Services

Prevention

Our goal at McMinnville Family Dental is to do everything we can to help our patients prevent cavities, bone loss, and other dental problems. We are certainly happy to help fix things when bad things happen, but we think our patients are happiest when their mouths are healthy and problem-free.
The main purpose of a comprehensive exam is to get “the whole patient picture” so that we can customize/idealize treatment for the patient. This is the type of exam we do for new patients. We also do this type of exam every several years for our regular patients just so we can be sure we are providing the best service we can for them. This thorough exam includes xrays, an oral cancer screening, measurements of gum and bone health, occlusion recordings, a check for cavities, and various other related screenings.
Periodic exams are generally done for our patients every 6 to 12 months. These often include xrays. They always include an oral cancer screening and a check for cavities.
Limited exams are when a patient only wants something specific addressed, such as a broken tooth. Depending on the problem we will use of variety of methods to determine appropriate treatment. Most often this minimally includes an x-ray and visual exam.
Our office uses Dexis digital x-rays and a digital panoramic machine. Benefits of digital x-rays include lower radiation (20% the amount of radiation with standard film), immediate visualization, and large visualization so that the patient can see what the dentist sees.
The main reason that cleanings are done is to maintain the health of the structures supporting the teeth (the bone and the gums). When a dentist or hygienist cleans the teeth, they remove the hard buildup material called calculus (or tartar). If the calculus is left on the teeth, the body reacts to it as if it were an infection and the result is swollen, bleeding gums and bone resorbtion (the bone slowly dissolves). Swollen gums is called gingivitis. Resorbing bone is called periodontitis. If left untreated (not cleaned), periodontitis will eventually lead to loss of bone which can lead to tooth loss.
Fluoride varnish is the method we use for applying topical fluoride to teeth. It is becoming increasingly popular with dentists as it keeps the fluoride on the teeth longer and it has been shown to be more effective than previous methods.
If teeth are not professionally cleaned regularly, the calculus (see “cleanings” above) gets larger and goes deeper as the bone resorbs. When a patient has this problem, we usually recommend “scaling and root planing” or in lay terms, “a deep cleaning”. For deep cleanings we usually numb the area so that we can do a thorough cleaning comfortably for the patient. Usually after a deep cleaning is done, the gum health improves and the bone resorption greatly slows, which helps the patient to keep their teeth.
Many people grind and clench their teeth at night when they sleep. Often this is related to stress. The grinding (bruxism) can wear the teeth down or crack them. A nightguard is a custom-fit, plastic piece that the patient wears at night to keep the teeth from grinding on each other. Some patients grind so hard that they need to have the nightguard replaced because they will wear through it. However, replacing a nightguard is a much better solution than wearing through the teeth and having to replace them!

There are different types of nightguards that can be made. One we often do, especially for patients who get tension-related headaches, is a system called NTI (Nociceptive Trigeminal Inhibition). This system works particularly well for helping patients not to clench thus preventing muscle spasms that cause tension-headaches.
Sportsguards help prevent mouth injuries from sports. When we think about mouth injuries in sports, we often think about football, baseball, and wrestling, but other sports such as basketball and soccer are also common sources of mouth injuries. The sportsguards we make are custom fit to the upper teeth and gums. This works well because the Patient can still talk with them in. They can be made in a variety of colors or a mouth strap can be attached at your request (e.g., for football players).

Restorations

Restorations are used to replace missing tooth structure. One of the most basic restorations is a filling. These are used for replacing small amounts of tooth structure. Other restorations such as crowns and onlays are can be used to replace large amounts of tooth structure or to protect teeth from breaking.

There are usually several options for a given tooth in a given situation. At your appointment, we can discuss what would be best for you. Below are descriptions of different types of restorations that we do for our patients.
Composites are tooth-colored fillings. The material is plastic (resin) reinforced with stronger filler materials. Composite fillings work well when the cavities are small.
Amalgam fillings are a metal alloy (a mix of metals). They work well for small to medium sized fillings. They are stronger than composite so sometimes it is preferable to use them if a filling is needed in an area that is not of an esthetic concern for that patient.
Crowns are commonly used when teeth have been compromised by larger cavities or when they are cracked. If the walls of the tooth are thinner because of large cavities, they become prone to breaking. In these situations, we will often recommend crowns. Crowns can help prevent future breakage of the thin walls. They also restore the top of the tooth in an anatomically correct way to promote better chewing.

Another common use for a crown is when a tooth is cracked. In these cases, a crown can often keep the crack from getting larger and can potentially prevent the loss of the tooth from the crack.

A third use for a crown is to put it on top of an implant to replace a missing tooth.
Onlays are similar to crowns in that they often cover the top of the tooth completely. The main difference is that instead of wrapping the entire tooth, they often just cover the top. They are often a good solution when they are replacing a deep filling that does not involve the sides of the teeth, because they protect the top of the tooth from breakage while maintaining the strength of the outer walls.
Implants can be used in many different ways including to retain dentures. For restorations, they can help replace single to multiple teeth. If there is enough bone in the area of the missing tooth to do them, they are usually the best solution for replacing missing teeth.
Veneers are typically used on the front teeth for esthetics. They can be a very good solution for correcting small alignment issues and/or severe color problems. Another use for veneers is to replace large fillings in the front teeth with a restoration that is stronger and that can last longer.
When one or two teeth are missing, a bridge can be a good way to permanently fill the space. Dentists these days typically prefer implants, but in some situations, e.g., when there isn’t enough bone present for an implant, a bridge can be a very good solution. Prior to the invention of implants, bridges were used a lot more in dentistry.
Inlays are basically a stronger type of filling. They are usually made out of a gold alloy or a strong ceramic material. The downsides of this treatment is that they are a lot more expensive than amalgam or composite fillings and it takes two appointments generally to have one done. On the upside, they are stronger than a typical filling and usually last longer.

Cosmetic Dentistry

Cosmetic dentistry means different things to different people. For some it is “getting a Hollywood smile”. For others it might mean simply replacing some old fillings that have darkened with time for a more esthetic look. For others it will mean to straighten crooked teeth or to whiten their teeth. My approach to this area of dentistry is to try to educate a patient on their options, giving both the pros and cons of any treatment. My goal is that after treatment, the patient will be happy with how things look, and we will have given treatment that will function well.
We started using the KoR Deep Bleaching products for our bleaching services this past year (2017) and we have been very pleased with the results. KoR is considered by many dentists to be the best bleaching system available. Everything about the system is optimized to create the best patient experience from low sensitivity to excellent whitening results. The system also includes good options for difficult cases such as fluorosis/hypocalcification and tetracycline staining.
Veneers are thin, ceramic restorations that are glued to a patient’s teeth. They are often used for correcting slight alignment problems and for giving a more esthetic appearance to teeth. Sometimes if a patient has large fillings in a tooth, a veneer can be used as a restoration that will last longer than a filling.
Composite fillings (also commonly referred to as resin fillings or tooth-colored fillings) are probably the most common treatment we do for helping a patient keep an esthetic appearance to their teeth. Composite fillings have many uses. They can be used to fix cavities. They can be used on front teeth to correct esthetic issues such as closing a space between front teeth. For patients not wanting metal in their mouth, composites are often a reasonable metal substitute.
Composite fillings (see above) work well when they are replacing small amounts of tooth structure. If a larger amount of tooth structure needs to be replaced ceramic fillings (such as inlays and onlays) can be used.
Orthodontics can be used to straighten teeth, change facial features, and improve the way teeth come together/chew. Orthodontics can be used in more complex, cosmetic dentistry cases to position teeth in the correct positions before putting crowns or veneers on.
For teeth that need large, protective restorations, tooth-colored crowns work very well. Our office does three basic types of tooth-colored crowns: porcelain fused to metal, monolithic lithium disilicate, and monolithic zirconia. Different crown types work best in different situations, so we would discuss what would work best for your particular situation.
There are many good treatment options that utilize implants, but probably the most-basic use of an implant is to place a single crown (tooth) on a single implant. This can be a great option for someone missing a single tooth in most areas of the mouth. Benefits of this treatment include minimal risk to adjacent teeth, ease of cleaning, good esthetics, a permanent restoration, and good function.
After a root canal is done, sometimes a tooth will turn dark. This is especially problematic when it is a front tooth. In this situation, internal bleaching is often an excellent way to bring the tooth back to its normal color. Usually anesthesia is not needed for this procedure. The process involves putting a bleaching agent inside the tooth and leaving it there for several weeks. When the desired shade is reached, the bleaching agent is removed and the tooth is re-restored with a tooth-colored filling or other restoration.

Implants

A dental implant is a titanium screw that is placed into the patient’s bone. The dentist then connects a tooth or other restoration on top of it. For some good pictures, see Wikipedia’s article on it. I will describe some uses of implants below.
Perhaps the most basic use of a dental implant is to replace a single missing tooth. Benefits include: 1) no damage to adjacent teeth as with a bridge, 2) minimal risk to the bone of adjacent teeth (as with crown lengthening), 3) easy to clean, 4) chews very similarly to a normal tooth, and 5) they usually last a lifetime.
If a patient is missing three to four teeth in a row, often two implants can be placed at either end of the gap and a bridge can be placed on these two implants.
Implants can also support a “long bridge” such as one that replaces all the upper or all the lower teeth. Often, four to six implants are placed to support a bridge like this.
Upper dentures usually have some suction to the top of the mouth and this is what helps keep them in. Lower dentures on the other hand do not have this suction (the tongue is in the way); they sit on the tissues below, and they have a much greater tendency to move. Implants now help many people with this problem. Two implants can be placed in the front mandible and then special connections allow the denture to snap on to these two implants. In my experience patients are tremendously pleased with the results, especially those who have worn a lower denture without implants.
Implant “supported” dentures are a step up from implant “retained” dentures. Typically four implants are placed, either in the upper jaw or lower jaw (or both), and then the denture(s) is snapped onto the four implants. This arrangement has even less movement than implant retained dentures.
A Hader Bar is a custom bar made by a dental lab that connects to implants and functionally connects all of them together. A special denture can be made that snaps onto this bar. This is generally even better for chewing than a denture snapped onto four individual implants.

Root Canal Therapy

The root canal is the part of the tooth that contains the nerve and blood supply for the tooth. This space is connected to (next to) the bone, so if bacteria gets into the root canal space it can travel out into the bone and cause infection. Root canal therapy removes the contents of this space and replaces it with a filling material. It is necessary to do this to save a tooth if a cavity goes into the root canal, if a crack goes into the root canal, or if the contents of the root canal dies, e.g., from trauma. The alternative to root canal therapy, when it is found to be necessary, is removal extraction of the tooth.

Extractions

Extraction means to remove a tooth. While we always like to save teeth for a patient when we can, there are many situations where a tooth may need to be removed. Examples include trauma which can break a tooth too badly to fix or a cavity that is too large to fix. There are two basic categories of extractions described in greater detail below: Simple and Surgical.

As the idea of extractions commonly causes anxiety for patients, I think I should say here that I have never operated on a case where I was forced to finish with a patient asking me to stop. If the patient is not numb or if for any other reason that patient wants to stop, we CAN stop. For most cases, the patient is completely numb and we are able to get the tooth out. In the rare case where a patient doesn’t get numb or we are unable to completely remove a tooth, we can refer to an oral surgeon who can put a patient to sleep if necessary and do the extraction. We also refer to an oral surgeon when a patient doesn’t want to be awake for extractions (such as for impacted wisdom teeth).
A simple extraction means that the tooth is simply loosened and removed. It is a more common procedure for single rooted teeth than for double or triple-rooted teeth.
A “surgical extraction” usually means that a drill has been used in the extraction process. Most teeth that need to be extracted are started as simple extractions and then if we can’t get them out that way, we move to extracting it “surgically”. An exception to this is when teeth are impacted (buried partially or totally under the gums). These cases are almost always done as “surgical extractions” to start.

Dentures

Complete dentures and partial dentures are often the most economical way to replace missing teeth, especially when there are multiple teeth missing. They are removable, meaning that they come in and out, as opposed to prosthetics like implants that are permanent in the mouth. There are usually multiple options for each patient case. After we complete your exam, we can discuss what options would be best for you.
A complete denture can refer to both a top or bottom plate. They are used to replace teeth when all the teeth in an upper or lower arch are missing. Some variations of complete dentures exist and I have tried to explain the basics in the following descriptions.
Immediate complete dentures are complete dentures that are made prior to teeth being extracted. This works out very well for people who don’t want to go around “toothless” until a set of dentures can be made. (It takes 6-8 weeks for enough healing to take place and to make a new set of dentures after extractions are done.) Usually patients are satisfied with the immediate dentures long-term, though there is no guarantee that the teeth will be in the precisely right location. This is because we cannot try the dentures in the mouth during the fabrication stage to make sure everything is just right before they are finished like we can if the teeth are already missing.

In the 6-12 months after extractions, the gums and bone where the teeth were taken out heal and also shrink down. After this time, additional shrinkage occurs, but at a much slower rate than during the first year after the teeth are taken out. At the end of this period, it is often necessary to do a reline procedure to idealize the fit of the immediate dentures.
Interim complete dentures are a step up from immediate complete dentures. These are just like immediate complete dentures except they are a temporary set. This is accomplished by using economy denture teeth which greatly lowers the lab bill. After healing has taken place and most of the bone-remodeling has occurred (usually 6-12 months), a completely new set is made.
Upper dentures usually have some suction to the top of the mouth and this is what helps keep them in. Lower dentures on the other hand do not have this suction (the tongue is in the way); they sit on the tissues below but they have a much greater tendency to be displaced. Implants now help many people with this problem. Two implants can be placed in the front mandible and then special connections allow the denture to snap on to these two implants.
Implant “supported” dentures are a step up from implant “retained” dentures. Typically four implants are placed, either in the upper jaw or lower jaw (or both), and then the denture(s) is snapped onto the four implants. This arrangement has even less movement than implant retained dentures.
Partial dentures are often made when the patient has some remaining teeth that can help the denture stay in. Metal framework partials are the most expensive, but are also usually the best for chewing. They are versatile in that additional teeth or modifications can be made to them at relatively low costs. Occasionally some metal will show, e.g., in the patient’s smile, and if this is a concern for the patient, it is probably a good idea to also consider other options.
Flexible partial dentures don’t have any metal in them and so they can be very good esthetically. They can be kept in for eating, but since they flex, they are usually not as good for chewing function as the metal framework partials. They also cost less than metal framework partials so that is attractive to many people as well. One of the downsides to them is that they are relatively expensive to modify, should e.g., a tooth need to be added. They are also generally harder on the gums and can cause recession on the teeth and related problems. I think flexible partials work particularly well when replacing a minimal number of teeth.
Flippers are the least expensive way to replace missing teeth. A flipper is much like a retainer that someone would use after orthodontics, except that it has, e.g., one or two teeth attached to it. For the most part, they are used on a temporary basis. They are for looks only and should usually be removed for eating as they are not designed to hold up against chewing forces.
Once a tooth is extracted, a patient will usually continue to lose bone height in that area over their lifetime. This can make their partial dentures or complete dentures not fit very well. Dentures do wear out with time, but often it is a lot more practical to reline a denture that is still chewing well rather than to replace it. There are two basic types of relines we do. One is done by a lab and the other is done in one day in the office. The lab type costs more and takes two office visits by that patient, but the end result is slightly higher quality. I will usually recommend this type if a lot of material is being added to the denture. “In-office” relines work best in cases where smaller amounts of reline material is needed.

TMD/TMJ Splints

“TMJ” stands for temporomandibular joint. This is the joint that connects each side of the lower jaw to the skull. Often when people have pain associated with their TMJ they will say, “I have TMJ.” But what they really are referring to is “TMD” which stands for temporomandibular joint disorder. TMD represents a wide array of problems related to the joint and/or the musculature of the area.

Treatment of TMD is complex as there are many theories about the best ways to treat TMD and there are many treatments for TMD. Treatments include but are not limited to repositioning the jaw, relaxing the musculature, lavaging the joint, and surgery. In our office most of the treatments we do use splints to do a combination of the following: Relax the muscles, protect the teeth, and reposition the jaw. For TMD problems that require additional treatment, we can refer to specialists.

Splints are like retainers in that they go in the mouth. Usually they are only worn at night. Below I will explain several splints that we use to help treat TMD.
Soft splints are our least expensive option. Primarily they are used to protect the teeth from the harmful effects of grinding and clenching teeth.
The classic nightguard design is a hard, full-arch splint. It snaps over all the teeth of an arch (upper or lower) and touches all the opposing teeth when the patient bites down on it. It will protect the teeth from clenching and grinding and often aids in helping the muscles to relax.
The NTI splint is specialized toward helping muscles relax. This is usually the type of splint I will recommend for patients who get a lot of tension headaches. (For more information you can visit the NTI website.)