FAMILY DENTISTRY

J. Bruce Johnson, D.D.S.

Preventative Care

Preventative care in the form of routine dental cleanings & exams helps to preserve natural tooth structure and maintain existing restorations. It is important to take good care of the teeth and gums so issues like decay and gum disease do not threaten the dental system.

Issues concerning the health and longevity of natural tooth structure or restorations are addressed to avoid loss of a tooth. There are options available to compensate for the loss of a natural tooth. Implants are the most preferable option as they are the closest to replicating the purpose and function of the natural tooth.

Establishing or maintaining a proper bite, adequate airway, and healthy joints is vital for balance in the dental system. These three each directly impact and are impacted by each other.

Restorative

Restorative dentistry refers to the area of dental treatment that deals with damaged, decayed, abnormal, or missing teeth. Though this includes periodontics, prosthodontics and implants, these are discussed separately (below). Fillings and crowns are the most predominant restorative procedures.

Fillings: Dr. Johnson provides composite fillings, also commonly referred to as "tooth colored" or "invisible" fillings. Though clearly appearing on x-rays, when looking at the tooth, the filling is indistinguishable from the tooth (see image). Aside from esthetic reasoning for using composite material instead of amalgam ("silver") fillings, composite mimics natural tooth structure better than any other filling material. Placing composite fillings requires less natural tooth structure be removed and avoids the "graying" effect that silver fillings can create. For more information, see Mercury Concerns.

Crowns: The tooth needs a restoration that will satisfy the need to make it whole again. Because of the extent of damage to the tooth, it needs a "Crown". This restoration is designed to return the tooth to its original size, shape, bite, and strength. Due to technological advances, there are a variety of types of "Crowns". The following list is in order of the most desirable (also more expensive) to the least desirable (also less expensive).

Fiber Reinforced Resin Crowns (Sculpture). Strong and durable, they are very esthetic and conservative. They can be made to cover part or all of the tooth. They have no metal in them at all and look and feel more like the real thing than any other crown. They require the least amount of tooth structure removal of any of the "crowns".

All Ceramic Crowns (OPC). These are similar to the Resin Crowns except not as strong and require more tooth removal. Their superior esthetics makes them the choice for "capping" or "veneering" front teeth.

Porcelain fused to Metal Crowns (PFM). These have been the standard tooth colored crown for more than 25 years. They are strong and durable, but esthetics is average at best due to the metal underneath the porcelain. These tend to leave a dark line at the gumline unless the edge is buried deep under the gum. The gums prefer tooth structure instead of crown edges, so when possible, they are avoided. The combined thickness of the metal and porcelain make this the most destructive restoration in terms of tooth structure removal, but they are a necessity when the crown must extend under the gumline.

All Gold Crowns. These have been the standard for more than fifty years where appearance is not an issue. They are strong, durable, relatively conservative, but not very esthetic in today's world. If looks aren't an issue, probably the best value in restorative dentistry.

Cracked Amalgam Filling

Restored with Composite

Gum Recession & Periodontal Disease:

Periodontics

This is the area of dentistry that deals with the condition or disease of the gums and bone- the structures that support the teeth. Gum disease is the #1 reason for tooth loss and afflicts a disturbing percentage of the population. Part of the reason for this is that it is initially painless and the signs of onset can be so subtle that a problem isn't realized until it's too late. Many people are still unaware of just how detrimental periodontal disease can be. When properly educated, we see patients take a more active and aggressive approach to preventing or controlling this condition.

Periodontal disease can begin at an early age, even within teenage years, especially when preventative measures have not been consistently and properly taken. It is necessary to brush and floss every day and to see the hygienist on a regular schedule. Addressing bruxism issues is another preventative measure as this is also a causative factor of periodontal problems.

Some signs that your periodontal state may be (or is) in trouble:

• Gums bleed when brushing or flossing
• Persistent bad breath
• Soft, swollen, or tender gums
• Loose teeth
• Gum recession (gums shrinking away from the teeth)

Periodontal treatment ranges based on the status of the condition and the needs of the patient. Whatever the treatment, the goal is to inhibit the progression of the problem and control the disease. Bone loss is irreversible, but with proper care you can impede the process and prevent further damage.

Causative Factors:

• Bacteria build-up & Plaque accumulation into calculus
• Diet / Nutrition
• Occlusal stress (bad bite)

Prosthodontics & Implants

Both address the issue of missing teeth but in very different ways.

Prothodontics deals with replacing missing (either lost or congenitally) teeth through the use of bridges and partial or full dentures. Bridges adjoin to adjacent teeth to replace one or a couple missing teeth. A partial denture is used when several teeth are missing and a full denture when all teeth are missing. With any of these, the crown portion of a tooth is artificially recreated to fill the gap of missing teeth.

Implants are surgically placed into the bone to recreate the root of a missing tooth. This is the preferred method for replacing a missing tooth. An implant abutment extends into the oral cavity and provides retention for the crown (or denture) to be placed. The implant is provided seperately by an oral surgeon who works in conjunction with the dentist.