Routine Cleanings • Routine Exams Treating Periodontal Diseases Veneers • Tooth Whitening • Bridges Children's Dentistry Crowns • Implants • Dentures Root Canals • Toothache • Tooth Knocked Out Wisdom Teeth • Extraction Flexible Payment Options • Insurance Filing

Routine Cleanings
Regular dental cleanings help to remove plaque and calculus (hardened plaque) from your teeth. One of Dr. Carpenter's hygienists will thoroughly and gently clean your teeth. Stains and other deposits are also removed during the cleaning.

Routine Exams
After your teeth have been cleaned, Dr. Carpenter will examine your mouth. The teeth are carefully inspected for any signs of decay, attrition, or failing restorations and/or fillings. The bone levels around the teeth and the health of the gingiva (gums) are evaluated as well. Dr. Carpenter also checks the lips, cheeks, roof of the mouth, throat, tongue and under the tongue for any signs of tumors, growths, conditions or cancers. Routine exams allow us to catch problems early, helping to minimize the treatment that is necessary.

TREATING PERIODONTAL DISEASES
Treatment methods depend upon the type of disease and how far the condition has progressed. The first step is usually a thorough cleaning that may include scaling to remove plaque and tartar deposits beneath the gum line. The tooth roots may also be planed to smooth the root surface allowing the gum tissue to heal and reattach to the tooth. In some cases, the occlusion, or bite may require adjustment.

When deep pockets between teeth and gums (4 to 6 millimeters or deeper) are present, it is difficult for the dentist or hygienist to thoroughly remove the plaque and tartar. Likewise, you may have trouble keeping these pockets clean and free of plaque. If the pockets do not heal after scaling and root planing, periodontal surgery may be needed. Bone surgery may be used to rebuild or reshape bone that has been destroyed. Grafts of the patient's bone or artificial bone may be used, as well as special membranes. Dr. Carpenter often refers patients with moderate to severe periodontal disease to a gum specialist (periodontist).

VENEERS
Thin (usually about 0.5mm thick) pieces of porcelain, which are bonded to the front surface of the teeth. Veneers can be used to improve the appearance of teeth by changing the shape of the teeth, by changing the color of the teeth, by masking stains and by replacing small fractured pieces of teeth.

To construct veneers, Dr. Carpenter will usually (but not always) need to remove a small amount (0.4-0.5mm) from the front surface of the tooth. Dr. Carpenter will then take an impression of your teeth. This is sent to a dental technician, who makes the veneers. At the next appointment (usually one to two weeks later), he will carefully clean the surfaces of the teeth and bond the veneers in place. In some cases, because so little tooth is removed, no provisional (temporary) restorations are needed between the two visits.

Porcelain is a very hard, wear resistant, non-porous material that will keep its appearance far longer than tooth colored resins. Porcelain, however, is brittle and can chip if hit by hard objects. If you have porcelain veneers, it is advisable to cease habits such as fingernail biting, pen and pencil chewing, biting into hard nuts or candy.

TOOTH WHITENING
A custom-made tray is vacuum-formed onto a model of the individual mouth, and allows Dr. Carpenter to determine the amount of gel which contacts the teeth. The design of the tray insures that there is close contact between the bleaching gel and the surface of the teeth, without the tray impinging on the gums and causing discomfort. The tray also prevents contact between the gel and the saliva. Custom-made trays are more comfortable to wear, and less visible to others as they can be made of a clear material. Irritation of the gums can occur because of chemical irritation from the peroxide, or from physical contact of the tray. Both of these are more likely to occur with stock trays because of their poor fit. With custom-made trays, all of the excess gel can be removed easily by wiping it away from the edges of the tray as soon as the tray has been inserted into the mouth and pushed home into position over the teeth.

Gels supplied by dentists for home use in "Home tray vital bleaching" have higher levels of peroxide compounds than over-the-counter products and thus are more effective at treating internal stains. As with the adhesive strips, it is reasonably common to experience mild tooth sensitivity (particularly to cold and hot foods) from the action of the peroxide within the teeth, which resolves within several days after the treatment has stopped. Several professional products may have desensitizing agents such as potassium nitrate or fluoride included, which means that problems of tooth sensitivity will be less. Sensitivity can be reduced by limiting the number of hours that the trays are worn each day, or by using the trays every alternate day. Patients whose teeth are sensitive to thermal changes before whitening commences are likely to notice an increase in this sensitivity during the whitening treatment.

You should keep the trays and obtain new stocks of bleaching gel from Dr. Carpenter to repeat the whitening periodically. The trays will continue to fit your mouth for many years in most cases. Bleaching using home trays will be unlikely to alter the staining effects of certain types of antibiotic drugs (e.g. tetracycline) that may have been used during childhood.

BRIDGES
A bridge is an appliance permanently fixed in the mouth to replace missing teeth. It uses remaining teeth to support the new artificial tooth or teeth. A bridge is made up of two crowns for the teeth on either side of the gap-these two anchoring teeth are called abutment teeth-and a false tooth/teeth rigidly attached in between. The bridge can be made from gold, alloys, porcelain or a combination of these materials.

Recently, more patients are opting for implants to replace a missing tooth.

The advantage of implants is that adjacent teeth are conserved and left untouched.

CHILDREN'S DENTISTRY
Early visits can prevent minor problems from becoming major ones. Dr. Carpenter will be able to detect early decay. Baby (milk) teeth are necessary not only for appearance, eating and smiling, but also serve to hold spaces for developing permanent (adult) teeth. In addition, baby teeth play a role in the development of speech.

The most common dental decay problem seen in infants and younger children is nursing decay. Dental decay can affect baby teeth extensively. Teeth normally affected are the top front teeth. The back teeth in top and bottom may also be affected. Bottle and breast-fed babies are both susceptible.

Babies left with a bottle as a pacifier and those who are frequently nursed, especially at night, run the danger of bottle or nursing decay due to the prolonged exposure to milk (human milk is no exception) or juice.

Children may need X-rays more often than adults. This is because their teeth and jaws are still developing and because their teeth are more likely to be affected by tooth decay than those of adults.

CROWNS
Dental crowns (also sometimes referred to as 'dental caps' or 'tooth caps') cover over and encase the tooth on which they are cemented. Dr. Carpenter uses crowns when rebuilding broken or decayed teeth, as a way to strengthen teeth and as a method to improve the cosmetic appearance of a tooth.

Crowns are made in a dental laboratory by a dental technician who uses moulds of your teeth made by Dr. Carpenter. The type of crown Dr. Carpenterrecommends will depend on the tooth involved and sometimes on your preference. They include porcelain crowns, porcelain-bonded-to-metal crowns, which combine the appearance of tooth colored material with the strength of metal, gold alloy crowns and acrylic crowns.

Dr. Carpenter may recommend a metal crown for molars especially if you have a heavy bite or you grind your teeth at night. He may also suggest a combination of metal and porcelain, using metal only on the chewing surface and at the gum area.

IMPLANT FACT SHEET
Many patients who previously suffered from missing teeth, denture soreness, decreased chewing ability or loss of facial structures are now taking advantage of dental implants to solve these problems.

WHAT ARE DENTAL IMPLANTS? They are replacement tooth roots made out of titanium that are placed into the jawbone. The process of receiving implants is generally comfortable and the implants literally become attached to the jawbone with a great deal of retention.

THE INITIAL PHASE of dental implants is to have the implants placed into the jawbone. At this point your case may take one of two paths. In many cases today, the implants may be restored with a crown, bridge or overdenture on the day of the implant placement. In other cases, the implants require several months of healing before they are restored. During this time, most patients who have worn dentures previously can continue to do so. It generally take anywhere from four to six months for the implants to become completely secure. At that time, the final prosthesis, such as highly retained dentures, crowns or bridges, will be placed.

ADJACENT TEETH ARE NOT COMPROMISED to replace missing teeth.

Tooth replacement with traditional tooth-supported bridges requires grinding down the teeth adjacent to the missing tooth/teeth, so that the bridge can be cemented on them. This tooth structure can never be replaced and the long-term health of these teeth is compromised.

INCREASED STABILITY AND A SENSE OF SECURITY that teeth will not fall out when eating, laughing or sneezing. People who wear dentures often worry that their dentures will fall out. Since the bone is bonds to the implants, replacement teeth have a stable foundation and are securely attached to the implants, so there is no fear that teeth will fall out.

IMPROVED ABILITY TO TASTE FOOD. Wearing an upper denture can prevent someone from really tasting food, as the roof of the mouth is covered. With implant-supported replacement teeth, it is not necessary to cover the roof of the mouth, so it is possible to enjoy the taste of food.

ELIMINATION OF DENTURE ADHESIVES. Since implant-supported-teeth are securely attached to the implants, there is no need for messy denture adhesives, which are often needed to keep dentures from falling out.

IMPROVED APPEARANCE. Since implants preserve bone, preventing deterioration of the facial structures, appearance is improved.

INCREASED CONVENIENCE OF HYGIENE. It is much easier to care for an implant-supported crown, which can be cleaned like a natural tooth, as opposed to a tooth-supported bridge, which requires the use of a floss-threader for proper cleaning.

HOW LONG DO IMPLANTS LAST? Documented clinical research demonstrates that implant-supported replacement teeth have been successful for over 35years. Theses were some of the first root-form implant cases ever completed and they have been closely monitored from the beginning. Dental implants are designed to be permanent; however many factors contribute to the long term success of implant treatment, such as home care and regular maintenance visit to the dentist.

DO IMPLANTS EVER FAIL? Dental implant treatment is one of the most successful procedures in the dental field, with documented success rates over 95%. Although successful treatment is very predictable, there are rare occasions where the bone does not completely bond to the implants. When this occurs, new implants are placed. Smoking or putting too much pressure on newly placed implants, as with excessive grinding of the teeth, can cause problems with the bone bonding to the implants, and should be avoided.

WHAT IS THE COST OF IMPLANT PLACEMENT? The actual cost of implant treatment is based on a number of factors, such as the number of missing teeth being replaced, the type of implant-supported teeth (treatment option) recommended and whether additional procedures such as bone grafting and sinus lift, are necessary to achieve the proper esthetic and functional result. There is often a misconception that there is a set cost for each implant. The only way to accurately estimate the cost is to have an examination and consultation with a dentist.

DENTURES
Some removable dentures are made to be inserted immediately after the removal of the teeth so the patient never has to go without teeth. These types of removable dentures are commonly termed 'immediate dentures'. They are made inexpensively and are only used for an interim healing period. The rapid shrinkage of bone following extractions means the denture will soon need to be remade once that shrinkage has slowed down enough. Often times, Dr. Carpenter places a soft "healing liner" in the immediate denture to make it more comfortable to wear while the patient is healing. After the definitive denture is made, patients report a much better fit. This new denture maybe done between three and six months after an immediate denture has been fitted. Dr. Carpenter will advise you when your definitive (final) denture is ready to be made.

All dentures lose their fit through natural changes in your mouth. You should see your dentist yearly for a denture check, when refitting or relining may be necessary. For example, many patients report that their full dentures are loose after a period of rapid weight loss.

You may want to consult your dentist about an implant supported dentures.

NITROUS OXIDE (Laughing Gas)
Nitrous oxide is a sedating gas that is combined with oxygen to make patients feel more comfortable during dental care. A small rubber inhaler is placed over the patient's nose and adjusted so that the patient breathes through it. With Nitrous Oxide, most patients experience an initial feeling of lightheadedness, which gradually leads to an overall feeling of well-being. The advantages of inhalation sedation are its rapid onset, lack of lingering effects, the ability of the patient to engage in conversation while under its influence.

ROOT CANALS
Inside the tooth is a fine space called the root canal. The root canal contains the dental pulp. If the dental pulp becomes diseased or dies, a toothache or an abscess may occur. In the past these problem teeth were extracted but now Dr. Carpenter can offer you root canal treatment to care for these teeth.

Local anesthetic and modern painkillers are used to provide comfortable treatment. Usually painful symptoms improve once treatment is started. It is very important that any restoration adequately seals the root filling from infection by bacteria from the mouth. Teeth requiring root canal treatment often have large fillings or extensive damage and will require a crown to restore them properly. These teeth are also weaker and the added protection of a crown is recommended.

If the root canals are able to be fully cleaned and sealed and the tooth properly restored then treatment has a very high success rate. The treatment may take several visits to complete with temporary fillings and dressings placed in the tooth between visits. Antibiotics are sometimes prescribed when an infection is present.

Because the root canals are very fine and curved in some teeth it may be difficult to clean the canals completely. Occasionally a piece of a file may break off in the root canal due to the strain placed on these fine instruments. Sometimes these are retrievable but they may also be sealed in the root canal as part of the filling. Pain or discomfort may occur between appointments due to ongoing tenderness of the tissues around the tooth or a flare up of an abscess, or a hair-line crack in the root. An abscess or ongoing pain will rarely persist following root canal treatment. If this occurs the tooth will require some further treatment. Occasionally a surgical procedure may be required if discomfort persists. The alternatives to root canal treatment are implants, or extraction followed by bridgework.

TOOTHACHE
Very persistent toothache is always a sign that you need to see a dentist as soon as practicable. In the meantime, you should try to obtain relief by rinsing the mouth with water and trying to clean out debris from any obvious cavities. Use dental floss to remove any food that might be trapped within the cavity (especially between the teeth).Take pain relief if necessary, using pain medicines that you know you are safe with. Remember, no pain relief tablets will work directly on the tooth. They must be swallowed as directed. If placed on the tooth, they can cause more trouble (especially aspirin).

TOOTH KNOCKED OUT OF MOUTH If dirty, rinse tooth in milk holding it by the crown (not roots). If milk is not available use water (for a few seconds only), then put the tooth back in the socket. If the tooth cannot be replanted, place it in milk or in the patient's mouth inside the cheek. Go to a dentist within 30 minutes if you can. Time is critical for successful replanting.

X-RAYS
Our use of digital x-ray now reduces your radiation exposure by 80%-50% as compared with traditional film based x-ray. The radiation from a full set of dental x-ray is about 1/30 of average annual radiation exposure, in the U.S. from natural sources.

If you are a new patient, Dr. Carpenter may recommend x-rays to determine the present status of the hidden areas of your mouth and to help analyze changes that may occur later. If you have had recent radiographs at your previous dentist, your new dentist may ask you to have the radiographs forwarded.

The needs for x-rays at recall visits varies according to your age, risk for disease and signs and symptoms. Recent films may be needed to detect new cavities, or to determine the status of gum disease or for evaluation of growth and development.

Many diseases of the teeth and surrounding tissues cannot be seen when your dentist examines your mouth. An X-ray examination may reveal:

1. small areas of decay between the teeth or below existing fillings
2. infections in the bone
3. periodontal (gum) disease
4. abscesses or cysts
5. developmental abnormalities
6. some types of tumors

Finding and treating dental problems at an early stage can save time, money and unnecessary discomfort. It can detect damage to oral structures not visible during a regular exam. If you have a hidden tumor, radiographs may even help save your life.

WHY DO WISDOM TEETH CAUSE PROBLEMS?
Wisdom teeth that are healthy and properly positioned can be a valuable asset to the mouth. Unfortunately this is not often the case, and problemsdevelop that require their removal. For example, when the jaw is not large enough to accommodate these teeth, they can become impacted-unable to come into their proper place. They may go sideways, emerge only partway from the gum, or remain trapped beneath the gum and bone. Impaction occurs most often in the third molars of the lower jaw. After examining your mouth and taking X-rays, Dr. Carpenter will discuss whether your wisdom teeth should be removed.

WHY ARE WISDOM TEETH REMOVED?
Extraction of wisdom teeth can protect the overall health of the mouth. It is generally recommended when the following conditions occur:

1. Wisdom teeth only partially erupt. This leaves an opening for bacteria to enter around the tooth and cause an infection. Pain, swelling, jaw stiffness and general illness can result.
2. Impacted wisdom teeth continue growing without enough room, damaging adjacent teeth. This continued pressure can destroy the healthy second molar tooth.
3. Impacted teeth crowd adjacent teeth out of alignment, causing an incorrect bite or crooked teeth.
4. A fluid-filled sac (cyst) or tumor forms, destroying surrounding structures such as bone or tooth-roots.

WHY REMOVE WISDOM TEETH EARLY?
People between the ages of 16 and 18 should have their wisdom teeth evaluated. If they need to be removed, it should be considered before age 18 when generally fewer complications occur. At a younger age, tooth roots are not fully developed, the surrounding bone is softer and there is less chance of damaging nearby nerves or other structures. There is also less surgical risk.

EXTRACTION
What should you expect when you are scheduled for a tooth extraction? Dr. Carpenter will anesthetize the area to lessen any discomfort. After the extraction, your dentist will advise you of what post extraction regimen to follow, in most cases a small amount of bleeding is normal.

Avoid anything that might prevent normal healing. It is usually best not to smoke or rinse your mouth vigorously, or drink through a straw for 24 hours. These activities could dislodge the clot and delay healing.

For the first few days, if you must rinse, rinse your mouth gently afterward.

For pain or swelling, apply a cold cloth or an ice bag. Ask Dr. Carpenter about pain medication. You can brush and floss the other teeth as usual. But don't clean the teeth next to the tooth socket.

DRY SOCKET (alveolar osteitis)
A condition that sometimes occurs after a tooth is extracted. When the socket is slow to heal, the condition can be very painful for three to five days or so.

The treatment may include cleaning the site and placing a medicated dressing in the socket, which helps provide relief of pain. The dressing may be changed daily until the pain diminishes and the socket begins to heal. A nonsteroidal anti-inflammatory drug may be recommended such as aspirin or ibuprofen, or other pain relievers may be prescribed. Cigarette smoking or other tobacco use can delay healing and should be avoided.