The Chairside Instructor: A Visual Guide to Case Presentations [11 ed.] 1941807720, 9781941807729

Citation preview

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Top 4 Steps to a Healthy Smile Step 1

Step 2

Step 3

Step 4

Keep your mouth clean

Visit your dentist regularly

Make healthy food choices

Avoid tobacco in any form

Regular visits to your dentist make it possible for your dentist to treat problems in the early stages.

For teeth to be healthy, they need vitamins, protein, calcium and phosphorous — and you can get them all from a healthy diet.

During your oral exam, your dentist will check for:

• Avoid sugary drinks. This includes sodas, sports drinks, energy drinks, and even 100% fruit juices.

If you use any form of tobacco — including electronic cigarettes and chewing tobacco — you increase your risk for gum disease and tooth loss. Cigarette smoking also increases your risk for oral cancer.

• Brush your teeth 2 times a day for 2 minutes each time. • Use toothpaste with fluoride, a mineral that can help keep your teeth strong. • Clean between your teeth every day with floss or another between-the-teeth cleaner.  This removes food particles and plaque from under your gum line and between your teeth — places that your toothbrush can’t reach.

• tooth decay and cavities • gum disease • signs of oral cancer

• Limit your snacking between meals.

• anything that doesn’t look normal

• If you have sugary foods and drinks, have them with meals.

Plus, a professional cleaning helps remove stains, plaque and tartar from your teeth. It also helps prevent gum disease and keeps your smile looking great!

• Chew sugarless gum with the ADA Seal of Acceptance.

EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

• Drink water with fluoride.

Quitting tobacco use is a great step forward for your dental and overall health. Ask your dentist or physician for advice on how to quit.

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Table of Contents

The Chairside Instructor

Oral Anatomy

Gum (Periodontal) Disease

Tooth Replacement

Cosmetic Options

The Oral Cavity . . . . . . . . . . . . . . . . . . . . . . . . 2

Warning Signs of Gum Disease . . . . . . . . . 13

Effects of Tooth Loss . . . . . . . . . . . . . . . . . . 31

Treatments: Before and After . . . . . . . . . . 44

The Tooth and Its Supporting Tissues . . . . 3

Stages of Gum Disease . . . . . . . . . . . . . . . . 14

Fixed Bridge Placement . . . . . . . . . . . . . . . . 32

Veneers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Tooth Development: Primary Teeth . . . . . 4

Gum Disease Treatment and Maintenance . . . . . . . . . . . . . . . . . . . . . . 15-16

Resin-Bonded Bridge . . . . . . . . . . . . . . . . . . 33

Tooth Development: Permanent Teeth . . 5

Periodontal Surgery . . . . . . . . . . . . . . . . . . . 17 Bone Graft . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Gum Recession . . . . . . . . . . . . . . . . . . . . 19-20

Prevention and Diagnosis Sugar and its Effects . . . . . . . . . . . . . . . . . . . 6 Plaque and its Effects . . . . . . . . . . . . . . . . 7-8 Brushing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Flossing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Sealants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Dental X-Rays (Radiographs) . . . . . . . . . . 12

Removable Partial Dentures . . . . . . . . . . . 34 Full Dentures . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Implant Placement . . . . . . . . . . . . . . . . . . . . 37

Other Oral Conditions

Peri-Implantitis . . . . . . . . . . . . . . . . . . . . . . . 38

Tooth Erosion . . . . . . . . . . . . . . . . . . . . . 46-47

Implant-Supported Bridge . . . . . . . . . . . . . 39

Wisdom Teeth . . . . . . . . . . . . . . . . . . . . . . . . . 48

Bone Grafting . . . . . . . . . . . . . . . . . . . . . . . . . 40

Temporomandibular Disorders (TMD) . . . 49 Cracked Tooth . . . . . . . . . . . . . . . . . . . . . . . . 50

Decay, Cavities and Restorations

Tooth Grinding and Clenching (Bruxism) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Tooth Decay . . . . . . . . . . . . . . . . . . . . . . 21-22 Tooth Decay in Baby Teeth . . . . . . . . . . . . 23 Cavities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Typical Restorations (Fillings) . . . . . . . . . . 25 Inlays and Onlays . . . . . . . . . . . . . . . . . . . . . . 26 Crown Preparation and Placement . 27-28

Frenectomy and Tori Removal . . . . . . . . . . 52

Orthodontics

Tobacco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Orthodontic Treatment . . . . . . . . . . . . 41-42

Mouth and Throat Cancer and Mouth Sores . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Surgical Correction . . . . . . . . . . . . . . . . . . . . 43

Photo Credits . . . . . . . . . . . . . . . . . . . . . . . . . 55

Root Canal (Endodontic) Therapy . . . . . . 29 Endodontic Surgery . . . . . . . . . . . . . . . . . . . 30 EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

The Chairside Instructor

1

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Oral Anatomy

Oral Anatomy

Parts of the Oral Cavity

Oral Health Checklist Frenum

n

Clean teeth (free of plaque)

n

No chipped, worn or broken teeth

n Pain-free

Hard palate

Soft palate Uvula Tonsil Tongue

n No

decay or cavities

n

No missing teeth

n

No loose teeth

n

Firm gums

n Fresh

breath

n

No bleeding

n

No sore areas or lesions

n

No swelling or growths

n

Adequate saliva

n Pain-free

Frenum

teeth

jaw movement

n No

difficulty opening your mouth

n No

occlusal (bite) problems

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

2

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

The Tooth and Its Supporting Tissues

Crown: part of the tooth you can see

Oral Anatomy

Enamel: hard outer covering of the tooth Gums (gingiva): soft tissues that help support the tooth and hug your teeth tightly Pulp chamber: space inside the tooth for the nerve and blood vessels Dentin: the inner tissue that’s located beneath the enamel Jawbone: bone that supports the tooth Root canal: passageway for nerves and blood vessels

Root: part of the tooth inside the bone socket

Cementum: hard material that covers the tooth roots and attaches to the periodontal ligament Periodontal ligament: tissue that anchors the tooth to the bone Nerves and blood vessels: supply the tooth with nutrients

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

3

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Tooth Development: Primary Teeth Primary Teeth

Oral Anatomy

Early Childhood Upper Teeth

Erupt

Shed

Central incisor Lateral incisor Canine (cuspid)

8-12 mos. 9-13 mos. 16-22 mos.

6-7 yrs. 7-8 yrs. 10-12 yrs.

First molar

13-19 mos.

9-11 yrs.

Second molar

25-33 mos.

10-12 yrs.

Lower Teeth

Erupt

Shed

Second molar

23-31 mos.

10-12 yrs.

First molar

14-18 mos.

9-11 yrs.

Canine (cuspid) Lateral incisor Central incisor

17-23 mos. 10-16 mos. 6-10 mos.

9-12 yrs. 7-8 yrs. 6-7 yrs.

Adult teeth Baby teeth

Adult teeth start to form under the baby teeth.

Every mouth is different. Teeth may come in/fall out earlier or later than what’s shown in this chart.

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

4

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Tooth Development: Permanent Teeth Permanent Teeth UPPER TEETH Central incisor Lateral incisor Canine (cuspid)

Oral Anatomy

Chart of Tooth Types ERUPT 7-8 yrs. 8-9 yrs. 11-12 yrs.

First premolar (1st bicuspid) 10-11 yrs. Second premolar (2ndbicuspid) 10-12 yrs. First molar

6-7 yrs.

Second molar

12-13 yrs.

Third molar (wisdom tooth)

17-21 yrs.

LOWER TEETH Third molar (wisdom tooth)

ERUPT 17-21 yrs.

Second molar

11-13 yrs.

First molar

6-7 yrs.

Second premolar (2nd bicuspid) First premolar (1st bicuspid) Canine (cuspid) Lateral incisor Central incisor

11-12 yrs. 10-12 yrs. 9-10 yrs. 7-8 yrs. 6-7 yrs.

Molars 2nd Premolars (2nd bicuspids) 1st Premolars (1st bicuspids) Canines (cuspids) Lateral Incisors Central Incisors

Every mouth is different. Teeth may come in earlier or later than what’s shown in this chart.

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

5

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Sugar and its Effects Sugary food and drinks harm your teeth! • Plaque bacteria found on your tooth surfaces feed on the sugars in your food and drinks.

You may be drinking your dessert! You may not realize just how much sugar is in your favorite beverage. This chart shows you how many cookies are equal to the amount of sugar that’s in these popular drinks. How much sugar are you drinking every day? = 4 grams of sugar

Sweet Tea • 1 cup: 12 grams

• They turn the sugar into acids.

Energy Drink • 1 can: 25 grams

• These acids attack the hard surfaces of your teeth (enamel) for up to 20 minutes after you are finished eating/ drinking.

Regular Sports Drink • 1 bottle: 30 grams

• Over time, your enamel can get damaged and can cause cavities to form or erosion to occur.

Prevention and Diagnosis

Regular Soda/Cola • 1 can: 33 grams Fruit Smoothie with Yogurt • 1 cup: 34 grams Blended Cold Cappuccino Drink • medium: 44 grams Source: United States Department of Agriculture’s SuperTracker Food-A-Pedia, www.supertracker.usda.gov/foodapedia.aspx

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

6

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Plaque and its Effects

Prevention and Diagnosis

Plaque and Tartar Plaque is a soft, sticky film with bacteria that constantly forms on teeth. It can cause tooth decay and gum disease. Plaque that is not removed can harden and form tartar (also called calculus), which makes it difficult to keep your teeth clean. Only a professional dental cleaning can remove tartar from your teeth.

Before professional dental cleaning

After professional dental cleaning

Buildup of tartar can also be seen on x-rays.

Plaque can harden into tartar if not removed and can build up around your teeth. This makes it harder to keep them clean on your own. Image ©Elsevier Inc. All rights reserved.

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

7

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Plaque and its Effects

Prevention and Diagnosis

Other ways you can control plaque

A disclosing agent can reveal the amount of plaque that’s in your mouth after you brush. It can help point out areas in your mouth that you may not be reaching when you clean. Image © Elsevier Inc. All rights reserved.

You can also get decay in places where your toothbrush can’t reach — like in between teeth. Be sure to clean between your teeth every day using floss, picks, or other cleaners. Your dentist or hygienist can help determine which method works best for your mouth.

Anti-gingivitis mouthrinse reduces bacteria that can cause gingivitis, an early form of gum disease.

For some people, a powered toothbrush may be easier or more comfortable to use than a regular toothbrush.

• Ask your dentist or hygienist to show you how to use these tools to suit your needs. • Look for the ADA Seal of Acceptance when you buy these products. • Brush for 2 minutes, twice a day with a fluoride toothpaste. Learn the proper way to brush on the next page. • Floss or clean between your teeth every day. Find out how on page 10. The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

8

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

How To Brush Your Teeth

Prevention and Diagnosis

1. Place your toothbrush against your gums at a 45-degree angle. Move the brush back and forth gently in short strokes, about as wide as each of your teeth. Your dentist or hygienist can show you how.

2. Brush the outer tooth surfaces.

3. Brush the inner tooth surfaces.

4. Brush the chewing surfaces.

5. Use the top part of the brush to clean the inside surface of the top and bottom front teeth. Use a gentle up-and-down motion.

6. Brush your tongue, which may help remove bacteria and freshen your breath.

EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

The Chairside Instructor

9

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

How To Floss

Prevention and Diagnosis

1. Break off about 18 inches of floss and wind most of it around one of your middle fingers. Wind the remaining floss around a finger on the other hand. This finger will take up the used floss. Hold the floss tightly between your thumb and forefingers.

2. Guide the floss between your teeth, using a gentle back-and-forth motion. To avoid injuring your gums, never snap the floss into gum tissue.

3. When the floss reaches the gum line, curve it into a “C” shape against one tooth. Gently slide it into the space between the gum and the tooth.

4. Hold the floss tightly against the tooth. Gently rub the side of the tooth, moving the floss away from the gum with up and down motions.

5. Repeat this method on the rest of your teeth. As you move from tooth to tooth, unwind the clean floss with one finger and take up the used floss with a finger on the other hand. Don’t forget the back side of the last tooth.

If you have trouble handling floss, you may find it helpful to use a floss holder or other between-the-teeth cleaners, like special picks or narrow brushes.

EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

The Chairside Instructor

10

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Sealants A sealant is a coating that protects a tooth from decay. It can also be used to help stop the progression of early signs of decay on the chewing surface of a tooth. When teeth are treated with sealants, they are less likely to get cavities. Sealants can be applied quickly and painlessly.

Prevention and Diagnosis

How sealants are applied

Tooth surface before a sealant is applied.

Tooth surface protected by a sealant.

How sealants help prevent decay

Tooth groove Toothbrush bristle

The chewing surfaces of a molar (magnified) have pits and grooves that trap plaque and bits of food.

Even a toothbrush bristle is too big to reach inside a groove in the tooth (magnified). The Chairside Instructor

EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

11

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Dental X-Rays (Radiographs) X-rays help your dentist see the jaw bone, the roots of the teeth, or teeth that have not yet erupted, as well as the contact areas between the teeth. In some cases, x-rays can reveal a condition at an early stage, when it is easier to treat. Some Conditions X-Rays Can Help Detect: • small areas of decay in the teeth or below fillings

Bitewing This X-ray shows decay between the teeth (interproximal decay). Sometimes occlusal decay can also be seen on a bitewing film.

Periapical (around the tooth’s root) This X-ray shows the crown of an impacted molar.

Prevention and Diagnosis

Occlusal (upper or lower jaw) This X-ray shows an unerupted tooth.

CBCT (cone-beam computed tomography) CBCT images can show more detail than X-rays.

• bone diseases • abscesses or cysts • signs of periodontal (gum) disease • developmental and other defects • some types of tumors • positions of tooth roots and jaw bones

Complete-mouth series of bitewing and periapical X-rays shows all of the teeth, roots and related areas of the jaws.

• signs of trauma

Panoramic This X-ray shows developing permanent teeth that have not yet erupted.

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

12

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Gum (Periodontal) Disease What is Periodontal Disease? Periodontal (PERRY-o-DONtal) disease — also called gum disease — is an infection and inflammation that affects the tissues and bone that support your teeth.

Periodontal Probing

Gum Disease

Bone Loss

6mm

Periodontal probe of healthy gums.

Periodontal probe showing space forming between the tooth root and the gums. Dentists call this a pocket.

Radiograph showing supporting bone.

Radiograph showing periodontal bone loss.

Warning Signs of Gum Disease • • • • • • • •

gums that bleed when you brush or floss gums that are red, swollen, puffy, or tender gums that no longer hug your teeth tightly bad breath that doesn’t go away pus between your teeth and gums feeling that your teeth are loose a change in the way your teeth fit together when you bite a change in the way your partial dentures fit

You may notice one or some of these warning signs, or you may not notice any warning signs at all. Plaque that is not removed between the teeth and on the gum line can cause the gums to become red, puffy, and swollen. Image ©Elsevier Inc. All rights reserved.

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

13

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Stages of Gum Disease

Gum Disease

Image ©Elsevier Inc. All rights reserved.

Gums Ligament Bone

Normal, Healthy Gums

Your teeth are held in place by gums, bone and connective tissues. Your gums tightly hug your teeth and there is little or no buildup of plaque and tartar on them.

Pus

Gingivitis

The bacteria in plaque make your gums red, tender, and swollen. Your gums might bleed at this stage. You also can have gingivitis and not have any signs of it.

Periodontitis

In time, your body responds to the harmful toxins that the bacteria produce by breaking down the gum tissues and bone around your teeth.

Advanced Periodontitis

Your teeth may become loose, fall out or need to be removed by your dentist. Loose or missing teeth can create problems, like making it hard for you to eat the foods you like.

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

14

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Gum Disease Treatment and Maintenance

Gum Disease

Deep Cleaning – Scaling and Root Planing

Deeper cleanings like scaling and root planing are performed to help your gums properly heal from gum disease.

Scaling removes plaque and tartar from below the gum line.

Root planing smoothes the tooth root and helps the gums re-attach to the tooth.

Image ©Elsevier Inc. All rights reserved.

Before treatment

After treatment

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

15

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Gum Disease Treatment and Maintenance

Gum Disease

Advanced Periodontitis Treatment Other Treatments • Oral irrigation after deep cleaning • Prescription mouthrinse • Antibiotics or other medicines Before scaling and root planing treatment

After treatment

• Additional home care in addition to daily brushing and flossing • Gum (periodontal) surgery

Oral irrigation keeps your pockets clean after scaling and root planing. Image ©Elsevier Inc. All rights reserved.

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

16

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Periodontal Surgery

Gum Disease

Flap and Osseous (Bone) Surgery Probe

6mm 2mm

Gums

Bone

Probe shows pockets due to periodontal disease. Gums are inflamed and bone loss has occurred.

The bone is contoured and any remaining tartar is removed.

Healed site after periodontal surgery.

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

17

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Bone Graft Surgery

Gum Disease

Bone Graft and Guided Tissue Regeneration

Membrane Grafting material

Diseased tissue is removed from the pocket. In some cases, the bone may be reshaped.

Bone has been reshaped.

Grafting material is placed over the bone. A membrane covers the grafting material.

After the healing period

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

18

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Gum Recession If your gum tissue begins to pull away from your teeth, you may have gum recession. This can leave your tooth’s roots exposed and they may become sensitive to hot and cold. Plus, they are more at risk for decay. Even if you take good care of your teeth, it’s possible that gum recession may still happen.

Gum Disease

gum recession exposed tooth root inflamed gum tissue

You can develop gum recession at any place in your mouth and on any tooth.

Causes: • periodontal (gum) disease • brushing your teeth too hard or using a toothbrush with hard bristles • trauma to gum tissues, such as a sports injury • partial dentures that don’t fit right • genetics — some people are born with gums that are thin or weak • larger-than-normal tooth roots or attachment muscles that can push gums out of place • smoking and using any kind of tobacco

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

19

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Gum Recession Treatments One or more of these treatments could be recommended by your dentist:

Gum Disease

Gum Graft Exposed tooth roots

• Proper brushing techniques can help prevent damage to your gums. Your dentist or hygienist can work with you on the best ways to clean your teeth. • Deep cleaning (scaling and root planing) is often the first step in healing your gums. • Adjusting or remaking partial dentures will make sure they fit correctly.

Before gum graft Exposed tooth roots are more at risk for cavities and sensitivity.

After gum graft Repaired gums now protect tooth roots.

Before gum graft

After gum graft

Image ©Elsevier Inc. All rights reserved.

Image ©Elsevier Inc. All rights reserved.

• Surgery is sometimes needed to treat gum recession.

Gum Graft A thin piece of gum tissue is taken from another place in your mouth and attached where your gum tissue has receded.

Grafts may be done around one or more teeth to protect the root from sensitivity and decay. Grafts can also be used to make a smile look better.

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

20

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Tooth Decay

Decay, Cavities and Restorations

Progress of Tooth Decay

Abscess

Abscess Healthy teeth and roots without signs of decay. Decay in tooth grooves

Decay under filling

Early decay may not be easy for you to notice.

Decay between teeth

If not treated, tooth decay can cause an abscess (arrow) and can lead to serious infections. Image © Elsevier Inc. All rights reserved.

Root decay

Abscess

Decay under the surface may be larger than it looks from the outside.

If not treated, tooth decay can cause an abscess and can lead to serious infections. The Chairside Instructor

EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

21

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Tooth Decay

Decay, Cavities and Restorations

Common Sites of Decay

Chewing surface decay (Occlusal decay)

Decay in between teeth (Interproximal decay)

Decay Under fillings

Decay at the gum line (Cervical decay)

Root decay (Radicular decay)

Tooth decay can form under fillings.

X-ray of tooth with decay under a filling.

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

22

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Tooth Decay in Baby Teeth

Decay, Cavities and Restorations

Tooth decay in infants and toddlers happens when teeth are in contact with sugary liquids often or for long periods of time. These liquids include fruit juice, soda and other sweetened liquids. Decay can destroy the teeth of an infant or young child.

Decay in Baby (Primary) Teeth white lesions

Healthy baby teeth

Initial decay

Moderate decay

Ways to Prevent Early Decay • Do not let your child sip constantly on drinks with sugar (including juice drinks).

Moderate to severe decay

Severe decay

Use the right amount of toothpaste for your child

• Babies and toddlers should finish their naptime and bedtime bottles before going to bed. • Encourage your child to drink from a cup by his or her first birthday. • If your child uses a pacifier, don’t dip it in sugar or honey, or put it in your mouth before giving it to the child. The cavity-causing bacteria in your mouth can be passed to your baby. • After each feeding, wipe your infant’s gums with a clean, damp washcloth or gauze pad. Once the first tooth appears, brush your infant’s teeth twice daily with a child-sized, soft-bristled toothbrush. • Visit the dentist by your child’s first birthday. Consider this a “well-baby checkup” for your child. EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

For children under 3 years old

For children 3-6 years old The Chairside Instructor

23

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Cavities

Decay, Cavities and Restorations

When decay gets through the enamel of your tooth, a cavity can form. Once a cavity forms, it can continue to spread deeper and deeper into the layers of your tooth. It’s important to catch and treat a cavity as early as possible to avoid serious problems, like an abscess or an infection.

General Steps of a Filling

1. Tooth is prepared. Your dentist will help you feel comfortable during treatment and will go over options that will make sure you don’t feel any pain in and around the tooth being filled. Your mouth may be numbed.

2. Decay is removed. Your dentist removes all of the decayed area from your tooth.

3. Tooth is Rinsed and Dried. Your tooth is rinsed and dried to get it ready for the filling material.

4. Filling material is placed and shaped. Once the new filling is in place, your dentist will shape to restore the form of your tooth. Your bite is also checked to make sure it feels natural.

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

24

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Typical Restorations (Fillings)

Decay, Cavities and Restorations

Anterior (Front) Restorations These drawings show some of the positions where restorations are often needed. The type of material used depends partly on where the restoration is located.

Cervical restoration Common options include composite resin, dental amalgam or glass ionomers

Interproximal restoration Composite resin

Incisal restoration Composite resin

Three-surface restoration, cast or gold alloys

Three-surface onlay, which restores the biting surface and one cusp

Posterior (Back Teeth) Restorations

One-surface restoration, dental amalgam

One-surface restoration, composite resin

Two-surface restoration

Pin-retained restoration

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

25

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Inlays and Onlays Inlays and onlays are often used to restore teeth that have been damaged by decay and wear. They are made in a dental office or lab and are typically placed on the chewing surfaces of the back teeth or molars. Inlays and onlays are very durable. They are often used when the area to be filled is too large for a regular filling, but not large enough to need a crown.

Decay, Cavities and Restorations

Inlay

Onlay

Decay

Before

An inlay fits within the contours of a tooth, in an area that the dentist has prepared.

Inlay

Before the inlay is placed

An onlay restores one or more peaks of the tooth (cusps) or the entire biting surface.

Onlay

After the inlay is placed

Before the onlay is placed

After the onlay is placed

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

26

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Crown Preparation and Placement Steps in placing a crown:

Decay, Cavities and Restorations

Anterior (front) Crowns

1. Your dentist prepares the tooth by removing its outer portion so the crown will fit. Any decay is also removed. If additional tooth structure is needed to support the crown, the dentist may build up the core of the tooth. 2. An impression is made to provide an exact model for the crown. 3. You will get a temporary crown while you wait for the permanent crown to be ready. 4. The dentist or a laboratory technician then uses the model to help make the crown.

Full porcelain/ceramic crown

Porcelain-fused-tometal crown

Anterior Crown Placement

When the new crown is ready, your dentist places it in your mouth and makes the necessary adjustments. When you and your dentist are satisfied with how it looks and feels, the crown is cemented in place. Prepared tooth

Crown placed on prepared tooth

Crown in place The Chairside Instructor

EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

27

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Crown Preparation and Placement

Decay, Cavities and Restorations

Posterior (Rear) Crowns

Full porcelain fused to metal crown

Full gold crown

Replacing a Filling With a Crown

Posterior Crown Placement

Before – Worn filling with decay under filling

Crown is positioned over prepared tooth

Full porcelain/ceramic crown

After crown placement

Before – Amalgam filling with decay at the edge

After – Filling replaced by a crown

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

28

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Root Canal (Endodontic) Therapy

Decay, Cavities and Restorations

Steps of Root Canal Therapy

Healthy tooth and root

Tooth decay can cause an abscess (infection).

The decay is removed and an opening is made through the crown of the tooth into the pulp chamber.

The pulp is removed, and the root canals are cleaned, shaped, and disinfected.

The root canals and pulp chamber are filled.

A metal rod (post) may be placed in the root canal to help retain the core (filling) material, which supports the restoration (crown).

The crown of the tooth is then restored. If bone is lost due to infection at the root tip, this will heal over several months after the root canal is cleaned and sealed.

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

29

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Endodontic Surgery

Decay, Cavities and Restorations

Apicoectomy Sometimes the infection does not go away even after root canal therapy. In these cases, an apicoectomy can be done to remove diseased tissue from the bony area around the root of your tooth.

Crown Abcess

Filling

A cut is made to allow access to the base of the tooth. Any diseased and inflamed tissue is removed. The tip of the tooth root is also removed.

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.

A crown is placed to protect the tooth; as healing occurs, new bone grows in and fills the space.

Tooth with bony defect is given root canal treatment.

The diseased crown and root are sectioned off and removed.

A fixed bridge is placed to stabilize the treated tooth. As healing occurs, bone grows in.

Root Hemisection and Restoration

EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

The Chairside Instructor

30

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Effects of Tooth Loss Drifting Teeth

Tooth Replacement

Facial Collapse Without tooth replacement

Position of teeth immediately after a tooth is lost.

If the tooth is not replaced, other teeth can drift out of position and change the bite.

Without tooth replacement

With tooth replacement

With tooth replacement

When teeth are lost and not replaced, the face looks older. The lips appear thin and flattened. The chin moves forward and upward and appears pointed.

Also, the mouth loses some of its shape, and the lip line straightens. Pouches become pronounced on either side of the lower jaw. Cracks and sores may form at the corners of the mouth.

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

31

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Fixed Bridge Placement

Tooth Replacement

Pontic

Missing tooth

To replace a missing tooth with a conventional three-unit bridge, teeth next to the gap are reduced.

The custom-made bridge is placed over the prepared teeth.

After adjustments are made, the bridge is cemented into place.

Flossing Under a Bridge

Using a floss threader, insert floss under the bridge.

Gently rub the side of each tooth next to the bridge with the floss, cleaning under the gum too.

EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

Rub the floss from side to side along the underside of the pontic. The Chairside Instructor

32

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Resin-Bonded Bridge

Tooth Replacement

Placement of a Resin-Bonded Bridge

Smile is missing a tooth

Resin-bonded bridge is being inserted

Smile restored by resin-bonded bridge

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

33

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Removable Partial Dentures

Tooth Replacement

Placement of a Removable Partial Denture

Partial denture above gum

Partial denture in place

Partial denture in mouth (metal clasps on two teeth are visible)

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

34

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Full Dentures

Tooth Replacement

Conventional Dentures

Mini-Implants with Denture

Image © Elesevier Inc. All rights reserved.

Before

If you are missing all of your teeth, your dentist may recommend dentures. Complete dentures are custom-made to fit your mouth. They are usually held in place by one of two methods:

Implants with Denture

With mini-implants

After

• Conventional complete dentures rely on your cheek muscles, lips, saliva, and sometimes your tongue to stay in place. Conventional dentures are removable. • Implant-supported complete dentures attach to cylinders that have been surgically placed in the jaw. Many patients find these dentures to be more secure and comfortable, and the implants can help reduce possible bone loss. These dentures may or may not be removable.

Implants in upper jaw

Dentures placed on implants

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

35

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Implants

Tooth Replacement

Before and After

Natural Tooth

Dental Implant

Crown

Missing tooth

Gum tissue Tooth root

Bone

Abutment (post)

Implant

Tooth replaced by a dental implant

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

36

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Implants There are three general phases of implant treatment:

Tooth Replacement

Steps of Implant Placement

• Implant placement: The dentist surgically places the implant into the jaw. • Healing: The bone grows around the implant and holds the implant in place. This can take up to several months. • Replacing your missing teeth: The abutment, then a crown, bridge or denture will be made to fit your mouth and your implants. Once completed, the man-made teeth are attached to the implant posts.

Missing tooth

Implant and abutment in place

Tooth replaced by a dental implant and crown

Steps of Implant Surgery Bone

Implant

Gum tissue

Abutment

Crown

Before implant

The implant is surgically placed in the jaw. Bone and tissues grow around the implant.

A crown is placed on the implant. The crown may be connected to the implant by an abutment. The Chairside Instructor

EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

37

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Implants Peri-Implantitis

Tooth Replacement

Peri-Implantitis

Bone Loss and Gum Recession

Peri-Implantitis (the inflammation and bone loss around implants of soft tissue around the implant).

Bone and gum recession with implant exposure.

Implants are not invincible! Just like your natural teeth, implants can last for many years if you take good care of them every day. But, you can still experience problems with implants if they are not properly maintained. This may lead to implant infection and inflammation — known as peri-implantitis. This can cause your implant to become loose or shift because the bacteria and soft tissue is preventing your jaw bone from growing around the abutment.

If the infection is not treated, it could spread to other parts of your mouth and your implant may need to be removed and/or replaced.

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

38

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Implants

Tooth Replacement

Implant-Supported Bridge

Missing teeth

A bridge is placed on implants

After the bridge is placed

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

39

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Bone Grafting

Tooth Replacement

Building Up Bone to Support Implants If there is not enough bone to support the implant, bone can be added by a process called bone grafting. Bone substitutes — either synthetic or natural — can be placed under the gums. Over a period of about 8 to 12 weeks, these materials replace missing bone and can stimulate new bone growth.

Before

Bone substitute is placed

Treatment area is protected

After

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

40

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Orthodontic Treatment

Orthodontics

Malocclusion: Early Treatment

Malocclusion: Adolescent Treatment

Before treatment

Before treatment

After treatment

After treatment

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

41

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Orthodontic Treatment

Orthodontics

Appliances Used During Growth and Development Crooked teeth and bite problems are often solved with orthodontic treatment. Braces are the most common way to straighten teeth and correct major bite problems.

Gum Disease with Orthodontic Appliances

A space maintainer holds space for a permanent tooth.

A lingual arch holds space in the lower jaw when several teeth are lost too early.

During the growth period, conditions such as a narrow upper jaw may be corrected by a palatal expander.

Bonded clear brackets (upper) and/or metal brackets (lower) can be used as braces.

Removable retainer can hold teeth in place after braces are removed.

Removable retainer in place

Avoid unnecessary complications with your braces! It’s important to keep your mouth healthy — especially when you are wearing braces. Inflamed, puffy gums can make it difficult to keep your teeth and appliance clean. Your dentist or hygienist can show you how to properly clean your teeth when you have braces to help prevent issues, like gum disease. Inflamed, puffy gums

Image © Elesevier Inc. All rights reserved. EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

The Chairside Instructor

42

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Surgical Correction

Orthodontics

In some cases, surgery is needed to improve the function and appearance of a patient’s bite. This may be the case if skeletal problems with the upper or lower jaws have caused poor alignment of the teeth.

Protruded Lower Jaw

Protruded Upper Jaw

Before surgery

Before surgery

After surgery

After surgery

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

43

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Cosmetic Options Whitening

Before

Cosmetic Options

Veneers

After

Before

After

Combination Treatments #1

Combination Treatments #2

Before

Before

After

After

Combination Treatments #3

Before

After

EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

The Chairside Instructor

44

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Veneers

A porcelain veneer is placed

Cosmetic Options

After placement

A veneer is a thin covering that is placed over the front (visible) part of the tooth. Veneers can be used to fix gaps between teeth or improve the appearance of teeth that are badly stained, misshapen or out of alignment.

Before veneers

After veneers

Veneers are made of either porcelain or composite resin material. Your dentist will help you choose the material best for you based on strength, stain resistance, color and appearance. The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

45

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Tooth Erosion

Other Oral Conditions

Tooth erosion happens when your enamel begins to wear away and exposes the soft, yellow layer of dentin beneath it. When the enamel on your teeth thins out, your tooth protection is weakened and the inside layers can be exposed to more acid and bacteria. This puts you at greater risk of problems like decay, cavities and infection. Causes of Tooth Erosion • Eating and/or drinking items that are acidic or high in sugar, like soft drinks, fruit juices, candy and energy drinks • Frequent heartburn or acid reflux (also known as GERD) • Eating disorders like bulimia

Erosion and staining from drinking too much soda. The enamel has been worn away from around the existing fillings, putting the teeth at higher risk of decay and infection.

Severe erosion from acid reflux.

Erosion from an eating disorder (bulimia).

• Dry mouth (Xerostomia)

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

46

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Tooth Erosion

Other Oral Conditions

How to tell if you have tooth erosion: • Your teeth are sensitive to hot, cold or both • Your teeth appear shiny, transparent, or yellow/discolored • Dimples or indentations on the chewing surfaces of your teeth (also known as “cupping”) • Changes in size and shape of your teeth as the enamel wears away

Cupping on the chewing surfaces of teeth is a sign of moderate erosion from acid reflux.

As the acid wears away the enamel on your teeth, the size and shape will change.

The soft layers of your teeth become exposed and your teeth may change in color or appear yellow and shiny.

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

47

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Wisdom Teeth An impaction is when a tooth is unable to erupt into the mouth because the tooth is blocked by another tooth or by bone or gum tissue.

Other Oral Conditions

Different Types of Impactions

Bony Impaction — part or all of the tooth is covered by bone Tissue Impaction — biting surface of the tooth is covered by soft tissue (gums)

Extraction of Impacted Tooth

Inflamed area

Impacted third molar

After the molar is extracted, the site is sutured closed.

Over time, new bone will grow in and fill the site. The Chairside Instructor

EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

48

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Temporomandibular Disorders (TMD) Two temporomandibular (tem-PORO-manDIB-u-lar) joints work together in a delicate balance with muscles, ligaments, cartilage and your jaw bones. When problems prevent these parts from working together properly, known as Temporomandibular Disorders (TMD), pain may result.

Other Oral Conditions

Temporomandibular Disorders (TMD)

Treatment Options

Signs and symptoms may include:

• avoiding chewing gum

• pain in or around the ear

• using heat or ice packs to relieve the pain

• tender jaw muscles

• practicing relaxation techniques to control jaw tension, such as meditation

• clicking or popping noises in the jaw • difficulty opening or closing the mouth • pain when yawning or chewing • jaw joints that feel as if they are “locked,” “stuck” or they “go out”

• eating softer foods

• doing exercises to strengthen your jaw muscles • taking medications prescribed by your dentist • using a night guard or bite plate to decrease clenching or grinding of teeth

• headaches

The Temporomandibular Joint (TMJ)

Close-up of TMJ Cartilage

Ligament

TMD is a condition, not a specific disease. They are often managed rather than cured.

Jaw Bone

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

49

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Cracked Tooth

Other Oral Conditions

If you think you may have a cracked tooth, look for these signs:

Crack

• sharp pain that quickly disappears when biting down • pain that comes and goes • pain when eating or drinking • feeling that something is stuck between your teeth

A small crack in the tooth

Or, you may have no signs at all. If you are having symptoms, help your dentist and hygienist find the cracked tooth by sharing some information:

Crack widens as you bite down

Cracks in a tooth with a large filling

• the area where you feel pain • things that cause you tooth pain (such as heat, cold or foods that are sweet, sour or sticky)

Types of treatment include the following:

Why Does a Cracked Tooth Hurt? The crack may be too small to see, but when it opens, the pulp inside the tooth may become irritated. If the crack extends into the pulp, the tooth may become sensitive to extreme heat and cold.

• repairing the tooth with a filling material

• no treatment right away • placing a crown on the tooth to protect it from further damage • endodontic (root canal) therapy if the nerves of the tooth are infected • removing the tooth if it is severely cracked and cannot be saved

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

50

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Tooth Grinding and Clenching (Bruxism) What is Bruxism?

How is bruxism treated?

Bruxism (BRUCKS-is-im) is a habit of grinding or clenching your teeth. It can happen in children or adults of any age.

Treatment depends on each person’s situation. Your dentist may recommend one or more of the following treatments:

People who suffer from bruxism may have one or more of these symptoms:

• a protective night guard worn over your teeth while sleeping

• headache or earache • sore jaw • jaw clicking • frequent toothaches • sensitive teeth

Other Oral Conditions

• ways to lower stress • medication for pain or muscle spasms • exercises to relax jaw muscles • fillings or other dental treatment to repair damaged teeth

Bruxism before and after reconstruction

• facial pain • worn or cracked teeth or fillings • tongue indentations • trouble sleeping

This patient’s tooth enamel has worn away, exposing the dentin, the softer yellow layer underneath.

Bruxism damage repaired with full mouth reconstruction

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

51

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Frenectomy and Tori Removal

Other Oral Conditions

Frenectomy A frenum is a small band of tissue. Removal of the frenum, called a frenectomy, may be necessary if the frenum causes space between teeth.

Frenum

Frenum before removal

Incision of frenum

Frenum after removal, tissue stitched together for proper healing

Tori on both sides (bilateral)

Tissue is partially removed and pulled back to expose tori

Bone recontoured to remove tori

Tori Removal

A torus is a bony bump or growth. Sometimes a torus (or “tori” if more than one torus, as pictured above) needs to be removed to make room for a partial or a denture, or to make more room for your tongue. Image © Elesevier Inc. All rights reserved.

EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

Tissue is sutured following tori removal

The Chairside Instructor

52

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Tobacco Using tobacco in any form is risky to your oral and overall health. Whether you smoke, chew, dip, or vape, there is no such thing as a safe form of tobacco!

Other Oral Conditions

Smoking causes stains that can only be removed by a licensed dental professional.

Sores, gums that pull away from teeth and stains often result from using smokeless tobacco.

Tobacco users are at higher risk of gum disease, which can lead to tooth loss.

What happens to your mouth when you use tobacco products? • It can lead to gum disease and tooth loss. • Your teeth and tongue become brown and stained. • You can have bad breath that doesn’t go away. • You can get mouth sores. • It may take you longer to recover from dental treatments. • You can get mouth/throat cancer. The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

53

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Mouth and Throat Cancer and Mouth Sores During each dental exam, your dentist will check your face, neck and mouth for lumps, red or white patches, and sore areas that do not heal. Be sure to tell your dentist if you see any changes in your mouth and neck. If signs of cancer are found, it is easier to treat at this stage than later on.

Other Oral Conditions

Mouth Cancers

Signs of oral (mouth) cancer: • a sore or irritation that doesn’t go away

Cancer on the tongue

Cancer on the lip

• red or white patches • pain, tenderness or numbness in mouth or lips • a lump, thickening, rough spot, crust or small eroded area

Mouth Sores

Leukoplakia (which can turn into cancer) inside the cheek

Throat Cancer

• difficulty chewing, swallowing, speaking, or moving your jaw or tongue • a change in the way your teeth fit together when you close your mouth

Signs of throat cancer: • lump or growth in the throat or neck area

Tonsil Tongue

Canker sores

• cough or sore throat that doesn’t go away • earache • trouble with swallowing • hoarseness or other changes in your voice

Cold sores or fever blisters

Candidiasis (a fungal infection, also called oral thrush or moniliasis) Throat cancer affects the base of the tongue and tonsils.

The Chairside Instructor EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

54

Copyright @ 2017. American Dental Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Photo Credits

The ADA thanks our members who contribute their clinical photos to the Chairside Instructor. If you have high-quality digital images to share, please email [email protected] and ask for submission guidelines.

Page 7, “Plaque and Its Effects” — Calculus photos courtesy of Daniel M. Schweitzer, DDS. X-ray of calculus buildup courtesy of Dr. Padmaja Mutyala.

Page 24, “Cavities” — General steps of a filling photos courtesy of Dr. Roy Daniels, www.myfamilydentist.com.

Page 11, “Sealants” — Sealant photos courtesy of Adam A. Francois, DMD, FAGD.

Page 26, “Inlays and Onlays” — Inlay and onlay photos courtesy of Dr. Ting-Wey Yen.

Page 12, “Dental X-Rays” — CBCT courtesy of Dr. Tawana Feimster.

Page 28, “Crown Preparation and Placement” — Filling/crown photos courtesy of John R. Nosti, DMD, FAGD, FACE, FICOI, SmileDesignNYC.com.

Page 14, “Stages of Periodontitis” — Advanced Periodontitis photo courtesy of Dr. John C. Hall.

Page 35, “Full Dentures” — Implant denture photos courtesy of Dr. Ting-Wey Yen.

Page 16, “Gum Disease Treatment and Maintenance” — Before-and-after photos courtesy of Dr. Dorothy Anasinski.

Page 37, “Implants” — Implant photos courtesy of Dr. Ting-Wey Yen.

Page 19, “Gum Recession” — Gum recession photo courtesy of Dr. Kevin D. Dow, www.chicagostylesmiles.com.

Page 38, “Peri-Implantitis” — photos courtesy of Dr. H. Ryan Kazemi.

Page 20, “Gum Recession Treatments” — Gum recession photos courtesy of Dr. Bernard W. Murray.

Page 41, “Orthodontic Treatment” — Before-andafter photos courtesy of Grant Bowbeer, DDS, MS.

Page 22, “Dental Caries” — Decay Under a Filling photo captured by Dr. Joseph Nelson II. X-ray courtesy of Dr. Padmaja Mutyala.

Page 43, “Surgical Correction” — Before-and-after photos courtesy of Grant Bowbeer, DDS, MS.

Page 23, “Tooth Decay in Baby Teeth” — Initial decay photo courtesy of David M. Hasson, DMD.

Page 44, “Cosmetic Options” — Before-and-after photos for Whitening and Combination Treatments #1 courtesy of Dr. Victor H. Burdick. Veneers courtesy of John R. Nosti, DMD, FAGD, FACE, FICOI, SmileDesignNYC.com. Combination Treatments #2 and #3 courtesy of Robert A. Lowe, DDS.

Page 45, “Veneers” — Before-and-after photos courtesy of John R. Nosti, DMD, FAGD, FACE, FICOI, SmileDesignNYC.com. Reprinted with permission from Dentaltown Magazine. Page 46, “Tooth Erosion” — Photos courtesy of Mark M. Montana, DDS.

Page 47, “Tooth Erosion” — Photos courtesy of Martha Ann Keels, DDS, PhD.

Page 48, “Wisdom Teeth” — Panorex radiograph (top left) courtesy of Brian A. McMurtry, DDS, FAGD. Radiograph (top center) and impaction photo (top right) courtesy of Dr. Jeffrey Dorfman, nycdentist.com. Page 50, “Cracked Tooth” — Photo of cracked tooth with large filling captured by Dr. Joseph Nelson II. Page 51, “Tooth Grinding and Clenching” — Before-and-after photos courtesy of Dr. Ting-Wey Yen. Page 53, “Tobacco” — Nicotine stain photo courtesy of Othman Shibly, DDS, MS, School of Dental Medicine, University at Buffalo, State University of New York.

The Chairside Instructor

EBSCO : eBook Collection (EBSCOhost) - printed on 9/2/2019 1:49 PM via CENTRAL GEORGIA TECHNICAL COLLEGE AN: 1599478 ; Association, American Dental.; The Chairside Instructor : A Visual Guide to Case Presentations Account: mac2.main.tcsg

55