Services

What are dental implants?

Dental implants are recommended for those seeking a permanent solution to missing teeth. They are designed to look natural while also giving you the ability to have stable function of natural teeth. Dental implants are surgically placed into the mouth by inserting a titanium anchor into your jaw. After the anchor is placed, the bone will heal (about 6 months) around the titanium and hold it into place. When your dentist thinks you are ready, they will place your custom made artificial tooth into the anchor.

Dental implants are not recommended for everyone. In order to be eligible to receive implants, you must have enough bone structure to support the implant, free of chronic illnesses and must ensure that you will maintain proper oral hygiene to care for a new implant.

Inlays/Onlays are recommended in situations where due to a lack of remaining natural tooth structure a regular filling is no longer an option. They can also be a conservative alternative to a full coverage crown. Being both functional and cosmetic, they offer a stronger and longer lasting solution to tooth structure that has been lost due to decay or damage. Depending on your particular needs, inlays/onlays can be made from resin materials, porcelain or gold.

The procedure itself is typically completed over two dental visits.

At the first visit, the decayed or damaged tooth is prepared and an impression is taken. You will be sent home with a temporary restoration to protect your tooth while a dental laboratory fabricates your new inlay/onlay.

At your second visit, your final restoration is cemented or bonded to the surface of your remaining tooth structure. Your dentist will check your bite, all contacts and margins of your new inlay/onlay to ensure a successful fit.

What are porcelain fixed bridges?

Porcelain fixed bridges are non-removable appliances that are placed on teeth to replace a tooth that is missing. Porcelain bridges are made to match the natural color of your teeth and help fill in the gap where a tooth is missing. Bridges are essentially two crowns that that anchor an artificial tooth in between. The two crowns are cemented onto the teeth surrounding the missing tooth to help anchor the artificial tooth into place (abutment). The artificial tooth (pontic) is in place of the missing tooth to fill in the gap and allow your teeth to look natural.

The process of getting a porcelain fixed bridge

When you and your dentist decide that a porcelain fixed bridge is the right option for you, the dentist will begin preparing the two teeth that surround the missing tooth. The teeth are prepared so that two crowns can be placed in order to support the artificial tooth. Several impressions will be taken in order for the dentist to determine the size of the crowns and artificial tooth. Once the impressions are taken, they are sent to a dental laboratory where your bridge will be made. Setting a bridge generally takes two dental visits to complete. Once the dental laboratory has made your bridge, the dentist will cement the crowns into place.

Porcelain fixed bridges are very durable and can last a very long time when they are well taken care of. Your dentist will give you special instructions on how you can keep your bridge clean through brushing and flossing.

What is a root canal?

Root canal therapy is a treatment used to save a tooth when the tissue, blood vessels and nerves inside of a tooth have become inflamed. In order to save the tooth and remove the pain, the dentist will need to remove infected and diseased tissue to help clean out the infected area. The canal inside is then medicated to allow the surrounding area to heal.

Reasons a root canal may be performed

• Deep decay
• Infections at the tip of the root or inside the tooth canal
• Cracked, broken or injured teeth

Generally, but not always, a crown will need to be placed after the root canal treatment is complete in order to protect the tooth from any further damage. Sensitivity after the procedure is generally experienced by many patients and subside when the tooth has healed. When your treatment has been completed, your dentist will provide you with special instructions on how to care for your newly treated tooth.

What are veneers?

Veneers are custom made shells of porcelain that are cemented to the front of your original tooth structure. They can be used to change the color, size, shape, spacing and alignment of your teeth.

Veneers generally involve 2 visits. During the first visit tooth structure is prepared to make room for the veneers. An impression will also be taken and later sent to a dental laboratory to aid in the fabrication of the final veneers. At the second visit the veneers will be cemented to your existing teeth, creating your new beautiful smile.

Cosmetic dentistry can help maintain, protect and enhance your smile. It can improve your self-confidence and also help improve oral hygiene. Due to modern technology, these treatments can be quick and affordable as well!

From simple procedures such a whitening, to full mouth reconstruction, involving bite improvement, tooth replacement, veneers and/or crowns, we are able to do it all! Give us a call at 908-431-5624 to schedule a free cosmetic consultation.

A Denture is a removable dental appliance that can be made for patients who have lost their teeth. It can help in restoring function and appearance; allowing a patient to speak and eat. A complete denture is recommended when all teeth have been lost in one/both arches of the mouth. A partial denture is recommended when some teeth are still remaining.

Impressions are taken to allow for a custom complete/partial denture to be made. Appointments will be made to try-in the denture to approve the fit and cosmetics prior to receiving your final finished denture.

Fillings are the most common treatment used to restore decayed teeth, and are normally completed in a single visit. Local anesthesia can be used to numb the tooth, decay is removed, and the filling is placed, shaped and polished.

Two types of materials; composite and amalgam, are normally the materials of choice for fillings. Composite fillings are available in a wide variety of shades and can be mixed to achieve a natural result. This material is also used to bond teeth that are worn, stained or cracked.

Temporary temperature sensitivity is normal after first receiving a filling. The sensitivity will subside as the tooth becomes used to the new restoration.

Periodontal disease is a direct result of build-up of plaque formations on the teeth. When this build-up becomes severe, the body’s immune system reacts and causes inflammation of the gums. As a result, tenderness, bleeding, and swelling of the gum tissue will be noticeable. In severe cases, the bone surrounding tooth structure can become damaged, leading to tooth mobility and possible tooth loss.
Recent studies also show a link between Periodontal Disease and Premature births in pregnant women, Respiratory problems, Diabetes and Cardiovascular Disease.

Periodontal Disease can be stabilized through a professional deep cleaning and proper oral hygiene maintenance.

Through the use of clear aligner technology, Invisalign has been able to provide an option for those seeking orthodontic treatment without the use of traditional metal braces. Custom removable aligner trays are replaced every two weeks shifting your teeth until the desired result is achieved. Invisalign can be used in cases involving overbites, underbites, crossbites, gaps, and overcrowding. Since the trays are made of a smooth plastic and can be easily removed, they allow for better hygiene, less cheek and gum irritation and no hassle in food consumption.

What’s involved with getting Invisalign?

Once your dentist decides that you are good candidate for Invisalign, impressions and x-rays will be taken of your teeth. A treatment plan will be created and your dentist will then be able to show you a computerized video of how your teeth will move and shift as your treatment progresses. Treatment time will vary depending on the severity of each individual case

Temporomandibular Joint Disorder (TMJ/TMD) is pain that is experienced where the head and jaw connect on the lower jaw. This pain can be a result of stress, grinding/clenching, misaligned teeth, injury to the joint itself or arthritis. Along with soreness and severe pain, TMJ can cause problems with speech.

How to treat TMJ/TMD?

In select cases of TMJ/TMD the pain and soreness may subside over time. Other times treatment as listed below, may be necessary to alleviate discomfort.

• Try and relax your jaw, avoiding constant and/or extreme movements
• Alternate between the used of mild heat packs and ice packs
• Stick to a soft food diet
• Pain medication or a muscle relaxant may be prescribed
• A Custom fit Mouthguard/Nightguard may be indicated

Certain severe cases may require alternative treatment, including but not limited to surgery.

We understand that at times addressing your dental needs can be an overwhelming process. In addition, finding the correct office and dentist is an important and key part of treatment. By offering a FREE consultation/second opinion appointment we are allowing patients to essentially “test drive” our office. Schedule and Appointment, come in and meet our staff and dentist, tour our state-of-the art office and discuss your dental needs at length and at no charge.

Our ultimate goal is the same as yours, to promote the health and beauty of your teeth. Let us help you maintain your smile for a lifetime.

A tooth may require an extraction when it is severely decayed, infected or damaged. Most non-impacted extractions can be completed at our office.
When an extraction is required the area will be numbed using a local anesthetic. After the extraction is completed cotton gauze will be placed over the wound and slight pressure will be applied. Stiches may be required for some patients. Depending on the severity of the decay, damage or infection, antibiotics may be prescribed along with a pain killer.

For most patients, recovery after an extraction will be limited to a few days. In order to help with healing remember to relax after surgery, avoid smoking, take medication as prescribed, stick to a semi-liquid/soft food diet and generally avoid the area until healed.
Eventually the lost tooth can be replaced with a fixed bridge, implant, or removable denture.

A crown is a full coverage restoration used to help restore a tooth that is severely damaged or decayed. It consists of gold, metal and/or tooth-colored porcelain made to match the rest of your teeth to give a natural appearance.

This procedure normally takes place over two visits. At your first visit, the tooth/teeth will be prepared, any present decay will be removed, and an impression will be taken. If necessary a Build-Up or Post & Core for added retention will be completed. The patient will then be sent home with a temporary restoration while the final crown is being fabricated at a dental laboratory. At the second visit, the temporary will be removed and the new crown will be tried. The crown’s margins and fit will be verified both clinically and radiographically. Once the bite is confirmed, the crown will be cemented to the surface of the tooth.

With proper hygiene and care, crowns can last a long time.

As we age teeth tend to discolor. Poor oral hygiene, staining from food or drinks, and tobacco can worsen this discoloration. The process of Teeth Whitening can help remove these surface stains and achieve a bright beautiful smile.

Custom trays are made to hold a gel-solution (ZOOM) which is then directly applied to the teeth. The trays containing the whitening agent will be applied for a period of 7-14 days until the desired shade is achieved. Make sure to keep the custom trays in a safe spot, they can be used at a later date to update your whitening results as surface stains return.

Contact us to see if you qualify as a candidate for tooth whitening.

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.