What We Do

Overview

At Pike Place Dental, we offer a full range of services. In addition to standard dental procedures, we offer services that improve and maintain oral health.

Dental Procedures

Oral Health Services

Dental health education

At Pike Place Dental, we believe that education is the most important service we offer. We provide information on how patients can manage their own care for optimum dental health, including the latest and best techniques for brushing, flossing and other oral health aids. The advances in dentistry over the past few years have been profound. Our forebears could only dream of the procedures, materials and technologies now available to us.

Poor oral health can affect the health of the entire body. See our Practice Philosophy page for more information.

Dental consultation

In order to gather the appropriate amount of information, at a patient's initial visit, Dr. de Vigné likes to take some time to evaluate what we have learned. Patients usually come back for a separate consultation visit where we show them what we have found, make appropriate recommendations and explain various treatments. We explain the pros and cons of various treatment choices and the possible consequences. We prepare a document that contains all this information for patients to take with them and study. We realize that the path to dental health often requires a significant investment in time and resources, so people need time to consider how they can best proceed. They need to find a harmonious balance between the pursuit of dental health and the rest of their life.

Our hope is that our patients will choose dental health, so that they may enjoy a better quality of life and minimize the possibility of the discomfort of dental emergencies. We also understand that this may not be a priority for some people, and we respect that choice. In any case, the consultation process should lead to an informed decision.

Dental examination and X-rays

Dr. de Vigné does a complete and thorough dental exam, which includes:

  • Evaluating the health of the teeth for decay, cracking and leaking fillings and cracked or fractured teeth
  • Oral cancer screening
  • Taking intraoral pictures
  • Evaluating the health of the gums.
  • Evaluating over all health through a health history.
  • Blood pressure and pulse monitoring.
  • Taking impressions for study models

During a patient's initial visit, we usually take full mouth X-rays consisting of 18 films. In addition to the usual 'check up' X-rays, these include X-rays that show the entire root of the teeth, the bone, the upper jaw, sinus areas, and the lower jaw bone. Viewing these areas helps us determine if there are any bone cancers, sinus infections, bone loss related to periodontal disease, or any symptomatic or non-symptomatic abscessed teeth. This number of X-rays is only necessary every 5-10 years, depending on a patient’s level of oral disease. Check-up type X-rays (bite wings) are usually taken about every year. Our X-ray machines are regularly calibrated for safety, and we use lead shields to minimize radiation exposure.

We also have a panographic type of X-ray available that shows the status of dental growth and development of our child patients, the status of wisdom teeth, bone cancers and trauma to the jaw or tempromandibular (jaw) joint.

Biopsy of oral tissue

During a patient's initial comprehensive examination, and also during their periodic cleaning appointments, we do an oral cancer screening. If we see any areas that look like they may be cancerous or pre-cancerous, we may recommend biopsying all or part of that area to have it evaluated by an oral pathology lab. Many forms of cancer can be arrested if they are detected and treated at the initial stages, with no effect on quality of life.

Dental cleaning

Our dental hygienists deliver dental hygiene appointments. They clean plaque and tartar off the teeth and below the gum line, as well as helping to remove coffee, tea and tobacco stains. They measure the health of our patients' gums and makes the appropriate recommendations -- perhaps more extensive cleanings. or more regular or frequent cleaning appointments. They educate patients in the use of oral hygiene aids and mouthwashes, and assist Dr. de Vigné in evaluating patients for the possibility of oral cancer and general health of the teeth.

Deep dental cleaning (root planing)

If a patient has not had regular professional dental cleaning, or if thorough brushing and flossing has not been a regular routine, plaque and tartar can build up. Periodontal disease, gingivitis or gum disease can then develop. This is a bacterial infection of the gums, and toxins are formed that damage the ligament and bone that support the teeth. The ligament can break down, gum pockets develop and the bone erodes away. If this process is allowed to continue, teeth will be lost.

In order to stop this process, plaque and tartar must be removed and regular home care initiated. If the buildup is extensive, administration of local anesthetic may be necessary so that deep cleaning can be accomplished comfortably. After deep cleaning, home care instructions are provided to the patient, in order to prevent plaque and tartar buildup from recurring. Sometimes, therapy with a systemic antibiotic, or an antibiotic placed directly in the gum pocket,. is necessary to control gum infection.

We usually have patients come back 3-6 weeks after their deep cleaning, in order to monitor their progress and perform any additional cleaning that may be necessary. Patients that have gum disease usually need to have maintenance cleanings every 3-4 months to keep the disease under control.

Sealants

Teeth grow together from tooth buds before they break through the gums. Ideally, the tooth enamel from adjacent tooth buds fuse together to form a complete tooth. Often this fusion of the enamel is incomplete, leaving a gap in the defensive enamel layer.

Bacteria are able to grow in these deep grooves, which makes the softer, underlying tooth structure vulnerable to decay. In order to prevent decay, we flow a composite material, a sealant, into the deep grooves that becomes hard when exposed to a fiber-optic light. These sealants also have time-released fluoride that further increases the tooth’s resistance to decay, in addition to sealing out bacteria.

We place sealants in teeth that are vulnerable to decay, in both children and adults. Since the advent of sealants and fluoride, we see many patients that have no need for restorative dental care. Once a tooth is decayed and needs a filling, the tooth has been compromised. Modern dental porcelain filling materials approximate the properties of tooth structure, but they do eventually wear out and have to be replaced. Each time a filling is replaced due to wear or recurrent decay, more tooth structure is lost and the fillings get closer to the nerve. Due to grinding or clenching, a tooth may sometimes fracture and require a crown. Occasionally, the nerve inside the tooth may be so traumatized that it dies and/or becomes infected, requiring a root canal. If we stop this entire process before it starts by placing a sealant, we believe we are doing our patients a good service.

Porcelain fillings

At Pike Place Dental, we have made the commitment to not use mercury-silver fillings in our practice. Mercury is a toxic substance, and we do not feel comfortable putting it in patients' bodies. Additionally, if we were to use it, some of the leftovers would go into our suction systems, then into our sewage system and ultimately into the water supply.

The alternatives to mercury-silver fillings have dramatically improved in recent years. The composite or porcelain fillings we use are strong and dense, as well as adhering both physically and chemically to a remaining healthy tooth. Composites come in many shades, and can be matched to the shade of the tooth. They can also be highly polished to resemble the shine of natural teeth.

Porcelain-bonded crowns

Sometimes, decay and damage to teeth is so extensive that a filling will not restore it adequately. Previously, the only option available would be a full- or partial-coverage gold or porcelain crown, resulting in the sacrifice of significant amounts of healthy tooth structure. (We would have had to remove healthy material on the sides of the tooth so that the crown would stay on.)

With porcelain-bonding technology, we can now make partial-coverage porcelain onlays that adhere both physically and chemically to a tooth. We do not have to remove nearly as much existing tooth, and studies show that the bond between the tooth and the onlay is so strong the tooth a tooth would actually break before the bond. We are also able to make these onlays look like perfect natural teeth. Many times, when a patient with onlays comes back for routine cleanings, the only way we are able to tell the difference between the onlay and an unrestored natural tooth, is by looking at the patient’s check up X-rays.

Porcelain-fused-to-gold crowns

Sometimes, the decay and damage to teeth is so extensive that there is not enough healthy tooth structure to restore the tooth with a porcelain filling or a porcelain-bonded crown. In this case we will recommend either a full gold crown or a porcelain-fused-to-gold crown. Gold seals teeth with greater longevity than any other material available. We use a white gold substructure and then bake porcelain over the top. The advances in porcelain-bonding technology allows patients to have the best of both worlds; the ideal sealing of the gold and the beautiful natural esthetics of a healthy-looking porcelain tooth.

Root canals (endodontics)

Root canals are necessary to save teeth if decay has progressed in the nerve inside the tooth. This usually causes the nerve to become infected (abscessed) or the nerve to die (become necrotic). A root canal might also be indicated when a tooth fractures into the nerve inside the tooth.

When a tooth abscesses it can be a very painful experience. Before the advent of antibiotics, root canals had a bad reputation for being painful procedures. If the patient is properly managed with pre-operative antibiotics 7-10 days before a root canal procedure, this will help to get the infection under control, thus making it possible to completely anesthetize the tooth. Also, current anesthetics now work better in an infected environment

During the root canal procedure, the nerve and other infected or diseased tissue is removed from inside the tooth. The cleaned nerve chamber is then filled with a hard rubber-like material called gutta percha. The tooth is then built up in preparation for a crown. Sometimes this buildup requires a stainless steal post, depending on the amount of the tooth that needs to be replaced. Since the advent of composite bonding materials, we have less need to rely on posts for retention.

When the nerve is taken out of a tooth, the blood supply for the tooth is also lost. The tooth becomes non-vital, or dead, but it still can be functional for a patient's lifetime if properly protected. A non-vital tooth is more brittle than a vital tooth, so to prevent the tooth from fracturing away, a gold or porcelain crown should be placed over the tooth.

Porcelain veneers

Porcelain veneers are placed on front teeth when a portion of the tooth is chipped away, or if the tooth is discolored. Sometimes there is too much tooth fractured away to restore with a tooth-colored filling, or a more esthetic result is desired. Porcelain veneers fit over the tooth like acrylic fingernails. Modern dental bonding agents allow a very strong bond between the tooth and the veneer. You can bite with them just like your natural teeth so you can enjoy our wonderful Washington apples, plus, they look great!

Cosmetic bonding

Cosmetic bonding is used when some portion of the tooth is chipped away, or a change in the color or shape of the teeth is desired. This is a less costly option than porcelain veneers, but the esthetics are not as good, and bonding does not last as long as porcelain veneers.

Teeth whitening

This procedure is also sometimes referred to as bleaching. We take an impression of the teeth and make custom whitening trays. Then we dispense the whitening agent and give instructions regarding its use. In this office, we use only10% cabamide peroxide, as we feel that higher dosages could cause increased sensitivity to teeth and possibly damage the supporting gum tissues. We have patients return for shade checks (monitoring progress with a shade guide) as well as checking the health of the gums.

Oral surgery

Oral surgery refers to the removal of teeth. These are usually teeth that have been decayed, fractured or infected to the point that they cannot be restored. Sometimes there is not enough room in the mouth for wisdom teeth, and they push against adjacent teeth, causing them to be eroded, decayed or pushed out of their proper alignment. In such cases, we recommend removal of wisdom teeth before they can do permanent damage. Patients often request use of nitrous oxide (laughing gas) for removal of wisdom teeth. If they request total sedation we work with an oral surgeon who will provide that service for them.

Night guards

Many people grind their teeth at night, which causes their teeth to wear faster than if they were just using them for eating, biting, and chewing. Most often this is due to the stress in the world around us. Some people manifest their stress and tension in their backs, others in their necks and shoulders and still others in their jaw muscles. This habit, called nocturnal bruxism, can cause considerable damage to the teeth, the supporting bone and the jaw joint. The long-term objective would be to reduce stress and develop relaxation techniques.

In order to reduce the damage to teeth and supporting tissues night guards are often recommended. There are many types available depending on wear patterns, patient habits and preferences. They cushion the traumatic forces of overworking chewing muscles.

Nitrous oxide (laughing gas)

Some of our patients find it helpful to use a mixture of nitrous oxide and pure oxygen during their dental appointment. This helps them to relax, and their time in the dental chair goes by more quickly. We use an evacuation system so the effects are not experienced by the dental team. Some people experience some nausea if they use nitrous oxide on an empty stomach, so we recommend that they have a small meal approximately one hour before their dental visit. Most patients return to their normal state of awareness after 10 minutes of 100% oxygen and are able to return to work and resume their usual activities. A few individuals are drowsy for the rest of the day. If a patient is easily affected by medications, we recommend that a friend or family member accompany them home.

Relaxation techniques and referrals

We live in a stressful and anxious time for our planet. A visit to the dentist is a source of anxiety for some people. Anxiety is often simply fear of what might happen. This is why we spend so much time during our consultation to build a relationship with a patient, listen to their concerns, and communicate what modern dentistry has to offer. If a patient had a negative experience in the past -- or as a child -- this does not have to be repeated. We do things better now!

We can offer suggestions that can reduce a patient's anxiety before and during their visit to our office. Some relaxation techniques include:

  • Regular exercise
  • Meditation and affirmations
  • Yoga
  • Open communication with us
  • Listening to soothing music or relaxation CDs
  • Talking to a counselor about dental anxiety.
  • Referrals for reduction or cessation of tobacco, caffeine, and/or alcohol use
  • Adequate rest and sleeping habits
  • Eating a balanced health diet
  • Support of family and friends

Smoking and tobacco cessation referrals

Tobacco, whether chewed or smoked, increases the risk of developing cancers of many different kinds. Tobacco use can also increase the risk of periodontal disease. We encourage all our patients that use tobacco to make this habit no longer a part of their lives. There are many tobacco cessation programs available. Ask us for a referral.