Oral Pathology/Cancer Screening
During your routine exam your doctor will perform an oral cancer screening. This
involves checking the appearance and feel of the soft tissues of the head and neck, as
well as noting any abnormalities on your radiographs.
Even though each doctor may perform this exam a little differently from one another,
we are all evaluating the tissues for normal feel, appearance and function. Some of the
common areas examined are:
- Hard and soft palate
- Floor of the mouth
- Temporomandibular Joint (TMJ) or jaw joint
Digital Radiographs/3D Scans
LandMark Dentistry is committed to providing you with the most efficient imaging while
using the lowest possible dose of radiation to obtain them. Each of our offices is
equipped with an extraoral (outside the mouth) imaging system that allows us to obtain
all the information needed for proper diagnosis in one simple scan!* Additionally, our
Charlotte location is able to provide 3D scans of any specific area of the mouth. We
often use this function to help plan for root canals or implants, but its benefits are
numerous and allow our doctors to have all the information about your tooth at the
click of a button!
*Please note, not all patients will qualify for this technology and a determination of
which radiographs are needed will be made for each individual patient.
Do you ever wonder what we are actually looking at? With our intraoral camera we can take pictures of your mouth so you can see what we see!
One of the most important parts of your dental exam is the evaluation of your
periodontal health (gums and bone around the teeth). Your hygienist will use a
miniature ruler to measure around each of your teeth, as well as note any areas of
bleeding or other signs of infection. We also use your radiographs to evaluate the
height of the bone around your teeth. The combination of this information will allow
your doctor to properly diagnose your periodontal status and recommend appropriate
therapies and recall intervals.
Preventive Care Therapy (prophylaxis/cleaning)
For our healthy patients, preventive care therapy is performed once every six months.
This is your routine visit with your hygienist and doctor. During this visit plaque and
stain is removed from the crown of the teeth and an exam is performed.
Once a year radiographs are taken for your doctor to evaluate for cavities, bone levels,
and signs of infection that may not be visible in your mouth. Periodontal (gums and
bone around the teeth) measurements and evaluation is also performed once a year to
monitor your overall periodontal health.
Fluoride Varnish (applied in office)
There are many benefits of fluoride application and almost all patients need fluoride in some capacity.
For children, fluoride helps to protect their forming and newly formed teeth as they
erupt into the mouth. As children learn about proper oral hygiene and diet choices the
fluoride application protects their teeth from “sugar bugs” by pulling mineral from the
saliva and coating the teeth with a protective layer.
For adults, that mineral protective layer can serve different purposes. Fluoride
application in adults can help reduce sensitivity, helps to protect existing restorations
from marginal breakdown, can maintain areas that have lost mineral from progressing
to a cavity, and can help protect the teeth from dry mouth. Some common reasons we
recommend fluoride application in adults are:
- Multiple restorations (fillings and crowns)
- Drinking bottled water
- Snacking throughout the day
- Dry mouth
- Brushing and flossing 0-1x per day
**To evaluate if you are a candidate for fluoride application, fill out our “Do You Need Fluoride” survey under the new patient forms.**
Usually placed in children, sealants are a resin material placed in the grooves of the
molars to protect the areas from cavity formation. These grooves are small enough for
bacterial to reach, but not big enough for your tooth brush to get to. Sealants fill the
groove and provide a smooth surface to brush and keep clean.
Periodontal disease is an active infection that has caused IRRERVERSIBLE damage to the
gingival tissues and bone. This is typically the result of years of plaque and calculus
build-up, irregular dental visits, and infrequency of flossing. Some medical conditions,
such as heart disease or diabetes, can make the disease worse and it is extremely
important for these patients to see their dentist regularly. There are cases in which the
disease has come on rapidly, and these cases are usually localized to a few specific area
of the mouth.
- Very red in color
- Loss of texture (smooth in appearance)
- Puffy appearance
- Loss of texture (smooth in
- 4-5+mm pocketing between the gum tissue and the tooth
- Moderate to heavy bleeding
- Moderate to heavy subgingival calculus and visible soft and hard plaque
- Moderate to severe bone loss
- Foul odor and/or bad taste
- Mobility/loss of the teeth
Active (Non-surgical) Periodontal Therapy (scaling and root planing)
Active periodontal therapy is performed when there are any areas of your mouth that
have been diagnosed with periodontal disease (see What Is Gum Disease). This is the
first line of intervention after determining the presence of periodontal disease.
The procedure involves:
- Two visits—one half of the mouth will be worked on at each visit
- Numbing the area to be worked on
- Removal of plaque and bacteria from the crown of the tooth
- Removal of plaque and bacteria from the root surface of the tooth
- Removal of any rough areas on the root surface of the tooth (to reduce future collection of debris in these areas)
- Can be performed in specific areas or throughout the entire mouth
The goal of active periodontal therapy is to reduce inflammation (puffiness, redness and bleeding) and allow your body to heal from the attack of active infection.
Supportive Periodontal Therapy (periodontal maintenance)
While similar in some ways to a preventive care appointment, the supportive
periodontal therapy functions to maintain those areas where periodontal therapy has
been performed. If you have had active periodontal therapy your future appointments
with your hygienist will be supportive therapy appointments. Your first supportive
therapy will occur 6 weeks after active therapy is completed.
The ways this differs from a preventive visit are:
- Removal of plaque and bacteria from the crown and the root of the tooth
- Selective active therapy in areas that need calculus removal and/or smoothing of the root surface
- More frequent visits to monitor areas that had active therapy and to prevent to progression of periodontal disease
- Periodontal patients will be seen every 3-4 months
Arestin® is an antibiotic medication that can be placed directly into a periodontal
pocket, and helps to reduce the bacteria in these areas. In areas of your mouth that have
deeper pockets (areas that will be harder for you to keep clean), Arestin® helps by attacking the
bacteria in the pocket. This medication can be placed during active therapy or at any of your
supportive therapy visits.
Crowns are a very common restorative procedure used to protect the entire tooth after
significant loss of tooth structure or when a tooth is at risk of fracturing. Some of the
common reasons your doctor may recommend a crown procedure are:
- Fracture lines in your teeth
- Very large existing fillings
- Previously root canal treated teeth
- Broken teeth
Crowns can also be used for cosmetic reasons for anterior teeth to cover chipping along
the edge of the tooth or white spots within the teeth.
What does a crown procedure involve?
- 2 appointments: a crown preparation appointment and a crown seat appointment
- Preparation of the tooth: conservative removal of the tooth structure to allow room for the crown to comfortably seat without interfering with the other teeth
- A series of impressions
- To make your temporary
- To show the lab the preparation
- To show the lab how your teeth come together
- A temporary crown
- A resin material made in-office from a mold of your original tooth
- Protects the tooth between preparation and seat date
- Keeps the appropriate spacing between the surrounding teeth
- Seating the permanent crown: the temporary crown will be removed at the start of the appointment, any necessary djustments are made to the permanent crown
prior to cementation
Typically used only for cosmetic purposes, veneers provide an alternative to crown
preparation for the front teeth. Veneers can close small spaces between front teeth
with or without orthodontic treatment, can cover chipping of the edge of the teeth, and
can cover white spots or extensive staining.
Veneers are similar to crowns in their design and material, but only cover a portion of
the tooth. It is recommended that multiple veneers be completed at the same time for
each case to achieve the best esthetic/pleasing look of the front teeth.
What does a Veneer procedure involve?
- Diagnostic impressions for models: this allows your doctor to plan your case for the best cosmetic and functional outcome
- A wax model of the teeth is usually completed for the doctor and lab to know what the exact final appearance of the veneers will be—you are always welcome to see this stage prior to starting treatment.
- 2 appointments: a preparation appointment and a veneer seat appointment
- Preparation of the teeth: very conservative removal of the enamel layer of the teeth on the front surface and wrapping around the edge of each tooth
- A series of impression
- To show the lab the preparation and how your teeth come together
- Temporary veneers
- Typically made from the wax model to replicate what your restorations will look like
- Protects the teeth between the preparation and seat appointments
- Seating the veneers
- Each veneer is tried on to make any necessary adjustments prior to cementation
- You will have a chance to look at the outcome prior to cementation
Implants and Implant Crowns
Although a surgical procedure, implants serve to replace missing teeth and can give you
a more natural appearance in your restoration. Implants can replace single missing
teeth or multiple teeth, and can even be used to help anchor your removable appliances
(dentures and partials).
**See the surgical tab for a more detailed explanation of the implant procedure
Implant crowns require an impression to be taken after the implant has completely
healed. The impressions are sent to a lab for the crown to be made and in about 3
weeks your permanent crown is seated on the implant. The crown should look like a
real tooth and allow you to floss around it like your natural teeth.
Dentures & Partials
For our patients who are missing multiple or all of their dentition we offer several
options for replacement. While implants offer the highest level of esthetics and
stability, we understand not all of our patients will meet the criteria for or choose this
option, and for those patients traditional partials and dentures are available.
Features of Partials
- A metal and acrylic appliance used to replace multiple missing teeth
- Partials rely on the remaining teeth in the arch to stay in place through the use of clasps and rest seats
- Rest seats are small areas on the teeth that are prepared (with a handpiece and bur) to allow room for the partial to sit
- Metal is used for the framework of the partial to produce a strong base that can absorb force without flexing
Features of Dentures
- An acrylic appliance used to replace an entire arch of missing teeth
- Dentures rely on the bone and soft tissue to determine fit and help keep them in place.
- The color, shape and size of your denture teeth are selected by your doctor using a guide. We can also change the color of the gums to better match your natural color.
- **Please note, while we can typically achieve a good fit in the upper arch, the lower arch has much less bone to rest on and can be more difficult to produce a denture that will stay in place on its own. Because of this we do recommend considering
implant placement for lower dentures.
There are many options on the market for whitening your teeth, and not all of them are effective. In our offices we provide multiple ways for you to achieve your whitest smile!
The fastest way to get your results! This is an in-office treatment that will give you immediate same-day results. During your appointment, your dental assistant will apply a whitening gel to the front side of your teeth. A light is then placed over the teeth to accelerate the whitening properties of the gel. In about two hours, you will leave the office with a bright, white smile!
Custom Whitening Trays
By taking a quick impression your office can make you a custom fit whitening tray that will allow you to whiten at home. The tray fits over the teeth similar to a retainer. A small amount of whitening gel is placed in each tooth spot of the tray and the tray is
seated in the mouth. Depending on the strength of the gel you are using you can wear your trays anywhere from 15-60 minutes.
When first starting you will want to wear your trays multiple days in a row (usually 7-10 days). However there is no specific time frame for whitening maintenance, and usually 1-2 applications will get you back to your brightest!
The LandMark Whitening For Life Program
As a new patient coming into a LandMark office for your first hygiene appointment, you are eligible for our Whitening For Life program. For a small one-time fee you will receive your 10-day starter kit of pre-loaded whitening trays. Patients in good account standing will then receive two refill trays at each of your regular hygiene appointments, for life! Call us today to make your first appointment!
While we always encourage our patients to maintain their natural teeth there are situations in which teeth need to be removed. These can include (but are not limited to)
- Teeth broken or decayed beyond restoration
- Third molars (wisdom teeth)
- When a tooth is affecting the overall health of a patient
- Endodontic infection
- Periodontally involved teeth
We understand that having a tooth removed can be stressful and strive to make the
experience as comfortable for you as possible. Your doctor will numb you sufficiently in
the area where the tooth is to be removed and will speak with you throughout the
Pressure is applied to the tooth to loosen it in place using a series of instruments. Once
enough movement is achieved the tooth will be removed using forceps. In some cases
the procedure may require removing some of the bone around the tooth or separating
the tooth into pieces in order to remove it fully. Sutures may be necessary depending
on the site and surgical extent of the extraction.
Once the tooth is removed, your doctor will review instructions with you for caring for
the area while it is healing.
Third Molars (Wisdom Teeth)
There are different types of third molars
- Erupted: fully in the mouth in line with your other teeth
- Partially impacted: the tooth has broken the surface of the gum, but has not fully come into the mouth
- Fully impacted
- Soft tissue: the tooth has begun to erupt but has not gotten through the gum tissue
- Bony: the crown portion of the tooth is partially or completely covered with bone
Typically third molars are extracted around college-age (18-21), but every patient is
different in their development and are evaluated on an individual basis through
panoramic radiographs and if the teeth are visibly erupted. Depending on the position
of your third molars your doctor may or may not recommend removing them. These
teeth vary greatly in their positioning and your doctor may recommend seeing an oral
surgeon for removal if the position is complicated.
A bone graft is often used at the time of tooth extraction to help preserve the bone
during healing. This allows the bone to keep its original dimension as it remodels
without the tooth in place, and in doing so provides a more optimal site for replacement
of the missing tooth.
The bone material is placed into the socket and packed into placed with an instrument.
It is then covered with an absorbable membrane and sutures are placed to hold the
graft and membrane in place. Your doctor will typically request to see you again two
weeks after the procedure for a post-operative appointment to check the status of
healing of the site.
An implant is a small appliance placed directly into the bone at the site of a missing
tooth. The site is evaluated by your doctor for proper spacing in relation to all
surrounding structures and to ensure there is enough bone present to stabilize the
implant at time of placement. Implants can be placed long after a tooth has been
removed or, in some cases, the same day as an extraction.
What is involved in an implant placement procedure?
- Your doctor will make a cut in your gum to access the bone below.
- A sequence of drills are used to prepare the bone for placement, checking positioning and depth with a gauge throughout the sequence.
- Once the correct size is reached the implant is slowly placed into the site until it reaches depth.
- A cap is placed on the implant at this point to prevent tissue from growing into the top of it.
- The gum is sutured around the implant.
- Once placed, your doctor will discuss instructions to care for the site and will see you two weeks after placement for a post-operative appointment to check the status of healing of the site.
When a tooth becomes infected from decay or the nerve of a tooth becomes
hyperactive a root canal is necessary in order to fully restore the natural tooth. In the
center of your tooth is the pulp, a network of blood vessels and nerves. When the nerve
is hyperactive or if bacteria has reached the pulp it is necessary to remove this tissue to
avoid any additional discomfort or infection.
What is involved in a root canal procedure?
- The pulp is accessed in a similar manner to a filling, and if there is any decay present it is removed at this first stage.
- Your doctor will locate all the canals present in your tooth and use small instruments to remove the pulp tissue from these canals.
- The canals will also be rinsed with a solution that kills any bacteria that may be present.
- Once the canals have been completely cleaned, a filling material is placed into each canal and the tooth is sealed with a filling material.
- If the infection is excessive, a second appointment may be necessary to complete the root canal.
- Most teeth will require a crown after completion of the root canal therapy, as the tooth structure has been weakened.
**See the Restorative and Cosmetic tab for a description of the crown procedure
At LandMark Dentistry we typically see children starting around age 3. However, the American Academy of Pediatric Dentistry (AAPD) does recommend a child seeing a dental professional by 6 months of age, or when their first tooth comes into the mouth. This helps the child to get used to the dental office, as well as instilling in them the need for dental care as early as possible.
It is extremely important to care for your child’s primary teeth and keep them until it is time for the permanent teeth to come into place. The primary teeth help your child to learn how to eat solid food, to begin and learn good oral hygiene practices, and to act as a placeholder for the permanent teeth.
Around age 6 your child should lose their first tooth (this is an average and can vary between children). For the next 6-7 years the permanent teeth are still forming and coming into the mouth.
This means your child may have primary teeth until the age of 12, or after.
During this time routine dental visits should be started that include prophylaxis (cleaning), a doctor exam, and occasional radiographs to check development and monitor for decay.
Orthodontic practice consists of using appliance to move your teeth into a more ideal alignment. There are two types of orthodontics that are typically used to achieve this: traditional brackets and clear aligners. Depending on your age and the severity of your case you may be referred to an orthodontist for treatment, however many of the LandMark doctors are Invisalign® certified.
In order to move the teeth, pressure is applied to the teeth at different points and at different times to push them into alignment. With brackets, this is done through changing of your wires and placement of the brackets. With Invisalign® this is achieved through changing your trays every so often, and each tray being in a slightly different position than the previous one. Over time the slight changes will move your teeth into alignment.
Some general reasons for orthodontic treatment are (but not limited to):
- Crowding of the teeth
- Spaces between teeth
- Open bites or other orientations that may cause trauma to the teeth
- Early intervention for children with narrow arches
Your Invisalign® certified LandMark providers are:
- Dr. Mark Tripp
- Dr. Andre Brun
- Dr. Jennifer Slaughter
- Dr. Ashley Walsh
- Dr. Anait Balasanyan
The LandMark doctors are committed to making your visits as comfortable and stress-
free as possible. We understand that coming to the dentist can be difficult for some
patients. Because of this we offer patients the option of oral anxiolysis (anti-anxiety)
and conscious sedation. These options help to remove some of the anxiety associated
with coming in for a procedure, and allow you to get through your procedure
comfortably and without worry.
Our doctors are trained and licensed to treat patients under the following conditions:
- Oral anxiolysis (anti-anxiety medication) such as Halcion or Valium
- Inhaled conscious sedation: Nitrous-oxide
- A combination of the two
Tempromandibular Joint Disorder (TMJD) and Occlusal Guards
A great number of patients suffer from discomfort in the jaw at some point during their
adult life. Some patients experience symptoms every day, while others only experience
them once in a while. The jaw joint withstands a lot of pressure through normal activity
(eating, speaking, etc.), but also takes on the additional task of trying to maintain
movement that is outside its normal functions.
The majority of patients grind and/or clench their teeth at some point throughout the
day and night. Many grind at night and are unaware of the activity unless told.
Clenching happens at night as well but is also very common during the day, in particular
during times of concentration and stress. If you are unsure if you grind or clench your
teeth some common symptoms include:
- Jaw joint and/or muscle discomfort
- Popping of the jaw joint
- Neckaches/stiff neck
- Wear on the teeth
- Gum recession
If you are experiencing any of these symptoms talk to your doctor about treatment
options to help alleviate your discomfort.
One of the best ways to treat these symptoms is through the fabrication of an occlusal
guard. It requires impressions by your doctor to ensure a custom fit, and is then sent to
a lab to be made. Similar to a retainer the guard fits over the teeth and has a thick layer
that sits in between the teeth. This layer keeps your teeth separated while you sleep,
relieving some of the pressure on the jaw joint and reducing the overall muscle strain in
Your doctor can custom fit you for an appliance to help keep your airway open if you are
a patient that snores during sleep. This appliance is custom fit by taking impressions
and sending them to a lab to be made. Similar to retainers the appliance fits over the
top and bottom teeth. The difference is that the two pieces are connected by bands on
either side that help to hold the lower jaw in a forward position during sleep. By doing
this, the airway remains unblocked by the tongue and increases the airflow thereby