Individuals with healthy teeth and gums will generally only need to see their dentist every six months for a prophylaxis (preventative care) appointment. These visits generally consist of: • Cleaning • Exam • Appropriate X-rays • Oral cancer screening • Periodontal evaluation • Orthodontic assessment …as well as a consultation to answer any current questions or concerns that you may have about your teeth. Should any type of treatment be needed, you’ll schedule the procedure at that time. Unless you tend to develop heavy stain and tartar between appointments, a biannual cleaning is typically appropriate. Some patients prefer to be seen as frequently as three or four times a year to have superficial stain and deposits cleaned away for aesthetic purposes, even if it’s not covered by their insurance policy.

Gum disease causes permanent bone and soft tissue loss around the teeth, making them more challenging to brush, floss, and maintain. To prevent relapse of disease, most gum periodontal patients need to see their dentist every 3-4 months for maintenance appointments. Unlike preventative cleanings, these visits are meant to control infection and prevent it from spreading, rather than avoid the onset altogether. Depending on how your body responds and if any adjunctive procedures (such as bone or gum grafting) have been completed, your scheduled maintenance visits can be spread out appropriately.

Even if you no longer have natural teeth that you’re caring for, you should still see your dentist routinely (at least once per year) to check for soft tissue diseases like oral cancer or to monitor the fit of your dentures. As time goes by, removable prosthetics can start to wear down or fit loosely because of changes in your natural oral anatomy. Having the denture relined or adjusted can ensure that it fits comfortably throughout the day.

It’s important that issues like toothaches be attended to at your earliest convenience. Most types of dental infections will not resolve themselves on their own. Seeing your dentist sooner can eliminate unnecessary pain and provide an opportunity for more conservative (and affordable) treatment options.

When you see a new dentist for the first time — or it’s been a while since your last dental exam — you may be wondering what to expect at your appointment. Although each dental office is different than the next, your regular checkup will general consist of the same steps in some way or another, including:

• Tour of the Office: Many offices will take new patients for a quick walk through of their practice to see different rooms or technology, such as the sterilization area, lab, or digital equipment.
• Medical History Review: Your new patient paperwork provides your dentist with important information about your medical and dental background. Be sure to bring a list of all medications and supplements that you take, as well as the dosage of each. Certain types of prescriptions or surgeries may contraindicate dental treatment, so it’s vital to communicate with your provider.
• Baseline X-rays and Photographs: In order to fully assess all of your smile’s needs, recent dental X-rays are a must. This may include a set of bitewings or a full mouth series/panoramic, or both. Additional digital photographs may be taken throughout the course of your exam in order to better communicate any findings that your dentist needs to make you aware of.
• Consultation with the Hygienist or Assistant: One of the staff members will review your information and discuss any concerns that you have.
• Examination by the Dentist: After speaking with the assistant or hygienist, the dentist will step in to perform a comprehensive examination and consultation. Some of the things being evaluated will include your:• Periodontal (gum) health • Oral cancer risk and screening • Existing dental work • Bite alignment • TMJ function • Primary concerns • Newly diagnosed conditions

• Proposed Treatment Planning: Your dentist will visit with you about their findings, sharing their recommendations and any applicable treatments you have to choose from. If you require immediate care, some treatments can start the same day. But in most cases, your treatment will be mapped out on a customized care plan and scheduled at a future date. The treatment or insurance coordinator will confirm your benefits to take existing coverage into account when calculating the costs of your care. Some people do not need any treatment, which is ideal. The treatment planning step is only needed if you have issues you need to correct or an elective service, such as cosmetic procedures that you’re planning for.
• Dental Cleaning by the Hygienist: As long as your teeth and gums are generally healthy, the hygienist will usually clean your teeth during your first dental checkup. For moderate to severe gum disease, you’ll be rescheduled for a series of deep cleanings at a separate appointment.

To keep your smile healthy, you’ll want to plan on scheduling a preventative care appointment every six months.

Dental hygienists are mid-level dental practitioners (similar to a Registered Nurse) who are licensed to provide therapeutic oral health services and screen for disease. You’ll see them during your “cleaning” appointments, even though they perform far more than just a cleaning. During your appointment with a dental hygienist you’ll be able to receive services such as: • Periodontal evaluation • Oral cancer screening • Medical screening • Prophylaxis • Soft tissue laser therapy for gum disease and cold sores • Local anesthetic, prior to your dental work • Periodontal therapy • Oral hygiene instruction • Nutritional counseling • Radiographs (X-rays) • Sealant placement • Desensitizing treatments • Sedation monitoring In school (hygienists hold an Associate or Bachelors degree) they are also trained to recognize the oral signs and symptoms of systemic health conditions and diseases.

During a prophylactic (preventative) cleaning, your hygienist will use manual scalers and/or an ultrasonic scaler to loosen and remove both hard and soft buildup. The hygienist will typically work from different angles, cleaning surfaces of each teeth from that direction before moving to a different position and cleaning from those angles. This method is for ergonomic and efficiency purposes, but to the average person it can feel as if their hygienist is “skipping around” throughout their mouth. Once all of the teeth are scaled free of debris, your hygienist will use a soft rubber-cup or air-polisher to polish away surface stains. You’ll have a smoother, brighter surface left behind!

Throughout the country, many dental offices are limiting the number of dental impressions that they have to take, thanks to digital scanning technology. These “digital impressions” use CAD/CAM systems to capture 3D images and transfer them into a computer system, providing the software with a virtual model of your mouth. But how does digital impression technology change the way you see the dentist? Here are just a few reasons why this option offers a superior alternative to conventional impression trays: No Gooey Messes or Gag Reflexes One of the biggest challenges of having your dental impression taken is that for many people it triggers their gag reflex. Add to the fact that the material feels soft, mushy, or even flows toward the back of the mouth and it can be – well – a recipe for disaster. Digital impressions only require a small handheld wand that’s scanned over your teeth. It’s essentially no different than having a dental exam conducted. Just say “ah,” and the digital tool does the rest. Instantly Send Digital Models to the Dental Lab If you’re having a custom restoration made by a ceramist or other dental lab expert, the model of your mouth has to be sent to a 3rd party, which requires someone to come pick it up or even shipping it out of town. Labs that are equipped with digital scanning capabilities can receive your virtual tooth impression instantly, shaving off hours or even days when it comes to how long you have to wait for a custom restoration to be designed. On Site Crown or Restoration Milling Dentists with in-house milling equipment such as CEREC can use digital impressions to make same-day dental crowns, inlays, and onlays while you wait or catch up on other treatments during the same appointment. This technology essentially takes traditional 2-visit procedures and makes them into a one appointment process. Extreme Accuracy Digital impressions are extremely accurate, allowing for creating of well-fitting restoration designs when aesthetics and comfort matter most. Thanks to technology like 3D CAD/CAM equipment, modern dental practices are able to greatly reduce the chances of human error while providing the highest quality of care for their patients. No Need to Re-impress Have you ever had a dental impression taken and then re-taken because the first one didn’t come out? That’s because a conventional impression takes a lot of practice to get just right. Even the texture of the impression material must have a certain consistency and then have a particular type of modeling material poured into it to create a replica of your mouth. If one step of the process bubbles, warps, or breaks, an entirely new impression is needed. Digital impressions are permanently saved as part of your records. As such, they don’t risk breaking or warping, so there’s no need to re-take them.

If you’ve ever wondered why your dentist draped you in a lead apron and all of their staff step out of the room each time you need a dental X-ray, it’s normal to have some concern about the safety of the procedure. Fortunately, getting dental X-rays today is extremely safe, and the only reason your technician stands away from the machine, is because of the risk of gradual exposure that accumulates day after day throughout their career.

A digital X-ray requires less radiation to capture a high-resolution image than the traditional X-rays used a few decades ago. Depending on the type of film, equipment, and image being taken, it may be as much as a 90% reduction in exposure. As such, it’s safe to say that today’s dental X-rays are extremely safe. Compared to not getting dental X-rays, the tiny amount of radiation exposure is an important trade off. Why? Because diagnostic imaging allows dentists to see inside and around the tooth structures where pathology (such as bone loss, oral cancer, or tooth decay) commonly lurk. Diagnosing them as early as possible allows for less-invasive and more cost-effective treatments. Otherwise, such problems can’t be detected until they’ve reached an advanced state that requires more aggressive therapies to manage.

Every day, we’re exposed to radiation. It comes from the sun, our cell phones, and even riding in an airplane (the longer the airplane ride, the more radiation you’re exposed to!) But when you get a set of four “bitewing” X-rays (the images that are usually taken about once a year to check for new cavities,) the total amount of radiation is only about 0.005 mSv (micro-Sieverts,) which is less than an average daily dose of radiation in everyday life. To give you an idea of other types of radiation encountered in everyday activities, consider these comparisons: • Going through an airport security scanner 80 times is the equivalent to a single day of casual radiation exposure. 1,000 times equals the amount of radiation used for a chest X-ray. • An average 7-hour plane ride exposes each passenger to approximately 0.02 mSv (or 16 small dental X-rays).

Radiology and health experts follow the rule of ALARA, or “as low as reasonably achievable.” This means limiting the risk of scatter radiation to staff and patents. While scatter radiation is minimal, it cannot perforate lead. As such, lead aprons are used to shield tissues that are most sensitive to radiation, including the thyroid gland and reproductive organs. While the risk is extremely low, the apron essentially prevents radiation exposure to other parts of the body that are of greater concern.

Do you have sensitive teeth or gums? You’ll be pleased to know there are a variety of anesthetic options available for making your next dental visit more comfortable. Whether you’re having a routine cleaning or a root canal, your dentist will help you select the best type of anesthetic for your needs. No Anesthesia: Numbing Gel or Rinse If you’re slightly worried about sensitivity during a routine dental procedure (such as a cleaning, or before having an area numbed with local anesthetic) your dentist can use a topical anesthetic that’s rubbed onto your gums. Since your gums are mucous membranes, topical anesthetic works very quickly and effectively, making it useful if you need a specific spot cleaned or are slightly sensitive in a particular area of your mouth. But because the effects wear off within a few minutes, topical products are not recommended for general routine procedures. Local Anesthetic Most restorative dental procedures call for local anesthetic, to temporarily numb the area of the mouth being worked on. This medication is infiltrated into the soft tissues or nerves on one side of your mouth, numbing the affected area for up to a few hours. There are numerous types of local anesthetic on the market, some with epinephrine and others without. The type that your dentists selects will depend on the area being treated, how long the anesthetic needs to last, and if you have any particular medical conditions that need to be considered. Since epinephrine is contraindicated for some people, it’s important to share your medical history so that your dentist can make the best decision for your health. What about sedation and analgesia? Most types of sedation dentistry involve lighter forms of sedatives that make you feel sleepy or experience amnesia related to your appointment. The lightest type of sedative is nitrous oxide (laughing gas) which is fast acting and quickly reversible. Deeper sedatives such as oral or IV sedation will last longer, but you will need someone to escort you to and from the appointment since you’ll be unable to drive. General anesthesia is typically not used unless your treatment involves oral surgery or is being completed in a surgical center. During this type of anesthesia administration, a licensed medical anesthesiologist or nurse anesthetist will administer and supervise the sedative for the duration of the procedure. You may want to opt for this type of anesthesia if you’re having a wisdom tooth extraction, jaw surgery, or other complex procedure.

It’s completely normal to want to attempt certain dental procedures without anesthesia and then go back to it if you’re too sensitive. For example, if you need a deep cleaning (scaling and root planing) you may want to just have the hygienist apply topical anesthetic. But if it’s too tender, you can have local anesthesia administered at any time. Or maybe you’re getting a small filling and want to avoid sedation, but you ask your dentist to keep the laughing gas on standby “just in case.”

Intravenous (IV) sedation is a form of sedation available in dentistry which delivers the sedative directly into a vein in your arm. IV sedation allows for rapid effect to produce adequate relaxation and comfort. The medication dose is easily individualized to meet the patient’s specific needs.

Anyone who has fear and anxiety about dental treatment is a candidate. Anyone who has a strong gag reflex, or has put off dental care for years because of dental anxieties or certain medical conditions could benefit from IV sedation.

Treatment will begin when adequate sedation is achieved. Vital signs will be continuously monitored for your safety. You must have a driver to and from the appointment, and plan on resting for the remainder of the day.

Dental Cone Beam Tomography [Dental CBCT] is a specialized type of x-ray that provides more information than conventional dental or facial x-rays. This computerized scan uses advanced technology to generate three-dimensional[3-D] images.

The benefits of a Dental CBCT scan are that it:

• Provides 3-D images of dental structures, soft tissues, nerve paths and bone which are considerably more detailed than conventional two-dimensional dental x-rays.
• Allows for more precise diagnosis and treatment planning.
• Is simple and comfortable to take and can diagnostically image both bone and soft tissue simultaneously.

Dental CBCT scans are commonly used to:

• Evaluate the position of teeth, bone structure, jaw joints and the airway.
• Aid in:
  • Accurate placement of implants
  • Surgical planning for the removal of impacted wisdom teeth
  • 3-D orthodontic evaluation
  • Complex root canal diagnosis and treatment

Although relatively low, Dental CBCT scans cause some exposure to radiation; the amount of exposure is approximately the same as taking a five-hour international plane flight. Due to radiation exposure, scans are not generally recommended for pregnant women and should be used cautiously in the pre-orthodontic evaluation of children.

During the scan, a motorized arm rotates 360-degrees around your head while capturing multiple images from different angles that are then reconstructed to create a single 3-D image.

The interpretation of a Dental CBCT scan may be done by your dentist, dental specialist or radiologist.