Cleaning and Periodontal Health
At our practice, we believe in “Care Management” rather than “Pain Management”. That is why we emphasize taking care of your teeth through regular re-care visits and proper home-care. After all, you want to have your teeth for a lifetime. Proper care of your teeth will also help prevent costly treatment and procedures in the long run.

What is Soft Tissue Management?
It is an individualized plan to eliminate infection of the gums and root surfaces.  Remember periodontal disease is an infectious and inflammatory disease that results from bacteria collecting on the tooth surface above and below the gum line which destroys gum tissues and bone. The greatest cause of adult tooth loss is gum disease.

Periodontal Disease
Scaling and Root-Planing
The procedure used is called Root-Planing.  This treatment is of the diseased root surfaces BELOW the gum-line. 

It focuses on eliminating:
  • Tartar and plaque below the gum 
  • Detoxifying the root surfaces where the disease occurs
  • Obtaining smooth roots 
  • Flushing out the pockets allow for healthy reattachment of the gums to the root surfaces.
The problem is due to multiple reasons, and hence the treatment needs to be multi-faceted, addressing each of these reasons.

The goals of this treatment are:
  • Gums that do not bleed.  HEALTHY GUMS DO NOT BLEED! Gums that are not red, swollen or tender
  • Fresher breath and taste
  • Reattachment of gum tissue to tooth surface
  • Smooth tooth surface
  • Flush out bacteria in pockets
  • Knowing how to effectively maintain good oral hygiene
  • Reduce pocket depths 
  • Control periodontal disease
What we need from you, our patient to make this treatment a success: :
  • Completion of the therapy as prescribed 
  • Thoroughly cleaning all tooth surfaces two times a day (See cleaning section below)
  • Flossing daily
  • Maintenance of regular re-care visits (See our FAQ on frequency of re-care).
  • We will offer thorough instructions on home care to insure the removal of bacteria on a daily basis. This includes proper use of the toothbrush, paste, mouth rinses, medications, floss threaders, and proxy brushes. Home care can effectively eliminate the plaque above the gums and down to 2 mm below the gums.
How do I brush my teeth?
  • Place your toothbrush at a 45-degree angle against the gums.
  • Move the brush back and forth gently in short (tooth-wide) strokes.
  • Brush the outer tooth surfaces, the inner tooth surfaces, and the chewing surfaces of the teeth.
  • Use the "toe" of the brush to clean the inside surfaces of the front teeth, using a gentle up-and-down stroke.
  • Brush your tongue to remove bacteria and freshen your breath.
How do i floss my teeth?
  • Break off about 18 inches of floss and wind most of it around one of your middle fingers. Wind the remaining floss around the same finger of the opposite hand. This finger will take up the floss as it becomes dirty. Hold the floss tightly between your thumbs and forefingers.
  • Guide the floss between your teeth using a gentle rubbing motion. Never snap the floss into the gums.
  • When the floss reaches the gum line, curve it into a C shape against one tooth. Gently slide it into the space between the gum and the tooth.
  • Hold the floss tightly against the tooth. Gently rub the side of the tooth, moving the floss away from the gum with up and down motions.
  • Repeat this method on the rest of your teeth.
  • Don't forget the back side of your last tooth.
Watch the brushing and flossing animation to learn more. People who have difficulty handling dental floss may prefer to use another kind of interdental cleaner. Ask Dr. Somani to recommend one for you.

Please check out this link for more details on periodontal health and problems associated with it.

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Fixed Crown and Bridges
Crowns are dental restorations otherwise known as "caps" which are coverings that fit over teeth. Crowns may be necessary because of broken down old fillings, fractured, chipped or sensitive teeth. Crowns are also used to improve the appearance of natural teeth that are malformed, mal-positioned or discolored.

Crowns are made of natural looking porcelain and are made to improve your overall smile or to blend in with your own teeth. Sometimes an underlying metal shell is used under the porcelain if additional strength is needed. A Bridge, as the name suggests, would be considered if you would need multiple crowns across adjacent teeth. .

Some of the indications for a crown are:
  • A previously filled tooth where there now exists more filling than tooth. The existing tooth structure becomes weakened and can no longer support the filling.
  • Extensive damage by decay.
  • Discolorations and compromised esthetics.
  • Fractures
  • Root canal - After root canal, teeth tend to become brittle and are more apt to fracture. These teeth need to be protected by a crown. .
  • Bridges - When missing teeth are replaced with a bridge, the adjacent teeth require crowns in order to support the replacement teeth.
Crowns strengthen and protect the remaining tooth structure and can improve the appearance of your teeth. Crowns can be made from different materials which include the full porcelain crown, the porcelain fused-to-metal crown and the all-metal crown. You and Dr. Somani will decide which type is appropriate, depending upon the strength requirements and esthetic concerns of the tooth involved.

Fitting a crown requires at least two appointments. During your first visit, the tooth is prepared for the crown, an impression or mold is made of the tooth, and a temporary crown is placed over the prepared tooth. At the subsequent visit, the temporary crown is removed and the final crown is fitted and adjusted and cemented into place.


There are a couple of additional facts you should know about regarding the care of your temporary crown:

  • Home care is extremely important while your temporary crown is in place. The health of your gum tissue and the success of your final treatment restoration depends upon it. PLEASE do not be afraid to clean your teeth between visits. With a minimal amount of home care, you should be able to maintain the continued health of your teeth and gum tissue during the time required to fabricate your new crown.
  • Sometimes, even with meticulous care, temporary crowns or bridges may become loose between visits. If this should occur, please place the temporary crown or bridge back on your tooth immediately. Putting a drop of Vaseline™ in the temporary crown or bridge will very often increase the retention and hold the temporary in place until you can schedule an appointment. You can also buy denttemp from drugstore and use it to temporarily cement the temporary crown. Once again, REPLACING THE TEMPORARY CROWN IMMEDIATELY IS VERY IMPORTANT! It only takes a short time for teeth to move if the temporary is not put back into its proper position. This could affect the final restoration significantly and may necessitate new impressions and a great deal of time. If you can not replace the temporary crown yourself, put it in a safe place and call the office. We will be happy to recement it for you at the earliest possible.

It is not unusual for the new crown to be mildly sensitive to cold temperatures for a few weeks. However, if the sensitivity is severe, does not subside, or if the bite feels uncomfortable, contact us. Further adjustments to the crown may be necessary.


If you have any questions regarding this or any other procedure, please feel free to ask our staff, and we will be happy to answer them.

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Implants
Implants have undoubtedly become the hottest new thing in dentistry. Dental implants are so natural-looking and feeling, you may forget you ever lost a tooth. You know that your confidence about your teeth affects how you feel about yourself, both personally and professionally. Perhaps you hide your smile because of spaces from missing teeth. Maybe your dentures don't feel secure. Perhaps you have difficulty chewing. If you are missing one or more teeth and would like to smile, speak and eat again with comfort and confidence, there is good news! Dental implants are teeth that can look and feel just like your own! Long-term studies continue to show improving success rates for implants.

A dental implant is an artificial tooth root that is placed into your jaw to hold a replacement tooth or bridge. While high-tech in nature, dental implants are actually more tooth-saving than traditional bridgework, since implants do not rely on neighboring teeth for support.


What Dental Implants Can Do?
  • Replace one or more teeth without affecting bordering teeth.
  • Support a bridge and eliminate the need for a removable partial denture.
  • Provide support for a denture, making it more secure and comfortable.

Before dental implant After dental implant

Advantages of Dental Implants Over Dentures or a Bridge
Every way you look at it, dental implants are a better solution to the problem of missing teeth. .

Esthetic Dental implants look and feel like your own teeth! Since dental implants integrate into the structure of your bone, they prevent the bone loss and gum recession that often accompany bridgework and dentures. No one will ever know that you have a replacement tooth.

Tooth-saving Dental implants don't sacrifice the quality of your adjacent teeth like a bridge does because neighboring teeth are not altered to support the implant. More of your own teeth are left untouched, a significant long-term benefit to your oral health!

Confidence Dental implants will allow you to once again speak and eat with comfort and confidence! They are secure and offer freedom from the irksome clicks and wobbles of dentures. They'll allow you to say goodbye to worries about misplaced dentures and messy pastes and glues.

Reliable The success rate of dental implants is highly predictable. They are considered an excellent option for tooth replacement.


Are You a Candidate for Dental Implants?
The ideal candidate for a dental implant is in good general and oral health. Adequate bone in your jaw is needed to support the implant, and the best candidates have healthy gum tissues that are free of periodontal disease.

What Can I Expect After Treatment?
As you know, your own teeth require conscientious at-home oral care and regular dental visits. Dental implants are like your own teeth and will require the same care. In order to keep your implant clean and plaque-free, brushing and flossing still apply! After treatment, we will work closely with you to develop the best care plan for you. Periodic follow-up visits will be scheduled to monitor your implant, teeth and gums to make sure they are healthy.

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Root Canals
What is a Root Canal Treatment?
Root canal treatment, also known as endodontic treatment, is a dental procedure in which the diseased or damaged pulp (core) of a tooth is removed and the inside areas (the pulp chamber and root canals) are filled and sealed.

Inflamed or infected pulp (pulpitis) most often causes a toothache. To relieve the pain and prevent further complications, the tooth may be extracted (surgically removed) or saved by root canal treatment. Root canal treatment has become a common dental procedure; more than 14 million are performed every year, with a 95% success rate, according to the American Association of Endodontists.

Aftercare
The tooth may be sore for several days after filling. Pain relievers, such as ibuprofen (Advil, Motrin) may be taken to ease the soreness. The tissues around the tooth may also be irritated. Rinsing the mouth with warm salt water several times a day will help. Chewing on that side of the mouth should be avoided for the first few days following treatment. A follow-up appointment should be scheduled for two weeks and then in six months after treatment to make sure the tooth and surrounding structures are healthy.
Normal results
With successful root canal treatment, the tooth will no longer cause pain. However, because it does not contain an internal nerve, it no longer has sensitivity to hot, cold, or sweets. These are signs of dental decay, so you must get regular dental check-ups with periodic x-rays to avoid further disease in the tooth. The restored tooth could last a lifetime; however, with routine wear, the filling or crown may eventually need to be replaced.

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Oral Surgery
Oral Surgery or Tooth Extraction – Why do I need it?
Tooth extraction is the removal of a tooth from its socket in the bone. Extraction is performed for positional, structural, or economic reasons. Teeth are often removed because they are impacted. Teeth become impacted when they are prevented from growing into their normal position in the mouth by gum tissue, bone, or other teeth. Impaction is a common reason for the extraction of wisdom teeth. Extraction is the only known method that will prevent further problems. Teeth may also be extracted to make more room in the mouth prior to straightening the remaining teeth (orthodontic treatment), or because they are so badly positioned that straightening is impossible. Extraction may be used to remove teeth that are so badly decayed or broken that they cannot be restored. In addition, patients sometimes choose extraction as a less expensive alternative to filling or placing a crown on a severely decayed tooth. Wisdom tooth extraction is generally needed if the tooth is extremely hard to reach and maintain.

see our Post-Op care instructions for more information.
Things to know about
Potential complications of tooth extraction include postoperative infection, temporary numbness from nerve irritation, jaw fracture, and jaw joint pain. An additional complication is called dry socket. When a blood clot does not properly form in the empty tooth socket, the bone beneath the socket is painfully exposed to air and food, and the extraction site heals more slowly. .
Normal results
After an extraction, the wound usually closes in about two weeks. It takes three to six months for the bone and soft tissue to be restructured. Complications such as infection or dry socket may prolong the healing time.
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Fillings
Why do you need Fillings?
Acid producing bacteria damage the enamel of your tooth. This damaged portion of the tooth needs to be drilled out, causing a cavity. Dental plaque provides a home for these acid causing bacteria. That is why good oral hygiene is extremely important for healthy teeth. (See our Cleaning and Periodontal Disease section above). Dental fillings are inserted as restorations in the treatment of dental cavities, after drilling out the cavities. However, once the infected hard tissues have been removed, the resulting cavity preparation must be filled in order to restore structural integrity to the tooth. This will prevent further damage to the tooth and hopefully avoid the eventual need for the tooth to be extracted.

Types of Fillings – It is your CHOICE!
Amalgam (silver filling)

Amalgam fillings are an alloy of mercury (from 43% to 54%) along with silver, tin, zinc and copper. Due to the known toxicity of mercury, the main component of amalgam fillings, there is an ongoing dental amalgam controversy on the use of this filling material. (See Dental Amalgam Controversy)

Composite resin (white or plastic filling)

Composite resin fillings are a mixture of powdered glass and plastic resin, and can be made to resemble the appearance of the natural tooth. They are strong and durable and cosmetically superior to silver or dark grey colored amalgam fillings. Composite resin fillings are usually more expensive than silver amalgam fillings.

Besides the aesthetic advantage of composite fillings over amalgam fillings, the preparation of composite fillings requires less removal of tooth structure to achieve adequate strength. This is because composite resins bind to enamel (and dentin too, although not as well) via a micromechanical bond. As conservation of tooth structure is a key ingredient in tooth preservation, Dr. Somani prefers placing composite over amalgam fillings when possible.

Things to know about
Fillings have a finite lifespan. Fillings fail because of changes in the filling, tooth or the bond between them. Amalgam fillings expand with age, possibly cracking the tooth and requiring repair and filling replacement. Composite fillings shrink with age and may pull away from the tooth allowing leakage. As chewing applies considerable pressure on the tooth, the filling may crack, allowing seepage and eventual decay in the tooth underneath.

The tooth itself may be weakened by the filling and crack under the pressure of chewing. That will require further repairs to the tooth and replacement of the filling. If fillings leak or the original bond is inadequate, the bond may fail even if the filling and tooth are otherwise unchanged

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Whitening

According to a recent study, the #1 question on people’s mind when it comes to their teeth is teeth whitening!

How does it work?
Each of your teeth is made up of an inner dentin layer and a hard outer enamel layer, which protects the teeth. When you put stuff in your mouth -- food, cigarette smoke, coffee, etc. -- another layer gradually forms on top of the enamel layer. Basically, the foreign material accumulates to form a pellicle film over the enamel layer. The problem is, as this pellicle layer sits on your teeth for years and years, the foreign material gets into the enamel. The deeper stains are basically harmless, but many people find them unattractive. This is where true tooth whiteners come in. Basically, the whiteners use bleaching chemicals to get down into the tooth enamel and set off a chemical reaction that breaks apart the staining compounds. Most tooth whiteners use one of two chemical agents: carbamide peroxide or hydrogen peroxide.

Different type of Whitening
The three most common types of whitening to consider are over-the-counter whitening, in-home whitening with customized trays and whitening material, and the in-office whitening. And as you can guess, each of the above system has progressively faster results. The in-office whitening gives you a brighter, whiter smile in just under an hour, and you could have a smile that is at least 4 to 6 shades lighter! (Results may vary based on individual conditions)

Some sensitivity may develop after the process, but is should subside after a few days. Ask Dr. Somani which is the right procedure for you!

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Veneers and Cosmetic Dentistry

Veneers are a thin, semi-transparent tooth shaped "shell" that are made of porcelain.  They are permanently bonded to your natural teeth which are located in your "smile zone" to enhance their shape, color, length or size.  They fit your teeth precisely to look completely natural.  They are used to conceal damaged, stained or misshaped surfaces of your teeth. 

The great thing about veneers is they allow a conservative approach  to long-lasting, major cosmetic changes.   

The benefits of veneers as an alternative to a white fillings or crowns is:

  • Only a small amount of the tooth structure (enamel) is removed (if any) during the procedure.
  • They can mask undesirable defects such as tetracycline stains, an injury or discolored fillings.
  • Often no anesthesia is needed.
  • It gives a natural appearance with little to no discomfort.
  • They are often a less costly alternative procedure to having crowns.
  • Porcelain veneers are durable, strong, stain resistant and beautiful. 

Braces vs. Veneers
Veneers are usually more expensive than braces, but the results are immediate. Veneers can improve the appearance of an overbite or underbite but NOT correct it.  Braces can realign the jaw and correct overbites and underbites, but they take time.  Veneers cost a lot less than braces.

Durability 
Veneers can last for years depending on how well you take care of them.  Their durability will be shortened if you use them to bite your nails, open objects with them, or chew on hard things like ice.  Veneers can also chip or peel if not cared for properly, To ensure they will last for years you need to maintain good oral health hygiene and regular dental cleanings and exams twice a year.
Aftercare
Care tips of your cosmetic restorations:
  • For about two weeks you will go through an adjustment period as you "get use to" your "new" teeth that have been changed in size and shape. It will take your brain some time to recognize the new position of your teeth or their new thickness as normal. If you detect any high spots or problems with your bite call us.
  • Veneers have great crushing strength but not "tensile strength".  Avoid anything that will twist the veneer.  Please avoid the following things would break even natural teeth such as chew on pistachio nuts, hard candy, chicken or rib bones, jelly apples or open things with your teeth.
  • As with your natural teeth, veneers require good oral hygiene. Brush with a ultra-soft toothbrush. Try a electric toothbrush for better cleaning.  Do not use a sonic type toothbrush as the vibrations may loosen the restoration. 
  • Use non-abrasive toothpaste or toothpaste with baking soda.  Avoid "extra whitening" toothpaste because they are often very abrasive and can scratch your restoration.
  • Floss between all teeth at least once a day to remove plaque. Flossing before bedtime is the best time. 
  • Clean around your gum line carefully.
  • Your gums may be sore, try rinsing them with water salt water (1 tsp. salt in 8 of warm water, rinse-swish-spit 3 times a day) for several days to reduce swelling and discomfort.
  • Eat a normal diet yet be careful when eating hard foods, they can damage veneers.
  • Do not rinse routinely with mouthwashes, as they are high in alcohol.  Alcohol softens bonding and weakens the bond of porcelain.  If mouthwash is desired, a solution of hydrogen peroxide and water could be used or select a non-alcohol containing mouthwash.
  • Dr. Somani will see you for professional maintenance, cleaning and polishing of your restorations every six months. ALWAYS tell the staff you have porcelain veneers when you have your teeth cleaned and make sure they use a neutral sodium fluoride.  Stannous fluoride or acidulated phosphate fluoride are not recommended for composite resin bonding or porcelain.  

DO NOT:
  • Brush with a medium or hard toothbrush with an abrasive paste...it can scratch your restorations.
  • Don't brush your teeth hard.
  • Do not use stannous fluoride or Acidulated Phosphate Fluoride products with your veneers.  They can etch the porcelain veneers and decrease the surface smoothness of your veneer.   
  • Smoke, it will stain your restoration.  Not smoking will increase the life span of you and your restorations.
  • Avoid chewing tobacco, it will stain the veneers.
  • Like natural teeth, the bonded material can pick up stains: try to avoid or keep to a minimum tobacco, coffee, tea, soy sauce, curry, colas, grape juice, blueberries or red wine or indulge in foods or drinks that have dark pigments because they can stain your veneers.  
  • If you feel a rough edge do NOT pick at it, make an appointment with use to have it smoothened.    
  • Allow anyone to clean your restorations with ultrasonic tools, air polishers or abrasive polishing pastes.  Only composite or diamond polishing paste is to be used for your professional cleanings.  
  • Like any restoration, it is possible for the veneer to come off or for small decay to develop.  In that situation a new veneer may be required. Also replacement of the restorations may be required in several years.
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Invisalign/Braces
Invisalign is the easy way to improve your smile. It is proven technology designed to give you the smile you've always wanted, without the pain and anxiety associated with metal braces.


How does it work?
To help you get a more beautiful smile, we use a series of clear, removable aligners to gradually move your teeth. You wear a set of aligners for about two weeks, removing them only to eat, drink, brush and floss. As you replace each set of aligners with the next in the series, your teeth will gradually move until they reach the position Dr. Somani has prescribed for you. To learn more, take a look at this video on the Invisalign website.

The clear alternative to metal braces.
By using a series of clear, removable aligners, Invisalign straightens your teeth with results you'll notice sooner than you think. The course of treatment involves changing aligners approximately every two weeks, moving your teeth into straighter position step by step, until you have a more beautiful smile. And unlike braces, these clear aligners can be removed while you eat and brush your teeth as usual.

Since Invisalign is practically invisible, there's no unwarranted attention to your mouth. In fact, very few people will notice at all - unless you tell them. They're comfortable to wear and remove easily when you eat, brush, and floss.


Less treatment time
An average Invisalign course of treatment takes about a year. You'll see Dr. Somani every 6 to 8 weeks for adjustments and to check progress. At regular intervals, you'll receive a new set of custom-molded clear aligners to continue the straightening process. The total number of clear aligners is specific to you, determined by Dr. Somani for your course of treatment.

All across the country, people like you now have great smiles and straighter teeth, thanks to Invisalign. Why not join them? That gorgeous smile you want is just a click away.


Schedule a free, no-obligation consultation today.
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Full and Partial Dentures

Dentures are replacements for missing teeth that can be taken out and put back into your mouth. While dentures take some getting used to, and will never feel exactly the same as one's natural teeth, today's dentures are natural looking and more comfortable than ever.

There are two main types of dentures: full and partial. Dr. Somani will help you choose the type of denture that's best for you based on whether some or all of your teeth are going to be replaced and the cost involved.

How do Dentures Work?
With full dentures, a flesh-colored acrylic base fits over your gums. The base of the upper denture covers the palate (the roof of your mouth), while that of the lower denture is shaped like a horseshoe to accommodate your tongue. Dentures are custom-made in a dental laboratory from impressions taken of your mouth. Dr. Somani will determine which type of denture is best for you.

Full Denture
A conventional full denture is placed in your mouth after any remaining teeth are removed and tissues have healed. Healing may take several months, during which time you are without teeth. An immediate full denture is inserted immediately after the remaining teeth are removed. Dr. Somani takes measurements and makes models of your jaw during a prior visit. While immediate dentures offer the benefit of never having to be without your teeth, they must be relined several months after being inserted. The reason is that the bone supporting the teeth reshapes as it heals, causing the denture to become loose.

Partial Denture
A partial denture rests on a metal framework that attaches to your natural teeth. Sometimes crowns are placed on some of your natural teeth and serve as anchors for the denture. Partial dentures offer a removable alternative to bridges.

How Long Before I Get Used to My Dentures?
New dentures may feel awkward or uncomfortable for the first few weeks or even months. Eating and speaking with dentures might take a little practice. A bulky or loose feeling is not uncommon, while the muscles of your cheeks and tongue learn to hold your dentures in place. Excessive saliva flow, a feeling that the tongue does not have adequate room, and minor irritation or soreness are also not unusual. If you experience irritation, call our office.

How long do Dentures Last?
Over a period of time, your denture will need to be relined, remade, or rebased due to normal wear. Rebasing means making a new base while keeping the existing denture teeth. Also, as you age, your mouth naturally changes. These changes cause your dentures to loosen, making chewing difficult and irritating your gums. At a minimum, you should see Dr. Somani annually for a checkup.

Tips for Denture Care
  • When handling your dentures, stand over a folded towel or basin of water. Dentures are delicate and may break if dropped.
  • Don't let your dentures dry out. Place them in a denture cleanser soaking solution or in plain water when you're not wearing them. Never use hot water, which can cause them to warp.
  • Brushing your dentures daily will remove food deposits and plaque, and help prevent them from becoming stained. An ultrasonic cleaner may be used to care for your dentures, but it does not replace a thorough daily brushing.
  • Brush your gums, tongue and palate every morning with a soft-bristled brush before you insert your dentures. This stimulates circulation in your tissues and helps remove plaque.

See Dr. Somani if your dentures break, chip, crack or become loose. Don't be tempted to adjust them yourself — this can damage them beyond repair.

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