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Oral Exam

An oral exam is performed on both new and existing patients to determine their dental and health status. New patients receive a more comprehensive exam that includes x-rays and checks for gum and bone disease, systemic disorders and oral cancer. A more routine exam is done for existing patients to see if there have been any changes in health since their last visit. In order to look for gum disease, the gum tissue is measured with a small ruler to measure the pocket depth between the tooth and connective tissue. A measurement of over 4mm could indicate disease or infection. Gum disease can develop easier in deeper pockets due to the extent that plaque collects in these deep pockets. If the oral exam reveals the need for tooth scaling or root planing, these services are performed in lieu of or in addition to the routine cleaning.




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Brushing

Step 1 - Place bristles along the gum line at a 45 degree angle. Gently brush using a circular motion along the outer and inner tooth surfaces.
Step 2 - Brush each tooth individually. Tilt brush vertically behind the front teeth. Using the front half of the brush, use the same circular motion.
Step 3 - Place the brush against the biting surface of the teeth and use a gentle back-and-forth motion. Brush the tongue to remove odor-producing bacteria.




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Flossing

In order to floss properly, begin by taking approximately 18 inches of floss and winding one end a few times around your middle finger. Leave approximately 6 inches of floss between your hands and wrap the opposite end of the floss around your other middle finger once. Put the floss between your thumbs and index fingers and hold tightly.

As you insert the floss between your teeth using a gentle rubbing motion, curve the floss in the shape of a C once it reaches the gum line. Move the floss up and down against the side of the tooth in a gentle manner, making sure you work the floss into the adjacent tooth before moving onto the next space. Before you move onto the next space, wind a little floss around your middle finger in order to get a new section of floss to work into your gums.




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Fluoride

Fluoride

Fluoride is an important part of healthy tooth development and will help prevent cavities.

Fluoride can provide protection from tooth decay in a couple ways:
1) It helps to strengthen the tooth's enamel so it can repel the acid that is formed by plaque.
2) Teeth that have been damaged by plaque can repair and re-mineralize themselves with the help of fluoride.

Fluoride is incapable of repairing already formed cavities, but it does assist in reversing low levels of tooth decay and helps in preventing new cavities from forming.




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Plaque

Plaque

Plaque is essentially the start of gum disease problems. Plaque is a build-up of particles from the foods you eat every day. Once sugars are introduced to plaque, it turns into a tooth eating acid that sits just above the gum line. If regular oral care isn't standard, the acid will start eating at the teeth and gums. Plaque that is allowed to sit for a prolonged period of time can cause cavities, gingivitis and other problems in your mouth. If it's left longer than that, serious dental procedures may be required to restore your decaying smile.




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Tooth Scaling

In order to remove plaque, tartar and calculus deposits from your teeth, a tooth scaling must occur. In some cases plaque and tartar are present below the gum line and a sub-gingival tooth scaling must occur.




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Root Planing

Sometimes after a tooth scaling, the roots of a tooth must be planed in order to create a smooth surface for the gum tissue to re-attach to. In addition to the planing, your dentist may also prescribe medication in order to control infection and pain.




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Who is an Endodontist?

Who is an endodontist

Endodontists are dentists with at least two additional years of advanced specialty education in diagnosis and root canal treatment.

Because they limit their practices to endodontics, they treat these types of problems every day. They use their special training and experience in treating difficult cases, such as teeth with narrow or blocked canals, or unusual anatomy.

Endodontists may use advanced technology, such as operating microscopes, ultrasonics and digital imaging, to perform these special services.

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Tooth Pain Guide

Tooth Pain Guide

Symptom: Momentary sensitivity to hot or cold foods.

Possible problem: If this discomfort lasts only moments, sensitivity to hot and cold foods generally does not signal a serious problem. The sensitivity may be caused by a small decay, a loose filling or by minimal gum recession that exposes small areas of the root surface.

What to do: Try using toothpastes made for sensitive teeth. Brush up and down with a soft brush; brushing sideways wears away exposed root surfaces. If this is unsuccessful, see your general dentist. If the sensitivity is coming from a decay you should see your general dentist.

Symptom: Sensitivity to hot or cold foods after dental treatment.

Possible problem: Dental work may inflame the pulp inside the tooth causing temporary sensitivity.

What to do: Wait two to four weeks. If the pain persists or worsens, see your general dentist.

Symptom: Sharp pain when biting down on food.

Possible problem: There are several possible causes of this type of pain: decay, a loose filling or crack in the tooth. There may also be damage to the pulp tissue inside the tooth.

What to do: See a dentist for evaluation. If the problem is pulp tissue damage, your dentist may send you to an endodontist. Endodontists are dentists who specialize in pulp-related procedures. Your endodontist will perform a procedure that cleans out the damaged pulp and fills and seals the remaining space. This procedure is commonly called a “root canal.”

Symptom: Lingering pain after eating hot or cold foods.

Possible problem: This probably means the pulp has been damaged by deep decay or physical trauma.

What to do: See your dentist or endodontist to save the tooth with root canal treatment.

Symptom: Constant and severe pain and pressure, swelling of gum and sensitivity to touch.

Possible problem: A tooth may have become abscessed, causing an infection in the surrounding gingival tissue and bone.

What to do: See your endodontist for evaluation and treatment to relieve the pain and save the tooth.

Symptom: Dull ache and pressure in upper teeth and jaw.

Possible problem: The pain of a sinus headache is often felt in the face and teeth. Grinding of teeth, a condition known as bruxism, can also cause this type of ache.

What to do: For sinus headache, see your physician. For bruxism, consult your dentist. If pain is severe and chronic, see your endodontist for evaluation.

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Myths About Root Canals

Myths About Root Canals

Myth #1 - Root canal treatment is painful.

Truth - Root canal treatment doesn't cause pain, it relieves it.

The perception of root canals being painful began decades ago but with the latest technologies and anesthetics, root canal treatment today is no more uncomfortable than having a filling placed. In fact, a recent survey showed that patients who have experienced root canal treatment are six times more likely to describe it as "painless" than patients who have not had root canal treatment.

Most patients see their dentist or endodontist when they have a severe toothache. The toothache can be caused by damaged tissues in the tooth. Root canal treatment removes this damaged tissue from the tooth, thereby relieving the pain you feel. (See more about root canal procedures.)

Myth #2—Root canal treatment causes illness.

The myth: Patients searching the Internet for information on root canals may find sites claiming that teeth receiving root canal (endodontic) treatment contribute to the occurrence of illness and disease in the body. This claim is based on long-debunked and poorly designed research performed in the 1920s by Dr. Weston A. Price. Dr. Price stated that bacteria trapped in the teeth during root canal treatment could “leak” and cause almost any type of disease, including arthritis, heart disease, kidney disease and others. This was before medicine understood the causes of these illnesses. At the time, Dr. Price recommended tooth extraction instead of endodontic treatment.

The truth: There is no valid, scientific evidence linking root canal-treated teeth and disease elsewhere in the body. In fact, by the early 1930s, a number of well-designed studies discredited Dr. Price’s research, and no subsequent research has supported Dr. Price’s findings. In 1951, the Journal of the American Dental Association devoted an entire issue to a review of the scientific literature and concluded that there was no evidence supporting Dr. Price’s theory and that his research techniques from the 1920s lacked many aspects of modern scientific research. The ADA recommended endodontic treatment as the standard of practice for teeth that could be saved. Recent research continues to support the safety of dental treatment as it relates to overall health.

The presence of bacteria in teeth and the mouth has been an accepted fact for many years. But the presence of bacteria does not constitute "infection" and is not necessarily a threat to a person's health. Bacteria are present in the mouth and teeth at all times, even in teeth that have never had a cavity or other trauma. Research shows that the healthy immune system takes care of bacteria in a matter of minutes. When a severe infection in a tooth requires endodontic treatment, that treatment is designed to eliminate bacteria from the infected root canal and prevent re-infection of the tooth.

Tooth extraction is a potentially traumatic procedure and is known to cause a significantly higher incidence of bacteria entering the bloodstream; endodontic treatment confined to the root canal system produces much less trauma and a much lower incidence and magnitude of bacteria entering the blood stream.

There is no adequate replacement for the natural tooth - it should be saved whenever possible. Endodontic treatment, along with appropriate restoration, is a cost effective way to treat infected teeth because it is usually less expensive than extraction and placement of an implant. In most cases, endodontic treatment allows patients to keep their natural teeth for a lifetime.

Myth #3 - A good alternative to root canal treatment is extraction (pulling the tooth).

Truth - Saving your natural teeth, if possible, is the very best option.

Nothing can completely replace your natural tooth. An artificial tooth can sometimes cause you to avoid certain foods. Keeping your own teeth is important so that you can continue to enjoy the wide variety of foods necessary to maintain the proper nutrient balance in your diet.

Endodontic treatment, along with appropriate restoration, is a cost-effective way to treat teeth with damaged pulp and is usually less expensive than extraction and placement of a bridge or an implant.

Endodontic treatment also has a very high success rate. Many root canal-treated teeth last a lifetime.

Placement of a bridge or an implant will require significantly more time in treatment and may result in further procedures to adjacent teeth and supporting tissues.

Millions of healthy endodontically treated teeth serve patients all over the world, years and years after treatment. Those healthy teeth are helping patients chew efficiently, maintain the natural appearance of their smiles and enhance their enjoyment of life. Through endodontic treatment, endodontists and dentists worldwide enable patients to keep their natural teeth for a lifetime.

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Root Canal

Causes of a Root Canal
Root canals are necessary when a cavity that has been left untreated becomes larger. Once the cavity reaches the pulp of the tooth, an infection forms at the base of the root canal, causing an abscess. This abscess is generally painful and will need to be removed.

The doctors at Heartland Endodontics & Periodontics know that serious tooth decay can often lead to a root canal. A root canal may be needed if the decay has reached the tooth's nerve. Essentially, a root canal involves cleaning out a tooth's infected root, then filling and sealing the canal.

Root Canal Procedure:
1) An opening is made through the crown of the tooth into the pulp chamber.
2) The pulp is removed, and the root canals are cleaned, enlarged and shaped.
3) The infected area is medicated.
4) The root canals are filled.
5) The crown opening is filled with a temporary.

If you are experiencing severe tooth pain, you may need a root canal. The only sure way to know is to call our Sebring, FL dental office at (863) 382-9947 and setup an appointment with Dr. Obermayr.




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Apicoectomy

Sometimes the infection persists even after root canal therapy. In these cases, an apicoectomy, or root end resection can be performed to remove diseased tissue.


1) An incision is made to allow access to the base of the tooth. The inflamed or infected pulp is treated and the canals are carefully cleaned and shaped.
2) A small filling may be placed in the remaining tip of the tooth to seal the root canal. The gum tissue is stitched back into place.
3) A crown is placed to protect the tooth.




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Retreatment

Retreatment

As occasionally happens with any dental or medical procedure, a tooth may not heal as expected after initial treatment for a variety of reasons:

Narrow or curved canals were not treated during the initial procedure.

Complicated canal anatomy went undetected in the first procedure.

The placement of the crown or other restoration was delayed following the endodontic treatment.

The restoration did not prevent salivary contamination to the inside of the tooth. In other cases, a new problem can jeopardize a tooth that was successfully treated.

For example:

New decay can expose the root canal filling material to bacteria, causing a new infection in the tooth.

A loose, cracked or broken crown or filling can expose the tooth to new infection.

What will happen during retreatment?

First, the endodontist will discuss your treatment options. If you and your endodontist choose retreatment, the endodontist will reopen your tooth to gain access to the root canal filling material. In many cases, complex restorative materials—crown, post and core material—must be disassembled and removed to permit access to the root canals.

After removing the canal filling, the endodontist can clean the canals and carefully examine the inside of your tooth using magnification and illumination, searching for any additional canals or unusual anatomy that requires treatment.

After cleaning the canals, the endodontist will fill and seal the canals and place a temporary filling in the tooth. If the canals are unusually narrow or blocked, your endodontist may recommend endodontic surgery. This surgery involves making an incision to allow the other end of the root to be sealed.

After your endodontist completes retreatment, you will need to return to your dentist as soon as possible to have a new crown or other restoration placed on the tooth to protect and restore it to its full function.

Is retreatment the best choice for me?

Whenever possible, it is best to save your natural tooth. Retreated teeth can function well for years, even for a lifetime.

Advances in technology are constantly changing the way root canal treatment is performed, so your endodontist may use new techniques that were not available when you had your first procedure. Your endodontist may be able to resolve your problem with retreatment.

As with any dental or medical procedure, there are no guarantees. Your endodontist will discuss your options and the chances of success before beginning retreatment.

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Tooth Fractures

Tooth Fractures

There are many types of cracked teeth. The treatment and outcome for your tooth depends on the type, location and severity of the crack.

Unlike a broken bone, a fracture in a cracked tooth will never heal. Early diagnosis is important, even with high magnification and special lighting, it is sometimes difficult to determine the extent of a crack.

A crown will bind and protect the cracked tooth. When a crack reaches the tooth root, root canal treatment is frequently needed to treat the injured pulp. A cracked tooth that is not treated will progressively worsen, eventually resulting in the loss of the tooth.




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Traumatic Injuries

Traumatic Injuries

How will my injury be treated?

Chipped teeth account for the majority of all dental injuries. Dislodged or knocked-out teeth are examples of less frequent, but more severe injuries. Treatment depends on the type, location and severity of each injury. Any dental injury, even if apparently mild, requires examination by a dentist or an endodontist immediately. Sometimes, neighboring teeth suffer an additional, unnoticed injury that will only be detected by a thorough dental exam.

Chipped or Fractured Teeth

Most chipped or fractured tooth crowns can be repaired either by reattaching the broken piece or by placing a tooth-colored filling. If a significant portion of the tooth crown is broken off, an artificial crown or “cap” may be needed to restore the tooth.

If the pulp is exposed or damaged after a crown fracture, root canal treatment may be needed. These injuries require special attention. If breathing through your mouth or drinking cold fluids is painful, bite on clean, moist gauze or cloth to help relieve symptoms until reaching your dentist’s office. Never use topical oral pain medications (such as Anbesol®) or ointments, or place aspirin on the affected areas to eliminate pain symptoms.

Injuries in the back teeth often include fractured cusps, cracked teeth and the more serious split tooth. If cracks extend into the root, root canal treatment and a full coverage crown may be needed to restore function to the tooth. Split teeth may require extraction.

Dislodged (Luxated) Teeth

During an injury, a tooth may be pushed sideways, out of or into its socket. Your endodontist or general dentist will reposition and stabilize your tooth. Root canal treatment is usually needed for permanent teeth that have been dislodged and should be started a few days following the injury. Medication such as calcium hydroxide may be put inside the tooth as part of the root canal treatment. A permanent root canal filling will be placed at a later date.

Children between seven and 12 years old may not need root canal treatment since their teeth are still developing. For those patients, an endodontist or dentist will monitor the healing carefully and intervene immediately if any unfavorable changes appear. Therefore, multiple follow-up appointments are likely to be needed. New research indicates that stem cells present in the pulps of young people can be stimulated to complete root growth and heal the pulp following injuries or infection.

Knocked-Out (Avulsed) Teeth

If a tooth is completely knocked out of your mouth, time is of the essence. The tooth should be handled very gently, avoiding touching the root surface itself. If it is dirty, quickly and gently rinse it in water. Do not use soap or any other cleaning agent, and never scrape or brush the tooth. If possible, the tooth should be placed back into its socket as soon as possible. The less time the tooth is out of its socket, the better the chance for saving it. Call a dentist immediately!

If you cannot put the tooth back in its socket, it needs to be kept moist in special solutions that are available at many local drugstores (such as Save-A-Tooth). If those solutions are unavailable, you should put the tooth in milk. Doing this will keep the root cells in your tooth moist and alive for a few hours. Another option is to simply put the tooth in your mouth between your gum and cheek. Do not place the tooth in regular tap water because the root surface cells do not tolerate it.

Once the tooth has been put back in its socket, your dentist will evaluate it and will check for any other dental and facial injuries. If the tooth has not been placed back into its socket, your dentist will clean it carefully and replace it. A stabilizing splint will be placed for a few weeks. Depending on the stage of root development, your dentist or endodontist may start root canal treatment a week or two later. A medication may be placed inside the tooth followed by a permanent root canal filling at a later date.

The length of time the tooth was out of the mouth and the way the tooth was stored before reaching the dentist influence the chances of saving the tooth. Again, immediate treatment is essential. Taking all these factors into account, your dentist or endodontist may discuss other treatment options with you.

Root Fractures

A traumatic injury to the tooth may also result in a horizontal root fracture. The location of the fracture determines the long-term health of the tooth. If the fracture is close to the root tip, the chances for success are much better. However, the closer the fracture is to the gum line, the poorer the long-term success rate. Sometimes, stabilization with a splint is required for a period of time.

Do traumatic dental injuries differ in children?

Chipped primary (or “baby”) teeth can be esthetically restored. Dislodged primary teeth can, in rare cases, be repositioned. However, primary teeth that have been knocked out typically should not be replanted. This is because the replantation of a knocked-out primary tooth may cause further and permanent damage to the underlying permanent tooth that is growing inside the bone.

Children’s permanent teeth that are not fully developed at the time of the injury need special attention and careful follow up, but not all of them will need root canal treatment. In an immature permanent tooth, the blood supply to the tooth and the presence of stem cells in the region may enable your dentist or endodontist to stimulate continued root growth.

Endodontists have the knowledge and skill to treat incompletely formed roots in children so that, in some instances, the roots can continue to develop. Endodontists will do all that is possible to save the natural tooth. These specialists are the logical source of information and expertise for children who are victims of dental trauma.

Will the tooth need any special care or additional treatment?

The nature of the injury, the length of time from injury to treatment, how your tooth was cared for after the injury and your body’s response all affect the long-term health of the tooth. Timely treatment is particularly important with dislodged or knocked-out teeth in order to prevent root resorption.

Resorption occurs when your body, through its own defense mechanisms, begins to reject your own tooth in response to the traumatic injury. Following the injury, you should return to your dentist or endodontist to have the tooth examined and/or treated at regular intervals for up to five years to ensure that root resorption is not occurring and that surrounding tissues continue to heal. It has to be noted that some types of resorption are untreatable.

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TMJ / TMD

TMJ and TMD Symptoms and Treatment Overview

Do you ever experience a clicking or popping sound when opening or closing your mouth? Have you been suffering from headaches or migraines and no one seems to be able to help you? Have you been taking pain medicine for years and would like to get off of it? Do you feel any clogging or congestion in one or both of your ears? These are just a few of many symptoms that might be associated with TMD, or Temporomandibular Dysfunction, a common condition affecting the jaw joint or Temporomandibular Joint (TMJ).

TMJ dysfunction, often referred to as TMD, is a disharmony between the way the jaw joint works in an unstrained position and the way the teeth and bite work during those movements. Possible causes of this disharmony include tooth loss, accidents (like whiplash), mal-positioned and/or underdeveloped cranial or jawbones, and perhaps habits like clenching or teeth grinding. Many people go through life suffering from headaches and a variety of facial and neck pains without knowing the ultimate cause, which in many cases is TMJ disorder.

Define TMJ and TMD

TMJ or The Temporomandibular Joint

They are the two joints which connect the lower jaw to the temporal bone at the side of the head. If you place your fingers just in front of your ears and open your mouth, you can feel the joint on each side of the head. Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew and yawn. When the TMJ is not functioning normally and it is not within its physiological limits, it creates a condition called TMD, or Temporomandibular Dysfunction.

TMD is a group of conditions resulting from not having a normal function or "comfortable" positioning of the TMJ, and will present as a cycle of pain, muscle spasms and jaw problems. When teeth are missing, out of alignment, crowded or misshaped, chewing and biting cannot be achieved in a balanced way, so the TMJ and the muscles of chewing try to compensate for this unbalanced movement which results in symptoms that will confirm the presence of TMD.

Temporomandibular Joint Disorder (TMD) is not just a disorder, but a group of conditions, often painful, that affect the jaw joint or Temporomandibular Joint (TMJ) and the muscles that control chewing.

TMD falls into three main categories:
  1. Myofascial pain, the most common form of TMD, which is discomfort or pain in the muscles that control jaw functions and the neck and shoulder muscles.
  2. Internal derangement of the joint meaning a dislocated or displaced disc or injury to the condyle (the rounded part at the end of the jaw bone).
  3. Degenerative joint disease such as Osteoarthritis or Rheumatoid Arthritis in the jaw joint. Causes of TMJ/TMD
There are many causes for TMD such as:
  1. Unbalanced occlusion or "Bad Bite"
  2. Stress (emotional or work/school related)
  3. Injury or trauma (this could have been an injury as obvious as a blow to the jaw with a fist or something as subtle as a whiplash injury with direct trauma to the head or jaw.
  4. Teeth grinding or Bruxism
A "Bad Bite" could be caused by any of the following:
  1. Missing teeth
  2. Crowded or "crooked" teeth
  3. Worn down teeth
  4. Old crowns and bridges
  5. Unbalanced dentures

When teeth are missing, or out of alignment, it causes the jaw to shift positions and the muscles to work harder to chew, swallow, bite...etc and eventually will cause: muscle spasms, tension and pain.

Muscle tension and misplaced TMJ could cause the TMJ disc to be pulled out of place which will result in pain, clicking and popping in the TMJ.

If the disc is displaced for a long time, the bones will start rubbing against each other and some damage will happen to the bone, this is called Osteoorthrosis.

If there is inflammation in other joints or bones of the body, it is called Osteoarthritis (Arthritis) which may involve the jaw bone and the TMJ. Some damage to the bone may be evident on the x-rays.

TMD Symptoms
  1. Headaches, Migraines or tension headaches
  2. Worn or loose teeth
  3. Painful muscles in the neck and shoulders (muscle spasms)
  4. Pain behind the eyes.
  5. Clicking and popping of the jaw joint (TMJ)
  6. Locked jaw or restriction in opening or closing the mouth
  7. Earaches or a clogging feeling in the ears
  8. Tingling or numbness in the hands and the fingertips

TMJ Diagnosis

While recognizing TMJ problems is within the ability of most physicians and dentists, not all practitioners are qualified to diagnose it properly and treat it right. It is imperative that a trained practitioner in Craniofacial pain or Neuromuscular Dentistry give the final and definitive diagnosis, and suggest the most suitable treatment plan.

There is a lot of skepticism about TMJ treatment in the medical society and that is simply due to the fact that physicians didn't receive the dental training and didn't acquire the knowledge required for such complicated diagnosis and treatment. Furthermore, many dentists rush into treating TMJ thinking that they can cure these problems, only to find that they lack the skill and experience to get the job done.

We have training and experience in the treatment of these problems with outstanding success rates. With highly advanced equipment and a high level of knowledge, we address your concerns and provide the best diagnosis for the optimal treatment.

Undiagnosed TMJ/TMD

Many patients who suffer from TMD symptoms, were never told that it is related to their TMJ problem, and were not aware that treating their TMJ could easily relieve their suffering. To explain this further...

Headaches and Migraines

If you suffer from headaches or migraines, TMJ dysfunction, could be the major and most likely cause of your suffering. Your doctors, including neurologists, have simply not received the dental training required to relate your migraine or headache pain to your TMJ problems. Once you rule out any brain tumors or aneurysms, TMJ should be checked and TMD should be treated to relieve the headaches and migraines.

Ear congestion

Due to the proximity of the TMJ to the ears, it is very common to feel ears congestion, or to have ringing in the ears when the TMJ bones move or dislocate from their place. In this case ENT's (ear doctors) won't find anything wrong with the ears, yet the patients keep complaining about their ears. Once the TMJ is put back into its natural position, the pressure put on the ears will be relieved and the congestion disappears.

Tingling or Numbness in the Fingers

When the TMJ is not in a balanced position, it affects the general posture of the body. When the posture is not straight and upright, the nerves coming out from the spine could be irritated, which could cause the numbness or tingling feeling in the fingertips.

Jaw Tracking

We use a state-of-the-art jaw tracking system that helps diagnose TMJ Dysfunction (TMD) by tracking the jaw movement. Research shows that there are certain jaw movements which show very specific types of TMJ dysfunction. For example, limited opening and closing or locking, jaw opening deviations and deflections, and restricted side-to-side jaw movements. All of these indications are widely accepted and published criteria for diagnosing TMD.

Joint Vibration Analysis (JVA)

The Joint Vibration Analysis (or JVA) has been accepted by the American Dental Association to help provide a fast, non-invasive method to accurately diagnose TMJ function and demonstrate the severity level of the problem.

Electromyographic Analysis (EMG)

We use an Electromyographic Analysis (or EMG) to measure muscle activity on head and neck muscles both at rest and in function. This is done by placing computerized sensors on the skin allowing us to accurately monitor muscle activity. Hyperactive muscles are common for patients experiencing pain symptoms associated with TMJ problems. Imbalances between right and left sides of the same sets of muscles are also typical. The EMG system is a safe and comfortable method do help detect such issues and getting to the root of a TMJ issue.

Neuromuscular TMJ Treatment

TMJ/TMD is treatable most of the time. Simple cases of TMJ can be treated with anti-inflammatory medications and a hot/moist compress.

Treatment for more complex cases usually consist of two phases:

Treatment of complex TMJ - Phase One:

Generally speaking, it includes the fabrication of an orthotic. An orthotic is an acrylic device that is worn on the lower teeth 24 hours a day. The orthotic is designed to reposition the jaw to the correct neuromuscular position. We analyze the bite, decide which muscles are causing the pain, and where the current position of the bone is and the disc. All this is done with the aid of advanced equipment like the TENS unit, K7 jaw tracking, Sonography, EMG's and advanced x-rays like Tomography, CT Scans and MRI's of the TMJ. This will help us determine the best and most comfortable position of the TMJ and the muscles. Once that position is determined, we place the orthotic on the lower teeth to keep the TMJ in that position. Orthotics usually are worn for 4-6 months or until most of the symptoms are relieved. Once an orthotic is in use, the symptoms start gradually disappearing until we reach a point that both the doctor and the patient are satisfied with. This concludes Phase I of the treatment.

Treatment of Complex TMJ - Phase Two:

After 4-6 months of relief and when the patient is no longer suffering from any TMD symptoms, Phase II will be considered. Phase II includes any of the following:

  1. Wearing a long term removable orthotic, full time or part time.
  2. Replace missing teeth.
  3. Orthodontic treatment (Braces).
  4. Restore all the lower and/or upper teeth with crowns and veneers to preserve the optimal occlusion (bite) that was achieved with the orthotic in phase I.

Most of the time, any of the above could be considered and chosen, depending on the patients' preferences and financial capability. If you are currently suffering from TMD, it is too early to think of phase II at this time, since it is important to get you out of your pain and symptoms.

Treating TMJ/TMD Caused by Dentures:

Many patients complain that when they received dentures, they noticed pain in the jaw, headaches, ear problems and other symptoms. Sometimes taking the dentures out will relieve those symptoms. If your dentures are not made to the correct bite, or vertical dimension, it will most likely cause these symptoms. Simple adjustments could get rid of these symptoms, but sometimes a whole new set of dentures need to be made according to the neuromuscular principles, to get rid of your headaches or jaw pain.

Orthotics or Bite Splints

An orthotic is an acrylic device that is worn on the lower teeth 24 hours a day. It is designed to reposition the jaw to the correct neuromuscular position.

An orthotic, sometimes called a Bite Splint, is a very effective method in relieving TMD symptoms. It provides an acrylic platform to bite against, sometimes moving the mandible to a new position that is more comfortable.




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Periodontal Bone Regeneration

When a tooth is lost, both bone and gum tissue compete for the defect space. The gum tissue generates quicker than bone, thus assuming the space. With a membrane placement we can keep the gum tissue from the space, while the bone regenerates. Bone regeneration is often used to rebuild the supporting structures around the teeth which have been destroyed by periodontal disease. Bone surgery may be used to rebuild or reshape bone. Grafts of the patient's bone or artificial bone may be used, as well as special membranes.




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Crown Lengthening

Crown lengthening is a surgical procedure that re-contours the gum tissue and often the underlying bone of a tooth. Crown lengthening is often for a tooth to be fitted with a crown. It provides necessary space between the supporting bone and crown, which prevents the new crown from damaging bone and gum tissue.




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Flap Surgery

When deep pockets between teeth and gums (6 millimeters or deeper) are present, it is difficult for a dentist to thoroughly remove the plaque and tartar. Flap surgery is a procedure where the gum flap is lifted away from the tooth. Diseased tissue and sometimes bone is removed. The rough surfaces of the tooth are then smoothed by root planing. The area is medicated and the gum flap is replaced and sutured allowing the bone and gum tissue to heal. One of the goals of flap surgery is to reduce the depth of the periodontal pockets to make them easier to keep clean.




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Frenectomy

If a patient has an excess amount of tissue that connects the lower and upper lips to the jaw and gum line, a frenectomy procedure is performed to remove the excess tissue.




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Sinus Lift

In the back of the upper jaw bone, dental implants are frequently needed. In order for a dental implant to be successful in this area of the mouth there must be sufficient bone height and width to connect (integrate) to the dental implant. When the upper back teeth are lost and not replaced, the sinus cavity becomes enlarged destroying any bone that is left behind. This very large sinus is like a "giant air pocket" and not capable of supporting an implant. A procedure known as sinus grafting (sinus lift) is performed to create bone that will ultimately hold the implants within the sinus. Sinus grafting is an extremely common form of bone grafting.




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Soft Tissue Grafting

Soft Tissue Grafting

A frequent periodontal condition is known as gum recession. This means the existing gum tissue has receded up or down the root of the tooth exposing various amounts of the root. Root exposure can create root sensitivity especially to hot and cold, an increased potential for root decay, and/or esthetic concerns. Gum grafting procedures are the treatment of choice to prevent the recession from continuing further. There are many different types of recession and hence many different types of gum grafting. Some are aimed at covering the root of the tooth and other procedures are focused on providing an excellent new zone of gum tissue to halt the recession.




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Ridge Regeneration

When a tooth is lost and not immediately replaced, the bone reacts to this event by 'shrinking back'. The bone becomes thinner from a width perspective and the bone height is frequently reduced. This process is known as bone resorption. In order to place implants, it is necessary to rebuild the bone width and height through regenerative surgical therapy. Bone grafting of the ridge is almost always required to enable accurate placement of dental implants. The grafting is completed utilizing tissue bank and/or synthetic bone particles combined with collagen membranes. It is a highly predictable procedure.




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Periodontal Health Affects

Research has shown that gum disease can influence heart disease and other health conditions in negative ways. They suggest that gum disease could even be a more serious factor in heart disease than smoking, cholesterol, hypertension and age. One reason for this is the fact that the bacteria found in diseased gums can come loose and move throughout the body. When this bacteria reaches arteries it can cause arterial plaque to build up and harden which in return adversely affect blood flow.




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Healthy Gums

Healthy Gums

Healthy gums are generally pink and anchor the teeth firmly in place.




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Gingivitis

Gingivitis is an early stage of gum disease. Gingivitis develops as toxins, enzymes and other plaque byproducts by irritating the gums, making them tender, swollen and likely to bleed easily. Gingivitis generally can be stopped with proper oral hygiene and minor treatment from your dentist. If this is achieved, your gums can return to a healthy state.




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Periodontitis

When the bone tissue starts to deteriorate, this is known as a form of gum disease called Periodontitis. This happens when the byproducts of plaque attack the tissues that hold your teeth to the bone. The gums begin falling away from the teeth and form pockets in the gums which allows more plaque to collect below the gum line. When this occurs, the patient becomes more sensitive to hot and cold and the roots of the teeth are more vulnerable to decay.




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Advanced Periodontitis

Advanced periodontitis occurs when a major amount of gum and bone tissue has been lost and the teeth are losing more and more support due to the loss of periodontal ligament and bone. Some teeth are unable to be saved and must be extracted. If left untreated, advanced periodontitis can cause severe health problems elsewhere in the body.




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Sensitivity

Suppress the urge to avoid cleaning teeth that are sensitive to cold! Teeth that have suffered damage from gum disease will always be more sensitive to cold. Avoiding them only makes it worse.

After any dental treatment, teeth may become sensitive. This is their way of letting you know that they've been injured. Any injury (cavity, tooth clenching/grinding, gum infection) can injure the nerves in a tooth. This should not last long if the teeth are kept clean. If the teeth are not kept clean, the sensitivity will remain or get worse.

If your teeth are especially sensitive consult with your dentist. This could be a sign of the need for root canal treatment or a gum tissue graft. Or a desensitizing toothpaste (with potassium nitrate) or concentrated fluoride gel (0.4% stannous- or 1.1% sodium-fluoride) may do the trick.




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Crown Lengthening

Crown lengthening is a surgical procedure that re-contours the gum tissue and often the underlying bone of a tooth. Crown lengthening is often for a tooth to be fitted with a crown. It provides necessary space between the supporting bone and crown, which prevents the new crown from damaging bone and gum tissue.




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What Is A Dental Implant?

Dr. Kirsch, an implant dentist in Sebring, is experienced in dental implant tooth replacement options. Implants are a tooth replacement option that involves placing a new "root" into the bone of your jaw. Once this titanium "root" has infused with your bone it can be used to support a crown, bridge, or denture. These implants can also be used to replace partials and other forms of dentures.

Implants are now the standard for replacing older dentistry and missing teeth because they look and feel like your natural teeth and have a higher success rate than all other forms of tooth replacement. The initial cost is higher for an implant over other forms of tooth replacement, but the long term benefits easily outweigh the slight additional cost.

For more detailed information, please CLICK HERE.




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Implant Benefits

Implant Benefits

There are many benefits to receiving a dental implant over other forms of treatment:

- Neighboring teeth do not have to be compromised
- Implants allow you to keep your jaw structure
- They look and feel like natural teeth
- Dental Implants can replace partials and are used to secure loose dentures




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Implant Placement

In order to place an implant, a couple of steps must be taken:

1) An incision is made into the gums using very precise measurements, then using a very small drill, the jawbone is given a "tap" that will allow the implant to be placed. After the implant is screwed into place, the gums are closed up and the healing process begins. This process can take approximately three to six months to ensure the implant has fused with the bone and created a sturdy base for the new teeth.

2) When the implant is ready, an abutment is attached to the implant, which allows for a new crown to be placed or a denture to be attached.




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Single Tooth Dental Implant

Do you have missing teeth? It is critically important to replace missing teeth. Eating and chewing with missing teeth can sabotage your bite and lead to incessant discomfort. Missing teeth can give rise to a mouth rearrangement that often results in facial changes that look decrepit.

A single tooth implant procedure may be done if a tooth has been extracted or is missing. A titanium implant base is placed into the jawbone to resemble the tooth root. We allow a period of time for the jawbone to heal over the implant base before fitting for a crown.


Next, an abutment is screwed into the base of the implant to allow for a crown to be fitted on top. Finally, a custom fabricated crown is placed over the abutment to function like a real tooth.




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Multiple Tooth Implants

In cases where multiple teeth are missing or have been extracted, multiple implants can be used to bring back your smile. The implants are placed into the jawbone and are given time to heal. After the bone has healed around the implants an abutment is attached to the implant which then allows for a crown or bridge to be placed right on the implant. These new teeth will look and act just like natural teeth.

Ask Dr. Kirsch, a popular implant dentist in Sebring, if dental implants are right for you.




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Full Arch Implants

In many circumstances all of the upper or lower remaining teeth need to be removed due to advanced periodontal disease and/or dental decay. One approach is a full upper or lower plate; however, this treatment modality is not recommended. The treatment of choice is to replace the upper or lower teeth with caps that are in place permanently and supported by dental implants. A common goal of treatment is to have (twelve teeth-caps) supported by eight implants. The four caps that are not supported by the implants are connected to adjacent implant supported caps. With this optimal approach, the maximum amount of bone is preserved.

For more detailed information, please CLICK HERE.




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Nitrous Oxide Sedation

Nitrous Oxide Sedation

Nitrous oxide, also known as laughing gas, is most often used for patients who are mildly or moderately anxious or nervous. It eases their fears so that they can relax and receive treatment comfortably and safely. Nitrous oxide is administered by placing a small mask over the patient's nose. As the gas begins to work, the patient becomes calm, but is still awake and can communicate. When the gas is turned off, the effects of sedation wear off almost immediately.




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Oral Sedation

Oral Sedation

Patients who are more anxious may need an oral medication that is stronger than nitrous oxide. With oral sedation, the patient may be sleepy but can be aroused if necessary and can respond to simple commands.

Minor side effects such as nausea or vomiting can occur with some medications. Before a visit in which a patient is to receive oral sedation, he/she should receive instructions about eating and drinking, what to expect and what to watch for after treatment. You may need assistance to get home after sedation. Patients may need to stay for a short observation after dental treatment has been completed.




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Bad Breath

Bad Breath

What you eat affects the air you exhale. Certain foods, such as garlic and onions, contribute to objectionable breath odor. Once the food is absorbed into the bloodstream, it is transferred to the lungs, where it is expelled. The odors will continue until the body eliminates the food. People who diet may develop unpleasant breath from infrequent eating. If you don't brush and floss daily, particles of food remain in the mouth, collecting bacteria, which can cause bad breath. Food that collects between the teeth, on the tongue and around the gums can rot, leaving an unpleasant odor. Dry mouth occurs when the flow of saliva decreases. Saliva is necessary to cleanse the mouth and remove particles that may cause odor. Dry mouth may be caused by various medications, salivary gland problems or continuously breathing through the mouth. Tobacco products cause bad breath, so if you use tobacco, ask your dentist for tips on kicking the habit. Bad breath may also be the sign of a medical disorder, such as a local infection in the respiratory tract, chronic sinusitis, postnasal drip, chronic bronchitis, diabetes, gastrointestinal disturbance, liver or kidney ailment.




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Dry Mouth

Dry Mouth

Saliva flow is important other than appearance and comfort. It keeps the mouth moist and aids in chewing, swallowing, digestion and speech. Dry mouth is a condition from the lack normal saliva flow.


Causes of dry mouth:
- Dehydration
- Emotional Stress
- Anemia
- Related to surgery
- Medical Conditions
- Medication
- Allergy
- Anti-depressant
- Blood pressure
- Some mouth washes high in alcohol content


Dry mouth symptoms:
- Mouth feels sticky
- Lips cracked and dry
- Tongue may have burning sensation


People who experience dry mouth are at high risk for developing:
- Cavities
- Gum disease
- Bad breath


Helping dry mouth:
- Chewing gum / lozenges
- Humidifier at night
- Maintaining good oral hygiene




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Oral Piercing

Oral Piercing

Oral piercings can be bad for your health. Because your mouth contains millions of bacteria, infection is a common complication of oral piercing. Pain and swelling are other side effects of piercing. Your tongue (a popular piercing site in the mouth) could swell large enough to close off your airway. Piercings can also cause uncontrollable bleeding or nerve damage. The jewelry itself also presents some hazards. You can choke on any studs, barbells or hoops that come loose in your mouth, and contact with the jewelry can chip or crack your teeth.




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Pregnancy

Pregnancy

We ask that our female patients who are pregnant or think they possibly could be to inform us prior to your x-ray examination and dental treatment.




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Tooth Fractures

Tooth Fractures

There are many types of cracked teeth. The treatment and outcome for your tooth depends on the type, location and severity of the crack.

Unlike a broken bone, a fracture in a cracked tooth will never heal. Early diagnosis is important, even with high magnification and special lighting, it is sometimes difficult to determine the extent of a crack.

A crown will bind and protect the cracked tooth. When a crack reaches the tooth root, root canal treatment is frequently needed to treat the injured pulp. A cracked tooth that is not treated will progressively worsen, eventually resulting in the loss of the tooth.




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Traumatic Ulcer

Traumatic Ulcer

It is not uncommon for children to inadvertently 'bite' on their lips or cheeks, particularly following a dental visit where local anesthetic was used. The main reason why this occurs is the natural curiosity that a child has about the area of the mouth that is 'numb'. We try our best to explain to children that local anesthesia is temporary and we give them (and their parents) instructions on how to prevent 'lip biting'. In the event that this occurs, please notify our office so we can determine if your son/daughter will require treatment (ie, antibiotics or pain medicine).





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