Serving St. John’s and the
Greater Portland Area Since 1974
During the examination process, Dr. Mellum takes a look at all of the hard and soft tissues of the oral cavity and determines if there is any pathology. If there is any problems, these are discussed thoroughly with patient and all options for treatment are discussed, along with potential costs, risks, and outcomes.
In 2013 we update our equipment in order to be able to take digital radiographs (x-rays). Digital radiographs are a great option as it significantly decreases the radiation exposure for the patient. They also eliminate the need to wait for film to develop as they appear on our computer screen almost immediately. These images are large and of high quality, allowing us to interpret the image better and to show the patient visually what is happening with their teeth easier. We also use a digital intra-oral camera to take pictures up close of teeth in question so patients can see on the computer screen what the condition of their tooth or soft tissues are.
There are different types of cleaning services that we offer. At the first visit we assess the bone and gum health by measuring the pocketing around the teeth, assessing radiographs, and checking for plaque and calculus levels. If there are large pockets around the teeth, we may suggest that you have a procedure called scaling and root planing done. This involves anesthetizing (numbing) the area in question, to allow a comfortable experience in removing the plaque and calculus that has built up over time under the gum tissue. This lowers the bacterial level in the mouth, and removes the irritation to the gums. This allows the area to heal and the pocketing to be reduced. We also can use ultra-sonic scalers to help eliminate large calculus buildups, so there is less of a scraping feeling on the teeth. Regular cleanings are important because oral health is connected to heart and overall body health.
There are two options for whitening of the teeth that we offer. We can whiten the teeth in office in an hour long visit, or we can make custom fit trays that the patient takes home and uses daily for a week or two. Whitening procedures will not damage the teeth, but can make the teeth sensitive to hot and cold for a week or two. It is recommended to use a de-sensitizing toothpaste while these procedures are being done.
Silver and Cosmetic Restorations
We offer both silver and cosmetic restorations. Many people prefer tooth colored restorations these days due to better esthetics and because there is some mercury metal in the silver fillings. We will leave the choice to the patients as to which type of restoration is placed, but it is our opinion that in some cases for posterior teeth that the silver fillings may be a better option for longevity for the patient. The reasoning for this is that if a cavity is close to the nerve of the tooth, the white filling material may cause the nerve to die off, requiring future root canal therapy and a crown for that tooth. White (composite) fillings require us to place an acid onto the tooth in order to make the filling bond to the tooth. This acid can cause major irritation to the nerve. We also use an alternative white filling called resin modified glass ionomer. This type of material does not require acid to be placed onto the tooth in order for the bond to hold, but is not a good alternative when the filling is very large. The reason that silver fillings typically last longer than white fillings is that they are harder, so less likely to break, and that the silver metal in the filling kills bacteria that try to eat away at the tooth around the edges of the filling. White fillings do not have anti-bacterial properties to them, so bacteria can get around the edges of the filling over time causing the restoration to fail. We always leave the final decision to the patient as to what type of restoration to place, but like to keep the patient fully informed as to different potential outcomes with the type of restoration that is placed.
A root canal procedure is something that we do to a tooth that has had the nerve either die off or begin to die off. The procedure involves placing a rubber dam around the tooth so that when the nerve chamber of the tooth is opened up, that no bacteria from the saliva in the mouth gets back into the tooth. We use files to hollow out the tooth all the way down to the tip of the roots. The inside of the tooth is sterilized and filled with a rubbery filling material called gutta percha. A silver or white filling is placed over this material to restore the tooth. Often times a tooth that has had a root canal treatment will require a crown to be placed on the tooth for the final restoration. The reason for this is that the tooth has been hollowed out greatly and no longer has a blood supply, so it becomes brittle and can fracture. The crown surrounds the tooth and helps prevent fracturing.
Porcelain veneers are an option for covering the facing of an anterior tooth without having to remove too much tooth structure. A small amount of enamel is removed on the front and tip of the tooth and an impression is taken. A porcelain piece is made at a lab that is bonded to the tooth. This can be done to cover up major staining that cannot be removed by whitening or for slightly broken or misshapen teeth.Porcelain veneers are an option for covering the facing of an anterior tooth without having to remove too much tooth structure. A small amount of enamel is removed on the front and tip of the tooth and an impression is taken. A porcelain piece is made at a lab that is bonded to the tooth. This can be done to cover up major staining that cannot be removed by whitening or for slightly broken or misshapen teeth.
A crown is placed on a tooth that is either at risk of fracturing, has fractured slightly, or has a cavity that is too large to have a conservative filling placed. During a crown procedure, the tooth is cut all the way around the tooth and reduced in height. After the tooth is cut, an impression is taken, and a temporary crown is placed onto the tooth. The permanent crown is custom made at a lab and cemented onto the tooth a couple of weeks later. We use different types of materials for crowns. A crown can be all gold, porcelain over a gold alloy, or all porcelain. There are many different types of new porcelains that vary in quality of esthetics versus strength.
Emergency Dental Work
If you are having a toothache, we make every best effort to get you in the same day to treat the condition. In some cases there may be too much infection in a painful tooth that we require placing you on an antibiotic regimen in order to remove the infection prior to working on the tooth.
For a patient that has lost several teeth or all teeth, removable prosthesis may be a good option for restoration. Complete dentures are an acrylic replacement for the teeth. Dentures are held in by creating suction with the soft tissues of the mouth. Not all patients will have a good hold for their denture, depending on the shape of their mouth. For patients that cannot achieve a comfortable fit for their denture, implants may be placed that can be used to have the denture snap onto.
Partial dentures use existing teeth that are stable and in good condition to hold the denture into place. There are different types of materials available for partial dentures. Metal may be used If needed for stability, but plastic and acrylic partial dentures that are more esthetic may be an option for some patients.
A bridge is a fixed restoration used to replace missing teeth.
In order to have a bridge restoration placed, a patient needs to have a tooth on both sides of the space where the teeth are missing. The teeth that will support the bridge need to be in good condition, otherwise the bridge could fail. The procedure for a bridge involves cutting down the teeth on both sides of the open space, just like a crown prep. An impression is taken, and a temporary bridge placed. Two weeks later the permanent bridge is returned from the lab and cemented into place.
When a tooth is beyond repair, either due to the amount of decay, a large fracture, or is no longer stabilized by the bone, it may need to be extracted. Most teeth can be extracted at our office, but if a tooth has very large curvature of the roots or is in close proximity to a sinus space or nerve pathway, you may be required to see an oral surgeon for the removal of the tooth.
Implants are considered the gold standard for replacing a missing tooth. An implant is a titanium “screw” that is placed into the bone, mimicking the root of a tooth. After the bone has fused to the bone for 3-4 months, we are able to place a crown, bridge, or denture onto the implant. We do not place implants in our office, preferring to refer to a specialist for this procedure, but we do place the final restoration onto the implant after initial healing.
SILVER & COSMETIC RESTORATIONS
EMERGENCY DENTAL WORK