Because of the quality of composite resin, porcelain and bonding system , dentist can solve the problem of front teeth such as dark color, shape, and structural and position abnormalities with veneer.

There are 2 types of veneer .First is porcelain veneer . It is beautiful , natural looking , high cost.

It need more tooth preparation and at least 2 appoinments. Because of invasive tooth preparation , porcelain veneer is irreversible treatment . Once the veneer breaks, It cannot be fixed, only remake a new one.

Another type is composite veneer. It’s quality is a little bit under porcelain veneer . It cannot mask dark color of the tooth completely . It needs less preparation , only one appointment and less cost.

In case of veneer broken, It may be repaired intraorally.

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Root canal treatment

When a tooth's nerve tissue or pulp is damaged by caries or other tooth structure loss , it breaks down and bacteria begin to multiply within the pulp chamber. The bacteria and other decayed debris can cause an infection or abscessed tooth. An abscess is a pus-filled pocket that forms at the end of the roots of the tooth. Bone loss around the tip of the root. In some case , drainage problems extends outward from the root. A hole can occur through the side of the tooth with drainage into the gums or through the cheek with drainage into the skin. An abscess may occur when the infection spreads all the way past the ends of the roots of the tooth . Moreover abscess may spread to other areas of the face, neck, or head.

During root canal or endodontic treatment, the inflamed or infected pulp is removed and the inside of the tooth is carefully cleaned and disinfected, then filled and sealed with a rubber-like material called gutta-percha. Afterwards, the tooth is restored with a crown or filling for protection. After restoration, the tooth continues to function like any other tooth.

Endodontic treatment helps you maintain your natural smile, continue eating the foods you love and limits the need for ongoing dental work. With proper care, most teeth that have had root canal treatment can last for a long time

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Amalgam Filling

Dental amalgam is a mixture of mercury, silver, tin and copper. Mercury, which makes up about 50 percent of the compound, is used to bind the metals together and to provide a strong, hard, durable filling. It has been used for more than 150 years in hundreds of millions of patients around the world.. Dentists use dental amalgam because it is easier to work , more successful and least expensive.

Dental amalgam contains elemental mercury. It releases low levels of mercury in the form of a vapor that can be inhaled and absorbed by the lungs. High levels of mercury vapor exposure are associated with adverse effects in the brain and the kidneys . However the amount of mercury released in the mouth under the pressure of chewing and grinding is extremely small and no cause for alarm. In fact, it is less than what patients are exposed to in food, air and water.

FDA has reviewed the best available scientific evidence to determine whether the low levels of mercury vapor associated with dental amalgam fillings are a cause for concern. Based on this evidence, FDA considers dental amalgam fillings safe for adults and children ages 6 and above. The weight of credible scientific evidence reviewed by FDA does not establish an association between dental amalgam use and adverse health effects in the general population. Clinical studies in adults and children ages 6 and above have found no link between dental amalgam fillings and health problems.

So Amalgam is safe filling material except that you are allergic to any of the metals in dental amalgam, (Link)

The serious issue about amalgam and other materials such as metal crown , Braces, Orthodontics wire is Galvanic current. Galvanic current is a term that has been used in dentistry for over 100 years. It is a condition created by the presence of dissimilar metals in the oral cavity. The different electric potentials of metals generate an exchange of ions with saliva acts as the electrolyte or a conductive medium . Have you ever felt a “shock” to your teeth caused by a piece of tin foil or a spoon that touches a sliver or mercury filling in your mouth? If you answer yes to this question, you’ve experienced a galvanic event. Sometimes the current may be high enough to irritate the dental pulp and cause pain. Other than tooth sensitivity, galvanism can cause a metallic or salty taste in the mouth, increase salivary secretion, and burning or tingling sensation of the tongue.

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During the past 60 years, the use of composite resin for direct restorations in anterior and posterior teeth has increased significantly, largely due to the esthetic demands of patients and concerns regarding mercury in amalgam fillings. Because composite resins require little to no preparation, minimally invasive procedures can be used to preserve tooth structure and provide natural-looking results. Composite resin also may eventually replace silver amalgam for direct restorations

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Synthetic resins evolved as restorative materials since they were insoluble, aesthetic, insensitive to dehydration, easy to manipulate and reasonably inexpensive. Composite resins are most commonly composed of Bis-GMA and other dimethacrylate monomers (TEGMA, UDMA, HDDMA), a filler material such as silica and in most current applications, a photoinitiator. Dimethylglyoxime is also commonly added to achieve certain physical properties such as flow ability.

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Gingivitis &Periodontal Treatment

When bacteria plaque accumulates on the surface of the tooth for a while , causing the gums to go red and inflamed; teeth may bleed when brushing them. This calls gingivitis . Even though the gums are irritated and bothersome, the teeth are not loose. There is no irreversible damage to bone or surrounding tissue.

However untreated gingivitis can progress to periodontitis .Because Infection and inflammation spreads from the gums (gingiva) to the ligaments and bone that support the teeth .Bone and periodontal ligament are destroyed by bacterial toxin and by one own’s immune system .Large pockets occur between gums and teeth . Plaque are trapped in the pocket . Continued inflammation and infection leads to damage bone more and more . Finally tooth become loose and can fall out.

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Gingival graft with root coverage

When gum recess tooth roots will be exposed and may be sensitive to hot and cold foods or liquid . Tooth with gum recession looks longer which is old people 's appearance .Gum recession can put you at risk of developing a cavity on the tooth root, and may lead to bone loss, eventually resulting in tooth loss. Soft tissue grafts, which move healthy gum tissue from one part of the mouth to another, can stop gum recession and bone loss. The treatment also improves the esthetics of the gum line, makes you look younger.

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Crown lengthening

This is a common surgical procedure. The periodontist removes gum tissue , bone or both to expose more of a tooth. Crown lengthening is done when tooth is decayed, broken below the gum line, or has insufficient tooth structure for a restoration, such as a crown or bridge

Some people have a lot of gum tissue around their upper teeth and teeth appear short . Dentists call this "gummy smile." This also can be treated with crown lengthening.

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Extraction , Surgical removal of Impacted tooth

When a third molar is impacted or partially impacted , food is trapped between impacted tooth and adjacent tooth . Dental caries easily occurs at the distal surface of second molar as well as gingival inflammation . Moreover the presence of an impacted third molar decreases the amount of bone on the distal aspect of an adjacent second molar. So even minor gingivitis , the causative bacteria have access to a large portion of the root surface , which results in the early formation of severe periodontitis

All impacted teeth should be removed as soon as the diagnosis is made. Actually the ideal time for removal is after the roots of the teeth are one-third formed and before two- third s formed, usually between ages of 16 and 18 . Younger patients tolerate the procedure better and recover more quickly.

There is better and more complete regeneration of bone and better reattachment of gingival tissue to the adjacent tooth.

Contemporary Oral and Maxillofacial Surgery : Peterson , Ellis ,Hupp , Tucker. 3rd Edition)

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The mouth plays a major role in the life of human being . All nutrients must pass through it. Beauty looking , speech are produced by lip ,cheeks and tongue. Therefore , a healthy mouth with a full complement of teeth , supported by healthy gingiva and bone is a basic of healthy and happy life.

Mothers plays a important role in providing this to her babies since pregnancy. She has to eat healthy diet ,avoid alcohol ,tobacco, keep her teeth and gum clean. Actually mother should have completed dental treatment before her pregnancy.

Initially , infant ‘s diet is milk ,whether from breast , the bottle, or both. The infant should be held by the parent while feeding from the bottle. Upon finishing , the infant should be cleaned the mouth with moist ,soft cloth . If there is a need of additional sucking . The contents in bottle should be limited to water.

Avoidance of sweetened beverages , optimal systemic fluorides and removal plaque from the teeth are all important . Studies have confirmed that the bacterial for dental disease are present at the eruption of the primary teeth ( Edwardsson and Mejare ,1978) The source of these bacteria most often is the mother. The period of infectivity is between 19-28 months of age . ( period of active tooth eruption ) Parent should start taking his child to see dentist . Dentist will give prophylaxis treatment : polish and apply topical fluoride , pit fissure sealant. This simple treatments can effectively decrease rate of dental caries.

Once teeth have erupted ,a wet , soft-bristled brush can be wiped over the teeth . A thorough cleaning before bedtime is very important. Parent have to remove plaque from all teeth.

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Bleaching (Tooth Whitening)

There are 2 types of bleaching.

First : Office bleaching by dentist. Dentist applies high concentration bleaching gel on the labial surface of teeth and activated with light from various source such as : Laser, LED light . The treatment time is about 0.5-1 hours. It is suitable for patients who have limited time but want immediate result. The disadvantages of this method are post – hypersensitivity ,relapse of the tooth color within 1 week and high cost.

Second : Home bleaching by oneself. Dentist takes impression for bleaching tray. Patient apply bleaching gel in the tray and put it in the mouth during bedtime. It takes about 7-10 days for maximum result . So this method is not suitable for person who wants to get immediate result. The advantages of home bleaching are less hypersensitive, lower cost. The result lasts for years. Patient can keep the trays for next bleaching and only pays for bleaching gel.

Orthodontics (braces)

Orthodontist has to complete his work under 3 criteria.

  1. Good Esthetics
  2. Good function
  3. Good stability
First Criteria :
Esthetics is the major reason for someone to invest his time and money in receive Orthodontic treatment. There are various norms used for reference to esthetics. However , not everyone fits for the norms . The best beauty norm is patient ‘s requirement which Orthodontist has to manage the esthetics requirement accompanying with good function and good stability.

Second Criteria :
Good function , patient is able to chew effectively without muscle pain or joint problem.

To fulfill this aim, Orthodontist has to set good occlusion that balances with the masticatory muscle and temperomandibular joint.

Third Criteria :
Good stability, After the second criteria is fulfilled .Before remove braces, orthodontist has to make fine adjustment in order to make roots parallel and perfect occlusion as possible as he can . Also wearing retainer , the teeth remain in their position until invasive change occurs such as tooth loss, periodontitis

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Dental Implant

Nowadays replacement tooth roots by Dental implants which provide a strong foundation for fixed (permanent) or removable replacement teeth that match natural teeth are widely performed.

In most cases, anyone healthy enough to undergo a routine dental extraction or oral surgery can be considered for a dental implant. Patients should have healthy gums and enough bone to hold the implant. They also must be committed to good oral hygiene and regular dental visits.

Heavy smokers, people suffering from uncontrolled chronic disorders -- such as diabetes or heart disease -- or patients who have had radiation therapy to the head/neck area need to be evaluated on an individual basis.

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Amalgam Removal

People referred from Holistic Clinic for removing Amalgam filling usually have high mercury burden. They have to get safe protocol to minimize the mercury vapor during the removal treatment.

Safe protocol of Removal Amalgam Fillings

The patient is prepared as follows, prior to amalgam removal:

  1. A dental dam (“raincoat”) is customized to fit the existing tooth/teeth to prevent particulates from contacting the oral mucosa;
    Generally ,rubber dam is used in every case . It does take some time to place and remove the rubber dam. It can be a little uncomfortable, and some patients simply cannot tolerate its use. There are some exceptions to its use such as mal- position teeth, 3rd molars, or so-called wisdom teeth
  2. Underneath the dam, activated charcoal is placed, along with a cotton roll and gauze. This helps to intercept particles and to chelate dissolved metals that seep under the dam.
  3. Oxygen is supplied to the patient with a nasal canula .
The removal of amalgam commences as follows:
  1. The oxygen and rubber dam are taken away;
  2. An immediate inspection under the dental dam occurs. The gauze, cotton roll and activated charcoal are wiped away. Gauze is then used to inspect the floor of the mouth and tongue to make sure no particulates seeped under the dam.
  3. All mucosal tissues are fully inspected and cleaned, the mouth is flushed with copious amounts of water and vacuum for at least 60 seconds. The patient should not swallow during the rinsing procedure, again to ensure no ingestion or absorption of amalgam particulates.
  4. Once the filling(s) have been removed , the dentist and the assistant remove and dispose of their gloves.
  5. The cavity is filled with composite resin after the amalgam is removed completely.

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Diastema closure

Nowadays the quality of composite resin, and bonding system has already met the esthetics need , dentist can close the space between front teeth naturally by composite resin. The treatment does not cut tooth structure and takes only one appointment.

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