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Smile by Design

Treatments

There is a specific art to designing a beautiful smile in which
rules of proportion, length, shape and symmetry are applied.

Restorations: Dental Implants

Dental implants are a great way to replace missing teeth and also provide a fixed solution to having removable partial or complete dentures. Implants provide excellent support and stability for these dental appliances.
Dental implants are artificial roots and teeth (usually titanium) that are surgically placed into the upper or lower jaw bone by a dentist or Periodontist – a specialist of the gums and supporting bone. The teeth attached to implants are very natural looking and often enhance or restore a patient’s smile!
Dental implants are strong and durable and will last many years.  On occasion, they will have to be re-tightened or replaced due to normal wear.

Reasons for dental implants:

  • Replace one or more missing teeth without affecting adjacent teeth.
  • Resolve joint pain or bite problems caused by teeth shifting into missing tooth space.
  • Restore a patient’s confident smile.
  • Restore chewing, speech, and digestion.
  • Restore or enhance facial tissues.
  • Support a bridge or denture, making it more secure and comfortable.

What does getting dental implants involve?
The process of getting implants requires a number of visits over several months.
X-rays and impressions (molds) are taken of the jaw and teeth to determine bone, gum tissue, and spacing available for an implant.  While the area is numb, the implant will be surgically placed into the bone and allowed to heal and integrate itself for up to six months.   Depending on the type of implant, a second surgery may be required in order to place the “post” that will hold the artificial tooth in place.  With other implants the post and anchor are already attached and placed at the same time. After several weeks of healing the artificial teeth are made and fitted to the post portion of the anchor.  Because several fittings may be required, this step may take one to two months to complete.  After a healing period, the artificial teeth are securely attached to the implant, providing excellent stability and comfort to the patient. You will receive care instructions when your treatment is completed.  Good oral hygiene and eating habits, alongside regular dental visits, will aid in the life of your new implant. If you have questions about dental implants or would like to schedule a consultation, please contact our office.

If you have questions about Dental Implants or would like
to schedule a consultation, please contact our office at
415.563.3100 or Request an Appointment

Restorations: Dentures & Partial Dentures

A denture is a removable dental appliance replacement for missing teeth and surrounding tissue.  They are made to closely resemble your natural teeth and may even enhance your smile.

There are two types of dentures complete and partial dentures. Complete dentures are used when all of the teeth are missing, while partial dentures are used when some natural teeth remain. A Partial denture not only fills in the spaces created by missing teeth, it prevents other teeth from shifting. A Complete denture may be either “conventional” or “immediate.” A conventional type is made after the teeth have been removed and the gum tissue has healed, usually taking 4 to 6 weeks. During this time the patient will go without teeth. Immediate dentures are made in advance and immediately placed after the teeth are removed, thus preventing the patient from having to be without teeth during the healing process. Once the tissues shrink and heal, adjustments will have to be made. Dentures are very durable appliances and will last many years, but may have to be remade, repaired, or readjusted due to
normal wear.

  • Reasons for dentures:
  • Complete Denture – Loss of all teeth in an arch
  • Partial Denture – Loss of several teeth in an arch
  • Enhancing smile and facial tissues
  • Improving chewing, speech, and digestion

What does getting dentures involve?
The process of getting dentures requires several appointments, usually over several weeks. Highly accurate impressions (molds) and measurements are taken and used to create your custom denture. Several “try-in” appointments may be necessary to ensure proper shape, color, and fit. At the final appointment, your dentist will precisely adjust and place the completed denture, ensuring a natural and comfortable fit.

It is normal to experience increased saliva flow, some soreness, and possible speech and chewing difficulty, however this will subside as your muscles and tissues get used to the new dentures.

You will be given care instructions for your new dentures.  Proper cleaning of your new dental appliance, good oral hygiene, and regular dental visits will aid in the life of your new dentures.

If you have questions about Dentures & Partial Dentures or would like
to schedule a consultation, please contact our office at
415.563.3100 or Request an Appointment

Periodontal Disease: Maintenance

It only takes twenty-four hours for plaque that is not removed from your teeth to turn into tartar! Daily home cleaning helps control plaque and tartar formation, but those hard to reach areas will always need special attention.

Once your periodontal treatment has been completed, your dentist and dental hygienist will recommend that you have regular maintenance cleanings (periodontal cleanings), usually four times a year.  At these cleaning appointments, the pocket depths will be carefully checked to ensure that they are healthy. Plaque and calculus that is difficult for you to remove on a daily basis will be removed from above and below the gum line.

In addition to your periodontal cleaning and evaluation, your appointment will usually include:

  • Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss.X-rays also help determine tooth and root positions.
  • Examination of existing restorations: Check current fillings, crowns, etc.
  • Examination of tooth decay: Check all tooth surfaces for decay.
  • Oral cancer screening: Check the face, neck, lips, tongue, throat, cheek tissues, and gums for any signs of oral cancer.
  • Oral hygiene recommendations: Review and recommend oral hygiene aids as needed. (Electric toothbrushes, special periodontal brushes, fluorides, rinses, etc.)
  • Teeth polishing: Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.

Good oral hygiene practices and periodontal cleanings are essential in maintaining dental health and keeping periodontal disease under control!

If you have questions about Periodontal Disease: Maintenance or would like
to schedule a consultation, please contact our office at
415.563.3100 or Request an Appointment

Periodontal Disease: Diagnosis

Periodontal disease is diagnosed by your dentist or dental hygienist during a periodontal examination.  This type of exam should always be part of your regular dental check-up.

A periodontal probe (small dental instrument) is gently used to measure the sulcus (pocket or space) between the tooth and the gums.  The depth of a healthy sulcus measures three millimeters or less and does not bleed.  The periodontal probe helps indicate if pockets are deeper than three millimeters.  As periodontal disease progresses, the pockets usually get deeper.

Your dentist or hygienist will use pocket depths, amount of bleeding, inflammation, tooth mobility, etc., to make a diagnosis that will fall into a category below:

Gingivitis
Gingivitis is the first stage of periodontal disease.  Plaque and its toxin by-products irritate the gums, making them tender, inflamed, and likely to bleed.

Periodontitis
Plaque hardens into calculus (tartar).  As calculus and plaque continue to build up, the gums begin to recede from the teeth.  Deeper pockets form between the gums and teeth and become filled with bacteria and pus.  The gums become very irritated, inflamed, and bleed easily.Slight to moderate bone loss may be present.

Advanced Periodontitis
The teeth lose more support as the gums, bone, and periodontal ligament continue to be destroyed.  Unless treated, the affected teeth will become very loose and may be lost.  Generalized moderate to severe bone loss may be present.

If you have questions about Periodontal Disease: Diagnosis or would like
to schedule a consultation, please contact our office at
415.563.3100 or Request an Appointment

Zoom!® Teeth Whitening

A pearly-white smile is beautiful to look at and can greatly improve self-confidence.  Many people are opting for the Zoom!® Chairside Whitening System (Zoom!®) for fast, safe and effective teeth whitening.  Zoom!® combines the newest advances in dental technology with proven chemical formulas. This ensures that the bleaching experience is painless, and the results are satisfying.

There are many reasons why teeth become stained or discolored, including tobacco use, and drinking dark liquids such as red wine, coffee, tea and cola.  However, the natural aging process and prescription medication use can also cause yellowing and graying.

There are literally hundreds of whitening treatments available in the marketplace, including take-home strips, bleaching toothpastes and take-home whitening gels.  Many take-home gels are ineffective and may not elicit the desired results.
Zoom!® has many advantages over these other treatments, including:

  • All teeth treated simultaneously.
  • Faster treatment times.
  • Longer lasting results.
  • Reduced sensitivity.
  • Removal of stains on crowns, veneers and other restorations.
  • Safe procedure and treatment.
  • Treatments are performed by an experienced professional.

It is important to seek advice from the dentist prior to beginning a bleaching regime.  Women who are pregnant or lactating should not seek bleaching treatment.

How does Zoom!® whiten the teeth?
Zoom!® is a bleaching process that lightens the dentin and enamel of the teeth.  Zoom!® contains a hydrogen peroxide component (25%), which is the active ingredient in the gel.  When hydrogen peroxide is applied to the teeth, the peroxide component breaks down into tiny oxygen bubbles.  It is these bubbles that eliminate yellowing and staining.

A mercury metal halide light is used to activate the gel and expedite the whitening process.  This specialized light contains a unique infrared filter that works to reduce the amount of heat (and therefore sensitivity) on the surface of the teeth during the procedure.  The internal structure of the teeth remains completely healthy and intact during and after the treatment.

As with any whitening system, the post-treatment results can vary according to the degree of staining and the condition of the teeth.  A consultation with the dentist prior to treatment will provide information as to what kind of results Zoom!® can provide in specific instances.  Zoom!® is only applied to healthy teeth and gums.  If tooth decay or gum disease is an issue, these need to be controlled before the bleaching treatment is performed.

How is the Zoom!® treatment performed?
Prior to treatment, there will be a consultation where the dentist will outline the exact procedure.  On treatment day, a deep cleaning (prophylaxis) will be performed to rid the teeth of any debris and plaque.  Then, special eyewear will be provided to protect the eyes from the halide light, and splashguards to protect the clothing from the bleaching agent.

Here is a brief overview of the Zoom!® procedure:

  1. Cheek retractors will be placed to expose the entire surface of the teeth.
  2. The gums will be painted or covered to reduce sensitivity.
  3. The dentist will apply the whitening gel to the teeth.
  4. The halide light will then be applied to activate the gel.  This specialized Zoom!® light can be positioned to work on all the teeth simultaneously.
  5. After 15 minutes, gel will be removed from the teeth and the mouth will be rinsed.
  6. More gel will be applied for another 15 minutes.
  7. Again, the gel will be removed and the mouth will be thoroughly cleansed.
  8. The final treatment of gel will be applied for 15 minutes.
  9. The gel will be removed for the final time.
  10. What happens after treatment?
  11. The same external factors that caused the discoloration in the first place can quickly work their way back onto the teeth.  For this reason, the dentist recommends flossing once a day, thorough cleaning with anti-sensitivity toothpaste twice a day, and occasional retreatment with Zoom!® Weekender.  These post-treatment measures will ensure that the smile stays at its whitest for a long time.

If you have questions about the Zoom!® Chairside System, please ask your dentist.

If you have questions about Zoom!® Teeth Whitening or would like
to schedule a consultation, please contact our office at
415.563.3100 or Request an Appointment

Root Canal Therapy

Root canal therapy is needed when the nerve of a tooth is affected by decay or infection.  In order to save the tooth, the pulp (the living tissue inside the tooth), nerves, bacteria, and any decay are removed and the resulting space is filled with special, medicated, dental materials, which restore the tooth to its full function.
Having a root canal done on a tooth is the treatment of choice to save a tooth that otherwise would die and have to be removed.  Many patients believe that removing a tooth that has problems is the solution, but what is not realized is that extracting (pulling) a tooth will ultimately be more costly and cause significant problems for adjacent teeth.
Root canal treatment is highly successful and usually lasts a lifetime, although on occasion, a tooth will have to be retreated due to new infections.

Signs and symptoms for possible root canal therapy:

  • An abscess (or pimple) on the gums
  • Sensitivity to hot and cold
  • Severe toothache pain
  • Sometimes no symptoms are present
  • Swelling and/or tenderness
  • Reasons for root canal therapy:
  • Decay has reached the tooth pulp (the living tissue inside the tooth)
  • Infection or abscess have developed inside the tooth or at the root tip
  • Injury or trauma to the tooth

What does root canal therapy involve?
A root canal procedure requires one or more appointments and can be performed by a dentist or endodontist (a root canal specialist).

While the tooth is numb, a rubber dam (a sheet of rubber) will be placed around the tooth to keep it dry and free of saliva.  An access opening is made on top of the tooth and a series of root canal files are placed into the opening, one at a time, removing the pulp, nerve tissue, and bacteria.  If tooth decay is present, it will also be removed with special dental instruments.

Once the tooth is thoroughly cleaned, it will be sealed with either a permanent filling or, if additional appointments are needed, a temporary filling will be placed.

At the next appointment, usually a week later, the roots and the inside cavity of the tooth will be filled and sealed with special dental materials.  A filling will be placed to cover the opening on top of the tooth.  In addition, all teeth that have root canal treatment should have a crown (cap) placed.  This will protect the tooth and prevent it from breaking, and restore it to its full function.

After treatment, your tooth may still be sensitive, but this will subside as the inflammation diminishes and the tooth has healed. You will be given care instructions after each appointment.Good oral hygiene practices and regular dental visits will aid in the life of your root canal treatment.

If you have questions about Root Canal Therapy or would like
to schedule a consultation, please contact our office at
415.563.3100 or Request an Appointment

Restorations: Crowns (Caps)

A crown (or cap) is a covering that encases the entire tooth surface restoring it to its original shape and size.  A crown protects and strengthens tooth structure that cannot be restored with fillings or other types of restorations. Although there are several types of crowns, porcelain (tooth colored crown) are the most popular.  They are highly durable and will last many years, but like most dental restorations, they will eventually need to be replaced.  Porcelain crowns are made to match the shape, size, and color or your teeth giving you a natural, long-lasting beautiful smile.

Reasons for crowns:

  • Broken or Fractured Teeth
  • Cosmetic Enhancement
  • Decayed Teeth
  • Fractured Fillings
  • Large Fillings
  • Tooth has a Root Canal

What does getting a crown involve?
A crown procedure usually requires two appointments.  Your first appointment will include taking several highly accurate molds (or impressions) that will be used to create your custom crown.  A mold will also be used to create a temporary crown which will stay on your tooth for approximately two weeks until your new crown is fabricated by a dental laboratory.

While the tooth is numb, the dentist will prepare the tooth by removing any decay and shaping the surface to properly fit the crown.  Once these details are accomplished, your temporary crown will be placed with temporary cement and your bite will be checked to ensure you are biting properly.

At your second appointment your temporary crown will be removed, the tooth will be cleaned, and your new crown will be carefully placed to ensure the spacing and bite are accurate.

You will be given care instructions and encouraged to have regular dental visits to check your new crown.

If you have questions about Crowns (Caps) or would like
to schedule a consultation, please contact our office at
415.563.3100 or Request an Appointment

Tooth colored Restorations

We are a mercury-free practice. However, many people still have silver/mercury fillings in their mouths from years past. These fillings are not particularly pleasing to the eye, and we know that by unavoidable design, silver/mercury fillings ultimately result in a weaker tooth structure. Porcelain Onlays and Tooth Colored Restorations (composite resin fillings) create fillings that are not only beautiful (or unnoticeable) but also add strength to weakened teeth.These restorations are esthetically pleasing and very strong thanks to new bonding technologies.

Disadvantages of Silver fillings:
Silver fillings have many drawbacks. The edges of the silver filling can wear down, become weak or break. This results in the tooth not being protected and lets cavities get started once again. With age, the metal of a silver filling expands, contracts, and can split. They can corrode, leak and cause stains on your teeth and gums.
Fortunately, silver fillings can safely be replaced with Tooth-Colored Restorations.

Advantages of Tooth-Colored Restorations
There are many advantages to tooth-colored restorations. Composite Resin Fillings  are bonded to the teeth creating a tight, superior fit to the natural tooth. Such restorations can be used in instances where much of the tooth structure has been lost. The tooth remains intact and stronger.
Since the resin used in tooth-colored restorations contain fluoride this can help prevent decay. The resin wears like natural teeth and does not require placement at the gum line, which is healthier for your gums!
The result is a beautiful smile!

Replacing Silver Fillings with a Tooth Colored Restoration
You can have your silver fillings replaced with tooth-colored restorations (porcelain onlays). This process requires two appointments.

Your First Appointment:

  1. The old filling is removed along with any additional decay.
  2. An impression is made of your teeth. A model of your teeth is made and sent to the lab.
  3. A temporary onlay is placed on the tooth.
  4. At the Lab: A resin is carefully placed into the model of your teeth. It is then designed to look natural.

Your Second Appointment:

  1. The temporary onlay is removed.
  2. A conditioning gel is placed on your tooth to prepare it for the new onlay.
  3. Bonding cement is placed on the tooth and a high intensity light bonds the resin to the tooth.
  4. The tooth is then polished.
  5. Your teeth are restored to a natural look and feel, they are stronger and the tooth is protected!

If you have questions about Tooth colored Restorations or would like
to schedule a consultation, please contact our office at
415.563.3100 or Request an Appointment

Sedation Dentistry

 NOW YOU CAN RELAX
Does the thought of having your teeth cleaned make your entire body tense with fear? Would you rather endure the agony of a toothache than step foot in a dentist’s office? You’re not alone. A lot of people are so phobic about going to the dentist that they prefer not to have any treatment.
For people who avoid dentists like the plague, sedation dentistry may take away some of their anxiety. Sedation can be used for everything from invasive procedures to a simple tooth cleaning. How it’s used depends on the severity of the fear.

WHAT IS SEDATION DENTISTRY?

Sedation dentistry uses medication to help patients relax during dental procedures. It’s sometimes referred to as “sleep dentistry,” although that’s not entirely accurate. Patients are usually awake with the exception of those who are under general anesthesia.

The levels of sedation used include:

  • Minimal sedation — you are awake but relaxed.
  • Moderate sedation (formerly called “conscious sedation”) — you may slur your words when speaking and not remember much of the procedure.
  • Deep sedation — you are on the edge of consciousness but can still be awakened.
  • General anesthesia — you are completely unconscious.

SEDATION DENTISTRY MAY BE APPROPRIATE FOR PEOPLE WHO

  • Have a low pain threshold
  • Can’t sit still in the dentist’s chair
  • Have very sensitive teeth
  • Have a bad gag reflex
  • Need a large amount of dental work completed

Sedation is most appropriate for people with a real fear or anxiety that is preventing them from going to the dentist. Sometimes, children are given sedation if they are terrified of going to the dentist or refuse to cooperate during the visit. Nitrous oxide tends to be safe in children, and just about any dentist can administer it. A smaller percentage of pediatric dentists are trained to give children oral sedation. Oral sedation can be safe when kept within the recommended dose for the child’s age and weight.

WHAT TYPES OF SEDATION ARE USED IN DENTISTRY?

  • Inhaled Minimal Sedation
: You breathe nitrous oxide — otherwise known as “laughing gas” — combined with oxygen through a mask that’s placed over your nose. The gas helps you relax. Your dentist can control the amount of sedation you receive, and the gas tends to wear off quickly. This is the only form of sedation where you may be able to drive yourself home after the procedure.
  • Oral Sedation
: Depending on the total dose given, oral sedation can range from minimal to moderate. For minimal sedation, you take a pill. Typically, the pill is Halcion, which is a member of the same drug family as Valium, and it’s usually taken about an hour before the procedure. The pill will make you drowsy, although you’ll still be awake. A larger dose may be given to produce moderate sedation. This is the type of anesthesia most commonly associated with sedation dentistry. Some people become groggy enough from moderate oral sedation to actually fall asleep during the procedure. They usually can, though, be awakened with a gentle shake.
  • IV Moderate Sedation: You receive the sedative drug through a vein, so it goes to work more quickly. This method allows the dentist to continually adjust the level of sedation.
  • Deep Sedation and General Anesthesia
: You will get medications that will make you either almost unconscious or totally unconscious — deeply asleep — during the procedure. While you are under general anesthesia, you cannot easily be awakened until the effects of the anesthesia wear off or are reversed with medication.

Regardless of which type of sedation you receive, you’ll also typically need a local anesthetic — numbing medication at the site where the dentist is working in the mouth — to relieve pain if the procedure causes any discomfort.

If you have questions about Sedation Dentistry or would like
to schedule a consultation, please contact our office at
415.563.3100 or Request an Appointment

Appointments

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Office Information

Office Tour
Forms

Please take a few moments to complete the following patient information forms. The sooner we receive them, the better we are able to prepare for your visit. When the form is ready to send click the submit button on the bottom of each page listed below.

Financial Arrangements

Our office accepts most dental insurance plans that allow you the freedom to choose your own dentist. Our goal is to provide the finest dental care available. We request our patients pay the estimated patient portion of their dental care at the time of treatment. We will then send a claim to your insurance company for the estimated insurance portion of your treatment.

We take insurances and are in network providers PPO:

  • Delta Dental
  • Aetna
  • Assurant
  • Premier Access
  • Principal
  • Guardian
  • Cigna
  • United Concordia
  • First Dental Health
  • MetLife
  • Humana
  • United Healthcare
  • Connection Dental
  • Blue Cross 100/200/300
  • Dentegra

In addition we accept VISA / Mastercard / Discover / American Express

We also offer a financing plan many of our patients find simple and convenient to use. This plan can make even the most extensive treatment very affordable. Using this option is easy, takes only minutes, and can be done online or by telephone from the privacy of your own home. Approval takes only minutes. We can tell you more about this option, or you can visit the financial institution we recommend at www.carecredit.com, or call it at 1-800-839-9078.

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