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ORAL HYGIENE CARE
Maintaining good oral hygiene is one of the most important things you can do for your teeth and gums.  Healthy teeth not only enable you to look and feel good, they make it possible to eat and speak properly.  Good oral health is important to your overall well-being. Daily preventive care, including proper brushing and flossing, will help stop problems before they develop.

In between regular visits to the dentist, there are simple steps that each of us can take to greatly decrease the risk of developing tooth decay, gum disease and other dental problems. These include:

  • Brush thoroughly twice a day and floss daily
  • Eat a balanced diet and limit snacks between meals
  • Use dental products which contain fluoride, including toothpaste
  • Rinse with a fluoride mouth rinse if advised to do so
  • Make sure children under 12 drink fluoridated water or take a fluoride supplement if they live in a non-fluoridated area
  • Visit your dentist regularly for professional cleanings and oral exams
  • Replace your toothbrush every 3-4 months

The following are indications of good oral hygiene:

  • Your teeth are clean and free of debris
  • Gums are pink and do not hurt or bleed when you brush or floss
  • Bad breath is not a constant problem
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DENTAL CLEANING
A dental "cleaning" is a professional cleaning you receive from a dentist or dental hygienist, and there are many types,  depending if gum (periodontal) disease is present or not. Most regular, preventive dental cleanings take only between 25 and 30 minutes.  Cleanings should be performed every three to six months to prevent excessive plaque buildup.  Plaque left untreated can lead to unhealthy gums and tooth decay.  A routine dental cleaning should include scaling and polishing.
Scaling: this is the process of removing plaque and tartar from all tooth surfaces in a variety of methods, depending on the amount of plaque and tartar.
Dental hygienists traditionally perform scaling by hand. However, new and advanced technology has lead to more modern methods such as electric scalers.  This sophisticated tool allows dental cleanings to be performed more efficiently and in less time.
Polishing: this is the last step in tooth cleaning and involves finishing the surface of the teeth to make them shiny and clean. 
There are two kinds of polishing: air polishing and rubber tip polishing. Air polishing works by spraying high pressured water mixed with baking soda paste onto the surface of your teeth.  This powered water washes away residue and plaque while baking soda removes stains. Usually we do this for patients with "braces." Rubber cup polishing uses a low-speed and gentle handpiece that contains a polishing paste made of abrasive ingredients ideal for removing stains.
TREATMENT: (Once gum disease is actually present, it has to be treated - a regular , preventive "cleaning" is no longer going to be effective. See Periodontal Maintenance section below.)
Root planing: this is the process of cleaning pockets underneath the gums to treat and prevent gum problems.
Root planing is used to treat moderate to advanced gum diseases. When the gum is inflamed, gum pockets become deeper and may lose connections to the bone inside.  The deeper the pockets, the easier it is for plaque deposits to become trapped and worsen gum problems.
Root planing involves inserting  dental tools called scalers into the gum pockets to clean plaque buildup. Depending on the degree of difficulty, root planing may take several appointments and a local anesthesia may be used to prevent pain. Usually a topical anesthetic, which is squirted up under the gum,  is sufficient for this procedure - nothing "pokey" or long-lasting! back to top

PERIODONTAL MAINTENANCE: Regular Cleaning vs Periodontal Treatment
healthy vs periodontalA regular cleaning (prophylaxis) is a preventive treatment. This cleans above the gum line. When there is disease present, it is below the gum line, and the disease requires actual treatment by cleaning off the root surface underneath the gums.
Gum (periodontal) disease is no longer considered a "dental" disease. It is an infection that allows the invading bacteria to spread in the bloodstream throughout the entire body. Research is linking gum disease to an increased risk of stroke; fatal heart disease; diabetes; pre-term low birth weight babies; and pneumonia. In men a six times increased risk of tongue cancer, and a 63% higher chance of pancreatic cancer have also been shown.
Some mainland insurance companies require the dentist to submit the claim for periodontal treatment to the MEDICAL insurance first. Because of its serious nature, it is considered primarily a medical condition. 

After the initial scaling and root planing phase of treatment, data shows that patients with a previous history of periodontal disease should obtain periodontal maintenance at least four times a year. This interval will result in a decreased likelihood of progressive disease, compared to patients receiving periodontal maintenance on a less frequent basis. Tooth loss has been shown to correspond with a lack of treatment and maintenance. Because we are ethical practitioners we are unable to allow insurance benefits to dictate treatment plans. You may find that  for the maintenance phase of  treatment that a certain, local behemoth of an insurance company does not cover ANY of the maintenance, although one of the local Hawaii companies at least covers half of the required  visits per year.

At the one year point, the periodontal status is re-evaluated and the treatment interval may be lengthened if the disease has been successfully stabilized. If there are still signs of active, progressive disease, then you may be referred to a specialist. back to top

FLUORIDE TRAYS
Fluoride trays, or fluoride gel carriers, may be used to prevent damage to the teeth, when the teeth are threatened by a variety of acid challenges. The trays are custom-made, and are easy to use. Simply keep the trays in the shower, put the prescription gel into the trays and keep them in once a day, for 5 minutes. Rinse them out when you have finished and leave them to air dry.
The tray is made from a thick, rubbery material that "squeezes" the fluoride into the surface of the teeth. The prescription gel is far more concentrated than is found in regular toothpaste, and the minerals penetrate the tooth surface, making the teeth stronger against the effects of dry mouth and acid erosion. You are over 90% less likely to get cavities with daily use of these trays.
If we suspect that you have a dry mouth from either medications, disease, radiation therapy,or that your mouth is subject to acid-attack from dietary habits or Gastro-Esophageal Reflux Disorder (GERD), then we will recommend fluoride trays to combat these effects.
Click on the "poor soles" above for the Academy of General Dentisty's patient information sheets! See "Dry Mouth" and "Tooth Erosion" back to top

HALITOSIS
Halitosis is sophisticated word for “bad breath”.  Depending on the cause, bad breath may strike on occasion or be a persistent condition. The most common cause of bad breath is bacteria.  Because the mouth is moist and warm, it creates perfect conditions for the millions of bacteria that live in the mouth.  In fact, approximately 80% of bad breath is caused by something in the mouth.

Some types of bad breath, such as "morning mouth," are considered fairly normal and are not usually health concerns. However, persistent bad breath may be a sign of more serious problems with the gums and teeth.

Bad breath may be caused by the following:

  • Poor dental hygiene – poor oral hygiene can leave food particles to decay in the mouth
  • Infections in the mouth such as periodontal (gum) disease
  • Respiratory-tract infections such as throat infections, sinus infections, lung infections
  • External agents including foods such as garlic, onions, and coffee, as well as cigarettes and chewing tobacco
  • Dry mouth caused by salivary gland problems or by breathing through the mouth
  • Systemic illnesses such as diabetes, liver disease, kidney disease, lung disease, sinus disease, reflux disease and others

Call our office promptly if you have bad breath with painful, swollen gums that bleed easily or loose teeth.  We will perform a physical examination of your mouth to determine the cause.  If we discover that systematic problems are the cause, we may refer you to your family physician.  In severe cases of gum disease, we may recommend a specialized periodontist.   back to top

SEALANTS
Sealants are used to fill narrow grooves in a tooth that cannot be adequately cleaned by brushing.  In some cases, the tooth structure has fine grooves or pits which accumulate plaque, not because the person doesn't brush, but because they're too narrow to allow even one bristle into them.  To avoid cavaties developing over time, the dentist will brush on a coating that seals the grooves and pits, making it possible to brush off all the plaque and keep your teeth healthy. back to top

 
BONDING
Bonding involves adhering composite resin material that is matched to the color of the tooth, to the front of the tooth. This is performed to repair damage caused by decay, to alter the alignment of the tooth, close gaps between the teeth, or for other cosmetic purposes. 

First the surface of the tooth is roughened in order to accept the bonding.  A gel is applied so the resin will adhere to the surface of the tooth.  The composite is then placed on the tooth and the bonding agent hardens with intense light. The last step is shaping and polishing to give a lustrous finish.  back to top

FILLINGS
A filling is a way to restore a tooth damaged by decay back to its normal function and shape.  If you have a tooth that requires a filling, the dentist will first remove the decayed tooth material, clean the affected area, and then fill the cleaned out cavity with a filling material.  A filling helps prevent further decay by closing off any cracks or spaces where bacteria can enter.

There are a variety of filling materials available including gold, silver, plastic and porcelain. The dentist will work with you to determine which material is best, depending on the extent of repair, where in the filling is needed, and cost.  Each filling material is briefly explained below:

· Gold fillings are custom made in a laboratory and then cemented into place.  While gold fillings are often the most expensive choice, many consider it the best filling material.  Gold inlays are well-tolerated by gum tissues and may last more than 20 years.

· Amalgam (silver) fillings are a more inexpensive choice and are tolerant to wear.  However, due to their dark color they are more noticeable than porcelain or composite restorations and are not recommended for fillings in very visible areas such as front teeth.

· Composite (plastic) resins are custom made to the exact color of your natural teeth, creating a more natural appearance. While white fillings may be less noticeable than other materials, they usually only last between 3 and 10 years and may not be ideal for large fillings as they may chip or wear over time.  They can also become stained from coffee, tea or tobacco.

· Porcelain fillings are called inlays or onlays and are custom created in a lab and then bonded to the tooth.  They can be matched to the color of the tooth, resist staining, and are about the same cost as gold fillings.  A porcelain restoration generally covers most of the tooth, making the filling nearly undetectable.

If decay or a fracture has damaged a large portion of the tooth, a crown (or "cap") may be recommended.  Decay that has reached the nerve may be treated through root canal therapy or through a procedure called pulp capping. 
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SEDATION DENTISTRY/DENTAL ANXIETY
Dental sedation is a technique that can be used when a patient suffers from dental anxiety or dental phobia.  We are happy to offer a number of solutions for our patients to make their dental visit as comfortable as possible.  Sedation dentistry techniques enable patients who might otherwise avoid the dentist, to receive dental treatment necessary for a healthy smile. Depending on the extent of the anxiety or phobia, varying degrees of dental sedation can be utilized as described below.

Nitrous Oxide Sedation
Nitrous Oxide sedation, also known as “laughing gas” is commonly used to make treatment more comfortable.  This sedation is inhaled through a mask that allows you to breathe in the medication and induces a state of relaxation.  Local anesthetic will be administered in conjunction with nitrous oxide to eliminate pain.

Oral Sedatives
This medication can be given to a patient the night before a dentistry procedure or 30 minutes to an hour prior to the dental appointment, depending on the severity of the anxiety. Oral sedatives do not provide pain relief, so an injection of local anesthetic will also be administered.

Intravenous (IV) Sedation
IV Sedation provides relaxation medication through a small needle inserted in your hand or arm.  Like oral sedatives, IV sedation does not provide pain relief, so a local anesthetic will also be administered. Intravenous sedation allows patients to be awake but in an extreme state of relaxation with little or no pain.
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NON-SURGICAL GUM TREATMENT
The gums, ligaments, and bone around the teeth form the foundation for  teeth. All structures are also referred to as the periodontium. When the periodontium is not healthy, it jeopardizes the teeth just as a bad foundation would threaten the stability of a house.  Signs of unhealthy periodontium include: gums that are red and bleed easily, persistent bad breath, gums that are pulled away from the tooth, loose teeth, and changes in the position or bite of the teeth.  With proper gum treatments,  it may be possible to return gum tissue to a healthy state.  If you're having a problem, come in and see us so we may treat it right away. The treatment usually involves a deep cleaning or root planing done under a local anesthetic, along with local antibiotic agents.  It is important to have gum problems checked promtly, as gum disease left alone may eventually need treatment through sugery or extraction.  back to top



 Advanced Procedures
 
CROWNS AND BRIDGES
Crowns and bridges are used to restore and enhance teeth that are damaged or to take the place of missing teeth. A crown (also referred to as a cap) is used to entirely cover a damaged tooth.  A crown not only strengthens a tooth, but it can dramatically improve a tooth’s appearance, shape and alignment.

Crowns may be used to:

  • Replace a large filling when there is little tooth structure remaining
  • Protect a weak tooth from fracturing
  • Restore a fractured tooth
  • Attach a bridge
  • Cover a dental implant
  • Cover a discolored or poorly shaped tooth
  • Cover a tooth that has had root canal treatment

A bridge is an ideal method to fill the space created by missing teeth. A bridge is one or more artificial teeth cemented into place using the teeth on either side for support. This is an option for filling the space created by a missing tooth.  Bridge work is as much an art as it is an exact science since it replaces a missing tooth both functionally and cosmetically. The materials used may be gold alloys, porcelain bonded to metal alloy, or all ceramic material made to match your natural tooth color.  The choice of material depends on requirements for strength, wear, and aesthetics.

It is important that a missing tooth be replaced as soon as possible.  If not treated, the teeth surrounding the gap begin to shift inward. Since teeth use their neighbors for support, if one is missing they begin to "fall” and shift into the open spaces. This may worsen the bite because of the changes in pressure and can eventually result in problems with the jaw such as TMJ.

Bridges and crowns are made by first taking an impression of your mouth.  The impression is sent to a dental lab where your crown or bridge will be custom made to fit your mouth and match your natural tooth color.  A temporary crown or bridge will be placed into your mouth until your permanent crown or bridge is ready and cemented into place. 

Bridges and crowns are very durable and can last a lifetime with extra care and good oral hygiene. back to top

TOOTH EXTRACTIONS
Good oral hygiene should always be practiced since the loss of a single tooth can have major impact upon your oral health and appearance.  Although dentists will use every measure to prevent tooth loss, there still sometimes necessary occasions when a tooth may need to be extracted.   tooth may need to be extracted for the following reasons:

                • Severe decay
                • Advanced periodontal disease
                • Infection or abcess
                • Orthodontic correction
                • Malpositioned teeth
                • Fractured teeth or roots
                • Impacted teeth

After careful examination and treatment, the dentist may advise to have a tooth extracted.  Before a tooth is removed, the dentist will take an x-ray in order to understand the shape and position of the tooth and surrounding bone.  Based on the degree of difficulty, we may refer you to a specialized oral surgeon.

For a simple extraction, we will first apply a local anesthetic to prevent pain and discomfort. The tooth will be loosened with a tool called an elevator and then removed with dental forceps. Once the procedure is complete, the area may be closed with one or two stitches.  We will then provide you with care instructions to alleviate discomfort and ensure proper healing. back to top

 

ROOT CANAL TREATMENT
Root canal treatment (also referred to as root canal therapy or endodontic therapy) is made necessary when an untreated cavity reaches all the way to this pulp.  Treatment may also be needed when deep restorations or trauma to a tooth cause nerve damage.  Once the pulp becomes infected, and can begin to eat away at the surrounding bone (this is known as an abscess).  If the pulp is infected, not only is it painful but it will require treatment as it cannot heal on it's own.   Symptoms that indicate the pulp has become infected may include sensitivity to hot/cold or sweets, pain, swelling, pain to biting or pressure, and a bad taste in the mouth.  However, sometimes no symptoms are apparent and you may be unaware of any problem until a checkup.

A root canal is performed to clean out the infected tooth pulp and disinfect the canals of the tooth.  Alternate treatment would be to extract the tooth.  Once the infection is resolved, the canal is filled in to prevent any further infection. Usually a core build-up and crown is recommended for restoring a tooth that has undergone root canal therapy. back to top

DENTURES
A denture is a removable replacement for missing teeth and surrounding tissues.  There are two types of dentures available, including partial and complete dentures.  Partial dentures are used when some natural teeth remain, while complete dentures are used to completely replace all teeth.  Dentures are made to resemble your natural teeth so there should be no noticeable change to your appearance. In fact, dentures may even improve your smile!

 

This restoration method is used to restore your smile and mouth function if all your teeth have been lost.  The dentures are custom created to resemble natural teeth and are positioned to take the place of natural teeth.  Complete dentures are removable and may require adjustments in order to create a proper fit with the gums and mouth.

A removable partial denture is a device used when one or more natural teeth still remain in the upper or lower jaw.  They usually consist of replacement teeth attached go a gum-colored plastic base which is held in place in the mouth.  A fixed partial denture acts the same as a removable denture, but it is cemented into place using adjacent teeth for support.

New dentures may feel awkward or loose for the first few weeks until the muscles of your cheek and tongue learn to keep them in place and you are comfortable eating and speaking. Although this may require some practice you will adjust and enjoy the benefits a full mouth of teeth can provide.  back to top

NIGHTGUARDS AND MOUTHGUARDS
Custom designed mouthguards and nightguards are made of flexible plastic and molded to fit the shape of your teeth. Mouthguards are recommended to protect the jaw and teeth during physical activity and sports such as boxing, football, basketball, or other activities where your mouth may be hit.  Guards also protect the soft tissues of your tongue, lips and cheek lining.

Nightguards,  or occlusal appliances, are recommended for patients who clench or grind their teeth at night as a way to protect their teeth and bite. They are custom made to fit exactly over the top teeth, and the inside part is soft. This acts as a shock-absorbing system, whereas the outside is a rigid acrylic, that is shaped very carefully according to your bite. If the teeth come together during use, the appliance guides the bottom jaw into a position where the muscles and the joints (TMJ's) are in a balanced, neutral position.

If you a guard is right for you, we will take an impression of your teeth which will then be sent to a lab to make a custom fit guard.  In most cases you can choose from a variety of colors and styles. On average, guards last between 3 and 10 years.back to top

TMJ TREATMENTS
TMJ stands for temporal-mandibular joint.  Temporal, as in temple area of skull; mandibular as in mandible, or lower jaw; joint as in where the head and jaw meet.  Problems in this joint may be caused by a misalignment of the teeth, trauma, or excess muscle tension. Cartilage buffers the two bones and five muscles that meet in this area, but any problems in this area can create quite a bit of pain and biting difficulties.  

Symptoms of "TMJ" include: Headaches

  • Earaches
  • Trouble/soreness in opening and closing the mouth
  • Clicking or popping of the jaw
  • Pain in the jaw muscles
  • Soreness in the area, sometimes extending to the face

Examination of the joint system involves an "occlusal analysis", gathering information from models of the teeth on a jaw simulator. Dental treatments for the condition can include replacing missing teeth, moving teeth, adjusting the bite and filling gaps between teeth. There is no one solution that is right for all cases. Occasionally a plastic mouthpiece (occlusal appliance) is used to prevent clenching or grinding that is contributing to the problem. If untreated and in severe cases, surgery may be required to repair a badly damaged joint. back to top

 Cosmetic Dentistry
 
COSMETIC DENTISTRY
Cosmetic dentistry includes procedures correct imperfections or enhance the appearance of the mouth.  Tooth color, alignment, spacing as well as regularity of the teeth are the characteristics that give the overall appearance.  Any of these can be enhanced to provide a stunning new smile.
 
WHITENING
Tooth whitening is a popular procedure to make teeth whiter and brighter, and therefore more attractive. Bleaching can be used to whitening stained and discolored teeth, or simply to enhance a dull smile.  Either way, tooth whitening is a safe and relatively painless procedure ideal for most patients.  Our office offers two methods of whitening: in-office whitening and tray whitening.

In-office whitening is an ideal for anyone wanting immediate results.  The entire process takes place in our office in about an hour, making it the perfect choice for busy individuals.  In this process, a protective gel is applied to your gums to protect the soft tissue.  A special light-activated gel is then applied to your teeth and a special light or laser is used to enhance the action of the agent - making your teeth whiter and brighter.  As a final step, we take impressions of your teeth to create custom trays for at home touch-ups, and give you instructions for keeping your smile bright. The result is dramatically whiter teeth that will last for years.

Tray whitening is a less expensive whitening treatment you can use while in the comfort of your own home.  We will first take an impression of your mouth to create a customized clear whitening trays for you to wear.  Within a few days your trays will be ready to be picked up and we will show you how to apply the special bleaching material to the trays.  The whitening gel trays should be worn 30-60 minutes up to twice a day.  At the end of this period, you will see maximum whitening results that are nothing short of dazzling.  Occasional treatment can be used at your convenience to maintain your new smile. 
The following link will provide you with more informatin about our most popluar method of whitening:
http://www.korwhitening.com/
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VENEERS
Veneers are a dental procedure in which a covering is placed over the outside (visible area) of the tooth. Veneers are usually only applied to the part of the tooth that is visible when talking or smiling. The procedure can be direct or indirect.

The direct technique usually involves placing composite resin on the outside of the tooth using bonding. This method is usually referred to as bonding.

The indirect technique usually involves two appointments because the veneers will be fabricated at a dental laboratory.  At the first appointment the teeth are prepared, impressions taken, and the teeth are given a temporary covering. In two to three weeks the veneers are back from the laboratory, the temporaries are removed and the veneers are bonded to the teeth. The laboratory fabricated veneers are usually made using porcelain or pressed ceramic and are very aesthetic.

The advantage of veneers versus crowns is that much less tooth material is removed, and the procedure is generally less uncomfortable. Veneers are recommended for teeth that have large fillings or little tooth structure.back to top

MINI IMPLANTS
Mini dental implants are an exciting new addition to dentistry. They have a variety of uses, and significant advantages over conventional implants in replacing teeth in certain situations.
If teeth are missing, it is desirable to replace them as soon as possible. If the teeth are not replaced, it is like taking a book out from a crowded shelf - all the other teeth move, and this can significantly impact the "bite" over time. The top teeth tend to drift down, and the back ones tilt forwards. The teeth no longer mesh together very efficiently, and the change to the  bite may ultimately impact the jaw joints (TMJ's)back to top

LASER BACTERIAL REDUCTION
We are constantly learning and striving to advance the standard of patient care in our offices. As such we have recently added a new procedure to your routine professional cleaning care to help fight periodontal disease. Periodontal disease affects approximately 80% of adults and is a growing epidemic in our society. Understanding of this disease has increased greatly over the last few years. We now know that Periodontal Disease is a bacterial infection in the pockets around teeth. As such, we now not only treat this disease with removal of mechanical irritants and diseased tissue (your normal cleaning) but are also addressing the underlying infection that causes it. With that thought in mind we recommend that all of our patients have their teeth decontaminated prior to cleaning appointments for three major reasons.

1. To reduce or eliminate bacteremia. During the normal cleaning process most patients will have some areas that may bleed, this allows bacteria that are present in all of our mouths to flood into the bloodstream and sometimes settle in weakened areas of our body such as damaged heart valve or artificial knee or hip, etc. We pre-medicate those patients we know have a heart condition or artificial joints with antibiotics so that these bacteria can’t cause harm to these areas. Latest research shows that these oral pathogens have now been linked to a number of other diseases such as cardiovascular disease, rheumatoid arthritis, low birth weight babies, diabetes, etc. Needless to say anything that we can do to reduce or eliminate this bacteremia is a positive for our patients.

2. To prevent cross contamination of infections in one area of your mouth to other areas. Decontamination minimizes the chance that we may inadvertently pick up bacterial infection in one area of your mouth and move it to others.

3. To kill periodontal disease bacteria and stop their infections before they cause physical destruction or loss of attachment around your teeth.

The laser decontamination process is painless and normally takes about 5-10 minutes. We highly recommend that you take advantage of this service as part of your routine cleaning.

 Laser decontamination is $35 and is NOT covered by insurance. Unfortunately insurance coverage is almost always behind the leading edge in high tech health care.back to top


76-6225 Kuakini Hwy, Suite B203  •  Kailua Kona, HI  96740
Phone: 808.329.6167
Text: 808.896.0675