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Procedures

You can click on each individual procedure below to learn more about what it entails. It is important to us that you are aware of what is involved in your treatment. We welcome questions anytime.

The Initial Visit

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When you first arrive at our office my office manager, Teresa, will greet you and go over any questions you may have regarding our office procedures and policies. She will also go over your dental insurance benefits to let you know what their contribution will be towards your dental care. Her goal is to provide an accurate estimate as to what your insurance covers before we begin any treatment.

My dental assistant, Lara, will escort you to your private room, and go over your health and dental history. She will then take the necessary digital X-rays that I need to get good pictures of your teeth. The X-rays give me valuable information as to the condition of your existing fillings, crowns, bone health, and any cavities you may have. Depending on my findings, I will discuss options and treatment recommendations for your consideration.

Regular Dental Cleanings

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For adults and children who have been going to the dentist regularly, I will clean your teeth at your first visit. If you have not been to the dentist for a long while and/or have some concerns regarding the health of your teeth or gums, we may decide to do your cleaning at a separate visit. Lara will first polish your teeth to remove any plaque and food debris. After she is finished, I will come in the operatory and remove any remaining stains and tartar (calculus) from your teeth, leaving them feeling smooth and clean.

Root Planing and Scaling

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If it has been several years since you last had your teeth cleaned, or if you have been told that you have periodontal disease, then it is often necessary to do a more extensive cleaning. For this we normally schedule two separate appointments after your initial visit. Each of these appointments involves a thorough cleaning of half the mouth under local anesthetic. We provide complimentary nitrous oxide for those patients who would like a little something extra to help them relax during the procedure. After I complete the root planning and scaling, I will want to see you every three months for "perio-maintenance" cleanings. Studies have found that it takes about three months for the bacteria that cause periodontal disease to re-establish themselves in the crevices around the teeth. Therefore, if I clean your teeth more frequently, I can prevent the gum disease from doing further damage to your gums and the bone surrounding your teeth. When the patient commits to this new regimen, they are on a path to not only a healthier mouth, but a healthier body, because oral health is tied to overall health. Studies have shown that people with untreated gum disease, "periodontitis", have a higher chance of having a heart attack and stroke.

Composites (tooth colored fillings)

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Sorry folks, but we don't do any silver fillings here at our dental office. I stopped doing them in 1993 when I learned that they may not be safe. If King County considers amalgam (silver/mercury) fillings as hazardous waste, and forces dentists to install an elaborate machine to remove it from our waste water, then I don't think they should be placed in human beings! Instead of amalgam fillings, I have been placing tooth colored fillings (composite fillings) for almost 20 years. I only use composite filling material that has been proven to be the best at restoring the tooth to health and long lasting function. For most small cavities, and the replacement of small fillings, composites work great. If the decay is too extensive, or if the tooth already has a large silver filling, the tooth may need a more extensive procedure called a crown or "cap".

Crowns

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When a tooth colored filling is not enough to repair a tooth because the tooth is cracked, fractured, or broken down from wear and tear, a porcelain or gold crown will be necessary to restore the tooth to its original shape and function. If the tooth is the furthest tooth back in the mouth, I will usually recommend a full gold or partial gold crown. I always try to provide the most conservative restoration that will fix the problem. Over the last 26 years I have placed thousands of partial and full gold crowns, and I believe that they provide the best service for the money. They require less of the tooth to be removed in the preparation as opposed to a porcelain crowns. They also do not fracture or wear as much as porcelain crowns. The one downside is that they are "gold", and thus not as attractive, which is why I keep them in the back of the mouth so that they won't show.

When I do crowns further forward in the mouth I most often use porcelain because most people do not want to look like they have crowns in their mouth. I have been using a dental lab in Tukwila, Creative Dental, for the last 15 years, and they are experts at creating porcelain crowns that are amazingly cosmetic and functionally perfect. I have tried the overseas labs and have had mixed results. The problem I find with these huge overseas dental labs is that there is no consistency. I do not have control over who makes my crown! When I use my local lab, I know exactly who is making it and who to go back to if it is not right. I will not compromise quality to save a buck.

Root Canal Therapy

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There are times when a cavity gets into the nerve of the tooth and causes the nerve to die or get infected. Also, when the crack in a tooth becomes too deep, or the filling in a tooth causes the nerve to become inflamed, the nerve in the tooth may need to be removed. This is called a "root canal" or endodontic therapy. I perform almost all my patients' root canals in my office under local anesthetic. If the tooth is infected, and there is some swelling of the surrounding gums or cheeks, I will prescribe antibiotics until the infection is under control, and then perform the root canal. I realize that the term "root canal" sends shivers down the sides of most people, but in my office this procedure can be performed simply and painlessly. And it is far better than the alternative…….losing the tooth. I will always recommend saving a tooth with a root canal, versus extracting it and having a space between the other teeth, or having one less tooth to chew with. If I determine that the root canal is beyond my abilities, or would be better handled by a root canal specialist, "endodontist", then I will refer you to the exceptional professionals whom I know and trust. After the root canal is completed, the endodontist will send you back to our office to have a crown made for the tooth involved. This will prevent the tooth from splitting, and the resultant extraction.

Extractions

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If a tooth does need to be extracted, I will most likely perform the extraction myself. I rarely refer patients out for an extraction, and this includes wisdom teeth. The only time I refer patients to a specialist, "oral surgeon", is when they want to be "put to sleep", or if the wisdom teeth are too impacted. After I graduated from the University of Washington Dental School, I went to Fort Worth, Texas, to spend the summer working with oral surgeons, extracting teeth at John Peter Smith Hospital, so I feel very comfortable with this procedure. I use local anesthetic and nitrous oxide for most of my extractions, and my patients seem to do well with this combination. If I do need to refer a patient, I refer to an extremely competent oral surgeon in Issaquah.

Implants

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After one or more teeth are extracted, I will definitely recommend that those teeth be replaced, not only to restore your lost chewing capacity, but also to help support the remaining teeth and oral tissues. One of the ways we can replace a tooth is by the use of a dental implant. An implant is simply a titanium screw that is carefully placed in the bone where you lost your tooth, or teeth. Over the last 25 years I have had to refer my patients to a specialist to have this done, but now, after several hours of continuing education, I am placing them myself in the lower jaw. If the implant is needed in the upper back part of the jaw, or if a bone graft (more bone is needed) before the implant is placed, I will refer you to a specialist to have the implant placed.

Implant technology has come a long way since I graduated from dental school. More and more patients are finding that losing a tooth is not the end of the world. They can get a dental implant and then a crown can be cemented on to the implant and serve as the missing tooth for the rest of the patient's life.

Implants can also be used to help support a denture or partial. There are many people who have loose dentures, (especially the lower one), and have a very hard time chewing and speaking without the denture or partial moving around. In most of these cases, one or two implants can have a dramatic effect on stabilizing the denture, making it much more comfortable for the patient to eat and speak.

Partial and Full Dentures

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When a patient has several missing teeth, or all their teeth missing, one option to replace the missing teeth is the fabrication of a partial removable denture, or a complete removable denture. In our office we make both of these. Obviously, I try to do everything in my power to prevent this from happening, but sometimes it is unavoidable. Patients with severe periodontal disease may eventually need to have their teeth extracted if all treatment options have been exhausted. Sometimes this happens over many years and they may need a partial denture which replaces just some of their missing teeth. The partial denture usually attaches to a few of the remaining teeth in their mouth. Most patients can function well for years with their partial denture, and especially if one or two implants are used to stabilize it. The same goes for full dentures, except they need at least two to four implants to help keep them from moving around. However, even a well-fitting set of dentures will only provide you with 30% of the chewing ability compaired with a set natural teeth. So my goal is to help you save your teeth above all!

Preventive Dentistry

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"Preventive dentistry" is a catch-all term that includes all that we do to help you "prevent" oral disease, cavities, gum disease, and oral cancer. Actually, what you do at home is the most important part of preventive dentistry. Good oral hygiene, such as brushing and flossing, eating a low sugar diet, not smoking or drinking to excess, using topical fluoride when appropriate, are all important life decisions that help you keep your teeth for a life time.

There are several things we can do to help our patients maintain healty teeth and gums. Our dental assistant can deliver flouride treatments to kids and some adults after their cleaning appointments. She helps instruct and reinforce good brushing and flossing technique. We also supply home products that can help to stop the growth of small cavities you may already have.

Instead of sealants, I usually perform "preventive resins" on kids with newly erupted molars that have deep grooves. Preventive resins are more involved than a sealant and require more of my time to perform them. Also, a preventive resin will last a lot longer than a superficial "sealant", and will protect the tooth better.

Another procedure to help prevent tooth wear and gum disease from getting worse, is the fabrication of a night guard. A night guard is a hard plastic device that we custom make for you based on impressions we take at the first night guard appointment. At the second appointment, we make sure the night guard fits perfectly to your mouth, usually to the upper teeth, and adjust it so that the opposing teeth, (usually the lower teeth) hit it evenly. With some patients we have also found that a night guard can alleviate TMJ pain, and relieve headaches that can result from grinding and clenching.

Cosmetic Dentistry

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Cosmetic dentistry is another catch all term that when most people hear it they think of someone who has had dental work done to improve their smile. This can incorporate many dental procedures and even things people can do at home, like Crest White Strips.

I have helped my patients bleach their teeth for 20 years. I have used many products over the years, but they mostly consist of a gel that the patient places in custom fabricated trays that fit close to your teeth. The gel contains 15-20% Carbamide Peroxide and doesn't seem to cause any reactions in my patients. This chemical is non-toxic and does sometimes cause tooth sensitivity to cold. It might also cause a temporary whitening of the gums near the edge of the bleach tray. This is temporary and does no permanent damage to the gums.

Over the last few years, most of our patients are using the white strips. We sell a stronger version than the strips that people can buy in the store. I still make the trays for patients, and I think they do work a little better than the white strips, but they are also more of an investment.

For me, cosmetic dentistry really encompasses everything that I do, whether it is a small filling, a crown or a full mouth reconstruction. I want all my dental work to look like it is not there. It needs to have the ideal form and function and also look great. If a patient is requesting six veneers on their front teeth, I will build them to restore lost tooth funtionality from decay or wear and tear, but also harmonize with the appeance. I like my porcelain crowns and veneers to look and feel as natural as possible, but also not distract from a patient's other facial features. I would rather call the dentistry I do "Comprehensive Dentistry " than "Cosmetic Dentistry", because cosmetics in just one small part of providing excellent oral healthcare.

What is The Moses®

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The Moses® appliance was designed to help open the airway to promote better breathing to help prevent or eliminate snoring or Obstructive Sleep Apnea. Feel free to download the brochure or pick one up in our office to learn more about it.

The Moses®

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