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Prosthodontist/Dental Specialist

A dental specialist is a dentist who has received additional post-graduate training after dental school. The American Dental Association recognizes nine dental specialties: Public Health Dentistry, Endodontics, Oral & Maxillofacial Pathology, Oral & Maxillofacial Radiology, Oral & Maxillofacial Surgery (Oral Surgeon), Orthodontics, Pediatric Dentistry, Periodontics and Prosthodontics.
Prosthodontics is one of the nine dental specialties recognized by the American Dental Association. Graduate programs in prosthodontics include classroom lectures and seminars, laboratory and clinical training in esthetics/cosmetics, crowns, bridges, veneers, inlays, complete and removable partial dentures, dental implants, TMD-jaw joint problems, traumatic injuries to the mouth’s structures, congenital or birth anomalies to teeth, snoring, sleep disorders, and oral cancer reconstruction and continuing care. Prosthodontists are masters of complete oral rehabilitation.  A prosthodontist is dedicated to the highest standards of care in the restoration and replacement of teeth.
A prosthodontist is a dentist who specializes in the esthetic restoration and replacement of teeth. Prosthodontists receive two or three years of additional training after dental school, and restore optimum appearance and function to your smile.  Additional training for prosthodontists is earned through a hospital- or university-based program accredited by the American Dental Association.  The training includes reviews of the literature, lectures, treatment of patients and laboratory experience in fabricating restorations.  A prosthodontist is the skilled architect who can restore optimum function and appearance to your smile.

*You need the care of a prosthodontist if:

*You are missing one or more teeth.

*You are interested in dental implants.

*You wear dentures or removable partial dentures.

*You want to improve the esthetics of your smile.

Prosthodontists offer several options such as bridges, complete and removable partial dentures, dental implants and lost tooth replacement.

Prosthodontists also understand patients’ unique needs such as:

*Cleft palates

*Maxillofacial prosthetic procedures such as oral cancer reconstruction and continuing care

*TMD, TMJ or other jaw joint problems

*Traumatic injuries

*Snoring and sleep disorders

Rigorous training and experience provide prosthodontists with a special understanding of the dynamics of a smile and the preservation of a healthy mouth.

There are several options to replace teeth such as crowns/caps, teeth whitening and veneers.
Prosthodontists have much more experience working with dental labs since the work we do always involves a lab.  Therefore, we have a lot of experiences with laboratories and only demand the finest quality and the most precise work available.  Lab fees may be higher due to the higher quality of materials, the attention to detail and the experience of the lab in providing the best for our patients.
Prosthodontists are dental specialists in the restoration and replacement of teeth who have completed dental school plus three additional years of advanced training and education in an ADA-accredited prosthodontic graduate program.

Extensive training and experience provide prosthodontists with a special understanding of the dynamics of a smile, the preservation of a healthy mouth and the creation of tooth replacements.  Serving as the architect of a dental treatment plan, a prosthodontist collaborates with general dentists, specialists and other health professionals to develop solutions to dental and oral health concerns.

Prosthodontists provide an extremely high level of care to patients with missing teeth, or having significant damage to their existing teeth.  Prosthodontists work with congenital defects as well as problems arising from trauma and neglect.

Prosthodontists are highly trained in state-of-the-art techniques and procedures for treating many diverse and complex dental conditions and restoring optimum function and esthetics.  These include: crowns, bridges, complete and removable partial dentures, dental implants, TMD-jaw joint problems, traumatic injuries to the mouth’s structure and/or teeth, snoring or sleep disorders and oral cancer reconstruction and continuing care.

Dentures

The best starting point to see if dentures are an option for you is to see your dentist or a prosthodontist, who is a specialist with an additional three years of training after dental school who focuses on the restoration and replacement of teeth, including dentures for even the most complex cases.  A prosthodontist also will be able to help determine if another treatment option might be more suited to your particular situation.

Dentures may replace all the teeth or only some of the teeth.  The dentures that replace all the teeth are known as complete dentures and they rest on the gums that cover the jawbones.  The stability and retention of these dentures can be improved by attaching them to dental implants.  Dentures that replace some but not all of the teeth are known as partial dentures.  They attach to the teeth that are still present and also cover and rest on the gums and bone where the teeth are missing.

Fees for dental services can vary based on many factors including the complexity of your particular treatment, the time required to accomplish the treatment, and the location of the dental practice. Payment terms also vary according to the business requirements of the specific practice.  The best way to determine fees for service is to visit with your dentist or prosthodontist and discuss the care you may need.  You may also contact your state or local dental society to find out if the organization has any resources for the public related to the cost of dental services.  You may want to seek the care of a prosthodontist, a dentist with three years of training beyond dental school who specializes in the care and maintenance of dentures.  You can use the ACP’s search to find a prosthodontist.

Yes, it is possible to have your teeth removed and dentures put in the same day.  The dentures are called immediate dentures and you should talk to your dentist or prosthodontist to see if that treatment is the best for your mouth.  A prosthodontist is a dentist with three years of training beyond dental school who specializes in the care and maintenance of dentures.

Most patients need to learn how use dentures properly and as a result, it takes a little time to get used to them.  After a while, you should be able to eat fairly normally, but it may take more time to get comfortable with harder foods or sticky foods.  Using a small amount of denture adhesive (no more than three or four pea-sized dabs on each denture) may help stabilize the dentures and help hold them in place while you learn how to get comfortable with them and may make the learning process easier.

If the dentures no longer fit as well as they once did you may need to have a procedure done to refit the base of the denture, called a “reline” procedure.  However, this procedure will enable your denture to fit better, and tighter, than it has previously.  This procedure can be done by your dentist or prosthodontist, a specialist in denture care and maintenance.

The best solution is to return to the dentist or prosthodontist who made your dentures and have the cracked denture repaired professionally.  It may seem easy to fix, but it is important that the repair is done correctly to prevent problems with chewing and to avoid any sore spots.  The dentist also needs to check the denture and adjust it after it is repaired.  The denture may be too old and may no longer fit closely to your gums, and you may need a new denture.

You should remove your dentures at night and give your gums and bone a chance to relax from the pressure of the denture during the day.  Dentures should be cleaned at night and stored in water during the night.  Dentures can be made to look like your teeth or, if you want changes in your teeth, the dentures can be made to improve your appearance.  You should work with your dentist or prosthodontist and tell him/her how you would like to look.  You may want to seek the care of a prosthodontist, a dental specialist with three years of additional training in the restoration and replacement of teeth, including dentures.

Dentures cannot be whitened like natural teeth, because dentures are made of plastic.  To minimize staining, properly clean your dentures daily to remove food and plaque bacteria. Brushing with a denture brush or soft toothbrush will prevent dentures from becoming permanently stained and keep your mouth healthy.  Moisten the brush and apply a non-abrasive denture paste (regular toothpaste is too abrasive).  Brush every surface, inside and out, scrubbing gently.  A variety of over-the-counter denture cleanser products may be safely used to remove most stains.  However, more stubborn stains may require removal by your dentist or prosthodontist, a specialist in denture care and maintenance.

No, toothpastes are designed to be used on teeth, and they often contain materials and chemicals that help whiten and strengthen teeth, but may harm dentures, which are made of a very durable plastic. Even though the plastic is strong, it is not as strong as the enamel of teeth and may be scratched by using toothpaste to clean your dentures.  You should use a dish washing liquid and a special denture brush to clean your dentures by hand every day.  After rinsing them thoroughly, soak your dentures in water-based cleaning solution overnight.  Do not use bleach on your dentures unless your dentist or prosthodontist gives you special instructions on using bleach.

There are a lot of consequences to loosing teeth and wearing dentures.  Many times there has already been a lot of bone loss due to periodontal (gum) disease and there may not be options to save the teeth.  Dental implants can help prevent further bone loss in addition to supporting dentures.  Ask a prosthodontist what is the best option for you.

There are dentures that attach to the implants so the denture cannot be removed by the patient (permanent type) or dentures that attach to implants but can be removed by the patient (removable type).  A removable denture that attaches to the implants and can be removed by the patient is less costly and it is easier to clean around the implants.  A denture that cannot be removed by the patient is more stable and some people prefer this type of denture since it is more like their own teeth.

You may consider having the upper denture checked to see if it positioned properly. Sometimes dentures can be made in a position that does not allow the lips to close resulting in excess saliva.  If swallowing is not impaired, you should be able to clear your mouth and the amount of saliva will generally decrease.  If this does not happen, you should see your dentist or prosthodontist to correct the problem.

Dental Implants

Dental implants are metal cylinders made of titanium surgically placed in the jawbone where teeth are missing.  They replace the roots of missing teeth and support single crowns, large bridges and dentures. State-of-the-art technology makes it possible for these replacement teeth to look, feel and function like natural teeth.

If you are missing one or more teeth, a restoration supported by a dental implant and/or implants is an option you must consider.  In many instances it provides the best alternative for care.

Several benefits exist to receiving dental implants.  They are fixed solidly in the bone and allow teeth to be replaced in a manner that is closest to natural teeth.  They have a long history of good success. However, dental implants require surgical procedures that usually include a small amount of discomfort and the time it takes for the implant to heal in the bone which can be a few months.  Because a dental implant requires both a surgery and then making a replacement tooth that attaches to the implant, it is usually more expensive than a bridge when replacing a missing tooth.

It varies from individual to individual and with health and habits.  For a healthy individual with good oral hygiene and good health, dental implants are predictably successful and survival rates above 90-95 percent are reported.  You may consider seeking the care of a prosthodontist, who is a dental specialist with three years of additional education after dental school, and who is trained to serve patients with a combination of needs including dental implants.

The cost will vary by patient.  A prosthodontist will make an assessment based on your unique needs.

Unlike natural teeth dental implants are not susceptible to dental disease such as decay; however, the health of the gums is vital to maintaining last implant success.  Conscientious home care by the patient and regular professional cleanings and check-ups are essential elements for dental implant sustainability.  Each patient is different, and success relies upon diagnosis and planning, medical history and a variety of other factors.

All on 4 is a process by which all of the teeth are replaced in one jaw by using 4 implants.  This process can be less expensive than the previous process that used 5 or 6 implants.

Dentures cannot be “made into implants.” Implants are metal screws placed into the jawbone to help anchor and support artificial teeth (dentures).  It may be possible to have implants placed beneath existing dentures to aid in the stabilization and support for those dentures.  This could only be done if the current dentures were otherwise in excellent condition and relatively recently made.  You should consult the dentist or prosthodontist who made the original dentures.

Implants can be safely removed and many times a bone graft is placed where the implant used to be.  Make sure the implant dentist you are seeing is a dental specialist such as a prosthodontist, periodontist or an oral surgeon for the best treatment available.   All of these are recognized specialties of the American Dental Association and the dentists have 3-5 years of advanced training beyond the four years of dental school.

No, dental implants are fixed solidly in the bone and allow teeth to be replaced in a manner that is closest to natural teeth.

Oral Cancer

People who use tobacco are six times more likely to develop oral cancer.  Eight of 10 oral cancer patients are smokers. Heavy alcohol drinkers are also more at risk.  80 percent of people diagnosed with oral cancer consumer more than 21 drinks weekly.  Finally, people with a history of oral human papilloma virus infections are at greater risk to develop oral cancer even if they don’t smoke or drink.

*Red or white patches in or behind the mouth

*Mouth sores or ulcers that bleed easily and do not heal

*Unexplained lump in the neck, throat or floor of the mouth

*Difficulty or discomfort swallowing

* Pain and tenderness in teeth or gums

*Change in the fit of dentures or partial dentures

*Visible change in mouth tissue

*Unpleasant sensations (pain, discomfort, numbness)

* Diminished ability to perform normal functions such as opening jaw, chewing or swallowing

*Unexplained swelling or fullness in neck

As the building block or our body, cells maintain our tissues and organs.  When cell production and regulation lapse, abnormal growths or malignant tumors destroy healthy tissues and spread or metastasize the diseased cells to other parts of the body.

About two-thirds of cancer of the mouth or oral cavity occurs in the floor of mouth and tongue, but can occur in the upper or lower jaw, lips, gums and cheek lining. Just behind the mouth is an area known as the orophyarnx. Oropharygeal cancer (one-third of cases) occurs in the back of the tongue, tonsils and throat tissue.

The American Cancer Society recommends a comprehensive oral evaluation and soft tissue exam annually, yet only one in five patient’s reports having an oral cancer exam in the last year.  Your prosthodontist is trained to perform a comprehensive evaluation of your mouth including the associated structures in the head and neck area.  An oral cancer screening is painless; treatment for advanced oral cancer is not.

Improving your Smile

When a tooth exhibits moderate to severe destruction such as; a large filling with recurrent decay or extensive wear, a crown, also known as a cap, gives you the strength, beauty, translucency and feel of a natural tooth.  Made from a variety of materials, your prosthodontist can help determine the correct crown for your mouth.

Tooth whitening lightens discolored enamel and dentin.  Studies have shown that proper use of dentist-monitored, whitening systems can enhance your smile.  Almost anyone can benefit.  After a thorough examination and diagnosis your prosthodontist can determine if you are a good candidate for home whitening.

Veneers may be an option is you are not happy with the alignment, color or shape of your teeth. Following a slight preparation of the enamel, a prosthodontist bonds a thin layer of porcelain permanently to the front of your teeth.  Veneers may be used to correct minor flaws of individual teeth, but often are used on multiple teeth to create a uniform smile.

Unsightly fillings can be replaced by all-ceramic inlays, a tooth-colored material bonded to the tooth. Instead of using the more traditional cement, this bonding process may actually improve the strength and beauty of the tooth.

From implants to permanent bridges, you have several options to replace missing teeth and blend them with your natural teeth.  Using advanced materials and tooth-color matching techniques, your prosthodontist can recommend the appropriate method for optimal function and esthetics.

A loose crown may indicate trauma, infection or a problem with the bonding cement, all of which need immediate attention!  You should seek the care of your prosthodontist as soon as possible to determine the cause and care for your loose crown.  If the prosthodontist who installed the crown is not available, you should still see a prosthodontist.

Bite Splints

A bite splint (also called bite plane, deprogrammer, intraoral orthotic, night guard, occlusal splint) is a removable appliance, usually fabricated of acrylic or composite, most often designed to cover all the occlusal and incisal surfaces of the teeth in the upper or lower jaw.

Bite splints (BS) are often used in the treatment of patients with oral parafunctions, temporo-mandibular joint (TMJ) dysfunction or temporomandibular disorders (TMD). The most common reasons for prescribing a BS are to protect the teeth in patients with bruxism, to improve jaw- muscle and TMJ function and to relieve related pain.   As a general rule, a dentist should not encourage a patient to use any type of splint for long periods of time without appropriate supervision, as they need to be checked and adjusted periodically!

A University of Michigan bite splint is a clear appliance made of hard processed acrylic, and is worn over the upper teeth.  It is designed to protect your teeth and muscles.  If properly designed and adjusted, this splint is effective as a diagnostic and treatment device. It reduces muscle hyperactivity, thereby helping the condyles to reposition in a way that promotes healing of internal TMJ structures. It is usually placed in the upper jaw covering all the maxillary (upper) teeth, giving the supporting cusps of the opposing mandibular (lower) teeth and the edges of the mandibular incisal teeth balanced even contacts with the splint at habitual closure.

A customary reason for prescribing a bite splint is to protect the teeth from excessive abrasion in patients with bruxism.  Splints are also used frequently to treat patients with internal TMJ (temporomandibular joint) dysfunction and other TMDs (temporomandibular disorders) with associated pain symptoms, such as tension headache and cervical-, neck-, and oral/facial pain.  A common goal of bite splint treatment is to protect the TMJ disks from dysfunctional forces that may lead to perforations or permanent displacements.  Other goals of treatment are to improve jaw-muscle function and to relieve associated pain by creating a stable balanced occlusion.

An important advantage of bite splints is that they can be used to make reversible changes in the occlusion (bite).  Occlusion affects the way jaw muscles function, and jaw muscle function affects the way the TMJ (temporomandibular joint) functions.  Therefore, changes in the patient’s occlusion will always have some effect on the jaw muscles and the TMJ structures.   A stable, balanced occlusion is important for maintaining normal jaw muscle and TMJ function.

*It is reasonable to recommend a bite splint for the following purposes:

• To protect oral tissues in patients with oral parafunctions

• To stabilize unstable occlusion and protect teeth

• To eliminate the effect of occlusal interferences

• To test the effect of changes in occlusion on the TMJ and jaw muscle function before extensive restorative treatment

*As a general rule, a dentist should not encourage a patient to use any type of splint for long periods of time without appropriate supervision, as they need to be checked and adjusted periodically!

There are no fixed rules for how long patients should continue to use splints.  Patients who have conservative bite splints prescribed, because of parafunctional motor activities like bruxing, clenching, and tongue pressure mainly use their splints during sleep.  However, those who cannot control such habits when awake might need to use the splint during the day also.  Only a dentist/prosthodontist should encourage a patient to use a splint indefinitely.

A prosthodontist specializes in occlusion (the bite).  A bite splint can be a valuable diagnostic and treatment aid in carefully selected cases if properly made, adjusted and maintained.   However, they are deceptively easy to fabricate and deliver when they are not made in the approved manner, and can be mass-produced by health professionals with only superficial knowledge of occlusion, TMJ, and jaw muscle physiology! Such practice may be a threat to the welfare of the patients; especially if they are given non-conservative splints. The negative effects of conservative splints may be subtle, but these splints are not beneficial to patients if they are poorly adjusted at delivery and left without arranging for regular maintenance visits.  A prosthodontist has the specific training to make, adjust and maintain your splint!

A bite splint is made by taking an impression of your upper and lower teeth.  The impressions are used to make models of your upper and lower teeth.  Those models are then mounted in a dental articulator which simulates how your teeth relate to one another and your jaw.  It is an important step that allows the prosthodontist to make the bite splint fit intimately to your upper teeth while also allowing for the proper thickness of the acrylic material and gives you a personal fit related specifically to your bite while permitting cuspid guided clearance.  These steps are necessary to make a bite splint properly.  The lab work and final fabrication for this method of making the bite splint takes about two weeks.

When your bite splint is delivered it is adjusted for a proper fit and accurate bite.  The bite splint will be fitted on your top teeth and the prosthodontist will check the fit and adjust the occlusion so that you are able to move your jaw freely.  The bite splint will require additional adjustments, as the muscles and joints relax, to maintain an artificially correct bite.  The forces of bruxing and clenching make grooves in the surface of the splint, which are called facets.  If the bite splint is not checked and these facets are not adjusted out or relieved, your bite will be locked in place and your jaw will not have free range of motion when you wear the splint.  It is VERY important that you have the bite splint adjusted and checked!  The recommended interval for adjustments is every 6 months.  Some adjustments are needed more frequently depending on the symptoms.   A bite splint can be a valuable diagnostic and treatment aid if properly made, adjusted and maintained.

The recommended interval for adjustments is every 6 months.  Some adjustments are needed more frequently depending on the specific case and symptoms.

If you have been prescribed a bite splint, by your dentist/prosthodontist, because of bruxism, TMJ (temporomandibular joint) dysfunction and other TMDs (temporomandibular disorders) with associated pain symptoms, such as tension headache and cervical-, neck-, and oral/facial pain- your bite splint should be worn as much as possible with the exception of eating.  When you first wear the bite splint, you may be aware of a temporary increase of salivation.  This is normal and will improve with extended wear.  Also, problems with speech may be noted, but will improve with regular use of the splint. When positioned each time, the bite splint may feel tight to the teeth for a few moments it will gradually go away.  When the bite splint is removed, your occlusion (bite) may feel different and the interferences that are present in your bite may temporarily seem greater.  This is to be expected and will disappear within minutes.  Be advised, if the bite splint is left out for prolonged periods, the symptoms may return.  Note:  If you do not wear your bite splint on a regular basis- it may no longer fit!  If this happens, a new bite splint will need to be made.   The bite splint should not be worn unless you are under the supervision of a dentist/prosthodontist.  If you move from your present home or discontinue treatment, do not continue to wear the bite splint without consulting a prosthodontist.

The bite splint should be brushed daily with a stiff bristle toothbrush and non-abrasive toothpaste to keep it clean.  Denture cleaners or soaks, such as Efferdent, may be used occasionally, if necessary.  Soaking your bite splint in mouthwash is NOT recommended as it is abrasive to the acrylic material.  However, you can dip it, briefly, in a mouthwash that has been diluted with water.  The bite splint MUST be kept clean for good oral hygiene!

Please note: To prevent the bite splint from warping, the splint must be stored submerged in water or wrapped with a damp piece of paper towel in a proper case/sealed baggie.  Storing the bite splint in a dry environment for more than a day will cause dehydration in the material and change the fit of the splint!

Anytime you have new dental work done you should have your bite splint checked by your dentist/prosthodontist.  If dental work was done on the upper arch, the bite splint may need to be modified to fit properly.  Typically, modifying the bite splint is easy to do and does not require any new impressions be taken or a new bite splint be made.  If several teeth have had new dental work- a new bite splint may need to be made and new dental impressions taken of your teeth.  Always check with your dental professional, as they will be able to determine what step(s) will need to be taken.