Sometimes teeth have a hopeless prognosis and cannot be restored. In these cases, extraction is indicated. After confirming that the area is anesthetized, the tooth is slowly and non-traumatically wiggled and maneuvered gently out of its socket. Sometimes a molar may need to be split in half and removed in multiple segments. The socket is then cleaned and irrigated, and the gum tissue sutured if necessary. If the site is planned for an implant, bone graft material may be placed in the socket to preserve healthy and robust bone levels.

Every tooth has a nerve and blood supply which allow for sensation of various stimuli, such as temperature or pain. When the nerve, or “pulp,” of a tooth becomes inflamed and/or infected due to decay or fracture, it must be extirpated. A “root canal” procedure involves carefully removing the dead or inflamed nerve tissue, cleansing and disinfecting the canal, and sealing it with a biocompatible material. It is entirely normal to have some post-operative pain or discomfort following this procedure, which most times can be effectively managed with a combination of over-the-counter NSAID’s (such as Motrin) and Tylenol. Although, with the removal of the pulp, the tooth loses its vitality and sensory ability, it is still wholly functional and can last for decades. However, since teeth with root canals do become more brittle and risk fracture, dental crowns are often recommended in order to protect the tooth going forward.

When a tooth has been extracted or is missing, an excellent restorative option is a dental bridge. The teeth on either side of the gap are filed down, and a series of connected dental crowns (or “caps”) are fabricated by the laboratory. The “fake” crown, or pontic, is held in place over the area of the missing tooth by its connection to the crowns on either side, and the entire bridge is permanently cemented. With the introduction and increasingly popularity of dental implants since the 1990’s, dental bridges have seen their usage diminish. However, they still represent an enduring choice to replace one or more missing teeth in instances where implants are not an option.

One of the newest and fastest-growing areas of dentistry, dental implants have revolutionized how dentists approach the challenge of restoring missing teeth. Most times, a 3D xray (also known as a CBCT, or “Cone-Beam Computed Topography”) will be taken prior to surgery to assess the quality and quantity of bone, note anatomical structures, and plan the surgical approach. On the day of surgery, the gum tissue is opened and a biocompatible titanium implant is placed into the underlying bone. After waiting a few months to allow the implant to integrate, the implant is uncovered and an impression taken for the fabrication of a restoration that will screw into the implant. Today, implants are the most ideal periodontal and restorative treatment option to replace missing teeth, and are the next-best thing to teeth themselves.

When implants or fixed bridgework are not viable options to replace missing teeth, a removable device may be considered. The partial denture, which can be manufactured with a range of materials, latches on to the remaining teeth to provide function and aesthetics. The denture is removed nightly to allow for proper hygiene and cleansing. Before fabrication, small divots and grooves are prepared in some of the remaining teeth, helping to anchor the clasps and hooks which keep the partial in place. This prosthesis has been in use for centuries and is a good restorative option for those who are amenable to wearing a removable device.

A “flipper” is an interim prosthetic device used when a front tooth must be extracted but cannot be replaced immediately. Made of thin plastic with small metal hooks, the flipper is for aesthetic purposes only and must be removed when eating. The prosthetic tooth is matched to the existing dentition and blends seamlessly into your smile. A flipper serves as an excellent temporary device until the permanent prosthetic treatment can be completed.

When plaque and tartar deposits are left undisturbed beneath the gums, the resulting chronic inflammation may lead to the slow destruction of the periodontium, the supporting structures of the teeth. Once bone has been lost and the gum tissue attachment compromised, periodontal pockets form, trapping even more deposits and bacteria. Deeper pockets of more than 4mm cannot be accessed with routine home care; in these cases, a deep cleaning may be advised to clean out the pockets and remove the inflammatory deposits. Completed in multiple visits, a deep cleaning usually involves administration of local anesthesia and subsequent debridement of the periodontal pockets using ultrasonic scalers, air polishing, and hand instrumentation. In 4-6 weeks, the periodontium is evaluated again to assess healing and devise a long-term periodontal maintenance plan.