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Preventive Dentistry | Laser Diagnostics & Therapeutics | Family, Children, and Adults
Cosmetic, Crowns, Veneers, Whitening | Emergencies
Dental Care
See us for all of your oral health needs:
- Preventive Dental Hygiene
- Soft Tissue Management Program
- Pain Management Program
- Restorative Dentistry
- Porcelain Crowns and Veneers
- Tooth Whitening
- Children’s Dental Care
- Porcelain Fused to High Nobel Gold Crowns and Bridges
- Implant Crowns and Bridges
- Root Canal Therapy
- Removable Prosthetics
- Oral Surgery
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Preventive Dentistry
As human beings, we are prone to tooth decay, gum disease, and even oral cancer. What can we do to minimize our chances of getting these problems?
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1. Brush twice a day using a soft, or even better, an electric toothbrush. With an electric toothbrush, just move it gently along the surfaces of the teeth- do not scrub; it does all the work for you.
2. Floss between your teeth and gently in the gumline area every night before bed.
3. Don’t use tobacco products, and don’t drink alcohol excessively. Both of these can lead to oral cancer, and heavy use of alcohol and tobacco increases your chances of getting oral cancer exponentially (that’s a lot).
4. Seek regular dental care at least every six months. That means having your teeth cleaned, having routine dental x-rays taken, and having the dentist check your teeth, gums and other soft tissues of the mouth for cavities, gum disease, and oral cancer screening. If you or a close family member are especially prone to any of these, you may need to have your checkup frequency increased to every 3 months. Remember, prevention is always better than treating the breakdown associated with disease.
5. Pay attention to your diet. Limit the amounts of and frequency of starchy and sugary snacks.
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We all eat starches and sugars, and so we are all going to have some acid forming in our mouths, which causes tooth decay. In fact, our mouths are rather like test tubes; there is always going to be some tooth mineral dissolving, but there is also repair, remineralization occurring.
The secret is to have more remineralization and less demineralization!
Case Study: Soda Sipper
| This patient had damage due to soda sipping. Note the extreme erosion of the chewing surfaces of the teeth. The teeth were restored with composite resin material and the patient quit her soda sipping habit! |
Before
After
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Laser Dentistry: Diagnostics and Therapeutics
Laser technology is an amazing and revolutionary aid to fighting the diseases that challenge dentists on a daily basis. The laser is a very precise instrument which allows the dentist to treat dental soft tissue ailments in a simple and comfortable way, often sparing our patients from more serious and invasive forms of treatment which might otherwise be needed. There is less bleeding and less risk of infection with laser dentistry as compared with conventional surgery using a scalpel. In fact, many procedures performed with the laser can be without dental anesthesia. Further, laser treatment at the very low power setting of 1 Watt can stimulate some healing of the periodontal tissues in the event of periodontitis, or gum disease. Our office was the first office in the Finger Lakes area to incorporate the use of lasers in dentistry.
Dr. Zax has been trained in the use of dental lasers through the Academy of Laser Dentistry. She has achieved Advanced Proficiency Status in the use of Nd:YAG (soft tissue) and Er:YAG (hard tissue) dental lasers. Dr. Zax also utilizes the Diagnodent diode laser for early detection of sub-surface dental decay which cannot yet be observed by dental x-rays.
Case Study: Laser Dentistry for overgrown gum line
Patient had malformed teeth due to infection during development. Typically only 1/3 of the tooth is affected as the teeth develop in 3 stages and only the intermediate stage is vulnerable.
Note missing enamel on the biting edge of the teeth. Also, unrelated but also important, one of the lower incisors looks short because the gums are overgrown.
Treatment involved bonding filling material to the areas missing enamel and lasing the overgrown gum tissue to give a longer look to the "short" tooth |
Before - missing enamel
Before - overgrown gum tissue
Before
After
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Case Study: Laser Dentistry for Tongue Biopsy
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Laser excision with biopsy for tongue growth.
Image 1 shows laser in place for biopsy.
Image 2 illustrates no bleeding with laser surgery and no need for stitches (immediate post-biopsy).
Image 3 shows the tongue at 10 months post-op check up.
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Family, Children, and Adults
In our office, we treat both children and adults. We encourage parents of new babies to bring them in for a review of home care techniques. Most infants start to get their first tooth around 6 months of age. For several months prior, it seems that the babies are drooling all the time! As soon as the first tooth begins to erupt in the mouth, the parent should brush the infants teeth twice daily. Also, if you live in an area where there is no fluoride in the water supply, the American Dental Association recommends that fluoride supplements be given beginning at 6 months and continuing until 16 years of age. This applies to our community of Ithaca, where the water supply is not fluoridated.
Since an infant cannot spit out the toothpaste, care must be taken not to have the baby ingest too much fluoride from the toothpaste. Some parents may elect to start with a fluoride-free toothpaste, but this will not deliver the anti-cavity benefit of fluoride. It is safe to use a tiny bit of fluoride containing tooth paste on the brush.
If you would like more information on how fluoride protects the teeth against tooth decay, please feel free to ask Dr Zax. She has a PhD on the subject and spent four years (beyond her dental school education) in full time research studying the effects of fluoride, magnesium and carbonate on developing human fetal enamel, as well as crystallographic studies of developing human fetal enamel!
When should parents begin to floss babies teeth? When the teeth touch which is usually between the ages of 2-4 years. That is when they become prone to cavities between the teeth, where only floss can reach to clean. Special flossers, like the “wild flossers” can make it easy to floss your babies teeth while his/her head is in your lap.
When should babies/children have their first tooth cleaning? Usually, at age 3. However, it is a good idea to have their teeth checked as early as 1 year, to be sure no cavities are starting, and that parents are knowledgeable about proper home care for babies teeth.
Finally:
Never put a baby into his/her crib with a bottle of anything besides plain water. If you do, the baby will sip all night and the teeth will be bathed in sugar; milk and juice and basically any beverage besides water has natural sugar in it! In a short time, babies can suffer from “baby bottle tooth decay” where their teeth are completely rotten and cannot even be fixed. No one wants to have their baby go through tooth extractions!
Nursing Moms: Don’t let your baby make you a pacifier. Once he/she is done nursing and has fallen asleep, the baby should not be sucking on your nipple for pacifier action as that will also result in baby bottle tooth decay. You can place your finger between the gums to dislodge your nipple.
If your baby does take a pacifier, use the NUK orthodontic pacifier which will not cause the tooth position to distort.
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Cosmetic, Crowns, Veneers, Whitening
Crowns are generally recommended for teeth which are broken down, where more than half of the tooth has been replaced by filling and there may not be enough natural tooth structure left to retain a filling, or the tooth could be prone to fracture without a crown.
Also, crowns are generally recommended after a tooth has had root canal therapy, as in this situation, usually the above criteria are present. Not every tooth which needs a crown also needs root canal therapy however!
Root canal therapy is only needed when the pulpal tissue in the root degenerates, most commonly due to tooth decay, but also sometimes because of trauma. Some patients will experience a toothache which most commonly comes and goes (“pulpitis”), although sometimes the nerve tissue dies and the patient has no pain, but a routine dental x-ray will reveal a loss of bone support around the root end, indicating the need for root canal treatment.
Veneers are restorations that cover mostly just the front of the tooth, in order to achieve a more beautiful appearance. Veneers can be made of different materials. In some cases, minimal or no tooth drilling need be done in order to place a veneer. In other cases however, a significant amount of the tooth/teeth may need to be drilled in order to achieve the beautiful result desired. If this is the case, orthodontics (tooth straightening) may be the better option. It may take longer, but it will preserve the natural tooth structure.
Case Study: A Veneer Case
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The top two photos show before and after of a veneer case.
The bottom two photos show close-ups, before and after, of the same smile.
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Case Study: Full Mouth Whitening
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This shows before and after in office full mouth whitening.
Whitening was very successful on the adult teeth, but did have a limited effect on the over-retained baby canine tooth (shown on the left).
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Implants offer the possibility to replace missing teeth with permanent, fixed crowns. Usually an oral surgeon places the implant(s) after evaluating the patient to see if he/she is a good candidate, based on dental and physical health. Most patients can have implants, although factors like smoking will lower the chance of success of this procedure. A number of months must pass while the implant (screw-like fixture placed in bone) integrates into the bone. Then the oral surgeon performs an uncovering procedure which allows the general dentist to take an impression, so that the implant abutment and crown can be fabricated. While the implant offers many advantages – it cannot decay, it is permanently fixed in the mouth, and does not require cutting down of any other teeth, the patient must still maintain excellent oral hygiene – brushing and flossing effectively and generally maintaining regular 6 month re-care appointments at the dentist, otherwise the implant may loosen and fail. With proper care, implants are highly successful.
Case Study: Implants
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Implant photos of missing teeth, temporary denture, impression copings, and final implant crowns. See image captions for details.
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Before - Missing Teeth
Before - The removable partial denture used as a temporary.
Before - The impression copings, enabling a model to be created for the laboratory to construct the custom abutments which will connect to the implant.
The final implant crowns in place.
After
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Case Study: Tooth Whitening, Crowns, and Veneers
| This middle aged adult presented with worn down teeth (short) and a single grayed lower tooth. |
Before
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| First the lower tooth was whitened internally to remove the dark pigments which had accumulated from the internal aspect. |
Mid-Treatment
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| Then porcelain crowns and veneers were placed to add 2mm to the length of the front teeth, restoring a more youthful image.
The patients friends noticed the change but thought he just whitened his teeth and so his smile was now more evident (no one knew he had 6 porcelain crowns and veneers placed - 2 full crowns on the central incisors which had large fillings, and veneers on the laterals and canines which did not need to be cut down for full crowns).
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After
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Emergencies
If you have a dental emergency, our staff will strive to accommodate your needs promptly. After hours, your call will be returned by our on-call emergency staff.
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