Cincinnati Smiles.com | General Dentistry for Adults and Children

In addition to the services already described, we offer the following treatments that may help you or members of your family. These treatments are basically repair services: to fix a dental problem after it has happened. Visit our PREVENTION site to learn how to avoid needing these services. They are arranged alphabetically.

Even your best friends won't tell you about this. Or so the story goes. It's a sensitive topic - bad breath. Often people try a mouth rinse as the first line of defense. This only works for a few minutes. And those rinses often contain alcohol that dries out the mouth, causing more problems.

An estimated 40 million Americans have bad breath that never goes away. Some of it is caused by gum disease. We can take care of that. Some is caused by food such as garlic and onions. That goes away by itself in a day or two. And some mouth odor is caused by the release of volatile sulfur compounds (VSCs) from germs in the tongue and in other parts of the mouth. This chronic bad breath does not go away: there is no permanent cure. But we have a program in our office designed to help you get the freshest breath possible. If you think you or someone close to you has this problem, here are four things you should know.

The health of the gums and teeth must be excellent. Gum disease, odor-causing foods, and smoking all contribute to bad breath.
Most over-the-counter products do not solve this problem. They only mask it temporarily.
Even good friends won't tell you about bad breath. Do people turn their heads or move away when you speak?
Our program is based on BreathRx, a system developed by a California dentist. It features Zytex, a unique and powerful dual-action chemical compound that fights bad breath in two ways: it reduces the foul-smelling VSCs and it kills the gram-negative bacteria that cause these VSCs to form. Our program offers the following products: mouth rinse, tooth brushing gel, tongue conditioning gel, tongue scraper, breath mints, chewing gum, breath gel caps, and breath spray.

Some patients have not been fortunate enough to save their teeth and must wear complete dentures. Dr. Bob takes time to make these restorations. We carefully record initial measurements of the jaw position and make meticulous impressions of the ridge form. We then have several try-in visits to allow the patient to be perfectly satisfied before the dentures are completed. Afterwards, we provide adjustments, if needed. Lower full dentures are the most difficult to wear because the ridge is usually smaller. The force of the tongue and the muscles of the floor of the mouth constantly move the lower denture out of position. Brush and floss because you don't want to have to wear these.

Some patients who are about to lose their teeth will choose an overdenture, a denture that fits over natural roots that have been reduced to the gum level. These teeth have had root canal therapy and do not hurt. Saving some strategic teeth in the overdenture technique means that the jawbone will be preserved longer and, with special magnetic attachments, this translates into a more secure denture.

A crown is a complete covering for a tooth. A crown is the best possible restoration to prevent the tooth from shattering, which happens when the tooth is weakened by large fillings, cracks, or root canal therapy. During the first visit, the dentist shapes the tooth, makes an impression and bite recording, takes a shade measurement, and constructs a temporary crown for you to wear while the regular crown is made in the laboratory. On your return visit, the dentist evaluates the fit, the shade and contour, and the bite. If everything is OK, the dentist cements the crown.

Crowns are made of gold (most durable), porcelain and composite resin, and porcelain bonded to metal. Dr. Bob and his staff will help you to decide which one is best for your tooth. Well-made crowns will last a very long time, if the patient returns for regular check-ups and if the crown is not subjected to unusual forces or acids.

Onlays are similar to crowns but not as large. They can be constructed of gold or porcelain. They cost less than a crown because a build-up is not necessary with an onlay. Onlays are more conservative than crowns in that not all the tooth structure needs to be removed. These are wonderful restorations, which can last for decades, if cared for properly.

Silver amalgams are the most commonly used fillings in dentistry and have been for decades. However there is adequate research now that shows they contribute to cracking and stress fractures in teeth. There was also a question about the safety of mercury used in the amalgam, although there are no published scientific studies to document this. We don't like to see teeth crack, especially when the crack penetrates the pulp and the tooth needs root canal therapy. Therefore, we prefer to use bonded fillings instead of silver amalgam in our office. We have been using internal (dentinal) bonding in our office since 1992 and have had excellent results at reducing sensitivity associated with metal fillings. The bonded fillings also have had good durability, although the composite resin is not as hard as amalgam.

If the filling area is large, then a bonded filling may be not be the best choice since it may break. Here, a gold or white onlay (a lab processed restoration) should be used. The white fillings also look very natural and are far more esthetic than the gray/black amalgams.

A fixed bridge is a tooth replacement that rigidly attaches to teeth on either side of the space. These are not removable. The adjoining teeth are prepared for crowns at the first appointment and a temporary bridge is made for the interim period. The dentist checks the fit of the bridge and then cements it. Materials used for bridges are gold, porcelain to metal, and bonded resins. Non-metallic bridges are fairly new and no long term studies have been done to show how well they will hold up after ten years. Although they are more esthetic than bridges with metal, they do carry a risk of breaking. The fixed bridge is the most predictable way of replacing natural teeth with rigidity.

As we age, our body changes and our mouth is no exception. The salivary glands do not supply as much water as in our younger days, so that an older adult's mouth is often dry. This allows the plaque to adhere firmly to the tooth, and especially to the root surface, inviting decay. You can fight this process by keeping your mouth as wet as possible. Drink plenty of water. Use home fluoride applications to make your teeth stronger. If your condition is severe, Dr. Bob can write a prescription for pilocarpine, a medication that will increase salivary flow. We also have a complimentary dry mouth kit that offers several products for you to try. We participate in the Golden Buckeye program and offer a courtesy discount to our senior citizens.

Many older adults have teeth that are brown or yellowed. Many are trying the bleaching and cosmetic dentistry restorations. There is nothing wrong with a nice, white attractive smile. It will make you look and feel younger.

With missing teeth, many people have trouble chewing. Some of our older adult patients are deciding to have dental implants done. Others are having their dentures and partial dentures relined. A good fit is important. Dr. Bob did a research project while at Ohio State and found that many oral cancer patients were people who had ill-fitting dentures for many years. Even if your teeth seem to fit well, the American Dental Association recommends a check-up for denture wearers at least once a year.

Dental implants have come a long way since the 1960s when most of the profession looked down upon their use. In 1980 Dr. Bob was one of the founding members of the Dayton Implant Study Group, an association of a dozen dentists who did the early implant work in the Cincinnati-Dayton area. Now he refers patients for the surgical phase to an oral surgeon.

A dental implant is a thimble-shaped metallic cylinder that is placed in the jawbone. A crown is then fixed into the device so that a rigid tooth results. Implants can be used for single tooth or multiple teeth replacements. Ever since the major Scandinavian research study showed that osseointegration (fixing to bone) provided predictable long term results, dentists have been more active in placing implants. The success rate is generally about 90% for implants in the lower jaw and a lesser percentage for the upper jaw. Implants can also be used, in certain instances, to replace complete dentures with a fixed appliance.

These are replacement appliances that supply some but not all teeth and are removable. The patient must clean the appliance daily and should remove it at night. If left in at night, the partial denture will act as a trap for plaque and the abutment (anchor) teeth may decay. If constructed well, a cast metal partial can function very well, although it will naturally move a little during chewing. The metal clasps of the partial will not cause the anchor teeth to decay. Only plaque, not cleaned off the tooth surface, can cause decay. Partials are less expensive than fixed bridges.

This phrase inspires terror in most people. The media loves to ridicule this aspect of dentistry. And, it's too bad because root canals just aren't that bad. Unless a tooth is terribly infected, the procedure is usually painless. Dr. Bob has been doing root canal treatment since 1971 while in dental school. However, when patients have very curved roots or other difficulties, Dr. Bob feels that a specialist should treat the case.

We now have instruments that make root canal therapy faster and easier, not only for the patient but also for the dentist. Usually the treatment takes one visit, but sometimes multiple visits are necessary. The inner part of the tooth is cleansed, sterilized with irrigating solutions, and shaped. You may need antibiotics, if infection is present. We use a material called gutta percha to fill the canals, and when warmed, it spreads into adjacent nooks and crevices in the root system, assuring a thorough fill. When the root canal is finished, the tooth usually requires a crown for protection since the tooth is more brittle than a tooth with a healthy pulp.

The success rate of root canal therapy is about 95%. Normally the tooth will last a lifetime after having this treatment. Best of all, the teeth will not shift and the bite is stabilized. However, it is wise to avoid prolonged chewing of hard objects on these teeth since the root may fracture. Not too long ago (1950s), these teeth were routinely extracted. Thank goodness for root canals!

If you have the bad fortune to sleep with a snorer, I feel sorry for you. And I feel sorry for the one who snores, as well. Those who snore often don't get a good night's rest ... and those nearby usually have trouble as well. For patients with a snoring problem, we make an appliance called Therasnore®. This is a relatively inexpensive, non-surgical approach to combat snoring. Most of our patients feel it has helped.

If snoring becomes more labored, it can turn into a condition called obstructive sleep apnea. People who suffer from sleep apnea often feel tired during the daytime and sometimes fall asleep while driving a car. For this condition, patients should first consult with a physician who is a specialist in sleep disorders. We can make a special device for sleep apnea, the Klearway® Oral Appliance. This fits on the top and bottom teeth and is very effective in these more advanced cases.

Many patients clench or grind their teeth, resulting in damage to the jawbone, the teeth, and eventually the TMJ. Some patients do it unknowingly during the daytime and others grind during their sleep. Often patients will complain of headaches, pain, and stiffness in the jaw muscles, making opening difficult. Teeth often become severely worn and usually chip or crack, sometimes fracturing the root, which requires extraction. What causes grinding and clenching? Researchers seem to think that it's stress. Some cases are caused by sleep disorders and some by certain medications.

How can you take care of this problem? First, realize that it's up to you to solve your stress. Look at your life and make a list of priorities each day. At a minimum, leave one hour before bedtime just for you. This time cannot be violated by any disruption. During this personal hour, congratulate yourself for all that you did right today and forgive yourself for things that didn't go so well. Read a couple chapters of the book, Don't Sweat the Small Stuff. Meditate. Practice deep relaxation. Do something just for you ... for fun ... and if all that doesn't work ...

Get a mouthguard for night grinding. These are hard appliances, much like an orthodontic retainer, that fit on the upper or lower teeth. Most of the time, they stop night-time grinding. The patient wakes up rested and his or her jaw muscles are relaxed. No more chipped teeth. No more broken crowns. Rarely do patients wear these in the daytime. If you clench or grind in the day, be aware of the damage it can do and observe your mouth so that you can learn what makes you do this. Often it's during a time of severe distress. Learn to let your jaw drop open, keeping the teeth apart. It is difficult to catch yourself when you clench but, with practice, you'll become more conscious of this and hopefully you will be able to stop this damaging habit.