Information for Patients

We strive to provide all our patients, both old and new. with answers to their ever question. We want you to feel at home and completely comfortable with the procedures and the staff.

Questions & Answers
Why Receive Care From A Prosthodontist?
Dental Home Care
Privacy

Questions & Answers

What is LUMINEERS by CERINATE?
LUMINEERS by CERINATE is thin porcelain shields that are bonded to the front of your teeth to create dramatic changes in your smile.

Is there any pain involved with LUMINEERS?
No! Because lumineerS by CERINATE require little to no preparation there is no need for shots or drilling with no removal of painful structure.

How long will it take to change my smile with LUMINEERS?
While some people may need other dental treatments, lumineerS by CERINATE typically requires two dental visits.

How do I know lumineerS by CERINATE is right for me?
Schedule a consultation with your dentist, who can show you how your smile can be improved with lumineerS by CERINATE.

How long lumineerS by CERINATE last?
Long-term clinical research with lumineerS by CERINATE (over 20 years) shows 100% retention with no discoloration.

I don't wear my lower denture because it moves too much.  Can you make one that stays put?
A lower denture relies on a “ridge”, the jawbone leftover after teeth are removed, and gravity to stay in place.  If you have lost weight or had this denture for many years, the shape of this ridge is different than when first placed so it feels unstable.  Many people tolerate this condition far longer than they should because an ill-fitting denture causes even more destruction of this ridge.  You should make an appointment, bringing your existing denture, and I will evaluate it and discuss your options.

My current bridge has made a dark line near my gums.  Can you fix this?
If a dark line occurs over time, it is either decay or the edge of the crowns that make up the bridge.  I can fix both conditions.  The paper-thin edge of a crown is actually metal, used to strengthen the crown, which slides under the gumline when first placed.  This metal usually begins to show if your gums recede due to vigorous brushing, periodontal disease, or sometimes aging.  It is important to determine the cause of receding gums during a dental exam.

I have some health problems that my current dentist says prevent the use of implants to replace my missing teeth.  Am I stuck getting dentures?
Admittedly, there are a handful of diseases that interfere with the use of implants, particularly a type called “endosseous”.  This type is most often used to replace single teeth.  However, prosthodontists are specialists in implants, placing several types and working with different manufacturers' designs.  A conference with your health care providers, combined with a properly-selected implant and proper maintenance, may be all that's needed to keep you out of dentures.

My family dentist doesn't do implants because she says they are problematic.  Is this true?
When implants first became available 20 years ago, no one realized the importance of the surgical technique and failures were quite common.  Today, there is a 92% success rate.  I have done over 6000 implants with few problems.  I suspect that your dentist is reluctant to try them because the technique is tricky or she has tried a few and had problems.

I was told that I needed “fixed prosthodontics” to replace a small front denture that I have worn since junior high.  What does that mean?
“Fixed prosthodontics” refers to any porcelain, metal, or porcelain-fused-to-metal structure of that is permanently cemented into place to fix existing teeth or replace missing ones.  If it fixes one tooth, it is a “crown”, and if it replaces one or more missing teeth by attaching to natural teeth on each side of the gap, it is a “bridge”.

My current lower denture moves so much when I chew, yet I need it to eat.  Do you have any suggestions to improve this situation?
Many people have the same complaint about their lower partial dentures or dentures and often refuse to wear them to eat.  That is not a good idea because it puts undue strain on the jawbone and can create bigger problems.  Your lower denture will stay put if it's made to attach to the jawbone.  Investigate the possibility of dental implants, surgically placed into the jawbone with a projection above the gum, to which an overdenture could fit.  The inside of the overdenture has snap-like fixtures that fit over the projections securely.

Are dental x-rays safe?
We are all exposed to natural radiation in our environment. The amount of radiation exposure from a full mouth series of x-rays is equal to the amount a person receives in a single day from natural sources.
Dental x-rays produce a low level of radiation and are considered safe. Dentists take necessary precautions to limit the patient’s exposure to radiation when taking dental x-rays. These precautions include using lead apron shields to protect the body and using modern, fast film that cuts down the exposure time of each x-ray.

How often should dental x-rays be taken?
The need for dental x-rays depends on each patient’s individual dental health needs. Your dentist and dental hygienist will recommend necessary x-rays based on the review of your medical and dental history, dental exam, signs and symptoms, age consideration, and risk for disease.
A full mouth series of dental x-rays is recommended for new patients. A full series is usually good for three to five years. Bite-wing x-rays (x-rays of top and bottom teeth biting together) are taken at recall (check-up) visits and are recommended once or twice a year to detect new dental problems.

How are composite fillings placed?
Composite fillings are usually placed in one appointment. While the tooth is numb, your dentist will remove decay as necessary. The space will then be thoroughly cleaned and carefully prepared before the new filling is placed. If the decay was near the nerve of the tooth, a special medication will be applied for added protection. The composite filling will then be precisely placed, shaped, and polished, restoring your tooth to its original shape and function.
It is normal to experience sensitivity to hot and cold when composite fillings are first placed, however this will subside shortly after your tooth acclimates to the new filling.
You will be given care instructions at the conclusion of your treatment. Good oral hygiene practices, eating habits, and regular dental visits will aid in the life of your new fillings.

What does getting a crown involve?
A crown procedure usually requires two appointments. Your first appointment will include taking several highly accurate molds (or impressions) that will be used to create your custom crown. A mold will also be used to create a temporary crown which will stay on your tooth for approximately two weeks until your new crown is fabricated by a dental laboratory.
While the tooth is numb, the dentist will prepare the tooth by removing any decay and shaping the surface to properly fit the crown. Once these details are accomplished, your temporary crown will be placed with temporary cement and your bite will be checked to ensure you are biting properly.
At your second appointment your temporary crown will be removed, the tooth will be cleaned, and your new crown will be carefully placed to ensure the spacing and bite are accurate.
You will be given care instructions and encouraged to have regular dental visits to check your new crown.

What does getting a fixed bridge involve?
Getting a bridge usually requires two or more visits. While the teeth are numb, the two anchoring teeth are prepared by removing a portion of enamel to allow for a crown. Next, a highly accurate impression (mold) is made which will be sent to a dental laboratory where the bridge will be fabricated. In addition, a temporary bridge will be made and worn for several weeks until your next appointment.
At the second visit, you permanent bridge will be carefully checked, adjusted, and cemented to achieve a proper fit. Occasionally your dentist may only temporarily cement the bridge, allowing your teeth and tissue time to get used to the new bridge. The new bridge will be permanently cemented at a later time.
You will receive care instructions at the conclusion of your treatment. Proper brushing, flossing and regular dental visits will aid in the life of your new permanent bridge.

What does root canal therapy involve?
A root canal procedure requires one or more appointments and can be performed by a dentist or endodontist (a root canal specialist).
While the tooth is numb, a rubber dam (a sheet of rubber) will be placed around the tooth to keep it dry and free of saliva. An access opening is made on top of the tooth and a series of root canal files are placed into the opening, one at a time, removing the pulp, nerve tissue, and bacteria. If tooth decay is present, it will also be removed with special dental instruments.
Once the tooth is thoroughly cleaned, it will be sealed with either a permanent filling or, if additional appointments are needed, a temporary filling will be placed.
At the next appointment, usually a week later, the roots and the inside cavity of the tooth will be filled and sealed with special dental materials. A filling will be placed to cover the opening on top of the tooth. In addition, all teeth that have root canal treatment should have a crown (cap) placed. This will protect the tooth and prevent it from breaking, and restore it to its full function.
After treatment, your tooth may still be sensitive, but this will subside as the inflammation diminishes and the tooth has healed.
You will be given care instructions after each appointment. Good oral hygiene practices and regular dental visits will aid in the life of your root canal treatment.

What does getting dentures involve?
The process of getting dentures requires several appointments, usually over several weeks. Highly accurate impressions (molds) and measurements are taken and used to create your custom denture. Several “try-in” appointments may be necessary to ensure proper shape, color, and fit. At the final appointment, your dentist will precisely adjust and place the completed denture, ensuring a natural and comfortable fit.
It is normal to experience increased saliva flow, some soreness, and possible speech and chewing difficulty, however this will subside as your muscles and tissues get used to the new dentures.
You will be given care instructions for your new dentures. Proper cleaning of your new dental appliance, good oral hygiene, and regular dental visits will aid in the life of your new dentures.

How does IV sedation feel like? Will I be asleep?
It may, indeed, feel like you were "asleep" during the procedure because of two factors: firstly, in most people, IV sedation induces a state of deep relaxation and you are not bothered by what's going on. Secondly, the drugs used for IV sedation will produce memory loss (amnesia) for the period of time when the drug first kicks in until it wears off (usually during the ride home). As a result, time will appear to pass very quickly and you will recall little (usually none) of your procedure. Although most patients fall asleep during IV sedation, if needed, you will be able to understand and respond to requests from Dr. Dietze.

Will Dr. Agarwal numb my gums before or after I'm sedated?
The drugs which are usually used for IV sedation are not painkillers (although some pain-killing drugs are occasionally added) but anti-anxiety drugs. While they relax you and make you forget what happens, you will still need to be numbed.
If you have a fear of injections, rest assured you will not be numbed until you have been fully sedated. Of course we will always wait until you're completely numb before starting on any procedure.

How is IV sedation administered?
"Intravenous" means that the drug is put into a vein. An extremely thin plastic tube is put into a vein close to the surface of the skin in either the arm or the back of your hand. The tube will remain there throughout the entire procedure. The drugs are put in through that tube into your bloodstream. This allows the drugs that we use to take effect very quickly so that we give you the amount that is just right for you.
Even if you are a "needle phobic", don't worry! Dr. Agarwal is very compassionate and understanding. Starting the IV will be quick and painless. We have a topical numbing cream available upon request. Just ask!
Throughout the procedure, your pulse and oxygen levels are measured using a "pulse oximeter". This monitor clips onto a finger and measures pulse and oxygen levels. Your blood pressure is taken automatically every 5 minutes from the time you sit in the chair until the time you walk out the door. Dr. Agarwal and his team will be monitoring you through your entire procedure.
IV sedation is EXTREMELY safe when administred by a specially-trained dentist like Dr. Agarwal. Statistically, it's even safer than local anaesthetic on its own!

What are the main advantages of IV sedation?
The drugs enter your system and take effect very quickly, and drug dosage and level of sedation are presicsly adjusted to meet your individual needs. This is a huge advantage compared to oral sedation, where the effects can be very unreliable. IV sedation, on the other hand, is both highly effective and higly reliable.

IV sedation is the method of choice if you don't want to be aware of the procedure - you "don't want to know".

The maximum level of sedation which is reached with IV is deeper than with oral or inhalation sedation.

The gag reflex is hugely diminished - people receiving IV sedation rarely experience difficulty with gagging.

IV sedation is ideal for those with a phobia of dental injections, noises, and smells.

Why Receive Care From A Prosthodontist?

According to the Journal of the American Dental Association , the prosthodontic dental specialty is one of the oldest, established in 1947.  It is responsible for diagnosis, rehabilitation and maintenance of patients with complex clinical conditions involving missing or deficient teeth, craniofacial tissues or both, and for providing treatment via the use of biocompatible substitutes such as implants.  The essence of the specialty, however, is expert treatment planning*.   The members of this specialty have pioneered many of the techniques now used in practice, focusing on materials that are compatible in the mouth as well as esthetically pleasing.  They look toward the future, evaluating new dental materials first.  Most importantly, they recognize the value of a multi-disciplinary approach to care and don't hesitate to conference first with other dental specialists to develop the optimal plan for care.

Prosthodontists receive an additional three years of training after dental school.  As such, they understand the importance of technique and biocompatibility when using dental materials.  They perform dental implants daily, rather than monthly, and select implant construction specifically suited for the biting load it must endure.  They also rise to the challenge of using man-made materials to accurately mimic natural teeth.  That explains why some people have easily-recognized crowns and dentures completed by dentists, while others have natural-looking crowns and dentures created by prosthodontists that closely resemble a youthful smile.

What Should Be Expected on my First Visit?

At your first visit, we examine your teeth and discuss the options that you have available, for meeting your needs. You should expect to spend 20 minutes in conversation with the dental team, asking and answering questions, and seeing pictures or models of related procedures that have been done in the past. You will also discuss, and receive paperwork, for financial options and an estimate for the work that is needed. Sometimes, it is necessary to take X-rays, measurements, and/or molds of your teeth to make good judgments. If you approve of the plan, appointments are scheduled.

Dental Home Care

Preventing dental disease starts at home with good oral hygiene and a balanced diet. It is continued in the dental office by the efforts of your dentist and dental hygienist to promote, restore, and maintain your oral health.

A beautiful, healthy smile that lasts a lifetime is our ultimate goal when treating patients.  Your personal home care plays an important role in achieving that goal.  Your personal home care starts by eating balanced meals, reducing the number of snacks you eat, and correctly using the various dental aids that help control the plaque and bacteria that cause dental disease.

Tooth brushing – Brush your teeth at least twice a day (especially before going to bed at night) with an ADA approved soft bristle brush and toothpaste.

1. -Place the brush at a 45 degree angle to the gums and gently brush using a small, circular motion, ensuring that you always feel the bristles on the gums.
2. -Brush the outer, inner, and biting surfaces of each tooth.
3. -Use the tip of the brush to clean the inside of the front teeth.
4. Brush your tongue to remove bacteria and freshen your breath.

Electric toothbrushes are also recommended.  They are easy to use and can remove plaque efficiently.  Simply place the bristles of the electric brush on your gums and teeth and allow the brush to do its job, several teeth at a time.

Flossing – Daily flossing is the best way to clean between the teeth and under the gumline.  Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

1. -Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
2. -Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
3. -Curve the floss into a “C” shape around each tooth and under the gumline.  Gently move the floss up and down, cleaning the side of each tooth.

Floss holders are recommended if you have difficulty using conventional floss.

Rinsing – It is important to rinse your mouth with water after brushing, and also after meals if you are unable to brush.  If you are using an over-the-counter product for rinsing, it’s a good idea to consult with your dentist or dental hygienist on its appropriateness for you.

Use other dental aids as recommended by your dentist or dental hygienist: Interdental brushes, rubber tip stimulators, tongue cleaners, irrigation devices, fluoride, medicated rinses, etc., can all play a role in good dental home care.

Privacy Policy

In accordance with the Health Information Privacy and Accountability Act of 1997, this office uses coded information, rather than patient names, when handling personal documents. This ensures that privileged information about patients' health status and dental treatment is confined to use on an as-needed basis.

Glossary of Procedures Amalgam Restoration = silver-colored filling material that replaces tooth structure damaged by decay or fracture. Build-up = strong material used to replace the inner core of a tooth, prior to placing a crown, when natural tooth structure is missing. Bridge = a series of crowns that attach together, permanently cemented in place, to fill the space where teeth are missing. Composite Restoration = tooth-colored filling material that replaces tooth structure damaged by decay or fracture. Cosmetic Bonding = tooth-colored material that is added to teeth to re-shape them. Crown = a porcelain or metal structure that covers the entire tooth above the gum line, usually used to mend a cracked tooth, strengthen a dead tooth, or replace missing tooth structure.

Edentulous = absence of all natural teeth. Erosion = wearing away tooth structure by mechanical means, such as vigorous brushing. Framework = metal structure to which replacement teeth in a partial denture are attached. Full Denture = acrylic, and sometimes porcelain, structure that resembles natural teeth that have been removed. Furcation = area on a tooth in which the roots split into separate directions from the main body of the tooth. This area is difficult to keep clean with ordinary home care. Gingivitis = inflamed gums, a reversible condition that occurs with inadequate oral hygiene. Immediate Denture = acrylic, sometimes porcelain, structure that resembles teeth, inserted immediately after surgical removal of natural teeth. Implant = pure titanium metal post that is surgically inserted into the jaw to replace a tooth or teeth that have been lost, serving as a stabile foundation for additional crowns or a denture. Incipient Decay = beginning decay on the outermost (enamel) surface of a tooth that has not yet penetrated to the softer layer (dentin) underneath, where it requires dental treatment. Interproximal = space between the teeth, in which one tooth touches another. Malocclusion = teeth that do not line up properly to function at their best, and healthiest. Microleakage = deterioration of dental restorations that allows bacteria to leak down into tooth structure, often causing sensitivity or more decay. Overhang = excess dental material that causes a ledge on a restoration, making the area difficult to floss and keep clean. Periodontal Disease = irreversible condition that painlessly allows bacteria to destroy bone and tissue that holds teeth in the jaw. Periodontal probing = a tiny ruler that slips into the sulcus (space around a tooth, under the gumline) to measure the level of bone present in 6 places around each tooth. Periodontal pocket = an area of missing bone around a tooth that traps bacteria and accelerates the disease process, when not properly maintained or corrected. Pulpitis = inflammation of the nerve of a tooth, sometimes irreversible, but often not. Recession = exposure of the root surface, which is more prone to decay, caused by gum tissue that slowly moves toward the tip of the root. Resorption = dissolving of bone or tooth structure from excessive force, movement, or disease. Rest = metal platforms on a partial denture which prevent it from pushing onto the gums while chewing, which are located near "clasps" that hold the partial denture onto teeth. Root canal = removal of infected nerve(s) within the tooth that may be, or may become, non-vital. The area must then be debrided, sterilized and filled with a sealing material. Subgingival = located under the gumline. Supragingival = located above the gumline. Sulcus = the healthy, 2-3 millimeter fold of gum tissue that surrounds each tooth, much like a turtleneck collar. Veneer = thin layer of porcelain that is cemented to the front of front teeth to change their shape or color. Xerostomia = a dry mouth condition, often induced by aging or medications, which encourages decay.