Procedures

Our ultimate goal is to secure the safety, health, and beauty of your teeth for a lifetime so you can always smile with confidence. The very best way to achieve this is through an individually tailored prevention program designed through the cooperative effort of the patient, the dentist, and our dental staff.

With the practice of good oral hygiene at home combined with a balanced diet and regular dental visits, we can effectively preserve the natural dentition of your teeth and their supporting structures for years to come. This is the very best way to minimize or eliminate the onset, progress, and recurrence of dental diseases and conditions that can result in serious and costly dental problems. Let us help you maintain a healthy, confident, and beautiful smile.

Teeth in a Day, or All-On-Four(R), is a solution for patients who have lost some or all of their teeth, and would like to restore their smile, as well as regain the function of their normal teeth. This innovative process takes advantage of dental implants to support an entire dental arch.

In the past, when patients lost their teeth, they would simply receive a conventional denture made by their dentist. This is an acrylic plate that is freely removable, typically taken out at night, and is supported only by the gums, or soft tissue. Many patients complain these dentures are loose, don’t fit properly, and may even be painful. In addition, these dentures do not offer the same ability for patients to eat the foods they used to enjoy. For some, the psychological ramifications of not having any teeth is not inconsequential.

A second option for patients came with the advent of dental implants. This is the so-called implant-assisted denture, or locator denture. In this case, 2 to 4 implants are placed in the jaw bone. Connected to these implants is either a bar, or male-type connectors that snap into housings on the inside surface of the denture. This improves the retention of the denture; however, the denture is still removed at night by the patient, and not all food choices are suited to these snap-on dentures.

Most recently, we are able to strategically place four dental implants in the jaw bone, and secure dentures directly to these implants with screws. Typically this is done in a day, or, more commonly, in a morning (hence the ‘teeth in a day’ moniker). These dentures are not removed by the patients. They are fixed. Only the dentist removes them, and usually just for cleanings (typically once a year).

But these are not your typical dentures either. The denture/prosthesis/teeth is shaped like your arch, in a U-shape, and it is supported by a custom made, titanium-milled bar. Because of this design, there is no acrylic covering the roof of your mouth, or rubbing against the inside of your gums. They look, feel, and work like your own, natural teeth. Patients’ ability to chew are improved. They can taste foods better because there is no acrylic covering the taste buds of the palate. And many patients describe this as a life-changing procedure for them, instilling the confidence and esthetics they used to have.

Dr. Goulston is a specialist with the highest level of training in dental implant surgery; he carries with him over ten years of experience in the All-On-Four procedure, and full arch reconstruction. After having performed countless cases, Dr. Goulston now also lectures and trains other oral surgeons on the nuances of the All-On-Four procedure, and how to achieve the best surgical and esthetic results.

We at Oral and Maxillofacial Surgery and Implant Specialists of Middlesex would be happy to sit down and discuss dental implants, All-On-Four (R), or any other questions you may have. Feel free to call us and schedule a consultation at your earliest convenience.

Wisdom teeth are the third and final set of molars that most people get in their late teens or early twenties. Sometimes these teeth can be a valuable asset to the mouth when healthy and properly aligned, but more often, they are misaligned and require removal.

When wisdom teeth are misaligned, they may position themselves horizontally, be angled toward or away from the second molars, or be angled inward or outward. Poor alignment of wisdom teeth can crowd or damage adjacent teeth, the jawbone, or nerves.

Anatomy of the Teeth

The teeth are the hardest substances in the human body. Besides being essential for chewing, the teeth play an important role in speech. Parts of the teeth include:

• Enamel: The hardest, white outer part of the tooth. Enamel is mostly made of calcium phosphate, a rock-hard mineral.
• Dentin: A layer underlying the enamel. Dentin is made of living cells, which secrete a hard mineral substance.
• Pulp: The softer, living inner structure of teeth. Blood vessels and nerves run through the pulp of the teeth.

Wisdom teeth also can be impacted — they are enclosed within the soft tissue and/or the jawbone or only partially break through or erupt through the gum. Partial eruption of the wisdom teeth allows an opening for bacteria to enter around the tooth and cause an infection, which results in pain, swelling, jaw stiffness, and general illness. Partially erupted teeth are also more prone to tooth decay and gum diseas,e because their hard-to-reach location and awkward positioning makes brushing and flossing difficult.

How Do I Know if I Have Wisdom Teeth?

Ask your dentist about the positioning of your wisdom teeth. He or she may take an X-ray periodically to evaluate for the presence and alignment of your wisdom teeth. Your dentist may also decide to send you to an oral surgeon for further evaluation.

Your dentist or oral surgeon may recommend that your wisdom teeth be extracted even before problems develop. This is done to avoid a more painful or more complicated extraction that might have to be done a few years later. Removal is easier in young people, when the wisdom teeth roots are not yet fully developed and the bone is less dense. In older people, recovery and healing time tend to be longer.

How Are Wisdom Teeth Removed?

The relative ease at which your dentist or oral surgeon can extract your wisdom teeth depends on their position and stage of development. Your oral health care provider will be able to give you an idea of what to expect during your pre-extraction exam. A wisdom tooth that is fully erupted through the gum can be extracted as easily as any other tooth. However, a wisdom tooth that is underneath the gums and embedded in the jawbone will require an incision into the gums and then removal of the portion of bone that lies over the tooth. Often, for a tooth in this situation, the tooth will be extracted in small sections rather than removed in one piece to minimize the amount of bone that needs to be removed to get the tooth out.

What Happens During Wisdom Teeth Removal?

Before your wisdom teeth are pulled, the teeth and the surrounding tissue will be numbed with a local anesthetic — the same type used to numb a tooth prior to having a cavity filled. In addition to the local anesthetic to numb the pain, you and your dentist or oral surgeon may decide that a sedative is desired to control any anxiety. Sedating medications that could be selected include: nitrous oxide (otherwise known as “laughing gas”), an oral sedative (for example, Valium), or an intravenous sedative (administered via an injection into your veins). If nitrous oxide is given, you will be able to drive yourself home. If any of the other medications is selected, you will need someone to drive you both to and from the appointment.

Dental implants are a solution for lost or severely broken-down teeth. They restore not only the form and function of normal, healthy teeth, but they also engender a self confidence and outlook that many people with missing teeth may have lost. Patients with dental implants will boast: “I can eat whatever I want,” and “I have my beautiful smile back again.”

What are dental implants?

Dental implants themselves have two parts. The first part is the small titanium post that is inserted into the jawbone where the tooth or teeth are missing. This is typically referred to as the implant. These titanium posts or screws act as tooth root substitutes. They are threaded and have a porous surface which ultimately gives them their strength and ability to support a crown.

The second part of the dental implant is the actual crown or cap that is secured to the post or screw. A good analogy of this is a house and its foundation: the post is like the foundation of a house, and the crown of the tooth is the house itself. It’s just that simple. Usually, an oral surgeon will place the post in the bone, and your dentist will fabricate the crown to go on top of the post.

The surgical portion of this procedure may be done with local anesthesia and intravenous sedation, or with local anesthesia alone. This procedure is very well tolerated and most patients can’t believe how “quick and easy” it truly is. The bone — over a period of time — fuses to the surface of the implant. This is called osseointegration, and is what gives the implant its strong foundation.

Dental implants represent a wonderful treatment option for replacing missing or non-restorable teeth for nearly all patients, and many different treatment options exist. At Oral and Maxillofacial Surgery and Implant Specialists of Middlesex, we pride ourselves on staying on the cutting-edge of technology, while providing the highest level of care, in a warm and comforting environment.

If you have questions about dental implants or would like a consultation, we would be happy to meet you and schedule an appointment at your earliest convenience. You may schedule an appointment any time by calling 908-222-0040, or on our website under the Request Appointment tab.

Does the thought of having your teeth cleaned make your entire body tense with fear? Would you rather endure the agony of a toothache than step foot in a dentist’s office? You’re not alone. A lot of people are so phobic about going to the dentist that they prefer not to have any treatment.

For people who avoid dentists like the plague, sedation dentistry may take away some of their anxiety. Sedation can be used for everything from invasive procedures to a simple tooth cleaning. How it’s used depends on the severity of the fear.

What Is Sedation Dentistry?

Sedation dentistry uses medication to help patients relax during dental procedures. It’s sometimes referred to as “sleep dentistry,” although that’s not entirely accurate. Patients are usually awake with the exception of those who are under general anesthesia.

The levels of sedation used include:

• Minimal sedation — you are awake but relaxed.
• Moderate sedation (formerly called “conscious sedation”) — You may slur your words when speaking and not remember much of the procedure.
• Deep sedation — you are on the edge of consciousness but can still be awakened.
• General anesthesia — you are completely unconscious.

What Types of Sedation Are Used in Dentistry?

The following types of sedation are used in dentistry:

• Inhaled minimal sedation. You breathe nitrous oxide — otherwise known as “laughing gas” — combined with oxygen through a mask that’s placed over your nose. The gas helps you relax. Your dentist can control the amount of sedation you receive, and the gas tends to wear off quickly. This is the only form of sedation where you may be able to drive yourself home after the procedure.
• Oral sedation. Depending on the total dose given, oral sedation can range from minimal to moderate. For minimal sedation, you take a pill. Typically, the pill is Halcion, which is a member of the same drug family as Valium, and it’s usually taken about an hour before the procedure. The pill will make you drowsy, although you’ll still be awake. A larger dose may be given to produce moderate sedation. This is the type of anesthesia most commonly associated with sedation dentistry. Some people become groggy enough from moderate oral sedation to actually fall asleep during the procedure. They usually can, though, be awakened with a gentle shake.
• IV moderate sedation. You receive the sedative drug through a vein, so it goes to work more quickly. This method allows the dentist to continually adjust the level of sedation.
• Deep sedation and general anesthesia. You will get medications that will make you either almost unconscious or totally unconscious — deeply asleep — during the procedure. While you are under general anesthesia, you cannot easily be awakened until the effects of the anesthesia wear off or are reversed with medication.

A tooth that is severely damaged may need to be removed. A surgeon who specializes in surgeries of the mouth (oral and maxillofacial surgeon) or your dentist can remove a tooth.

Before removing your tooth, your dentist will give you a local anesthetic to numb the area where the tooth will be removed. A stronger, general anesthetic may be used, especially if several or all of your teeth need to be removed. General anesthetic prevents pain in the whole body and will make you sleep through the procedure.

After the tooth is removed, you may need stitches. You can gently bite down on a cotton gauze pad placed over the wound to help stop the bleeding. The removed tooth can be replaced with an implant, a denture, or a bridge. A bridge is a replacement for one or more (but not all) of the teeth and may be permanent or removable.

What To Expect After Surgery

In most cases, the recovery period lasts only a few days. The following will help speed recovery:

• Take painkillers as prescribed by your dentist or oral surgeon.
• After 24 hours, rinse your mouth gently with warm salt water several times a day to reduce swelling and relieve pain. Make your own salt water by mixing 1 tsp (5 g) of salt in a medium-sized glass [8 fl oz (237 mL)] of warm water.
• Change gauze pads before they become soaked with blood.
• Relax after surgery. Physical activity may increase bleeding.
• Avoid smoking.
• Eat soft foods, such as gelatin, pudding, or a thin soup. Gradually add solid foods to your diet as healing progresses.
• Do not lie flat. This may prolong bleeding. Prop up your head with pillows.
• Avoid rubbing the area with your tongue.
• Continue to carefully brush your teeth and tongue.

After the tooth is removed, you may need stitches. Some stitches dissolve over time, and some have to be removed after a few days. Your dentist will tell you whether your stitches need to be removed.

Why It Is Done

Removing a tooth is necessary when decay or an abscessed tooth is so severe that no other treatment will cure the infection.

Our ultimate goal is to secure the safety, health, and beauty of your teeth for a lifetime so you can always smile with confidence. The very best way to achieve this is through an individually tailored prevention program designed through the cooperative effort of the patient, the dentist, and our dental staff.

With the practice of good oral hygiene at home combined with a balanced diet and regular dental visits, we can effectively preserve the natural dentition of your teeth and their supporting structures for years to come. This is the very best way to minimize or eliminate the onset, progress, and recurrence of dental diseases and conditions that can result in serious and costly dental problems. Let us help you maintain a healthy, confident, and beautiful smile.

Taking dental x-rays or radiographs is essential for diagnosing dental disease and concerns. These radiographs show teeth, bones and soft tissue to help dentists determine if there are caries or hidden dental problems such as bone loss that cannot be seen when looking into a mouth. Taking dental x-rays can also help catch dental disease early to prevent pain and expensive dental treatment.

Dental x-rays use very small amounts of radiation and exposure to this small amount of radiation is safe. When a patient receives a full mouth series of x-rays, this is equivalent to radiation exposure in everyday life.