The value of a regular dental exam is often underestimated. When a patient comes into the dental office for an “exam and cleaning” usually the most important part of the visit is the exam. The cleaning helps keep calculus (tartar) build-up from occurring. The exam and x-rays however, help the dentist identify problems such as oral disease, tooth decay and even oral cancer early when a solution can be simpler and less costly. When treatment is needed especially when it is more complex, a plan allows the dentist to prioritize and sequence the treatment. This prevents unnecessary appointments and procedures and can save time, money, and teeth. When the patient is involved in the planning, follow-through is better and the result is better.

Restoring a “filling” or a broken or decayed tooth is a large part of what a dentist does every day.  Damage to teeth can come in a variety of unpredictable ways, so several solutions are employed. In our office we have found that most patients prefer composite or “tooth-colored” fillings. Usually this will be the type of simple filling used.  For more extensive damage to a tooth, crowns (caps) or onlays (partial crowns) are used to hold the weakened tooth together and prevent breakage.

The area of oral surgery includes tooth extractions, biopsies, frenulectomies (releasing a tied lip or tongue), and many other procedures. Some general dentists choose to refer all surgery to a specialist. This can be costly, can put limitations on a treatment plan and require more visits. Dr. Robertson has performed thousands of tooth extractions and other surgical procedures. He has the experience to perform simple extractions, multiple extractions (eg. for a denture), and extraction of impacted teeth safely, comfortably, and successfully. If a patient prefers treatment from a specialist, or if the nature of the case indicates the need for advanced training Dr. Robertson will happily refer to one of many good specialists in our area.

Endodontics is the procedure performed to preserve a tooth with a pulp that is necrotic, infected or irreversibly inflamed. The more common title is “root canal”. Root canals have a negative reputation because they are usually needed when the patient has a toothache. The procedure then becomes associated with pain even though the pain was pre-existing. Root canals are performed under a good local anesthetic so that the patient is comfortable. Frequently the toothache is gone after the procedure, but often a pain medication like ibuprofen is needed for 1-2 days afterward until the toothache subsides. When the root canal is completed the tooth will need a restoration such as a crown or filling to reinforce it.

Periodontal treatment is designed to prevent or reverse gum disease. Periodontal disease used to be called pyorrhea. It is an inflammation and usually a chronic low-grade infection of the gingiva (gums). Inflammation is the body’s response to tissue damage and infection.  Normally inflammation is followed by tissue repair, but when the insult is continuous like when bacteria collect around the teeth, the chemicals of inflammation destroy the gingiva and bone that supports the teeth over time. Teeth eventually become loose and are lost. Periodontal treatment cleans away the plaque (soft build-up) and tartar (hard build-up) that harbor bacteria which allows the gums to heal and reattach to the teeth. This prevents further loss of underlying bone support. For periodontal treatment to be successful regular maintenance visits are important.

Dr. Robertson enjoys treating children and has a lot of experience working with kids. He has 8 children of his own and has spent a lot of time coaching, teaching, and playing with kids. Dr. Robertson’s approach to treating children is to use the experience and knowledge of Mom or Dad to manage each child individually. Parents are usually welcome in the treatment room with their child, since that often helps the child’s confidence. Parents have many questions and Dr. Robertson enjoys explaining his work and his plan. We have overhead screens for kids to watch videos and “happy gas” to help them relax if needed. Parents can help their child most by appearing positive about the dental visit even though they may have anxiety of their own. Children should be seen for a “fun visit” to get used to the dentist at about 2 or 3 depending on the parent’s judgment as to whether the child will likely allow a simple look in the mouth. The child should be seen earlier if the parent has a concern. The biggest concern at this age is baby-bottle decay.  Decay at this young age is infrequent unless there is the habit of using a baby-bottle or sippy cup with juice or other sugary liquid. Children always enjoy choosing a prize from the treasure chest after their visit.

Losing a tooth can have greater consequences than just the loss of the use of a single tooth. As a tooth is lost, adjacent teeth usually begin to drift and collapse into the empty space leaving other spaces. This jeopardizes the drifting teeth, and makes the bite uneven. It is beneficial to the long term health of the mouth to replace missing teeth. Implants are the newest and best long-term solution to tooth replacement. The most common type of dental implant is a cylinder of metal, shaped and surface-treated to promote bone growth around the implant. The implant is placed into a hole prepared in the site of the missing tooth. The implant on occasion can be immediately fitted with an implant crown (false tooth) or more often a “healing cap”. After a period of time which is usually about 2 months, the healing cap is removed and a crown is prepared and screwed or cemented onto the implant. The dental implant in effect serves as the root of a tooth. Implants have a high rate of success. Proper selection of an eligible case is a large factor in its success.

A fixed bridge is simply two or more crowns (caps) with one or more false teeth attached between.  A bridge is an improvement over a missing tooth or a partial denture, but has some drawbacks.  One drawback is that adjacent teeth which may be healthy must be reduced to stumps to receive the crown portions of the bridge. In addition, a bridge cannot be flossed or cleaned normally.  Finally, if a supporting tooth for the bridge fails then the whole bridge may fail.  Bridges sometimes have an advantage in cost, and in certain situations when a tooth may benefit by being splinted to another tooth. A bridge is also a good option when an implant is contraindicated.

Full dentures are pink acrylic bases with acrylic or ceramic teeth embedded to appear natural. Dentures fit over toothless gum tissue to provide some chewing ability and an improved appearance. Dentures are certainly an improvement over no prosthesis at all, but they have serious difficulties. The hard acrylic of the denture compresses the gingival tissue against the underlying bone and limits the amount of biting or chewing force. Dentures don’t have a perfect adhesion system, so they come loose often during inconvenient times. The lower denture is the worst for this. Dentures also have a problem with collecting food.

Partial dentures are usually made of a metal framework with pink acrylic and acrylic teeth for a patient who still has some teeth remaining. A partial denture also has advantages and problems. A partial denture can replace several missing teeth at once with considerably less expense than implants or bridges, and they still function to prevent drifting teeth. The disadvantages are that they are bulky, come in and out of the mouth, require meticulous care, retain food, can cause problems for remaining support teeth, and are not as natural looking as bridges and implants.

Who wouldn’t like to have a nice bright smile? A smile is the universal sign of joy and congeniality. When we have teeth that make us self-conscious, it interferes with our desire to smile. There are two answers to this problem: either smile anyway, or repair the smile.  While anyone looks better with a smile no matter what the condition of their teeth, it can be much more fun if you are proud of your smile. Veneers are a way to correct crooked, stained or otherwise unsightly teeth. A veneer is a little shell of porcelain that bonds to the front of the tooth. Usually the tooth is reduced to a shape that allows the veneer to fit ideally. On occasion a veneer can be bonded to an unprepared tooth. This is nice if possible, but makes the teeth thicker which can be tricky to get used to. Sometimes simple bonding of a composite tooth-colored filling material can accomplish a limited task. In any case, the smile is improved, and people can change their whole demeanor if they are no longer afraid to smile.

Historically teeth have been repaired with metals. Silver amalgam fillings have tarnished and darkened. Gold crowns (caps) are readily visible. With an increased awareness of the importance of appearance in business and personal relations, demand has risen for more natural-looking solutions. Composite (tooth-colored) fillings and all-porcelain restorations have effectively answered the call. Different modifications to porcelain have overcome problems with strength, abrasiveness, accuracy, appearance, etc. Dentists are now successfully restoring broken-down teeth with all-porcelain crowns and onlays that look indistinguishable from natural teeth and have great longevity. Dr. Robertson has found a significant reduction in post-treatment sensitivity with porcelain onlays, and a decrease in the recurrence of decay. All-porcelain restorations seem to have “cemented” their place in the repertoire of dental solutions.

One way to brighten your smile inexpensively is to bleach. Most bleaching systems contain hydrogen peroxide or carbamide peroxide in some concentration. This removes stain from tiny cracks and fissures in the enamel of the tooth. Tooth bleaching kits can be purchased over-the-counter, or Dr. Robertson can prepare a custom bleach tray with a higher concentration of the active ingredient. This also includes verbal instructions and a record of the patients’ initial tooth color. Finally “in-office bleaching” can be performed by the dentist. This requires isolation of the teeth with a thin sheet of rubber and a high concentration of the peroxide. Often the teeth are sensitive to temperature afterward and the cost is significantly higher. Bleaching provides a safe and fairly simple way of improving the appearance of a smile.