Bridges

What is a bridge?
A bridge is a dental restoration that replaces or spans the space where one or more teeth
have been lost. The most common bridges replace one missing tooth. The area of the
missing tooth must have a natural tooth in front of the space as well as behind the space
for a bridge to attach. The process of fabricating a bridge is similar to that of a crown.
The process of cementing a bridge is also similar to that of cementing a crown. Like a
crown, once a bridge is cemented it will stay in place and cannot be taken in and out.

I lost one of my teeth. What if I do not replace it?
If you are missing one or more teeth, you may be particularly self-conscious about
your appearance. And when teeth are missing, it is more difficult to chew. Teeth work
together. When a tooth is lost, the nearby teeth may tilt into the empty space. Or the
teeth in the opposite jaw may shift up or down toward the space. This can affect your
bite and place unusual stress on your teeth. Chewing on one side only may cause extra
stress on your jaw joints. A missing tooth also results in shrinking of the jawbone. This
can change how the lips and cheeks are supported. Teeth that have tipped or drifted
are often difficult to clean. This makes them more susceptible to tooth decay and gum
disease. In the long run, more teeth may be lost.

What will my bridge be made of? Will it look natural?
Dr. Pettyjohn normally recommends three different types of bridges depending on
your needs. She most often recommends bridges that are tooth colored porcelain
on the outside for esthetics and a mixture of gold and other metals on the inside for
strength. Sometimes, all porcelain bridges are used when a patient has very high esthetic
requirements. Rarely, full gold bridges are used when a patient has very high strength
requirements.

How will you make my bridge?
Dr. Pettyjohn will fabricate your bridge in much the same way that she fabricates a
crown. Two dental visits and several intricate steps are required. Please refer to the
section How will you crown my tooth? for a detailed description of this process.

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Cleanings

Why should I have a professional dental cleaning?
Regular dental cleanings are important to remove plaque, calculus, and stains that you are
unable to clean off with regular brushing and flossing. Dental cleanings help keep your
mouth and therefore your overall body more healthy. They also help prevent periodontal
(gum and bone) disease and give your hygienist a chance to review your oral hygiene and
diet. She may also recommend specific products such as toothbrushes, toothpastes, and
mouth rinses to help you keep your smile looking and feeling its best.

What causes gum and bone disease problems?
Periodontal (gum and bone) disease is a chronic infection caused by bacteria. It begins
when certain bacteria in plaque (the sticky, colorless film that constantly forms and
adheres on teeth and oral tissues) produce toxins and enzymes that irritate the gums. This
causes inflammation if plaque is not removed daily.

Do I have gingivitis?
Plaque that remains on teeth can irritate the gums, making them red, tender, and likely
to bleed. This condition, called gingivitis, can lead to more serious types of periodontal
(gum and bone) disease. Gingivitis can be reversed and gums kept healthy by removing
plaque every day with a good oral hygiene routine and regular professional dental
cleanings.

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Composite Fillings

I want a natural looking filling? What do you recommend?
Advances in modern dental materials and techniques offer new ways to create more
natural looking smiles. Composite fillings are one of the best functional and esthetic
ways to restore a tooth from decay. We have a wide range of composite filling shades so
that we can blend the filling material in with the natural color of your teeth.

How will you fill my tooth?
When you have a cavity, Dr. Pettyjohn will first remove the decayed part of the tooth.
Because composite fillings bond to your natural tooth, she can be more conservative
with removal of tooth structure than with amalgam fillings which require undercuts.
Composite fillings are placed in layers for optimum strength and then cured with a
high powered visible light. Finally, they are shaped and polished to mimic the natural
contours of your tooth. When finished, composite fillings are virtually invisible.

I think an old filling fell out. Should I have it replaced?
Dental fillings will last many years before they need to be replaced. However, there are a
number of reasons that old fillings may need replacement. Constant stress from chewing,
grinding, and clenching teeth may eventually cause a filling to chip, crack, wear down,
or fall out. A filling may also need to be replaced if the surrounding tooth structure
becomes decayed.

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Crowns

What is a crown? Do I need one?
A crown is a dental restoration that covers or “caps” a tooth to restore it to its normal
shape, size, and function. Its purpose is to strengthen and/or improve the appearance of a
tooth. A crown can:

  • restore a tooth when there isn’t enough tooth remaining to provide support for a
    large filling
  • protect a weak tooth from fracturing
  • restore a fractured tooth
  • cover a poorly shaped or discolored tooth
  • cover a dental implant

What will my crown be made of? Will it look like a real tooth?
Dr. Pettyjohn considers the look and function of a crown when choosing the material
most suitable for you. She will evaluate the tooth location, position of the gum tissue,
the amount of tooth that shows when you smile, the color or shade of the tooth, and the
function of the tooth in your bite.

Dr. Pettyjohn normally recommends three different types of crowns depending on your
needs. The most common crowns are tooth colored porcelain on the outside for esthetics
and a mixture of gold and other metals on the inside for strength. Sometimes, all gold
crowns are used when a patient has very high strength requirements. Sometimes, all
porcelain crowns are used when a patient has very high esthetic requirements.

How will you crown my tooth?
Two dental visits and several intricate steps are needed to complete a crown. Dr.
Pettyjohn will prepare the tooth by removing its outer portion to accommodate the
thickness of the crown. If additional tooth structure is needed to support the crown, she
will build up the core of the tooth as well.

An impression is made to provide an exact model of the prepared tooth. Dr. Pettyjohn
will send specific instructions to our local laboratory technician who then uses the model
to help develop the size, shape, and color of the crown.

A temporary crown is placed while the final crown is made. When the final crown is
ready, Dr. Pettyjohn puts it in place and makes the necessary adjustments. When you and
Dr. Pettyjohn are satisfied with how it looks and feels, the crown is cemented into place.

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Exams and X-Rays

Why are dental exams important?
Current research indicates that problems with your mouth can affect your overall health.
The opposite is also true. It is important to detect dental problems early so that your
mouth and your entire body remain healthy.

Can a dental exam detect cancer?
During your exam, we will screen for pre-cancerous and cancerous changes in your
oral tissues, head, and neck. Cancer detected at an early stage can be more successfully
treated. We will check your head, neck, and oral tissues for lumps, masses, growths, red
and white patches, and recurring sore areas.

What is gum and bone disease and how common is it?
Periodontal (gum and bone) disease affects more than 75% of adults and is the #1 cause
of tooth loss. It does not necessarily hurt and you may not even be aware of it until an
advanced stage. Regular dental visits are essential for detecting periodontal disease at
an early stage, before the gums and supporting bone are irreversibly damaged. We will
screen your mouth for signs of periodontal disease every time you visit our office for an
examination and teeth cleaning.

My mouth hurts. I think I might have an infection. Can you help?
We will screen your teeth for signs of tooth decay and infections. As part of your visit
we will also advise you of the best ways to keep your mouth healthy. We will review
your brushing and flossing techniques, discuss good dietary habits, and may suggest
additional products to help keep your mouth clean.

I am embarrassed to smile. Can you do anything for me?
While we are primarily concerned about your oral health, we understand the way your
teeth look is also very important. With dentistry’s many advances you no longer have
to settle for chipped, stained, and misshapen teeth. You now have choices that can
help you smile with confidence. These smile-enhancing treatments may be much more
comfortable, less time-consuming, and more affordable than you realize.

What can an x-ray do that my dentist cannot?
Many diseases of the teeth and surrounding tissues cannot be seen when Dr. Pettyjohn
examines your mouth. An x-ray exam may reveal the following concerns that otherwise
would not be visible:

  • areas of decay between the teeth and below old fillings
    infections and abscesses
  • signs of periodontal (gum and bone) disease
  • positions of tooth roots and jaw bones
  • growth and development of teeth and jaw bones in children
  • cysts and tumors
  • bone diseases
  • signs of systemic illnesses
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Gum and Bone Disease

Do I have gum and bone disease?
If you notice the following changes in your teeth and gums you may have periodontal
(gum and bone) disease.

  • gums that bleed during brushing and flossing
  • red, swollen, or tender gums
  • gums that have pulled away from your teeth
  • persistent bad breath
  • pus between your teeth and gums
  • loose or separating teeth
  • a change in the way your teeth fit together when you bite
  • a change in the fit of partial dentures

What causes gum and bone disease?
Gum and bone disease is caused when certain bacteria in plaque (the sticky, colorless
film that constantly forms and adheres on teeth and oral tissues) produce toxins and
enzymes that cause inflammation. If initial gingivitis or gum disease is not treated and
reversed it may develop into gum and bone disease or periodontitis. In gum and bone
disease these bacteria are trapped underneath the gum tissue and over time will destroy
the gum and bone that holds your teeth in place. Gum and bone disease affects over 75%
of adults and is the #1 cause of tooth loss.

How do you treat gum and bone disease?
Proper treatment for gum and bone disease usually starts with a more thorough cleaning.
Terms for this type of cleaning are scaling and root planing, periodontal cleaning, and
deep cleaning. During this treatment plaque, calculus, bacteria, and stain both above
and below the gum line are removed. A special instrument called an ultrasonic scaler
uses vibration and water spray to thoroughly and gently clean your mouth and remove
bacteria. This initial deep cleaning may take one or two visits and a local anesthetic may
be given to reduce any discomfort.

Do I need ongoing treatment for gum and bone disease?
Unfortunately, there is no cure for gum and bone disease at this time. After your initial
deep cleaning it will be important to continue with regular maintenance cleanings.
During a thorough cleaning with an ultrasonic scaler, bacteria above and below the gum
line are removed. However, those bacteria will re-grow every twelve weeks. When
the bacteria re-grow they will start to cause the gum and bone damage process again.
Therefore, we usually recommend regular maintenance cleanings every three to four
months. With regular maintenance cleanings we are normally able to improve gum tissue
health and slow down the process of bone loss. We are usually able to help patients keep
their teeth for a lifetime or significantly longer than if no periodontal treatment was done.

In cases of severe gum and bone disease we may refer patients to a gum and bone
specialist or periodontist. Periodontists have a wider range of treatment and surgery

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Implants

What is a dental implant?
When you lose a natural tooth, a dental implant is the best way to replace it. A dental
implant is much like a natural tooth, which has a root in your jawbone, topped by a
crown that you can see. When you need an implant, a dental specialist (an oral surgeon
or periodontist) inserts a titanium post beneath your gum and into the bone. It fuses
to the bone in your jaw and acts like the root of a tooth. Then Dr. Pettyjohn makes a
replacement crown on the titanium post, designed to blend in with the way your own
teeth look and feel. Dental implants can also be used to anchor bridges and dentures.

I lost a tooth. Am I a candidate for a dental implant?
Most patients find that an implant is secure and stable, an excellent replacement for their
own tooth. Implants, however, are not an option for everyone. Because implants require
surgery, patients should be in good overall health and have healthy gums. Further,
patients either must have adequate bone to support the implant or be good candidates for
surgery to build up the area needing the implant. Patients should also be committed to
very thorough oral hygiene every day and regular dental visits. If you are considering
implants, a full evaluation by Dr. Pettyjohn will help determine if you would be a good
candidate.

What are the advantages of dental implants?
In general, dental implants have a success rate of up to 98%. Over time, they are the
most cost effective and conservative way to replace missing teeth. Implants stand
alone between your natural teeth, but do not need to attach to your natural teeth. When
implants are placed and restored by a competent team of specialists and restorative
dentists they will normally last a lifetime. Implants have fewer complications and
maintenance issues than other forms of teeth replacement such as bridges or partial
dentures. Implants can never decay or develop infections needing root canal treatment.

Implants are the most comfortable way to replace missing teeth because they are the
closest replicas to your natural teeth. In addition, dental implants look and feel like
your own teeth, often improving self-esteem. Implants can also help improve eating
and speech by eliminating gaps between your teeth or securing your dentures. Lastly,
dental implants eliminate the embarrassing inconvenience of having to remove partials or
dentures.

I lost one of my teeth. What if I do not replace it?
If you are missing one or more teeth, you may be particularly self-conscious about
your appearance. And when teeth are missing, it is more difficult to chew. Teeth work
together. When a tooth is lost, the nearby teeth may tilt into the empty space. Or the
teeth in the opposite jaw may shift up or down toward the space. This can affect your
bite and place unusual stress on your teeth. Chewing on one side only may cause extra
stress on your jaw joints. A missing tooth also results in shrinking of the jawbone. This
can change how the lips and cheeks are supported. Teeth that have tipped or drifted
are often difficult to clean. This makes them more susceptible to tooth decay and gum
disease. In the long run, more teeth may be lost.

*Please note that much of the above information was excerpted from publications of
the American Dental Association 2011.

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Night Guards

How do I know if I grind my teeth?
People who suffer from bruxism (tooth grinding or clenching) may notice the following
symptoms:

  • headache
  • sore jaws
  • frequent toothaches
  • facial pain
  • worn or cracked teeth and fillings
  • loose teeth
  • earache
  • insomnia

Why do I grind my teeth?
We don’t know for certain why people grind or clench their teeth. Stress, sleep disorders,
and an abnormal bite are some of the things that may play a role. Grinding and clenching
your teeth can happen at any age, to children or adults.

Can my dentist tell if I grind my teeth?
Dr. Pettyjohn can diagnose grinding and clenching by looking for unusual wear spots on
your teeth and assessing related symptoms. Unusual wear spots may be located on the
biting surfaces of teeth or along the gum line. Patients may also have many small crack
lines in their teeth or even break off sections of teeth. In some cases, gum recession or
advancing gum and bone disease may also be related to grinding and clenching.

What can I do to prevent more damage?
Dr. Pettyjohn may suggest wearing a night guard while you sleep. Night guards are
custom-made from a firm acrylic or plastic. The night guard looks like a clear horseshoe
and fits over your upper teeth. It acts like a shock absorber and prevents damage to
the upper and lower teeth and surrounding structures. Most patients are able to get
comfortable sleeping in their new night guard within two weeks.

What will happen if I don’t wear a night guard?
For patients who grind or clench their teeth at night, a night guard is really the only
option to prevent untimely wear and tear. Without a night guard, patients will eventually
crack and break teeth and likely need crowns. Some patients with severe wear may lose
their teeth or need to see a dental specialist for a full mouth reconstruction.

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Whitening

Why are my teeth discolored?
If your teeth are discolored, tooth whitening may help. Many patients experience
discolored teeth for a variety of reasons including genetics, aging, trauma, medications,
tobacco, and dark foods and beverages.

How does teeth whitening work?
Dr. Pettyjohn recommends custom bleaching trays for you to take home and wear at night
for 10-14 days. Custom bleaching trays are the gold standard in tooth bleaching and will
give the best results that last the longest. Custom trays also give you the ability to “touch
up” your whitening months and years down the road. Our thin, clear custom trays are
made from impressions of your teeth and are easy and comfortable to wear.

Dr. Pettyjohn does not recommend in-office bleaching treatments. These procedures
utilize very high concentrations of bleaching agents which cause severe sensitivity in
some patients. There is also a lack of good, scientific evidence to support the efficacy of
lights and lasers for these procedures.

Am I a good candidate for teeth whitening?
Patients who have yellow/brown discolorations will be excellent candidates for tooth
whitening while those with blue/grey discolorations will not. Tooth whitening will
only change the color of your natural teeth. It will not change the color of any fillings,
veneers, or crowns.

Does teeth whitening damage my teeth?
Tooth whitening is very safe and will not cause any damage to the teeth with proper use.
The most common side effect is temporary tooth sensitivity to temperatures. This can
normally be managed with an over the counter sensitive toothpaste and will subside when
whitening is completed.

Whitening your teeth is a quick and easy way to improve your smile and overall
appearance! Patients are always pleased with the results that help them feel younger,
healthier, and more attractive!

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