Four Points to Successful Dentistry in Arlington, Virginia

• Anesthetic
• Crowns
• Exams
• Fillings
• Invisalign®
• Labs
• Night Guards
• Periodontal Disease
• Referrals
• Wisdom Teeth

Planning

This is where cases either succeed or fail. This phase breaks down into two parts; assessing your current situation, and identifying where you want to be.

Identifying where you are now

This involves getting an accurate diagnosis of the current condition of the following:

• Teeth
• Gum
• Bone
• Bite
• Smile
• Oral health

Identifying where you want to be

Once we establish your current condition, we can identify your goals. When we understand your expectations, priorities, and desired outcome we can begin to shape the process to reach your goals. This involves outlining the following:

• Realistic timeline
• Budget
• Any necessary external evaluations or therapy

Foundation

Next, we make sure that your treatment is built on a healthy, solid foundation. That means making sure gum tissue, bone tissue, bone and tooth structure are healthy.

Possible procedures to improve your oral health may include:

• Sinus augmentation
• Joint therapy
• Oral surgery
• Soft or hard tissue grafting
• Tooth movement
• Implant placement
• Removal of inadequate tissues

Precision

This is a factor we are most proud of, and what separates us from the rest. You’ll notice this only after your treatment is completed. Precision refers to uncompromising attention to detail and having the ability to execute that detail. Precision, coupled with advanced technique, modern equipment, an innovative laboratory, and master ceramist will deliver a beautiful end result that you can be proud of.

Maintenance

This is essential to making sure your new smile lasts a lifetime. Best practices for maintaining your smile include:

• 3-4 month recall appointments
• Night guards
• Practicing good oral hygiene

Following these three simple steps will ensure your dental work lasts and can safeguard your smile from malfunction or premature failure. Your oral health is an investment! Virginia Dental Center is here make sure that it endures, so you can continue smiling.

“No-Questions-Asked” Guarantee

We guarantee our work for 5 years, covering any structural failure without question. In order to take advantage of this guarantee, you must wear a hard night guard. These are strongly recommended for any dental restoration, even if you don’t clench or grind your teeth at night.

Failure to wear a hard night guard voids the guarantee.

Anesthetic in Arlington, Virginia

Making sure your experience is as comfortable as possible.

Injection of local anesthetic is common for most procedures: It provides patient comfort during restorative dental care.

Two or three injections are often needed with normal effects ranging from 2 – 12 hours post injection. It is okay to eat and drink, but keep in mind that sensation to biting forces and temperature is impaired. Please be careful. Almost all discomfort associated with dental procedures postoperatively is due to the injection/s and/or trauma to the gum, and not the actual procedure to the tooth itself.

Swelling, bruising and generalized discomfort at the injection site as a result of soft tissue trauma are common for up to 10 days. The discomfort may radiate and spread. Most patients feel little or no discomfort by the following day.

Dental Crowns in Arlington, Virginia

The Crown and Process

The purpose of a crown is to replace the structure, function and esthetics of a damaged or defective tooth. This protects the tooth, and often nerve, from future damage. Crowns are all-ceramic, highly esthetic restorations that fully cover teeth. To prepare a tooth for a crown, the visible portion is reduced in all dimensions (360°) by 1 - 1.5mm. All damaged tooth structure (including decay, fractures and old fillings) is removed. Sometimes, fractures decay and old restorations extend under the gum line. In this case, a laser is required to remove the gum tissue so that healthy tooth structure can be exposed and prepped. This process is called a “gingivectomy.” Tooth structure that needs to be replaced, to aid in the retention of the crown, is called the “buildup.” If a gingivectomy is needed, the gum tissue around the crown can be sore for 7-10 days. Proper hygiene less flossing should be continued to keep the gum area clean while it heals. The Motrin regiment below will be essential to limit discomfort during the tissue healing phase.

Temporary crowns are temporary

They protect the tooth and prevent space closure prior to final crown cementation. Temporary crowns can be in place for weeks to years. The temporary crown should not feel “high” and will not feel like a natural tooth or like the permanent crown. We recommend brushing the temporary crown as usual, but not flossing around crown unless absolutely necessary. To avoid pulling the temporary crown off while flossing, pull floss “down” between teeth then pull floss out to the side to remove. Avoid sticky or hard foods, like caramel, chewing gum or nuts. If the temporary crown comes off and you have a scheduled appointment to have the permanent crown cemented, do not worry. You will not hurt the tooth underneath. Exposed dentin will often cause the tooth to be more sensitive, but it is not imperative that the temporary be replaced so long as the discomfort is manageable.

Planning Exams in Arlington, Virginia

Knowing how long to plan for a hygiene appointment can make scheduling easier.

In the case of a missed or broken appointment, a hand written letter will be sent to the patient and scanned into their patient chart. Following the letter, the “patients due for recall” list will be obtained and phone calls will be made from designated location.

At every practicable time, a doctor will conduct an exam in the established order. Summon an exam doctor in the following order with relation to a 45 minute hygiene appointment:

• 0-30 minutes – the IE doctor
• 30-40 minutes – any available doctor
• Should a doctor not be available by the 40th minute the patient will be given three options:

1. No exam this appointment
2. Exam by a doctor at another day or time
3. Wait for the exam, possibly in either another room or the waiting room/area.

Late hygiene policy – cleanings should end 10 minutes prior to end of appointment (5 minutes cleaning and 5 minutes exam)

Planning Fillings in Arlington, Virginia

Proper care and planning can increase the longevity of restorations.

Before a filling is placed; cracks, decay and all old defective restorative materials (usually amalgam, gold, ceramic or old composite) are completely removed.

Dental composite (white filling material) is placed over a bonding agent, which bonds the composite to the tooth structure. Dental composites, similar to enamel, are very susceptible to acidic environments, and their lifespan is largely dependent on clenching/grinding habits, oral hygiene habits and oral pH. Similar to enamel, items with low (acidic) pH such as coffee, soda, tea and wine, greatly affect the lifetime serviceability of restorations.

Sensitivity

Because patients are often “numb” when the bite is checked, fillings may feel “high” once the anesthesia wears off. In this case, please call and return to the office for a bite adjustment. Sensitivity is normal and can last for 2-3 weeks following fillings, however 1-2 days is more common.

Planning Invisalign® in Arlington, Virginia

Planning for Invisalign®/What Do Buttons And Slenderizing Do?

Invisalign® was developed as an option to move teeth without using traditional braces. The technology works by taking the registration of a patient’s current dentition and using CAD/CAM technology to virtually manipulate the teeth into a desired esthetic and functional position. This measured movement is equally divided into 2 week segments that correspond with custom-manufactured aligners. Aligners (trays) are made of hard plastic and provide the necessary forces to move teeth to the next position predicted by Invisalign’s software. If more movement is required then more aligners will be needed.

Buttons? Slenderize?

Using “buttons” and “slenderizing” teeth are very common and both are often needed with adult cases. Buttons are small, transparent dental plastics placed on teeth to help facilitate movement. We describe them as Invisalign®’s more esthetic version of brackets that are used with traditional braces (they are usually unnoticeable by the casual observer). When buttons are prescribed, their purpose is to gain desired tooth movement. “Tooth slenderizing,” referred to as IPR (interproximal reduction) is simply removing a small amount of tooth structure between crowded teeth so they can move into alignment. Usually only the thickness of a fingernail is removed (0.1mm - 0.3mm). This process does not harm teeth.

Aligners

Invisalign® is only effective when trays are worn 20+ hours a day. Most people describe the first 3 days of each aligner as “pressure awareness.” Invisalign® is not painful; however, we recommend changing trays at night and taking ibuprofen to help with any initial discomfort. Usually, after three days of wearing an aligner, the teeth will move to their new location, the pressure subsides, and trays become easier to place and remove. If the aligners are not fully seating or fully engaging the buttons, after 7 days, please call our office for an Invisalign check.

Keeping aligners clean is important. Aligners should not be worn when eating or drinking (water is okay). We recommend brushing trays with a toothbrush and toothpaste each time you brush your teeth. You may want to brush them more often!

Your Invisalign® Delivery Appointment

At your invisalign delivery appointment, you will be given your first three aligners. By this time, if buttons or slenderizing were needed for your case, you will already have been to your appointments for these.

YOU MUST WEAR YOUR ALIGNERS! Your teeth will not move if you do not wear the aligners for AT LEAST 20+ hours EVERYDAY!!!

• Aligners should be out when you eat and drink anything but water. They should be worn at ALL other times.
• You will change your aligners to the next set after 14 days. Expect pressure for the first few days of wearing each aligner. When it is time to change aligners, our advice is to start the new aligner at night just before bed. Take 400-800mg of Motrin (assuming not contraindicated) at the same time. In the morning, most of the pressure will be gone!
• Brush your aligners with toothpaste and water at least every time you brush your teeth (no less than 2x/day). This will keep them clean.
• If a button comes off, do not worry. At your next appointment we will most likely replace it.
• It may take a few days for the aligners to seat completely. Continue to use thumb and finger pressure to force the teeth into their new position.
• Your bite will change over the course of treatment. You will notice this when the aligners are out. Do not worry. At the end of your case we will adjust your bite.
• In order to fine tune a case, additional aligners are sometimes necessary, this is referred to as a refinement. New impressions will be necessary and there is no fee for a refinement assuming aligners have been worn properly and adequately. A $600 processing fee will be applied to refinements if aligners have not been worn adequately.
• At the end of your case, you will want to choose a method to “retain” the movement and prevent relapse. We have found the longest lasting and best option for retainment of teeth movement and prevention of relapse is for patients to wear an upper hard night guard and lower removable retainer. Other options include a fixed wire on the back of teeth or lastly upper and lower removable retainers.

Planning with High Quality Lab Designs in Arlington, Virginia

One factor not mentioned, but we think is important for patients to know, is the difference in quality between dental labs who construct the final product. The Virginia Dental Center is proud to use Glidewell, a high-quality, commercial lab based in Southern California for the majority of our cases. It is family owned, has a great reputation, and uses cutting edge CAD/CAM technology to design and build most of its cases. We have visited Glidewell laboratory and fully endorse its technicians’ skill. We stand behind the high-quality products they supply for our patients.

In some instances, patients require or desire a lab to custom design, fabricate, match or characterize their cases. These cases involve a senior level ceramist to custom shade and build each tooth. These cases often involve one or more front teeth and tend to be very difficult technically. For these situations, we recommend that patients choose our premium level lab option, capable of providing the best possible esthetic result. A $249/tooth “custom shading and design” fee will be added for this premium product and service. It goes without saying that nature can not be duplicated, and we remind every cosmetic patient that perfection is, by definition, not achievable. For the patient that wants the very best dentistry can offer, we feel it is important to offer this premium level of product.

Lastly, we want to remind you that while our goal is to restore nature, it will be impossible to do so. A close evaluation of even the “best of the best” cases will reveal inconsistencies, discrepancies, and small imperfections. That being said, we will do everything possible to achieve the BEST possible esthetic result, not a perfect esthetic result. Prior to finalization/cementation, you will be given the opportunity to “accept” or “reject” the final product. If you accept the final product, changes to the restoration(s) incurred subsequent to cementation, that incur charges, will be your (the patients) responsibility. These charges may include, but are limited, to time, materials, lab fees etc.

The Virginia Center for Cosmetic & General Dentistry guarantees its work for 5 years with a “No-Questions-Asked” structural failure guarantee. This guarantee covers all prosthodontic work that sustains a structural failure. Failure to have and wear a Hard Night Guard voids this guarantee. Hard night guards are strongly recommended following the insertion of all anterior prosthodontic restorations.

Treating Periodontal Disease in Arlington, Virginia

What is Periodontal Disease?

Periodontal disease, or periodontitis, is a gum infection that damages the gums and can destroy the jawbone. It can be accompanied by bad breath, toothaches, bright red gums, loose teeth, receding gums, tender gums, or tooth loss.

How is Periodontal Disease treated?

The first step is to have a dental cleaning above your gum line.

The next step is to bring you back for a “deep” cleaning, called scaling and root planing. A local anesthetic will be given to reduce any discomfort. Using an instrument called an ultrasonic scaler, plaque and tartar will be carefully removed down to the bottom of each pocket. This procedure helps gum tissue to heal and pockets to shrink.

Once the scaling and root planing treatment is complete, it is recommended that you have periodontal maintenance cleanings every 3 months for one year. After one year, a re-evaluation of pocket depths will be conducted to determine if pockets have healed (less than 4mm probing depths).

We also recommend an oral antibiotic rinse (0.12% Chlorhexidine) to help reduce the overall number of bacteria in your mouth and soothe the inflamed gum tissues.

Home Care is Critical!!! We recommend maintaining good oral hygiene at home by brushing twice for at least 2 minutes twice a day and flossing between teeth at least one time everyday. Regular follow-up appointments to your dentist are essential to help prevent periodontal disease from becoming more serious or from recurring.

Planning for Night Guards in Arlington, Virginia

How can a night guard help me? Why should I worry about clenching or grinding? How do you know when a night guard is needed?

Why we recommend them and why you should consider one.

A nocturnal para-functional limiting device, commonly referred to as a Night Guard (NG), is custom designed to protect the teeth, gum tissue and TMJ - jaw joint.

Why are night guards recommended?

Night Guards are recommended based on a suspicion that teeth, gums, and/or TMJ are under greater-than-average force from clenching and/or grinding. These para-functional habits are called bruxism. Without a sleep study, no one can prove that a person is bruxing. Night guard recommendations are always made from indirect evidence that bruxing is occurring. Bruxing can occur during the day or night and can begin or end at any point throughout life. Bruxism is often, but not always, most acute when people are under increased stress.

What is the indirect evidence that we look for before recommending a night guard?

Teeth that have advanced wear/aging will be flattened, shortened and may have “potholes” on their biting surfaces from the splintering of enamel. This results from increased pressure. Gastroesophageal reflux disease (GERD), diet, unusual habits and/or a poor bite can also result in advanced wear.

Teeth may develop gum recession and simultaneous “notches” at the gum line called abfraction lesions. These may or may not be sensitive when under excessive forces. Abfraction lesions result from excessive pressure which fractures the enamel at the gum line. Traditionally, abfraction lesions are explained to patients by saying they are brushing “too hard.” This is a remote possibility, but the most common causes of abfraction lesions and gum recession is orthodontics and excessive force on the teeth. Teeth can become looser than normal. All teeth can be moved slightly, however, the excessive movement of teeth may indicate excessive pressure on them.

Gums can develop periodontal pockets and can bleed as the result of excessive pressure. The TMJ may be sore. Symptoms of temporomandibular dysfunction (TMD) are usually described as mild to moderate discomfort around the ear, increased numbers or severity of headaches, upper or lower teeth that “hurt” or are sensitive, popping or clicking with or without pain in the joint itself, or muscle pain in the cheek areas near the molars.

Excessive force on teeth (clenching) is generated from the contracting muscles that close the upper and lower jaw together. These muscles fatigue due to excessive contracting and often become sore. Additionally, the joint is compressed and the cartilage in the joint may become physically distorted and/or damaged.

Night guards are custom fit to the teeth. They physically protect the teeth and prevent the muscles from contracting by opening the mouth slightly (i.e. top and bottom teeth are not in contact). By preventing the muscles from being in their “happy place,” or the spot they like to contract, the NG encourages the muscles to relax and relieves the excessive pressure in the joint.

Night guards must be hard. Hard night guards allow the lower teeth to slide around freely when the lower jaw is in motion. The problem with soft night guards, commonly found at local drug stores, is that they exacerbate bruxism because the jaws naturally want to chew soft things. Soft night guards protect teeth but can lead to even worse symptoms in the muscles and joints as a result of these muscles working more and not less. Soft night guards make bruxism worse simply because they are soft and we want to use the very muscles and joints we should be relaxing to “chew” them!

All of our work is guaranteed for 5 years with a “No Questions Asked” structural failure guarantee. This guarantee covers all prosthodontic work that sustains a structural failure. Failure to have and wear a hard night guard voids this guarantee. Hard night guards are STRONGLY recommended following the insertion of any and all anterior prosthodontic restorations.

Referring Dental Specialists in Arlington, Virginia

Our Philosophy on Referrals/When We Refer Specialists/FAQs

It is not uncommon that we recommend patients to see a specialist. Our philosophy regarding referrals is based entirely on quality of care, skill of practitioner, and patient experience. We recommend a referral when we feel that the outcome of a given procedure will be better in the hands of another healthcare provider – usually a specialist.

Most often, we refer for oral surgery, implants, periodontal procedures and root canals. CT evaluations, oral cancer screenings and second opinions are also referred to providers outside of this office. The individual or group that we recommend is not a random choice. Our decision is based entirely on credentials, quality of care, skill, communicative ability and chair side manner. In our opinion, the specialist is the best choice for a given procedures. However, they may not be the least expensive. Referrals are not based on insurance plans, companies, or networks. There is no financial or other compensatory “kickback” for referrals to referring doctors, practices, or offices. Moreover, patients should know that the recommended doctor or practice has has our professional respect, and the quality standards mirror those of Virginia Dental Center's.

We like to point out that the quality of care of specialists varies greatly. Individual skills, office technologies, and chair side manner are highly variable in the local area. We make recommendations based upon whom we would select to perform a given procedure on our teeth; it is only with that in mind that we will refer patients to that doctor or office.

We often get questions about insurances, including who is in-network, and with which plans they participate. We understand that personal financial restrictions, especially with the current nature of the economy, are a factor for patients. Unfortunately, we have also seen “bad dentistry” - poor diagnostic and communicative skills, and overall below average experiences - that has cost our patients more money and time than if they had followed the original recommendation. We have found that, on average, out-of-network providers cost about 20% more out-of-pocket than in-network providers. Keep in mind that some procedures, such as implant placement, are not covered by insurance companies, which results in no out-of-pocket difference between in- and out-of-network providers.

We always encourage our patients to see whomever they feel comfortable with when it comes to their healthcare. When a referral is given from this office, it is in the spirit of trying to find the best match of skill and chair-side manner for a specific procedure or goal. Patients are welcome to choose any provider or group, and we at the Virginia Dental Center will work with your choice. Our recommendation is simply that, a recommendation. If you feel you need to see a provider in a certain network, please contact that network for a recommendation.

Wisdom Teeth Removal

The problem with wisdom teeth

We recommend your wisdom teeth to be removed because any perceived advantage to keeping them is significantly outweighed by the potential problems, pain and/or damage to adjacent teeth or tissues, resulting from not having them removed. Quite simply, our mouths are too small to accommodate and healthily maintain them; ultimately this fact is the underlying problem with almost all wisdom teeth.

Don't wait until it hurts

Wisdom teeth should be removed BEFORE they hurt. Waiting until wisdom teeth hurt is a bad idea. The discomfort and swelling that can be associated with impacted or non-impacted wisdom teeth can be quite acute. We like to remind our patients that the presence or absence of pain in medicine is not a good predictor of disease presence or absence, and therefore it is even a worse indicator for the need for treatment.

Why wisdom teeth should be removed

The following list comprises the most common problems and statistics associated with third molars. This list is our detailed response to why your wisdom teeth should be removed.

• The location of wisdom teeth and associated difficulty to clean them result in the harboring of bacteria that contribute to bad breath, gingivitis, periodontitis and dental decay in other good teeth.
• The often severe pain and discomfort associated with wisdom teeth are a result of a lack of space, inadequate irruption, and/or inadequate development.
• Cysts or tumors can develop around impacted wisdom teeth.
• Wisdom teeth can destroy investments in orthodontics, affect other teeth positions and/or possibly make future orthodontics difficult.
• An uneven bite and uneven occlusal plane as the result of wisdom teeth can result in excessive force and pain in the temporomandibular joint (TMJ).
• As patients age, the likelihood of wisdom teeth pain and problems increase. Approximately 85% of wisdom teeth will NEED to be removed as the result of pain, infection or both, if not done so electively. In addition, it is well documented that the chance for complications and morbidity related to the process of wisdom teeth removal increases dramatically.