Services

Cleanings - Composite Fillings - Cosmetic - Crowns and Bridges - Dental Implants - Dentures - Periodontal - Preventative - Root Canals - Surgical Procedures

Cleanings

Plaque, or the sticky film of bacteria that cover your teeth, is the primary causative factor of gum disease and cavities. When plaque stays on the teeth for long periods of time and interacts with saliva calculus (tartar) forms. Brushing twice a day and flossing at least once a day is an important factor in reducing the amount of disease-causing plaque. Regular cleanings are not only important in removing plaque and calculus, but also in reinforcing good oral hygiene, finding areas in the mouth that are being missed in brushing and flossing, and checking for early signs of gingivitis, periodontitis, and caries. Periodontitis often goes without symptoms until severe damage is done to the bone surrounding the teeth.

If it has been a while since your last cleaning, we may need to do a two or three step cleaning in order to remove excessive amounts of plaque and calculus or to adequately clean deeper periodontal pockets. After this we will try to get you on a maintenance or preventative program to keep your gums healthy.

Composite Fillings

Restorative procedures are done to replace tooth structure that is lost or damaged due to decay, fracture or other defects.  Composite fillings are a white resin material that is bonded to fix small or medium sized defects. 

Advantages of composite are that they are bonded to the tooth, are esthetically pleasing (white!) and they can be a very conservative restoration.  Composite fillings are appropriate for anterior and posterior defects, although we may recommend a stronger material, such as gold or porcelain, if the filling is large or there is evidence of significant wear or evidence of teeth grinding. 

It is also important to remember that teeth that have been filled with any filling material can still get recurrent decay, so they need to be brushed and flossed as you would your normal teeth.  Composite fillings can also become chipped or cracked, which may require replacement in the future. 

Cosmetic

Cosmetic dentistry refers to any dental procedure that improves the look of your smile. Doctor Vo provides many cosmetic services, ranging from small composites and whitening to all ceramic crowns. Below are some of the cosmetic dentistry options we offer at our offices:

Bleaching (Tooth Whitening)- Bleaching brightens teeth that are discolored or stained. Our offices can provide both in-office power bleaching or take home bleaching trays. Please talk to one of our doctors to decide which procedure is right for you.

Composite Bonding - Bonding is used to repair small to moderate sized chips, spaces, discolorations or other defects in teeth. A composite material of a similar shade is used to bring the tooth back to its proper shape.

Veneers - Veneers are thin layers of porcelain that are custom made and bonded over the front of the teeth. Veneer can correct teeth that are discolored, chipped, slightly crooked, or misshapen.

Our doctors always assess your cosmetic needs when looking at the different ways to restore your smile. We will give you the options that integrate esthetics and function to provide you with the best choice for your teeth. See our page on cosmetic dentistry for a more in-depth look at cosmetic procedures.

Crowns and Bridges

A crown, or cap, is restoration that covers the entire tooth to restore it to its original shape and form. Crowns are needed when a tooth does not have enough tooth structure to support a filling. This can happen due to fracture, decay, wear or other factors. Crowns can be made of different materials. Gold crowns are strong and very biocompatible. Gold crowns with porcelain over the top of them are more esthetic and resemble natural teeth. All porcelain crowns can be made to duplicate the shades and translucencies in natural teeth to make them very lifelike. Talk to your dentist to see what options are available for your situation.

A bridge is done to replace a missing tooth. Crowns are placed on the two adjacent teeth with a pontic (artificial tooth spanning the missing space) in the middle.

Dental Implants

Dental Implants are one of the most exciting treatments in modern dentistry. Although the first implant was placed 40 years ago, the new developments in the field are making implants a more often utilized restorative option for tooth loss and denture retention.  Dental implants can help replace missing teeth that can affect your appearance, oral function or self confidence. 

What is a dental implant? 

Dental implants are essentially titanium anchors that are surgically placed into the bone. The bone actually grows around the surface of the implant and has tremendous stability.  This process is called osseointegration and usually takes between 3-6 months.  An abutment, or attachment to the implant that sticks up out of the gum, and crown is then placed on the implant to look and feel like a natural tooth.  Alternatively, an abutment may also be placed which can attach to and retain a denture.

The procedure

The procedure can vary due to the type, location and circumstances present.  In an area where a tooth has been missing and there is an adequate height and depth of bone, a series of drills are used to enlarge the bone to the appropriate size for the implant.  The implant is then slowly screwed into the bone and either covered with tissue, covered with a small metal cap or , if in the esthetic zone, covered with a non-functional temporary restoration.  After 3 months in areas of dense bone (the lower back teeth) to 6 months in areas of less dense bone (upper teeth) an impression is taken and a final crown made.  Other steps may be needed, such as tissue contouring or implant uncovering.  Patients generally report little discomfort after implant procedures.

Success Rates

Success rates for dental implants vary depending on the study, but in general success rates are between 90-98%.  Selecting patients who are good candidates for implants is important and contributes to success.  Smoking, inadequate bone height, width or quality, systemic diseases, hygiene and other factors contribute to failure, but even people with some risk factors can still have dental implants. 

Implants can fail for a number of reasons.  Failure to osseointegrate or disproportionate force on the implant are two main problems.  Breakage of the implant components is also possible.  It is important to have your dental implants cleaned and checked regularly to keep these problems from occurring. 

Advantages

Implants have advantages in many situations over other treatments in that they:

  • Conserve bone- When a tooth is lost, the surrounding bone resorbs unless it is used. Implants help prevent this bone loss.
  • Conserve tooth structure- No preparation of adjacent teeth is needed as compared to a bridge.
  • Improve biting pressure and stability when used to support dentures or as a fixed bridge.
  • Longevity and reliability- Implants have become a very predictable procedure with high success rates.
  • More predictable in cases where adjacent teeth have questionable prognosis for a bridge as the whole bridge may need to be replaced if one part of it fails.
  • Preserves integrity of the dental arch- When a tooth is lost, the adjacent and opposing teeth move to fill the space.  This can cause spaces in other teeth, cheek and tongue biting or bite problems.

Other procedures

If you don't have an ideal space for an implant, don't worry.  Procedures such as sinus lifts, bone grafts or orthodontics to move teeth can be done to make space for an implant.  Talk to your dentist to see what needs to be done.

Dentures

Although we make every attempt to save teeth, dentures are sometimes necessary and the best treatment option for some people.  Our doctors work intimately with a local lab to create great looking dentures. 

No matter how well they are done, dentures do have some drawbacks.  They cover the roof of your mouth so it is harder to taste food.  Upper dentures suction to the roof of your mouth, but lower dentures tend to flop around. 

Implants have changed the way people with dentures are able to chew and function.  Dental implants are titanium screws that are placed in the bone and attach to the denture.  This stabilizes the denture are allows much better chewing efficiency and retention. 

Our office both fabricates and places implants in many situations.  Please contact us if you are interested.

Periodontal

Periodontitis is an infection of the supporting tissues of the teeth.  The milder form, gingivitis, is an inflammation of the gums that is reversible, although it may lead to the more aggressive disease, periodontitis.  Periodontitis occurs when pathogenic bacteria attack the supporting tissues of the teeth, leading to bone loss.  This will eventually cause the teeth to become loose, drift and fall out.  Diagnosis involves measuring the distance between the top of the gum and where it meets the tooth.  This is called a periodontal pocket and a deep pocket signifies bone loss and/or inflammation. 

The good news is that the primary factor that causes periodontitis is plaque (the white sticky stuff that gets on your teeth if you don't brush them for a while).  Therefore regular cleanings and good home care can slow down or stop periodontitis.  Other factors that can make you more susceptible to periodontal disease are:

  • Tobacco smoking or chewing
  • Systemic diseases such as diabetes
  • Some types of medication such as steroids, some types of anti-epilepsy drugs, cancer therapy drugs, some calcium channel blockers and oral contraceptives
  • Bridges that no longer fit properly
  • Crooked teeth
  • Fillings that have become defective
  • Pregnancy or use of oral contraceptives

Often chronic periodontitis does not show any symptoms (such as pain) until that last stages when it is too late to save the teeth.  There are some signs to watch out for, such as a bad taste in your mouth, red, swollen and bleeding gums, loose teeth or moving teeth, etc. 

Of course the best way to diagnose a problem is to see your dentist regularly for check-ups and cleanings.  If periodontal disease is diagnosed, there are several treatments we may use.  These include, but are not limited to, 3-6 months cleanings, surgical procedures, antibacterial products and the use of special cleaning instruments.

Preventative

Cleanings

Plaque, or the sticky film of bacteria that cover your teeth, is the primary cause of gum disease and caries. When plaque stays on the teeth for long periods of time and interacts with saliva calculus (tartar) forms. Brushing twice a day and flossing at least once a day is an important factor in reducing the amount of disease-causing plaque. Regular cleanings are not only important in removing plaque and calculus, but also in reinforcing good oral hygiene, finding areas in the mouth that are being missed in brushing and flossing, and checking for early signs of gingivitis, periodontitis, and caries. Periodontitis often goes without symptoms until severe damage is done to the bone surrounding the teeth.

If it has been a while since your last cleaning, we may need to do a two or three step cleaning in order to remove excessive amounts of plaque and calculus or to adequately clean deeper periodontal pockets. After this we will try to get you on a maintenance or preventative program to keep your gums healthy.

Fluoride

Fluoride is a compound that is found in naturally in water and can be incorporated into the enamel of teeth when they are formed, making them more resistance to the acid produced by decay-causing bacteria. Smaller amounts of fluoride can also be incorporated into teeth after they are formed, which is why drinking fluoridated water and using a fluoridated toothpaste is important. Swallowing large amounts of toothpaste or ingesting too much fluoride can cause stomach sickness or a condition called fluorosis in which the enamel takes on a dark stain.

The American Dental Association (ADA) states that community water fluoridation is the single most effective public health measure to prevent tooth decay. Community water fluoridation is the adjustment of fluoride found naturally in water to levels optimal for oral health. Community fluoridation has been practiced and studied for more than 60 years and has been found to be safe and effective. In fact, on average every $1 invested in community water fluoridation saves $38 in dental treatment costs. Seattle and some area communities practice water fluoridation, but at different levels. If your child has a high level of decay or you live in an area without optimal fluoridation levels, please contact our office for a risk assessment to see if supplemental fluoride is needed. For more information on community water fluoridation, please read the ADA pamphlet on Fluoridation Facts.

Brushing

Brushing should be done minimally 2 times a day for 2 minutes. The strokes should be in small concentric circles at a 45 degree angle to the gum line. Also, make sure to adequately clean all surfaces of your teeth and change your toothbrush every 3-4 months, or when the bristles are frayed.

A common problem we see in our offices is brushing too hard. This can lead to recession and abrasion of the roots that often requires restoration. We often recommend using a soft or ultra-soft toothbrush and brushing well enough to remove plaque but not too vigorously. Sometimes, a caries detecting dye can be used to show patients when all the plaque has been removed from their teeth. We can use this dye at your cleaning appointments to help show what is being missed and how much to brush a certain area. Some of the new power toothbrushes have mechanisms that either shut down or visibly show you when you are brushing too hard. This can be a valuable feature in addition to the timer mechanisms often used.

Flossing

Flossing is an often overlooked, but very important, part of oral hygiene. Flossing removes caries causing bacteria between the teeth where brushing cannot reach. We recommend flossing at least once a day for healthy teeth and gums.

Flossing Technique

First, break off about 18 inches of floss and wrap it around your middle fingers with a couple of inches in between. Then use your index fingers and thumbs to guide the floss between the teeth and in back of the last molar, with careful attention to not snapping the floss through and damaging the gums. Pull the floss in a C-shaped pattern down the front and one tooth until you feel slight resistance and then up and down the back of the other tooth. See this video from the ADA for a visual demonstration of the technique.

Floss Types

There are different types of floss, all of which are effective. For tight contacts, Glide floss or a dental tape may be the best choice. Other people may prefer waxed or unwaxed, they are both effective. Flossing aids such as the flossing pick may help those with reduced manual dexterity or those who want to save time.

Adjunctive Measures

Often people with open contacts or spaces between the teeth need other methods to clean food during the day. We recommend interproximal brushes as a good way to clean problem areas. You can get these at our office or your local store. Stimudents are also effective, as well as water piks. Water piks send a small jet of water to push food particles out of the gums.

Sealants

Pits and fissures are small grooves on the biting surfaces of molars that can develop decay more readily than other smoother surfaces of a tooth. This is because these grooves are often so deep and skinny that toothbrush bristles cannot adequately remove decay-causing bacteria from them.

Sealants are a plastic material that is bonded to the tooth and will prevent decay from getting in the teeth. They are relatively easy to apply and are proven to reduce decay on biting surfaces of teeth.

Root Canals

Root canal treatment, or endodontic treatment, is needed when the nerve of the tooth has died or is severely inflamed.  The process involves cutting a hole through the top or back of the tooth and removing the nerve and blood vessels in the tooth.  The canal is then thoroughly cleaned and filled with an inert filling material called gutta percha.  If the tooth is in the front of your mouth, it may require only a small filling to seal up the hole.  If it is a posterior tooth or an anterior tooth that has broken or decay has broken down the tooth, then a crown will be necessary to prevent fracture of the crown in the future. 

How do I know if I need a root canal?

Symptoms of a dead or dying nerve in a tooth are usually pain to cold, hot or biting pressure.  Cold sensitivity that lingers for a while can be a symptom that the nerve is inflamed and may die.  A nerve can die for many reasons, a few are:

  • Trauma - Such as getting hit in the mouth
  • Decay - Caries that has gone deep into the tooth and into the nerve chamber
  • Multiple or Large Restorations - Sometimes after a tooth has been restored multiple times it traumatizes the nerve
  • Cracked Teeth - A crack in a tooth that extends into the nerve canal may require root canal treatment or extraction if it is severe enough.
  • Internal Resorption - This can happen due to trauma of the tooth or for no known reason and causes the tooth root to resorb from the inside out. 

Can a root canal fail?

Althought the success rates for root canal treatment are high, occasionally a root canal can fail.  This is often due to leakage of the restoration on the top of the tooth.  A missed canal can also cause failure.  You will likely notice pain to chewing if this occurs.  If this occurs retreatment is an option.  If the tooth is not treatable with another root canal, then extraction is the only option.  Replacement can be made with a dental implant, bridge or a removable denture.

Surgical Procedures

Oral Surgery

Extractions - Our doctors are able to perform simple, surgical and wisdom tooth extractions.  Dr. Dan Bruce also can provide oral sedation to make the experience more comfortable for you.  We also have great relationships with local oral surgeons for especially difficult cases or if you desire IV sedation for your procedure.

Bone Grafting -  When a tooth is taken out, bone grafting may be done to preserve the bone ridge for implant placement or esthetics when a bridge is placed.  The two options for bone grafting are synthetic and freeze-dried cadaver bone.  This important step can increase the success of future implant dentistry.

Gingival Surgery

Gingival Grafting - Gingival grafting is needed when the firm tissue around the gums, or the attached gingiva, is lost.  This can result in bone loss, root exposure and other problems.  Our office can diagnose gingival problems and either treat or refer you to a periodontist in our referral network.  For more information on periodontal grafting procedures, see the Academy of Periodontology website.

Crown Lengthening - When decay or a fracture causes a restoration to get too close to the bone around the tooth, clinical crown lengthening is required to create enough space for the periodontal structures.  Crown lengthening may also be required in esthetic cases where the gums are too low or not even.

Frenectomy - The frenum is the attachment of mucosa between the lip and the gums.  The most prominent areas are between the front teeth on the upper and lower and the from between the lower teeth and tongue.  A frenectomy involves cutting the frenum.  This is done when the frenum pulls on the attached gingiva and causes either recession or movement of the teeth.