In addition to the meticulous cleaning, polishing, and examination of your teeth, we also take the time to help our patients develop proper oral hygiene habits at home. We will evaluate your hygiene techniques and suggest adjustments to your routine where needed. Our doctor and hygienists will also make suggestions for preventative measures such as dental sealants or night guards to protect against bruxism & TMJ.
If we feel that you are suffering from gingivitis or more severe gum disease (periodontitis), we may recommend scaling and root planing. These measures can be instrumental in preventing bone loss and helping you to keep your natural teeth.
Scaling & Root Planing
Scaling and root planing, (SRP), is a non-surgical procedure in which the hygienist removes plaque and tartar from below the gum line. Root surfaces are cleaned and smoothed with specially designed instruments. It is important to remove the plaque and tartar from the pockets, because aside from the bacterial toxins that irritate the gums, plaque and the rough surfaces of tartar make it easier for bacteria to gain a foothold.
Arestin
Arestin is a prescription product approved by the FDA. It is used together with SRP procedures for the treatment of adult periodontitis. The active ingredient in Arestin is an antibiotic called minocycline. It is available as a powder-like substance that uses "microsphere" technology. This allows extended release of the antibiotic so that it works to kill the bacteria that cause periodontal disease for up to 21 days. Arestin is placed painlessly under the gums, directly in the infected site.
- After the Arestin is placed, avoid touching areas of your gums that have been treated
- Wait 12 hours before brushing, and 10 days before flossing the treated area
- Avoid eating hard, crunchy, or sticky foods such as popcorn, caramel, etc. for one week after treatment
When used together with SRP, Arestin can significantly reduce the depth of the infected pockets that can form around teeth and help prevent disease progression. The combination of Arestin and SRP is more effective at fighting periodintal disease than SRP alone. In addition, Arestin has been shown to be particularly effective in patients who are smokers. There is no need for anesthesia or the use of needles when Arestin is placed. Arestin is naturally absorbed into the gums, leaving nothing that needs to be removed. Arestin does not require bandages, and won't leak.
Please inform your doctor or hygienist if you are allergic to minocycline or tetracycline. Arestin should not be used in children or in patients who are pregnant or nursing.
Bonding and Composite
A "bonding" is a composite resin that is used as an alternative to amalgams and veneers. This is an excellent cosmetic option for those patients who do not want the look of silver in their mouths and do not want the expense of veneers. Bonding can be done on teeth that are decayed, cracked, or stained.
Before and After Procedure
The bonding procedure is usually completed in one visit. The first step is to remove the decayed or unsightly portion of the tooth. The tooth is then etched or primed with a liquid or gel and a bonding agent is then applied. This will allow the composite resin to be placed in the prepared tooth. The resin is then trimmed and polished, leaving you with a beautifully sculpted, natural-looking restoration.
Bonding Durability
Although composite resins are cosmetically pleasing and easily 
placed, their durability is not as strong as other types of restorations. These resins typically last from 4-7 years before they begin to chip and wear away. When this happens, the restoration will need to be replaced.
Bridges
A bridge is one of the few options that you have when deciding how to deal with a missing tooth or teeth. The replacement of these missing teeth is necessary in order to maintain the proper mouth functions. Tooth loss can affect the way you eat, speak, and the alignment of other teeth in your mouth.
Types of Bridges
A bridge, by definition, is a link or connection between two permanent structures. A dental bridge is very similar in that it attaches the restorative teeth (bridge) to the natural teeth on either side of the gap. This bridge acts as your new teeth, closing the gap and restoring your smile. Bridges are often constructed of gold or metal foundations with porcelain fused to the foundation. This ensures that the bridge will support the normal functions of the mouth.
There are three main types of bridges:
- Traditional bridges involve creating a crown for the tooth or implant on either side of the missing tooth, with a pontic in between. Traditional bridges are the most common type of bridge and are made of either porcelain fused to metal or ceramics.
- Cantilever bridges are used when there are adjacent teeth on only one side of the missing tooth or teeth.
- Maryland bonded bridges (also called a resin-bonded bridge or a Maryland bridge) are made of porcelain teeth supported by a metal framework. Metal wings on each side of the replacement teeth are bonded to your existing teeth.
Proc
edure
The procedure begins with preparation of the natural teeth, or abutments. We will shape the abutment teeth so that the ends of the bridge will fit comfortably on each one. The next step is to take an impression of the area. This impression will be sent to our lab where your new restoration will be crafted. While this new tooth is created, we will provide you with a temporary restoration. Our temporary restorations will resemble your natural teeth so that you can continue with your daily life without worrying about a missing or unattractive tooth.
During your second visit to the office, we will proceed with the placement of your final restoration. This bridge will be fitted comfortably into the mouth. We will make every effort to ensure that the new bridge feels exactly like your natural teeth. The final step, usually a week later, after you have had a chance to try your new bridge out is to cement the bridge into your mouth, leaving you with a beautifully restored smile.
Crowns
As we get a little older, our teeth begin to change and are prone to decay. There are many possible reasons for this change in your smile. These reasons can include bruxism, (teeth grinding), general decay, cracked fillings, root canals, decreased salivary flow and more. If your tooth is beyond repair with a filling material, we may recommend that the best viable option to save the tooth is a full crown. The reasons for this type of restoration in a badly damaged tooth are durability, cosmetic appearance, and overall support of the chewing function.
Types of Crowns
If 
we decide that you are in need of a full crown, there are a few different options for the repair of your tooth. These options include a full porcelain crown, a porcelain fused to metal or gold crown, or a full gold crown. We will make the determination together as to which of these options is the most appropriate for your situation.
Procedure
When we have decided to go ahead with a full crown restoration, we will set aside 2-3 appointments for the entire process. Although the majority of crowns are completed in two visits, there is sometimes a need for a third visit to ensure a proper fit.
The procedure begins with the removal o
f all decay in the tooth. Once we have removed the decay, we will assess the need for a building the tooth up if there is minimal structure remaining. In most cases, we will then take an impression of the tooth. This impression will be sent to our lab where your new restoration will be crafted. While this new tooth is created, we will provide you with a temporary restoration. Our temporary restorations will resemble your natural teeth so that you can continue with your daily life without worrying about a missing or incompatible tooth.
During your second visit to the office, we will proceed with the placement of your final restoration. This crown will be fitted comfortably into the mouth. We will make every effort to ensure that the new tooth feels exactly like one of your natural teeth. The final step in the process is to cement the crown into your mouth, leaving you with a beautifully restored smile.
Inlays/Onlays
Inlays and onlays are sometimes referred to as partial crowns. These partial crowns are utilized when there is still a healthy enamel portion of the tooth. An inlay or onlay is a like a puzzle piece that will be fitted into the remaining portion of the tooth to help increase its strength. This piece is usually made out of porcelain or gold, but can also be made of a composite resin material. We will make the determination as to which restoration will work best in your specific situation.
An inlay is used when there is not damage to any of the cusps of your tooth and is essentially place within these cusps. An onlay is used when there is slightly more extensive damage to the tooth structure. This type of restoration is placed over at least one of the cusps on the tooth.The picture at the left shows an amalgam filling replaced with an onlay.
Procedure
When we have decided to go ahead with an inlay or onlay, we will set aside 2 appointments for the entire process. Although the majority of inlays and onlays are completed in two visits, there is sometimes a need for a third visit to ensure a proper fit.
The procedure begins with the removal of all decay in the tooth. Once we have removed the decay, we will take an impression of the tooth. This impression will be sent to our lab where your new restoration will be crafted. While this new tooth is created, we will provide you with a temporary restoration. Our temporary restorations will resemble your natural teeth so that you can continue with your daily life without worrying about a missing or incompatible tooth.
During your second visit to the office, we will proceed with the placement of your final restoration. The inlay/onlay will be fitted comfortably into the mouth. We will make every effort to ensure that the new restoration feels exactly like one of your natural teeth. The final step in the process is to cement the inlay/onlay into your mouth, leaving you with a beautifully restored smile.
Gingival Contouring
Gingivectomy procedures are done for both restorative dentistry and/or to improve the esthetics of your gum line. This procedure adjusts the gum level to expose more of the tooth so it can be restored.
Sometimes a gingivectomy is done to improve a "gummy" smile because the teeth appear short. The teeth may actually be the proper length but excess gum tissue may be covering these teeth. During this procedure, excess gum tissue i
s reshaped to expose more of the natural tooth.
The procedure is often done using an electro-surgery unit. The electro-surgery unit uses electricity to cut the gum tissues and at the same time, causes the gum tissues to clot and stop bleeding. A couple of weeks after the gum removal procedure, the area will be completely healed.
Post operative discomfort is generally minimal. Advil or Tylenol can be taken to relieve any discomfort.
Veneers
Porcelain veneers are extremely thin casings of ceramic that are bonded to the front of the patients tooth to create a new smile. Porcelain veneers are placed over the front of teeth that appear too small or large, slightly discolored, or simply are not cosmetically pleasin
g to the patient. For many patients, teeth may have chipped, become discolored, or are slightly crooked. For the majority of these patients, porcelain veneers can prove to be the perfect solution.
When placing porcelain veneers, we pay close attention to the patients surrounding teeth and design each veneer to complement the overall smile. The result is a beautiful, attractive new smile.
If cared for properly, your veneers will last you a long time. We ensure that your new veneers are constructed of the most durable and esthetic porcelain materials available.
Procedure
The procedure begins with the preparation of the tooth. This entails removing the discolored or unsightly portion of the tooth and meticulously shaping the tooth when needed in preparation for the new veneer. Sometime we do not need to shape the existing teeth. Once we have completed the necessary shaping, we will take an impression. This impression will be sent to our lab where your new restoration will be crafted. If necessary, while the new veneers are created, we will provide you with a temporary restoration. Our temporary restorations will resemble your natural teeth so that you can continue with your daily life without worrying about a missing or incompatible tooth.
Whitening At Home
Over time our teeth tend to become discolored or stained. Whether this is from smoking, coffee, or any other foods, a beautiful smile could be closer than you think. We offer a safe, inexpensive solution to an unsightly smile. Whitening your teeth is a very simple procedure that can be completed in relatively short period of time.
Procedure
The first step in the whitening process is impressions. We will take full impressions of your upper and lower teeth. These impressions will be used to make custom bleaching trays. The trays will fit onto your teeth perfectly so there is little possibility of gum damage from the bleaching solution.
The second step is to place the bleaching solution in the trays and wear them for a few hours a day. Within a few days, you will see a significant improvement in the color of your teeth. Your smile will look brighter and younger.
Bleaching only works on natural teeth and may not be 
effective in all cases. We will inform you as to the potential whitening for your specific situation.
Instructions
We suggest the following regimen:
- Brush and floss before wearing your whitening appliance.
- Apply a small dot inside the outer part of each tooth form in
your tray. Apply it to the ten front teeth.
- Place the tray in your mouth and look in a mirror to be sure the whitening material is spread out over the entire front of each tooth. If material oozes out, you have used too much. If you can't rub the outer part of your tray to distribute the material over your teeth, you will need to use more.
- Wear the tray for at least an hour (preferably longer). You may wear it overnight. The material is most effective for the first two hours but will be somewhat effective for up to four hours.
- You may experience some tooth and gum sensitivity. This is
transient in nature, but you can decrease your wear time if the sensitivity is bothersome.
- Generally, two weeks of twice daily wear will give you a good
result. Some people will wear the appliances for a longer period of time if they want a more dramatic result. Also increased strengths of the whitening material are available.
- We have touch-up kits in varying strengths. Many people will
do a two-hour touch up every few months.
- We would like to see you briefly in two to four weeks to do a
follow up shade matching. If you have any questions or concerns in the mean time, please give us a call. We will be happy to assist you.
In Office Whitening
You will have whiter teeth before you leave the dentaloffice.Through chemical activation, we can now whiten your teeth without the bothersome heat or harmful ultraviolet rays. The product simply activates itself as it sits on your teeth. In about an hour, you'll have noticeably whiter teeth.
Will additional whitening be necessary?
The in-office procedure is the greatest jumpstart to whiter teeth. But most likely you'll want to continue whitening after your procedure to ensure that your teeth reach their whitest potential. We can provide you with a system for follow-up treatment that you may use at home and continue to whiten your teeth.
How do I keep my smile white?
After you have the white smile you've long desired, it's important to keep it that way. Practice good oral hygiene and always remember to brush after consuming teeth staining foods or beverages.
Sports Mouth Guards
Sports mouth guards are resilient plastic appliances that have been designed in a fashion where they cover over and encase an athlete's teeth and the gums and bone that support them. When a guard is worn, it helps to provide protection for the hard, (teeth and jaw), and soft, (lips, cheeks, gum), tissues of the mouth by way of absorbing and redistributing the forces generated by traumatic blows. A mouth guard can also help to prevent jawbone fracture by minimizing the total amount of force that any one portion of the jaw is subjected to.
Custom mouth guards are typically regarded as the most protective and best type of guards, followed by "Boil and Bite", (a standard-shaped mouth piece that is placed in hot water and then bitten into shape by the patient), and then "stock" mouth guards that you buy at the store.
The importance of an athlete wearing a sport guard when participating in almost any type of sport cannot be over emphasized. When a blow is delivered to the mouth, the forces of the impact are absorbed by the structures the blow lands upon. In the case of hard oral tissues, such as teeth, a forceful impact can easily cause tooth fracture, result in tooth dislodgement, or damage existing dental work.
Botox for Dentistry
Botox for TMJ Headaches
The use of Botox for TMJ related headaches can be used to relieve several problems for patients who have been unable to find relief with conventional treatment. Used appropriately, and with a fully informed patient who understands that no treatment is guaranteed, Botox injections represent a new option for patients seeking relief from headache pain. Some of the benefits of using Botox include:
- Relief of tension headaches
- Relief of migraines
- Treatment of trismus, (lockjaw)
- Reduction of clenching and relief of pain of the face, jaw-joint, teeth, and chewing muscles
- Can relax the upper lip to reduce the appearance of a "gummy smile"
- Aids in the reduction of excessive and uncontrolled salivary flow
Botox is a simple, non-surgical procedure. Dr Graber will have you contract the muscle area to be treated so she can determine appropriate injection sites. Then, targeted injection areas may be numbed with an ice pack or topical numbing agent. Finally, she will administer several tiny injections directly into the muscle or gland. Only the injected areas will be affected. Results are seen within 4-12 days.
Is Botox safe?
Yes. Botox is a natural protein. It is a powerful muscle relaxant with minimal side-effects. Another safety benefit is that the botulinum toxin does not stay in the body indefinitely, so if there is an adverse effect, it is only temporary. There is also the likely possibility that with frequent treatments, the injected muscles will atrophy, allowing the patients to go longer and longer between treatments. It affects only the area treated.
What can I expect at the initial consultation?
At the initial consultation, Dr. Graber will determine if you are an appropriate candidate for Botox and if it is the best treatment for the condition that you have. It is important that you disclose all medications, vitamins, herbs, and supplements you currently take. These substances could hinder the potency of the Botox or cause bleeding and bruising at the injection sites.
Is there any pain involved?
The pain associated with this procedure is due to the injections, but is generally minimal and brief. Some patients have compared it to a "bug bite", or "prick". Pain can be reduced by proper injection techniques and by numbing the area. If you are afraid of needles, you may ask Dr Graber to provide nitrous oxide or a mild sedative. Sedatives cannot be administered unless the patient has a driver present.
What can I expect afterwards?
Muscle tenderness will start to disappear almost immediately. Pain and wrinkles begin to disappear within 48 hours. Salivary flow may be reduced after 3-4 days, (only when treated specifically for this). There may be a mild temporary bruising, numbness, or redness around the injection sites. Full effectiveness is experienced by 12 days and lasts for 3-4 months..
What is the long-term outcome?
Results of Botox generally last up to four months. Patients generally wait at least three months between treatments. There is also the likely possibility that with repeated treatments, the injected muscles will atrophy, allowing the patient to go longer between sessions. Your body may develop antibodies that would cause treatments to become less effective over time. This resistance can be minimized by using the lowest dose possible and extending the intervals between sessions.
Who is an ideal candidate?
An ideal candidate would meet any of the following conditions:
- Between the ages of 18-65
- Has a dento-facial problem caused by parafunctional muscle activity
- Has a drooling problem
- Does not object to the disappearance of his/her wrinkles
- Is looking for a non-surgical solution
- Is looking for a temporary solution
- Is knowledgeable about the procedure
- Is realistic in expectations
- Is in good physical and psychological health
- Is not pregnant or nursing
The above criteria are not comprehensive. Be sure to discuss with Dr. Graber if Botox is the best treatment for your desired results.
