General dentistry that treats the problem and protects the tooth

Dental exams and diagnosis

Every treatment starts with an accurate diagnosis. A dental exam is how the dentist finds out what's causing pain, sensitivity or swelling, or confirms that everything is healthy. During an exam the dentist looks at each tooth, your gums, your bite and the soft tissues of your mouth, and checks existing fillings and crowns for wear or leaks.

Depending on your symptoms and history, the dentist may recommend X-rays to see between teeth, below the gumline and around the roots, where problems are often hidden. X-rays are taken only when they're needed to answer a clinical question.

Questions worth asking at any exam

• What exactly did you find, and how urgent is it?
• What are my options, including waiting and monitoring?
• What happens if I don't treat it now?
• How many visits will it take, and what will it cost?

Routine exams are covered in more depth in our guide to preventive dental care, and our family dentistry page explains what changes at each age.

Fillings

A filling repairs a tooth that has been damaged by decay or a small fracture. Tooth decay is caused by bacteria in plaque that produce acids, which gradually dissolve tooth enamel. Once a cavity forms, it won't heal on its own; left untreated, it can grow toward the nerve and cause pain or infection.

What the procedure involves

The area is numbed with local anesthetic. The dentist removes the decayed or damaged portion of the tooth, cleans the space, and fills it with a restorative material shaped to match your bite. Tooth-colored composite material is commonly used; the dentist will explain which material suits the size and location of the filling.

Afterward

Your lip and tongue may stay numb for a few hours, so avoid chewing on that side until the feeling returns. Mild sensitivity to hot, cold or biting pressure is common for a short time. If your bite feels high or the sensitivity gets worse instead of better, call us; a small adjustment often helps.

When too much of a tooth is missing for a filling to be strong, a crown or onlay may be recommended instead.

Root canal treatment

In the past, teeth with diseased nerves often had to be removed. Today, root canal treatment allows dentists to save many of these teeth. Inside every tooth is the pulp, soft tissue containing nerves and blood vessels. When deep decay, a crack or an injury allows bacteria to reach the pulp, it can become inflamed or infected, causing pain and sometimes an abscess.

Signs you may need a root canal

• Severe, throbbing or lingering tooth pain, especially at night
• Sensitivity to hot or cold that lingers after the trigger is gone
• Pain when biting or touching the tooth
• Swelling of the gum, or a pimple-like bump that drains
• A tooth that has darkened after an injury

Some infected teeth cause no symptoms and are found on an X-ray. Only an exam can confirm whether a root canal is the right treatment.

What the procedure involves

After numbing the tooth, the dentist makes a small opening, removes the infected or inflamed pulp, cleans and shapes the canals inside the roots, and then fills and seals them. The tooth is closed with a temporary or permanent filling. Treatment may take one or more visits depending on the tooth and how much infection is present.

After a root canal

Tenderness for a few days is common and is usually managed with over-the-counter pain relief. Avoid chewing hard foods on the tooth until it has been fully restored. Back teeth that have had a root canal are often weaker and at greater risk of breaking, so a crown is frequently recommended to protect them.

Tooth extractions

Saving a natural tooth is usually the first choice, but sometimes removing it is the healthiest option. An extraction may be recommended when a tooth is too badly broken or decayed to repair, when infection has damaged too much of the supporting bone, when a tooth is severely loose from gum disease, or when a problem wisdom tooth is causing pain or infection.

What the procedure involves

The dentist numbs the tooth and surrounding gum thoroughly. A simple extraction loosens the tooth and removes it in one piece. A tooth that is broken at the gumline or has curved roots may need a surgical extraction, where the tooth is removed in sections. In some cases a bone graft may be placed in the socket to preserve the area for a future implant.

Healing and aftercare

• Bite gently on gauze to control bleeding for the first hour.
• For the first day, avoid rinsing forcefully, spitting, drinking through a straw and smoking; these can dislodge the blood clot.
• Eat soft foods and chew on the other side for a few days.
• Use cold packs on the face for swelling and take pain relief as advised.

Some pain and swelling for a few days is expected. Call us if pain gets worse after the third or fourth day, as this can be a sign of a dry socket, or if you have a fever, spreading swelling, or bleeding that won't stop.

Before an extraction, the dentist will talk about how the gap may be replaced, if needed, with an implant, a bridge or a denture.

Crowns

A crown is a custom-made cap that covers the entire visible part of a tooth. It's used to protect a tooth that is cracked, heavily filled, badly worn or weakened by a root canal, and to restore its shape and function. Crowns are also used on top of dental implants and as anchors for bridges.

Our crowns and restorations page covers when a crown is recommended, how it's made and fitted, and how to care for it.

Dentures

Dentures are removable replacements for missing teeth and the surrounding gum tissue. Missing teeth can make chewing and speaking harder, and over time the face can lose some of its support. Dentures help restore function and appearance.

Types of dentures

What to expect

Making dentures usually takes several appointments for impressions, measurements and try-ins, so the final denture fits well and looks natural. New dentures take time to get used to. Sore spots are common at first and can usually be eased with small adjustments. Your mouth changes shape over time, so dentures may need to be relined or remade eventually.

Caring for dentures

Clean dentures daily with a soft brush and a denture cleaner rather than regular toothpaste, which can be abrasive. Remove them overnight unless the dentist advises otherwise, keep them moist when out of the mouth, and continue to clean your gums and any remaining teeth.

Considering an alternative? See how dental implants compare.

Night guards for clenching and grinding

Many people clench or grind their teeth, a habit called bruxism, often during sleep and without knowing it. Over time grinding can wear teeth down, chip or crack them, damage fillings and crowns, and contribute to jaw soreness and headaches.

Signs you may grind your teeth

• Flattened, chipped or unusually worn teeth
• A sore jaw or dull headache when you wake up
• Tooth sensitivity without an obvious cavity
• A partner hearing grinding sounds at night

How a custom night guard works

A night guard is a thin appliance worn over the teeth while you sleep. It places a protective layer between upper and lower teeth to absorb the forces of clenching and grinding. A custom guard is made from impressions or scans of your teeth, so it tends to fit better and be more comfortable than over-the-counter options. The dentist can check whether a guard is suitable and adjust its fit.

Rinse and brush the guard after each use, let it dry, and store it in its case. Bring it to checkups so the dentist can look for wear. For sports, a separate athletic mouthguard is designed to protect against impact.

Gum care

Healthy gums hold your teeth in place. Gum disease begins as gingivitis, with red, swollen gums that may bleed when you brush. Without treatment it can progress to periodontitis, where the tissues and bone that support the teeth break down, which can eventually lead to tooth loss.

Treatment depends on the stage. Early gingivitis often improves with a professional cleaning and better daily brushing and cleaning between teeth. More advanced disease may need a deep cleaning (scaling and root planing) and closer follow-up. Learn more on our preventive dentistry page.