1. Prophylaxis and Examination
In prophylaxis, the dentist or dental hygienist uses special abrasives and scraping tools to remove dental tartar and other substances from the teeth. The dentist or an assistant may then X-ray the teeth to determine if there is any decay or other type of abnormality, such as an impacted tooth. Sometimes, all the teeth may be X-rayed with a single film, called a pentographic film. Most often, however, smaller individual films are used, with each film covering only a few teeth. In some cases, such as when dentures are to be fitted, when the teeth are to be straightened, or when some disease is suspected in the jaw bones, additional X-rays may be taken, including side and full-face views of the entire head. Similar X-ray films may be taken if the dentist decides upon a program of oral rehabilitation that includes relocating the teeth to correct a structural abnormality such as a malocclusion, or improper bite.
After X-raying the teeth, the dentist begins a physical examination of the teeth and other mouth tissues. He looks for areas where the enamel of a tooth may be deficient or entirely missing and he notices whether the soft tissues are being injured when the person chews. He also looks for teeth that have not developed properly and may test the vitality of the teeth with an electrical pulp tester. The dentist also examines any fillings, inlays, or bridges previously placed in the mouth to see if they still protect the teeth and to determine if decay has occurred under them. If new bridges or crowns are to be constructed, the dentist makes impressions of the teeth and later makes casts that he or a technician can use as a guide in preparing the bridge or crown.
As part of the examination, the dentist also records the patient's past dental and related medical history. If the patient has a gum disease, the dentist may inquire about his general health to determine if the gum disorder is a manifestation of an underlying systemic disease, such as an allergy, anemia, or a nutritional deficiency. In addition, the patient's medical history enables the dentist to know whether certain drugs and anesthetics should be avoided. For example, procaine (Novocain) is generally not given to older people or to people with known heart ailments.
After the dentist diagnoses any mouth disease or dental disorder, he plans his treatment and consults with the patient. He may advise the patient on home care of the mouth and prescribe fillings, bridges, or other restoration appliances that suit the patient's needs. He may also instruct the patient on how to brush his teeth, massage his gums, or use other techniques necessary for proper mouth hygiene.
2. Filling Cavities
Dental cavities are caused by decay and they can be detected either through X-rays of the teeth or by probing the teeth with a sharp pointed instrument known as an explorer. Once a cavity is detected, the dentist uses a high-speed drill to remove the decay and shape the hollow so that the filling material will be retained. Usually, the tooth nerve (pulp) and surrounding tissue are anesthetized so that the patient feels no pain while the tooth is drilled.
The major types of filling material are silver amalgam, gold, porcelain, synthetic porcelain, and plastic. Generally, the same kind of filling material is used in opposing teeth or teeth that are next to each other to avoid a mild electric shock caused by the difference in electric potential of the different metals. The most widely used filling material is silver amalgam, which is commonly used for small cavities. More extensive cavities are often filled with gold, which is less brittle than the silver amalgam and is stronger at the edges. Gold is generally used in making inlays or crowns. An inlay is a solid piece of gold that is cast to fit the cavity exactly. A crown, or cap, covers the entire tooth after the tooth's enamel has been removed. Crowns may be made of gold, plastic, or porcelain. Gold is often used for crowns on the teeth in the back of the mouth, while porcelain and plastic are used for front teeth because they are available in shades to match the patient's own teeth.
Sometimes the decay reaches the pulp of the tooth, causing the nerve to become inflamed and allowing infection to spread to the bone around the tooth. In such cases, the tooth can be preserved by endodontic therapy, which is popularly known as root canal work. The dentist removes the pulp of the tooth and replaces it with metal, gutta percha, cement, or some other material. The decayed portion of the tooth is then replaced with filling material, a gold inlay, or a gold or porcelain crown.
3. Treating Gum Diseases
Gum diseases are a major cause of tooth loss in adults. About 40% of all teeth that are lost result from the wasting away of the bone surrounding the teeth when diseases of the gums and periodontal tissue are neglected.
Injuries and diseases of the gums and periodontal tissue are often caused by accidents, irritation from improperly fitting crowns or dentures, impacted food particles, or the accumulation of dental tartar on the teeth. Dental tartar is a dense, chalklike material that collects on the teeth, and if it is not removed, it irritates the gums and may bring about infection. Usually, diseases of the gums and periodontal tissue are treated by chemical or surgical means. Surgical treatment entails the removal of diseased or superfluous tissues surrounding the teeth. Treatment with chemicals is usually done after the teeth are mechanically scraped to shrink the gums and to relieve any infection.
4. Occlusal Reconstruction
Occlusal reconstruction, also known as stomatognathics, is the restoration of the vertical and horizontal dimensions of the teeth after the chewing surfaces have been worn down. This practice takes into consideration the interdependence of the form and function of the teeth, the relation of the jaws to each other and to the skull, the occlusion of the teeth, and the appearance of the face. This type of treatment eliminates interferences in chewing and avoids injuries caused by improper bite.
Usually, the patient is first fitted with temporary splints or other structures to determine the amount of opening of the bite that can be tolerated. The final restorations are made of gold, stainless steel, porcelain, or plastic, and they may include crowns, inlays, fittings, and removable or fixed bridges.
5. Fitting Artificial Dentures
Artificial dentures may be either partial or complete. Partial dentures are used when some of the patient's natural teeth remain in the jaw, and complete dentures are used when all the teeth from either jaw are lost. Partial dentures are generally removable and are held in place by metal clasps that attach them to the neighboring natural teeth. A fixed bridge is a type of partial denture that is permanently attached to the natural teeth. Properly fitting complete dentures are held in place naturally. Adhesive powders and pastes if used for a long time are harmful to the gums and collect debris, stale saliva, and other mouth fluids that become offensive.
Modern techniques and materials have made it possible to construct highly efficient dentures with plastic gums that appear lifelike. However, dentists are experimenting with the implantation of artificial teeth directly into the gums to replace lost teeth or to serve as abutments for bridges perhaps eventually eliminating the need for artificial removable dentures.
6. Extracting Teeth
The extraction of teeth is always considered a last resort. Today, even badly decayed teeth that formerly would have been extracted can be saved with new techniques and drugs, especially antibiotics.
Extraction is usually painless under local anesthetics, such as Novocain, or general anesthetics, such as phenothal. In extracting a tooth, the dentist first anesthetizes the tooth and uses a scalpel or other sharp cutting instrument to loosen the gum from around the tooth. He then lifts out the teeth with a forceps or a sharp pointed instrument called an elevator. If the tooth has not yet erupted from below the gum, the dentist first makes an incision into the gum and then removes the tooth. Extraction is no longer a hazardous procedure but is performed with a surgical technique that minimizes the destruction of mouth tissues. Also, the aftereffects of an extraction are controlled so that healing occurs in a relatively short time.
7. Orthodontic Treatment
Abnormalities in the positioning of the teeth may be due to many causes, including heredity, improper use of the teeth in chewing, finger sucking, and generalized body diseases. The special appliances used to correct orthodontic problems include removable plates and fixed metal bands and wires. In cases where the jawbones are not large enough to accommodate all the teeth, some of them may be extracted in an attempt to overcome crowding or to correct protruding teeth.
