Descriptions Of Procedures
Initial Exam
An Initial Examination can vary depending on the patient's dental health. It may include a thorough visual inspection of the head, neck, and mouth for many disorders. We are looking for the most common problems such as visible decay and periodontal disease (gum disease), as well as less common problems such as cysts or tumors, temporomandibular joint dysfunction, and autoimmune disorders. During the examination we document all previous dental work and record your current dental status, including missing teeth, tooth alignment, and a description of the common mouth structures. Finally, in order to discover the stability of your teeth, we chart all of the periodontal pocket depths around each tooth. The deeper the pocket, the less the stability.

X-rays
A thorough examination is never complete without the appropriate x-rays, for then we can see what the visible exam cannot. For example, we can see how deeply decay may be penetrating a tooth, whether you have an abscessed tooth, or how big and at what angle your impacted wisdom teeth are growing (if you still have wisdom teeth.) Furthermore, we can find unerupted extra teeth with x-rays or missing teeth that will never erupt. We can find unusual growth patterns of bone, which may be a precursor to cancer, or remaining root tips from past extractions. Therefore, we believe that it is very important that a patient have updated x-rays. Which x-rays we take depend on your dental history and whether you have current x-rays (those taken within the last year) from another dental office.

Full mouth series
This series of x-rays is at the most 18 films that show each tooth in detail. They are necessary to fully diagnose periodontal diseases or rampant decay.
Bitewing X-rays: These are 2-4 films that show decay between the posterior teeth. Small cavities most frequently begin just below the contacts of the teeth and are not usually visible in the mouth until they are large. When a full mouth series is taken, bitewings are included in the 18 films and will not be charged separately.
Panoramic X-ray: This x-ray is a large, single film, which shows both upper and lower jaws and the maxillary sinuses. We take this important film every 3-5 years to screen for impacted teeth, cysts, tumors, or deformities in the jaws and teeth. Normally, we will not take a panoramic film and a full mouth series at the same time.
Periapical X-ray: This is an individual film of 1-3 teeth, which we may take to get a detailed view of a suspicious tooth and its entire root.
The most common combination of x-rays for a new patient who has maintained relatively good oral health is either:
1. A panoramic film and 4 bitewing x-rays for an adult (anyone 15 years old and older) if the patient has not had a panoramic film taken within the last 5 years
2. 4 bitewing x-rays for an adult who has a current panoramic x-ray
3. 2 bitewing x-rays for children 5 years old and older Prophylaxis
If a new patient has maintained good oral health prior to this first visit, then we will probably clean your teeth at your next appointment. This is called a prophylaxis or "prophy" for short. A prophylaxis includes mild scaling to remove any tartar, calculus, and stain from and between your teeth, followed by the polishing of your tooth surfaces. However, it is imperative that you understand that a prophy is only appropriate for someone who has maintained good oral hygiene, has regularly visited a dentist, and brushes and flosses effectively and regularly. A prophy is not always an appropriate procedure for someone with moderate to severe calculus (tartar build-up), gingivitis (bleeding gums), periodontitis (gum disease), or heavy stain. These patients require more than one appointment to correct their oral health and should not expect completion during one visit. We recommend that a patient with good oral health get his/her teeth cleaned every six months to avoid any of the aforementioned circumstances.
Furthermore, we recommend that children receive a topical fluoride treatment following a prophy. This is the opportune time for the fluoride to come in contact with the tooth surface and penetrate into the tooth because the tooth's protein layer has been removed during the prophy. While we do recommend fluoride rinses at home for some children we feel that the ideal fluoride treatment is the topical application following a prophy. We apply fluoride to children's teeth and adolescent's teeth until tooth development has ceased, and we recommend that this occur every six months following each prophy. A few insurance companies only cover one fluoride treatment per year, however, we do not let insurance companies dictate which procedures we do. Therefore, if your insurance company only covers one fluoride treatment each year for your children, and you only want us to apply fluoride once, then please let us know this in advance.

Gross Scaling
Some new patients, if they have not maintained good oral health, may exhibit more tartar than usual or more stain that usual. As stated above, a normal prophy is not enough to remove all of this build-up. It instead requires some deeper scaling, a gross scale, to remove it all. Then once the patient's gum tissue heals from the removal, he/she returns for another appointment in three weeks for a fine scale, which is similar to a normal prophy.

Root Planing and Scaling
Some new patients may have worse problems such as periodontitis. An indicator of this is deep pocket depths around certain teeth where build-up has occurred and eventually causes inflamed gums, gum recession, bone loss, and ultimately tooth loss. Therefore, we believe such patients must undergo the necessary treatment of root planing and scaling. Of course, we cannot evaluate such situations until the time of the initial exam. If we make this diagnosis, then we recommend that the patient return for several more visits so that we can remove the build-up along the gumline and root areas. Root planing and scaling may take four separate appointments to scale a quadrant of the mouth at each appointment, or it may only take two appointments when we scale half of the mouth for the less severe cases. For these appointments, we recommend that the patient receive a local anesthetic to numb the area of treatment and for those that require, it nitrous oxide to help the patient relax.. For a patient with periodontitis, this course of treatment is very important to prevent tooth loss in the future. Ideally, such patients, after the treatment of root planing and scaling, can begin regular prophy appointments every 3-4 months, ideally reaching every six months when good oral health is maintained.
Insurance Benefits
All of the above mentioned treatments can be considered either Preventive or Basic procedures by insurance companies. The breakdown usually is as follows:
PREVENTIVE
Exams
X-rays
Prophylaxis
Fluoride Treatment
BASIC
Gross Scaling
Root Planing and Scaling
NOTE: MOST insurance companies treat these procedures as so. However, occasionally we encounter an insurance company that will apply benefits differently. If you have any doubt as to how your insurance company covers such treatments, it is best if you contact your company and inquire. Also, some insurance companies may disallow our fees based on their schedules of usual and customary fees. For your first appointment, if you are concerned whether the treatments listed above will be covered fully, we encourage you to contact your insurance company before your initial visit.

Treatment Planning
Finally, during your first visit, we will discuss our diagnosis with you, answer any questions concerning your oral health, and formulate a treatment plan to obtain optimal oral health. We will discuss problem areas such as decay and any restorations you may need. We may recommend that your children have sealants or discuss orthodontic treatment for older children and adolescents that may benefit from it. We will also educate our patients how to achieve and maintain your oral health at home. Every patient's treatment plan is different, and we are devoted to formulate the best treatment plan possible for all of our patients.

We welcome any questions you may have concerning these procedures or our policies as stated here. Our staff is available to assist you. We look forward to you becoming one of our very important patients, and thank you for choosing us as your personal dental office.