tissue bank product is placed to cover the roots. The natural gum tissue heals and incorporates the graft, as shown in the picture on the right. The gums then fully cover the roots, reducing or eliminating tooth sensitivity in these areas, and improving the aesthetics of the smile. | 12 | Before

13: 13 | After

14: Veneers | A veneer is a thin porcelain facing that is bonded by strong cement to the front surface of the teeth for aesthetic improvement. Veneers can correct problems of stain, discoloration, and crooked or poorly shaped teeth. The patient shown here didn't like the stain or general yellow color of her teeth. She had old discolored fillings, dark gaps between teeth, and areas of recession, root exposure, and tooth sensitivity. To correct these problems she had ten veneers made for the upper teeth and ten for the lower teeth. The veneers gave the teeth a lighter shade, a longer, fuller look, and better coverage of exposed roots while filling dark gaps between teeth. She was thrilled with the appearance of her teeth, felt more confident with her smile, and had much less sensitivity of the teeth. | This photo demonstrates how veneers are bonded only to the front surface of the teeth. | 14 | Before

15: 15 | After

16: Porcelain Crowns | When a tooth has been weakened by root canal therapy or a large filling, it should be covered with a crown. Porcelain crowns differ from veneers in that they surround the tooth 360 degrees. The porcelain now used for veneers and crowns is more cosmetic and stronger than ever. The tooth is shaped to have an even taper from top to bottom. This shape allows the crown to slide onto and fit snugly over the tooth. Porcelain crowns can be made for front teeth and back teeth. | 16 | Before | After

17: The old crown shown above has a metal edge that makes a dark shadow along the gumline. The old porcelain looks dull and lifeless. This crown was replaced with an non-metal, all-porcelain crown. The gumline shadow is gone. The new crown looks more bright and natural. | 17 | Before | After

18: Fillings | Fillings are an artificial material used to repair decayed or broken teeth. Decay is a progressive disease that will advance deeper into the tooth until pain, abscess, or tooth fracture result. If the decay is replaced with a filling, the disease process is stopped. The earlier a cavity is filled, the smaller the filling will be, and the better this is for the health of the tooth. The red arrow on this x-ray points out decay (the dark area) between the teeth in a patient who rarely flossed. Once the tooth has been numbed, the decay is removed. The composite tooth-colored filling material is placed in the tooth and light-cured with an ultra-violet light. The final filling is polished smooth. It is very aesthetic. Composite fillings can be used for front teeth and back teeth. A filling stops the disease process of decay and ensures many more years of use from the tooth. | 18 | Before | After

19: 19 | After | Before

20: Sealants | Sealants are a coating that fills grooves to prevent cavities. The microscopic view on the left shows a single toothbrush bristle that is unable to fit into the groove in the tooth. Bacteria are small enough to hide down in that groove where the toothbrush can't clean them out. This situation is a cavity waiting to happen. The page to the right shows the normal grooves in a back tooth, which have collected stain. The lower photo shows the same tooth after a sealant has been bonded into the grooves. The teeth do not need to be numbed, and there is no drilling involved; having a sealant done is a painless procedure. With a sealant filling the grooves the bacteria can no longer hide in the grooves. The surface of the tooth is smoother and easier to clean with a toothbrush. Permanent teeth with grooves should have sealants as soon as they erupt into the mouth. These teeth erupt from ages 6-13. A tooth with grooves that does not get a sealant is seven times more likely to get a cavity. | 20

21: 21 | After | Before

22: The Cosmetic Pyramid | 22 | Let's put this all together with the dental cosmetic pyramid. This is Jared. He was self-conscious of his smile and felt that his appearance was affecting his success at work. He didn't like the crooked look of his teeth or the stain around old bonded fillings. The cosmetic pyramid plan for Jared's smile makeover includes phases of bleaching, perio, and restoration treatment. He did not need orthodontics because the crooked look of his teeth is from uneven gums, not uneven teeth. Jared whitened his teeth and improved two shades. Then he had a gingivectomy to make the gum level even and give the teeth a longer, more slender look. Finally, he had four veneers made for the front teeth to brighten their color, eliminate stains, and improve their size and shape. Now he is confident in his smile and confident in his work. Jared is thrilled with his new smile!

23: 23 | After | Before

24: Dentistry for Missing Teeth | 24

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26: Bone Loss in the Jaws | BONE LOSS WITH INDIVIDUAL MISSING TEETH Bone loss happens after the extraction of one or more teeth. In the photo below one front tooth is missing. Notice how the jaw bone is wider where the teeth are still present (blue line), while there is loss of bone width where the tooth is missing (red line). This patient needed a bone graft before his implant and crown (see pages 30-31). Without replacement of this missing tooth, the adjacent teeth are at 15% risk of also being lost, even if they are in good condition, which can begin a domino effect of losing teeth. A missing tooth should have a fixed replacement (an implant or a bridge) as soon as possible, ideally within the first six months after extraction. | The teeth roots support the jaw bone. Bone loss or resorption in the jaws begins after tooth extraction and is continuous. This photo contrasts the height of bone in a jaw with teeth and the height of bone in a jaw that has been without teeth for 20 years. That's a lot of bone loss! The consequences of bone loss in the jaws include decreased support to remaining teeth, difficulty in wearing a denture, poor nutrition, declined overall health, and a more aged look to the face and smile. | 26

27: BONE LOSS WHEN ALL TEETH ARE MISSING When all the teeth are extracted the jaw bones shrink even more. Compare the photos of these patients with and without teeth. After years of bone resorption the upper lip becomes unsupported, the nose droops, the corners of the mouth frown and wrinkle, and the lower jaw closes too far causing the chin to jut forward. This is the appearance of old age. It has been nicknamed “witch's chin” or “bitter beer face.” A denture alone does not stop bone loss. Continued bone loss will cause dentures to gradually become more and more loose. Loose dentures cause sore spots on the gums and difficulty when eating. Dentures need to be relined or remade over the years to fit the shrinking jaw bones. | 27 | Until dental implants there was no way to prevent bone loss in the jaws after tooth extraction. Implants are the answer to the problem of bone loss. Like natural tooth roots, implants support and stimulate the jaw bone to prevent bone loss. If you are missing teeth, the earlier in life you have implants placed, the sooner you'll stop the bone loss. Whether you're missing one or more teeth, you can prevent the problems associated with bone loss by getting implants as soon as possible.

28: Dental Implants and Crowns | Implants are a man-made replacement for the natural tooth root. They are the best tooth replacement option in dentistry today. An implant can replace one missing tooth or multiple missing teeth. Implants can also be used to anchor dentures. Implants will improve your ability to eat your favorite foods, will prevent bone loss, and will improve your oral health and overall health. | SINGLE BACK TOOTH REPLACEMENT When one tooth is missing, an implant is the first replacement option. There are three parts to an implant tooth replacement: the implant itself, the abutment, and the crown. The implant replaces the root of the tooth and sits at the level of the gums. The abutment is a post attached to the top of the implant and stands above the level of the gums, which allows a crown to be cemented onto the implant. The patient shown on the right is missing the lower right first molar. The area is numbed and the implant is placed to replace the root of the missing tooth. After a healing period of 3 to 6 months the abutment or post is attached to the top of the implant, as shown in the upper right photo. A crown is then made and cemented on the implant, as shown in the lower left photo. (The blue spots in this photo are from blue ink marking paper used to check the bite on the new crown; this ink is easily wiped off.) On the x-ray notice the implant (an artificial root) looks different than the roots of the natural teeth. With good oral hygiene, an implant can last up to 30 years. | 28

29: 29 | Before | After

30: Dental Implants and Crowns | SINGLE FRONT TOOTH REPLACEMENT An implant must be supported by bone 360 degrees. If there isn't enough bone for an implant, a bone graft may be done to add bone before implant placement. This patient lost a front tooth. The upper left photo on the page to the right shows bone loss in the area of the missing tooth. Because of bone loss in this area, he needed a bone graft. The upper right photo was taken after the bone graft had healed. Now the bone is wide enough to support an implant. The lower left photo shows the abutment post on the implant. The lower right photo shows the final crown cemented in place on the implant. A dental implant is a strong, aesthetic replacement for a missing tooth. An implant crown is strong enough to eat any foods this patient would like to eat. He no longer has a gap in his smile. His implant functions like a natural tooth in appearance, strength, and function. | 30

31: 31 | Before | After

32: Dental Implants and Bridges | REPLACING MULTIPLE TEETH Implant bridges can replace a few teeth or all teeth. The photos on the left show an implant bridge for three missing back teeth. The bridge is supported on both ends by implants. On the right is a patient who lost his front teeth after his mouth hit the steering wheel during a car crash. His missing front teeth were replaced with an implant bridge. The first photo shows the implants in the gums without the abutment posts. After the posts are attached to the implants, the four-tooth bridge is cemented. This bridge has been styled with white porcelain to replace the teeth and pink porcelain to replicate the gums. It looks very natural when the patient smiles, talks, or laughs. Implant bridges are the strongest replacement for missing teeth. | 32 | Before | After

33: 33 | Before | After

34: Dental Implants and Bridges | When all teeth are missing, implants can replace them all. Meet Joshua. He had multiple missing, broken, and abscessed teeth. None of the teeth were in good enough condition to be saved. He said he hadn't smiled confidently in 10 years. He wanted to be able to eat and smile again. He was interested in replacing all of his teeth with implants. All remaining teeth were extracted and then replaced with 17 implants and 26 new teeth made of porcelain-metal bridges. Treatment time from start to finish was about nine months. Now Joshua can eat whatever he wants. With better nutrition he is healthier. Implants support the bone (like the roots of natural teeth do) so he won't suffer from bone loss like denture wearers do. He smiles more. He is happier. Having a healthy mouth has changed his life! | 34 | Before

35: 35 | After

36: Dental Implants and Dentures | Problems common to dentures are sore spots on the gums, loose dentures, and difficulty eating. Dentures have 30% the bite strength of natural teeth, preventing patients from comfortably eating many of the foods they enjoy. Implants can help to solve these problems. An attachment inside the denture snaps onto the implants. The denture will be more stable, cause fewer sore spots, and improve eating. Two implants under a lower denture is a common treatment. More implants will stop bone loss and increase the stability and strength of the dentures even more. Unlike crowns and bridges, a denture attached to implants is removable. The denture should be removed and cleaned well at least once a day. Here is an example of a lower denture attached to two implants: | 36 | Before | After

37: Here is an example of an upper denture attached to implants. This implant denture is palate-less and more comfortable for speaking and eating than a non-implant denture. The denture attaches to a bar that is supported by six implants. When attached to this many implants a denture feels rigid and restores 80-90% of the chewing strength compared to natural teeth. | 37 | Before | After

38: Bridges | A bridge on natural teeth replaces missing teeth when there are existing teeth on both sides of the space. Crowns cover the adjacent teeth with the replacement teeth connected between the crowns. To support a bridge the teeth are first shaped with an even taper. The bridge is made to slide down and fully cover the teeth from top to bottom. A bridge feels more natural and stronger than a denture. The patient shown on the right is missing several front teeth. Three teeth shown here have been prepared to a taper and are ready to support a porcelain bridge. This beautiful six-tooth bridge fits over the three natural teeth shown in the first photo. She is thrilled with the result. | 38

39: 39 | Before | After

40: Partial Dentures | Partial dentures are a removable replacement for missing teeth that clasps onto remaining teeth. Dentures have the advantage of being an economic replacement for multiple teeth. Disadvantages of dentures include continued bone loss, less chewing strength than natural or fixed teeth, food entrapment, loose teeth, sore spots on the gums, and deficient nutrition. A denture should be removed and rinsed after eating in addition to being thoroughly brushed once a day. It is recommended to wear the denture everyday and to take the denture out while sleeping. Partial dentures have a metal framework that anchor the pink acrylic and white acrylic teeth. | 40 | The patient shown to the right is missing his back teeth. Notice the gaps in the back of his smile in the photos in the left column. This patient is interested in having a partial denture made. The photos in the right column show the partial dentures in place. The gaps in the back are filled with teeth. The partial denture replaces the missing teeth with white acrylic teeth anchored in pink acrylic that imitates gum tissue. The partial framework has clasps that snap around the natural teeth to keep the partial in place. The partial denture base covers the roof of the mouth. The partial denture gives the patient more back teeth to chew his food.

41: 41 | Before | After | Before | After

42: Full Dentures | A full denture is a removable set of teeth for the upper or lower jaw. Dentures are an aesthetic, economic teeth replacement. White acrylic denture teeth are attached to a pink acrylic denture base. The inside of the denture is the same shape as the gums and rests on the gums. It is held in place by water surface tension of the saliva, by a denture adhesive (paste or powder), or by dental implants. Dentures should be checked at least once a year to see if they need to be relined to fit the shrinking jaw bones. Denture teeth eventually wear out or the denture may break, and a new set is made every 8-15 years on average. | 42 | This patient is missing all of his teeth. The small photos to the left show the way the gums have healed after extracting all the teeth. The larger photos on the right show the denture in place on the same patient. Dentures provide a natural, functional replacement for missing teeth. They restore the proper height of the jaws. They improve social confidence. Dentures improve nutrition and health. | Before | After

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44: Periodontal Health | 44

45: 45

46: Dental Cleaning | 46 | Periodontal health exists on a sliding scale with healthy gums on one end and severe gum disease on the other. Gum disease is caused by plaque and calculus. Mild gum disease like gingivitis is totally reversible, and you can slide back up the scale to good gum health with consistent dental cleanings and good home care. Gum disease is considered advanced once there are signs of bone loss. If you slide too far down the scale to advanced gum disease, the bone loss is irreversible; you can't slide back up without a bone graft. The x-rays below compare healthy bone level (left x-ray) to someone with chronic gum disease that has caused gradual, painless bone loss (right x-ray). Otherwise healthy teeth lose the support of the bone, and can even become so loose that they fall out. Periodontal therapy is care of the gums to promote healthy support for the teeth. Dental cleanings reverse early gum disease or stop the bone loss of advanced gum disease by removing calculus and plaque. Treatment can range from a simple cleaning every six months to surgical treatment of advanced gum disease. | Healthy gums | Gingivitis, no bone loss | Moderate periodontal disease with bone loss | Severe periodontal disease with bone loss

47: 47 | Before | After | Brown stain and yellow calculus shown before the cleaning are removed and the teeth are polished to reveal the clean, smooth, white surface of the teeth after the cleaning.

48: Deep Cleaning | 48 | The initial treatment for advanced gum disease is a deep cleaning or scaling. Bacteria hiding deep in the gums around the teeth is removed. The gum tissue health will improve after this scaling treatment, and the health of the gums is re-evaluated. If healthy, regular dental cleanings continue every three or four months. If the gums are not healthy after scaling the next level of treatment may be local antibiotics, laser therapy, or surgery. In specific areas of deep pockets, an antibiotic powder can be placed to kill bacteria and improve gum health. The option of periodontal surgery removes excess gum tissue to make pockets around the teeth more shallow. Once you've had gum surgery it is recommended to have more frequent cleanings – every three or four months instead of every six months. All periodontal treatment options have the goal of changing deep pockets of gum tissue into more shallow pockets of gum tissue, and to change the type of bacteria in the mouth to a milder, less destructive bacteria. Shallow gums can then be cleaned and maintained on a daily basis with toothbrush and floss. Healthy gums will support the teeth for a lifetime. | Laser therapy In some cases laser treatment in conjunction with a cleaning is necessary. This laser is directed into the pocket of gum tissue around the tooth in specific problem areas to kill more bacteria.

49: 49 | Before | After | These photos contrast gum disease (red, swollen, bleeding gums with calculus present and deep pockets) with healthier gums one month after a deep cleaning (pink gums with fewer red areas, no calculus, and shallow pockets).

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51: Biteguards | 51

52: TMJ / TMD Biteguard | A biteguard or nightguard is made of plastic and snaps onto the teeth. It is the treatment of choice for excessive tooth wear, pain in the temporomandibular joint (TMJ), pain in the jaw muscles, or pain in the teeth caused by grinding or clenching. The biteguard is usually worn while sleeping because grinding is most common during sleep. It may also be worn during the day if grinding or clenching are daytime habits. A biteguard limits wear and tear of the teeth. Even if you grind and wear out the biteguard it is better to wear out the plastic that can be replaced rather than your own teeth. | 52 | The biteguard is a few millimeters thick. Biting on the biteguard stretches the jaw muscles to a slightly-open position. This is a weaker position than without the biteguard, so even if you continue to grind or clench it will be weaker forces. Weaker forces will reduce or eliminate pain in the jaws and teeth. A biteguard is flat and smooth. The lower teeth will skate smoothly along the biteguard. They cannot interlock with the upper teeth as they would without the biteugard. Grinding on the smooth surface of the biteguard decreases forces on the teeth. Limiting the forces of grinding and clenching will provide relief to painful teeth, jaw muscles, and joints.

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54: Sleep Apnea Biteguard Snore guard | Sleep apnea is a condition caused by the tongue or throat relaxing to block the airway while sleeping. These apnea events can happen through the night from 5 to 30 times every hour. Sleep apnea disrupts the proper sleep cycle so the deeper levels of natural sleep are never reached. Untreated sleep apnea has serious negative health consequences. The most serious is heart disease that can lead to heart attacks and death. Non-restful sleep can also cause fatigue, stress, narcolepsy, poor metabolism, weight gain, and more. If you have low energy even after 7-8 hours of sleep, snore loudly, or have congestive heart failure, consider having a sleep study done to see if you have sleep apnea. If you've been diagnosed with sleep apnea, dental treatment can help. A sleep apnea biteguard is designed to open the airway of the throat while you sleep. The only way the teeth fit into the biteguard is with the chin slightly jutting forward. With the chin in this position, the airway is opened to improve airflow. This biteguard can be the only treatment for apnea, or it can be used in combination with a CPAP airflow mask or surgery. A sleep apnea biteguard will also eliminate snoring and protect the teeth from grinding or clenching. It’s such a simple treatment, but just imagine having better sleep, feeling well rested, having more energy to exercise and lose weight, and improving your heart health. The sleep apnea biteguard is the most life-changing treatment dentistry has to offer. One patient said their biteguard eliminated snoring that had him sleeping in a separate bedroom from his wife for the first 10 years of their marriage. Elizabeth, another patient, says, “I noticed a change: I’m not tired like I used to be.” Proper breathing will provide a better night’s sleep and help keep the heart relaxed and healthy for a lifetime. | 54

55: 55 | Before | After

56: Sports Mouthguard | A sports mouthguard protects the teeth from injury during sports activity. The American Dental Association states that 15% of all sports injuries are to the mouth. Athletes are 60 times more likely to injure their teeth if they compete without a mouthguard. A dental sports mouthguard is recommended in sports that involve contact or speed: - football - soccer - boxing - lacrosse A sports mouthguard can prevent injuries like these: See pages 66-67 to read about emergency dental trauma treatment. The ideal mouthguard is durable, comfortable, and doesn't impair breathing. The moutguard covers the teeth and gums to provide support and protection. Impact to the upper teeth is cushioned directly by the mouthguard. Impact to the lower teeth is cushioned against the mouthguard which can lower the risk of concussion caused by blows to the chin. A mouthguard may even improve performance in power sports like weightlifting and baseball. Clenching on the mouthguard stabilizes the muscles of the head and neck to increase power in coordinated movements. | 56 | - basketball - baseball infielders - hockey - gymnastics | - skiing - martial arts - rugby - skateboarding | - racquet sports - wrestling - weightlifting - and more.

57: 57 | After | Before | Proper mouthguard protection will ensure the teeth look the same before and after a sporting impact.

58: Other Common Procedures | 58

59: 59

60: Root Canal Therapy | Root canal therapy removes pulp tissue from a tooth to replace it with a filling material. It alleviates the pain and swelling associated with an abscessed tooth. When the teeth are properly numbed a root canal is no more painful than having a filling done. A hole is made in the top of the tooth to access the pulp chamber, and the canals are cleaned to the root tip with long, narrow instruments. The empty space in the canal is then filled, and the access hole is also filled. After a tooth has had a root canal, a crown is recommended to strengthen the tooth. The page to the right shows x-rays of two painful, abscessed teeth. This sometimes looks like a pimple on the gums just below the tooth (the arrow points to the abscess). The first x-ray shows dark spots around the root tips of two teeth. This dark spot is the abscess. To make the toothache go away, the source of the pain and infection - the nerve - must be removed. Both teeth are in need of a root canal. The second x-ray shows the finished root canals. The nerve and pulp tissue in the center of each tooth has been removed. The canals have been filled to the root tips with a filling material that looks like a white line on the x-rays. The body's immune system will now be able to eliminate the infection and heal the bone. Six months later the third x-ray shows that the dark spots of infection are gone, and the bone around the teeth roots looks as normal and healthy as the rest of the jaw. The teeth have been pain free since the root canals were done. The teeth have also been strengthened with crowns. This patient can expect to keep these teeth for many more years. | 60

61: 61 | Before | After

62: IV Sedation | More than half of Americans delay seeking dental care due to anxiety. Delay in dental care may be the difference between a small filling and a root canal or extraction. The need for sedation dentistry to reduce anxiety is undeniable. Intravenous (IV) sedation is the most effective form of sedation. Medications are given with sterile water directly into a vein and have rapid effect. Even when sedated, your mouth will also be numbed with local anesthetic to ensure your comfort during the appointment. Many patients report not being aware of when the local anesthetic was given because the sedation had already taken effect. Patients report feeling that just a few minutes have passed and being surprised that the appointment is already over. You will need someone else to drive you home after sedation dentistry. Medications wear off about an hour after the appointment. Sedation can eliminate fear or anxiety about dental treatment. It is a comfortable way to get dental treatment done. | 62

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64: Wisdom Teeth Extraction | Wisdom teeth that come in straight into the proper position do not need to be removed. If there is enough space for the wisdom teeth to fully erupt, and they are cleaned well to prevent decay, you should keep your wisdom teeth. However, it is estimated that 80% of people have some problem with their wisdom and should have them removed. Problems with wisdom teeth include crowding, impaction (incomplete eruption), gum disease or infection, pain, and decay. Wisdom teeth are most commonly removed between ages 16 and 25. Today's techniques make tooth extraction more comfortable than ever. IV sedation is recommended for wisdom tooth removal. Local anesthetics provide excellent anesthesia. The gums are pushed away to expose impacted wisdom teeth. When the tooth is extracted only mild pressure will be felt. There is no sharp pain. Stitches may be placed to help the gum tissue heal afterwards. Many patients are surprised by how comfortable they feel during the appointment. Recovery time is 48-72 hours when some soreness and swelling occur. You can be most comfortable during this healing phase by taking prescription medication, applying cold for 15 minutes on and 15 minutes off, and getting good nutrition and drinking plenty of water. | 64

65: 65 | After | Before | These x-rays show an impacted wisdom tooth with curved root tips. An x-ray taken later shows that the bone has healed where the wisdom tooth used to be. The health of the gums and other teeth can now be maintained more easily without the impacted wisdom teeth present.

66: Emergency Dental Trauma | When a tooth gets bumped out of position, immediate treatment (in one hour or less) is required to ensure its long-term health. Right away: - Do your best to push the tooth back into the proper position. - If the tooth has been knocked out completely, hold it by the white enamel end (not the yellow root end), rinse it gently with water only, (do not wipe it or scrub it). Rinse the tooth socket with water, and place the tooth back in the socket, as close to the proper position as possible. - If the tooth has been knocked out completely and you can't get it back in the socket, store the tooth in: 1) Hank's Balanced Salt Solution or Save-A-Tooth (available at pharmacies), 2) cool milk, 3) 0.9% saline water (available at pharmacies), or 4) saliva. Have the person whose tooth was knocked out hold it inside their cheek. All these solutions have the purpose of keeping the cells of the tooth alive until it can be placed back in the socket. - Call your dentist immediately. If the tooth is repositioned and stabilized in one hour or less, it has a much better chance of healing well and staying alive. If it takes longer than an hour, then the body may reject the tooth during the healing process. Treatment for a dental injury to permanent teeth includes repositioning the tooth, stabilizing it, prescription medication, and evaluating the health of the nerve. The patient shown here was hit with an elbow while playing a pick-up game of football. He was not wearing a helmet or mouthguard. He had one tooth completely knocked out that no one could find. Another tooth was pushed slightly out of the socket (red line on x-ray), while the bone around a third tooth was broken (yellow line on x-ray). He arrived at the dental office eight minutes after his injury. Once the area was numbed, the teeth and broken bone were repositioned. A wire was bonded to the teeth to secure them in place while they healed. He was prescribed an antibiotic and pain medication. After two weeks the wire was removed. The two teeth had root canals and the missing tooth was replaced with an implant and crown. If he hadn't received immediate treatment he would have lost three teeth instead of one. | 66

67: 67 | Before | After

68: 68

69: Conclusion | 69 | Modern dentistry offers more comfortable treatment, better aesthetics, sophisticated technology, and longer-lasting results. The advances of the last few years with dental implants, sedation dentistry, stronger porcelains, and more make a lifetime of good oral health a reality. A healthy mouth improves nutrition, overall health, and the quality of life. A beautiful smile improves confidence and happiness. Let modern dentistry help you get the smile you've always wanted.

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  • By: Cori M.
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  • Title: Dental Treatment: Before and After
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  • Published: over 5 years ago