Charles Spalding DMD Charlesspaldingdmd@gmail.com 907-272-6288 Dental Specialties Charles Spalding DMD Charlesspaldingdmd@gmail.com 907-272-6288

Dental Specialties Endodontics- Root canals Periodontics- gums/bone, implants Orthodontics- braces Prosthodontics- crown/bridge/dentures Pedodontics- kids Oral maxillofacial surgery- EXT, implants, trauma, pathology

Specialty Training Training programs last 2-6yrs after dental school General dentists can perform most specialty procedures without a full residency; however in a legal situation a specialist would be called as expert witness. Example- Dr. X (a GP) performs a root canal and it fails and the patient sues. If the root canal was not performed using standard practices a specialist would point out that the technique used is not standard and Dr. X is liable. If the technique used IS standard and the failure was due to bad luck Dr. X would not be liable

Endodontics Root canals are performed if the pulp of a tooth dies Pulpal death can be caused by bacterial invasion (deep cavity or fracture that exposes the pulp) Pulpal death can be caused by trauma severing the nerve and blood supply at the apex of the tooth Pulpal death can be idiopathic Root canal procedure can be one appointment or multiple appointments with medicament left in the canal for weeks prior to final obturation

Endodontics Teeth have between 1 & 4 canals that need to be cleaned using files and disinfecting solution

Endodontics Disinfectant- NaOCl, EDTA, Chlorhexidine Hand files, rotary files Sealer and cone (gutta percha)

Endodontics Lateral Condensation Warm Vertical Condensation Thermafill/Guttacore Sargenti (controversial)

Periodontics Controlling gum disease (caused by bacteria) Replacing missing gum tissue (recession) Implant placement

Periodontics Surgical vs non surgical therapy Non Surgical- Deep cleaning with anesthesia Surgical- pocket reduction or crown lengthening

Periodontics Gum Grafting- adds keratinized tissue where it has been lost. Keratinized tissue harvested from palate.

Periodontics Aesthetic crown lengthening Restorative crown lengthening

Orthodontics Slow pressure over time to move teeth Bands, Brackets, invisalign Functional and Aesthetic driven

Orthodonic Classification Angle Class I, II, III (molar and canine relationship) Cross bite Overbite, Overjet

Orthodontics Interceptive ortho can solve problems before they get too bad. Doesn’t always involve full braces

Prosthodontics Crown, bridge, denture specialists Complex cases (full mouth rehabilitation) Opening Vertical dimension Precision attachments for partials Maxillofacial prosthetics

Prosthodontics Full mouth rehabilitation Vertical Dimension of Occlusion- measured from chin to nose. Heavy wear or loss of teeth diminishes VDO

Prosthodontics Full mouth rehab (crowns bridges, implants…) Expensive, but worthwhile

Prosthodontics Complex Bridges and partials. Stress Breakers, Precision Attachments

Prosthodontics Maxillofacial prosthetics-

Pedodontics Specialize in kids Sedation Full mouth rehab Space maintenance and early ortho

Pedodontics Early Childhood caries

Pedodontics

Pedodontics Baby teeth have thinner enamel and larger pulp Important for: chewing, saving space for adult teeth Tooth aches can keep kids out of school and cause pain with eating

Pedodontics Various levels of sedation based on need Patient safety is #1 Nitrous oxide (laughing gas) In office oral sedation (versed and demerol) General anesthesia in the hospital

Oral & Maxillofacial Surgery Tooth removal Trauma repair Soft tissue Hard tissue Pathology Implant placement Orthognathic (jaw surgery)

OMFS Trauma- car accidents, falls, assault, gun shot wounds

OMFS pathology Cancers- Squamous cell is most common Surgery, possible radiation and or chemo

OMFS pathology Ameloblastoma

OMFS pathology Odontoma

OMFS- Orthognathic Surgery Braces can only move the teeth in bone (ideally centered in bone) Orthognathic surgery moves the bone

OMFS- Orthognathic Done in combination with braces