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Smile More Often Miller, Werrin and Gruendel are the Pittsburgh dentists who render a truly superior dental health service. This means more than restoring or replacing teeth - we are devoted to building a high-trust, low-fear relationship with our patients. To read more about what makes us the ideal choice if you're looking for a caring dentist in Pittsburgh, please click here. Do you want a brighter, whiter smile? Are you looking for a cosmetic dentist who can help you with teeth that have been discolored, stained or darkened? Do you need crowns to cover fractured or badly shaped teeth? We provide the solution you're looking for. To read more about the services of these Pittsburgh cosmetic dentists, please click here. Miller, Werrin and Gruendel - the dentists with a real Pittsburgh connection Dr. Charles Jay Miller is a 1950 graduate of the University of Pittsburgh School of Dental Medicine, where is he currently a clinical professor in the graduate department of Prosthodontics and at the School of Dental Medicine. Dr. S. Rand Werrin is a 1967 graduate of the Temple University School of Dentistry, and currently serves as an Associate Professor in the Restorative Department, a member of the Continuing Education Faculty at the University of Pittsburgh, and the restorative advisor at Montefiore Hospital. Dr. John W. Gruendel, Jr. is a 1975 graduate of the University of Pittsburgh School of Dental Medicine, with a Certificate of Maxillofacial Prosthetics from the Eye and Ear Hospital in Pittsburgh. Dr. Gruendel currently serves as a clinical instructor and formal lecturer at Allegheny General Hospital, where he maintains an affiliation. Our friendly professional staff also include lab technicians, dental hygienists and dental assistants. To meet the staff of our Pittsburgh dental clinic, please click here. Our unique in-house dental laboratory also assures you of the very finest in dental technology and artistry. We are able to meticulously supervise the progress of your case as it flows through the laboratory process. Many years of expertise on the part of the four talented dental laboratory technicians work to your best interest to assure that the service rendered to you is of the finest quality. Dentists * Dr. Charles Jay Miller miller@dentalpgh.com Dr. Charles Jay Miller is a 1950 graduate of the University of Pittsburgh School of Dental Medicine, where is he currently a clinical professor in the graduate department of Prosthodontics and at the School of Dental Medicine. Dr. Miller began his dental career practicing with his father, I. Franklin Miller. Dr. Miller was recently honored, as was the memory of his father, at the VI Congreso Internacional of the Sociedad Peruana de Protesis Dental y Maxilo Facial, 50th Anniversary Celebration in Lima, Peru in 1996, in appreciation of the dental education and training they each had brought to this country. Dr. Miller has authored numerous scientific and clinical articles that have appeared in leading journals in the United States, Canada, United Kingdom and Peru. "Inlays, Crowns and Bridges, An Atlas of Clinical Procedures" was first published in 1962 by the W.B. Saunders Company, and has served as a landmark text for dentistry. This best-selling book, the first "show-and-tell" format for clinical dentistry, was translated into Portuguese, Spanish and German. Recognized as a leader and authority lecturer and clinician in the field of fixed partial prosthodontics and the restoration of dental implants, Dr. Miller has lectured before many prestigious dental societies in the United States, South America, United Kingdom, Europe, the Mideast, Asia and the Far East. In addition to membership in several professional organizations, Dr. Miller is a Fellow in the American College of Dentists, the International College of Dentists, the Greater New York Academy of Prosthodontics, and the International College of Implantologists. He is a Charter Member of the Midwest Academy of Prosthodontics and the American Academy of Esthetic Dentistry, and is a past president of the Academy of Electrosurgery and the Midwest Academy of Prosthodontics, among other local dental associations. Dr. Miller also serves on the advisory committee of the Continuing Education Department at the University of Pittsburgh School of Dental Medicine. He was responsible for raising the funds and overseeing the completion of the department's facility: a state-of-the-art auditorium, six treatment rooms, conference room, dental laboratory and associated office space. Dr. Miller has been listed in the 1996-1997 edition of "Who's Who in Medicine and Health Care", as well as the 1991-1992 edition of "Who's Who in the World", and will be recognized in the 27th edition of Who's Who. Close * Dr. S. Rand Werrin werrin@dentalpgh.com Dr. S. Rand Werrin is a 1967 graduate of the Temple University School of Dentistry, and currently serves as an Associate Professor in the Restorative Department, a member of the Continuing Education Faculty at the University of Pittsburgh, and was the restorative advisor at Montefiore Hospital. Dr. Werrin has developed several inventions for the field of dentistry. They include the Dental Bite Tray Posterior, Dental Bite Tray Anterior, Quadrant Triple Tray, Sideless Triple Tray, Extended Quadrant, Alpha, T-Loc, Richmond Reflective Shields, and Three Quarter Arch Triple Trays. He has published many articles for leading dentistry journals, including Journal of Dental Research, Quintessence International, Journal of Prosthetic Dentistry, Dental Magazine, and Dentistry Today. In addition to membership in numerous professional organization, Dr. Werrin is a Fellow of the American College of Dentists, the Academy of Dentistry International, and the International College of Dentists. He is a past president of the Pittsburgh Dental Research Club and the East End Dental Society, and past dental education chairman of the Dental Society of Western Pennsylvania. Dr. Werrin has lectured and offered clinics for the American Dental Association since 1975. He has also addressed members at local and regional associations in New York, Pennsylvania, Illinois, Arizona, West Virginia, and Ohio, and in such countries as Italy, Thailand, Ireland, Israel, the Philippines and Barbados. In addition to volunteering on the dental faculty at the University of Pittsburgh Medical Center, Dr. Werrin has acted as a product evaluator for Premier Dental Products Company, Richmond Dental Products and 3M Dental Divisions. Close * Dr. John W. Gruendel gruendel@dentalpgh.com Dr. John W. Gruendel, Jr. is a 1975 graduate of the University of Pittsburgh School of Dental Medicine, with a Certificate of Maxillofacial Prosthetics from the Eye and Ear Hospital in Pittsburgh. Dr. Gruendel currently serves as a clinical instructor and formal lecturer at Allegheny General Hospital, where he maintains an affiliation. Dr. Gruendel is a past president of the Pennsylvania Prosthodontic Association, Western Pennsylvania Prosthodontic Association, and the East End Dental Society. He is a member of numerous professional organizations, including the American Dental Association, Pennsylvania Dental Association, Odontological Society of Western Pennsylvania, and Pittsburgh Dental Research. Dr. Gruendel has presented several papers to local organizations, including the Pennsylvania Dental Association and the Pittsburgh Dental Research Club. Topics addressed have included oral management of the chemotherapy patient, prosthetic management of the staple bone plate, maxillofacial prosthetics, and dental care of the irradiated head and neck patient. Close * Dr. Robert R. Rogers Dr. Rogers has had a special interest in the treatment of sleep-disordered breathing since 1990, and treats patients in conjunction with many regional sleep centers. Dr. Rogers is the founding president of the Academy of Dental Sleep Medicine (ADSM) and served again as president in 1995 and 1999. In addition to being a member of the Board of Directors for 10 years, he chaired the Education and Curriculum Committee for six years and was the director of the ADSM Resource Center 12 years. Dr. Rogers is a diplomate of the American Board of Dental Sleep Medicine and a recipient of the ADSM Distinguished Service Award. Dr. Rogers conceived, designed and developed the ADSM educational slide series. He is a contributing author to the graduate dental text, Clark’s Clinical Dentistry, and has published numerous articles for both the professional and lay readership. Dr. Rogers is currently the dental consultant to Respironics, Inc., and lectures to students at the University of Pittsburgh. Dr. Rogers also lectures nationally and internationally to physicians and dentists about dentistry's role in the recognition and treatment of snoring and obstructive sleep apnea. Most recently, Dr. Rogers was a member of the task force for the revision of the American Academy of Sleep Medicine Position Paper and Practice Parameters on Oral Appliance Therapy that emphasized the efficacy of oral appliance therapy for the treatment of mild to moderate obstructive sleep apnea and its use an alternative for patients unable to tolerate a CPAP unit. Close Staff Members * Elizabeth Bannon - Office Coordination/Manager elizabeth@dentalpgh.com I am a resident of Monroeville and have two children, Laura and Joseph. I have worked in the dental field since the age of 19 - both assisting and at the front desk. Now that I have raised my family, I have resumed my office coordinating skills here in Oakland. I am the Office Coordinator/Manager and I look forward to meeting all of you and making your next visit to our office a warm and welcomed experience. Close * Tina Fisher - Office Assistant tina@dentalpgh.com My name is Tina Fisher and I am a recent graduate from the University of Pittsburgh School of Business. Since graduation, I have taken on a full time position here with the doctors. I have worked here for five years (part time), so I am looking forward to the coming year and being around quite a bit more! Close * Charles Winter - Dental Lab chuk@dentalpgh.com My name is Charles Winter. I have been employed by Dr. Miller for the last 40 years. I do all phases of dental lab work. My specialty is gold and composite crowns, inlays and onlays. We have a full service and up to date in house laboratory. Whenever you are in the office, stop in our lab and say "Hi!" We will be happy to meet you and answer any of your questions. Close * Laura Innerbrickler - Office Assistant something@dentalpgh.com CONTENT NEEDED EMAIL ADDRESS NEEDED Close * Terri Romanchak - Dental Hygienist teresa@dentalpgh.com I am married and have two boys - Andrew, 9 and Austin, 5. I just got the little girl everyone has wanted me to try for. Her name is Maggie and she is a German short hair pointer! I live in Freeport. I enjoy golfing and spending time with the boys. I have been with this office for 17 years and look forward to many more. Close * Peggy Gibson - Dental Hygienist peggy@dentalpgh.com I've been a dental hygienist with this office for 17 years. What a great ride it has been....always riding on the cutting edge of the dental profession. The doctors are exceptionally unique and special in so many ways that allow this practice to continue to evolve and be what it is. The true loves of my life are my husband Chris, and our three handsome sons- Marcus, Miles, and Mason. We love our Pittsburgh sports and keeping ourselves in super shape too! Close * Evelyn Glass - Dental Hygienist evelyn@dentalpgh.com I have worked 26 1/2 years for Dr.'s Miller, Werrin, & Gruendel. Prior to moving to Pittsburgh, I practiced in New York City. As you can see, I still love dental hygiene. Close * Carol Telford - Dental Assistant ToothAche Pittsburgh, Tooth ache Pittsburgh, Toothpain Pittsburgh, Tooth pain Pittsburgh, Dentist Pittsburgh, DentistPittsburgh, Dental clinic Pittsburgh, DentalclinicPittsburgh, Dental office Pittsburgh, DentalofficePittsburgh, Emergency dentist Pittsburgh, EmergencydentistPittsburgh, Emergency dental Pittsburgh, EmergencydentalPittsburgh, Emergency dental treatment Pittsburgh, EmergencydentaltreatmentPittsburgh, Miller, Werrin, Gruendel - Pittsburgh's Leading Dentists Devoted to Excellence, Emergency Dental Treatment Pittsburgh, Emergency Dentist Pittsburgh, Dental Clinic Pittsburgh Bleaching Pittsburgh, Binding Pittsburgh, Bridges Pittsburgh, Crowns Pittsburgh, Dental implants Pittsburgh. Dentist Pittsburg, Emergency dental treatment Pittsburg, Dental Pittsburg, dentist for patients Pittsburg, toothache Pittsburg, toothpain Pittsburg, Dental office Pittsburgh, Bleaching Pittsburgh, Binding Pittsburgh, Bridges Pittsburgh, Crowns Pittsburgh, Dental implants Pittsburgh. carol@dentalpgh.com I have worked for this office for 34 years. I'm looking forward to the next 34 years. Close * Brenda Ickes - Dental Assistant brenda@dentalpgh.com My name is Brenda and I have worked as a dental assistant with Dr. Werrin for 3 years and am looking forward to many more! Close * Brandon Trice - LabTechnician brandon@dentalpgh.com My name is Brandon Trice. I am 26 years old and a graduate of the Art Institute of Pittsburgh. I have been with our office for four years. I prepare the model work and also do work on porcelain restorations and dentures. Close * Amy Porter - Dental Assistant amy@dentalpgh.com I have been a personal dental assistant to Dr. Gruendel for the past 10 years. I am married with one child, Taylor Jean, who is three years old. I enjoy spending time with family and friends and watching my little girl grow. Close TeethAche Pittsburgh, Teeth ache Pittsburgh, Teethpain Pittsburgh, Teeth pain Pittsburgh, Dentist Pittsburgh,Teeth Crack Pittsburgh, Tooth Crack Pittsburgh,Dental clinic Pittsburgh, Dental practice Pittsburgh, Dental office Pittsburgh, Emergency dentist Pittsburgh, Emergency dental Pittsburgh, Emergency dental treatment Pittsburgh, Pittsburgh Dentist, Dentist for patients in Pittsburgh, Dentist Pittsburgh, Dentist in Pittsburgh Area, Dentists in Pittsburgh, Pittsburgh Dental Care, Pittsburgh Braces, Pittsburgh Tooth Whitening, Pittsburgh Dental Implants, Pittsburgh Cosmetic dentistry , Dental Care Pittsburgh, Braces Pittsburgh, Tooth Whitening Pittsburgh, Dental Implants Pittsburgh, Cosmetic dentistry Pittsburgh, teeth whitening Pittsburgh, tooth whitening Pittsburgh, CROWNS Pittsburgh, DENTURES Pittsburgh, IMPLANTS Pittsburgh, ROOT CANAL TREATMENTS Pittsburgh, BRIDGES Pittsburgh, TMJ TREATMENTS Pittsburgh, Pittsburgh Dental Office, ToothAche Pittsburgh, Tooth ache Pittsburgh, Toothpain Pittsburgh, Tooth pain Pittsburgh, Dentist Pittsburgh,Tooth Crack Pittsburgh, Dental Care Pittsburgh, Children's Specialist Pittsburgh, Emergency Dental Treatment Pittsburgh. Speciality Training Prosthodontics Bleaching Bleaching, also known as Tooth Whitening, is a procedure that brightens teeth that are discolored, stained or darkened because of injury. It can be performed on all types of teeth, even those that have had root canal treatment. A chemical oxidizing solution is applied to the teeth and may be activated by heat or a combination of heat and light. Generally, three to four visits are necessary with each visit taking under an hour. The advantages of bleaching are that it's economical and does not require tooth removal. Occasional touch-ups may be necessary to keep the teeth white. Bonding What is bonding? The addition of a tooth-like substance to a tooth to change its shape or color, increase its size or repair a defect. Bonding is a multi-layered process in which durable, enamel-like composite resins are intricately applied to the tooth before it is exposed to a special light. Is bonding painful? No. Bonding is painless and often performed without the use of an anesthetic since very little tooth removal is necessary. Is bonding a radical procedure? No. Bonding is the most conservative dentistry practiced today. It involves a minimal amount of tooth reduction and, in many cases, none at all. Is bonding natural looking? Yes, when it is performed by a dentist who specializes in cosmetic dentistry and has the practical skill and expertise required for intricate veneering and tooth sculpturing. Do bonded teeth stain or discolor? Microfill, the state-of-the-art bonding material, stains similarly to normal tooth structure. It is highly polishable and stain-resistant. Any extrinsic stains, which might occur, can be removed by a routine dental cleaning. Does a bonded tooth require extra care? There are few limitations. It is advisable to avoid biting into hard objects such as ice cubes and hard candy. Fingernail biting should be avoided. How long does bonding last? Longevity depends on the quality of the materials used and the expertise of the dentist. State-of-the-art bonding materials currently exhibit a five to ten year life and longer. A bonded tooth can be rebonded. Is bonding expensive? Bonding is generally less expensive than other cosmetic treatments. The amount of savings depends upon the type of procedure to be performed. How much time does bonding require? Most bonding procedures can be completed in one visit resulting instantly in a beautiful smile. The length of the visit varies according to the procedure. Is bonding for everyone? People of all ages can benefit by the cosmetic technique of bonding. Children, adolescents, adults and senior citizens can improve their smiles and appearance by this treatment. Bridges If you're missing one or more teeth, you may be aware of their importance to your appearance and dental health. Your teeth work together to help you chew, speak, sing and smile. When you lack teeth, it's difficult to do these things. Fortunately, missing teeth can and should be replaced. You can restore your oral health and your smile with a fixed bridge. What exactly is a bridge or fixed partial denture? A bridge (also called a fixed partial denture) is a restoration which replaces or spans the space where one or more teeth have been lost. There are two types of bridges - fixed and removable. Fixed bridges are bonded into place and can only be removed by a dentist. On the other hand, you can take out a removable bridge for cleaning. Removable bridges, while less expensive, may not be as desirable as fixed bridges and are not generally as stable. Why do I need a bridge? Your appearance, dental health and the proper functioning of your mouth are all important reasons for wearing a bridge. A bridge helps maintain the natural shape of your face and may help support your lips and cheeks. The loss of a back tooth may cause your mouth to sink and your face to look older. More importantly, though, your dental health may suffer when teeth are not replaced. Teeth were designed to complement each other. When a tooth is lost, the nearby teeth may tilt toward the empty space, or the teeth in the opposite jaw may move up or down toward the space. This places unusual stress on both the teeth and tissues in your mouth. In addition, the gum tissues and the bone that hold teeth in place can break down, increasing the risk of gum disease. Teeth that have tipped are difficult to clean, making them more likely to decay. As a result, even more teeth may be lost. Missing teeth can also affect the way you chew and speak. Chewing on only one side may cause stress to your mouth. You also need your teeth to speak properly, since they help you make the many sounds needed in speech. If you need extensive fixed bridge work, your dentist my refer you to a prosthodontist. A prosthodontist is a specialist trained in restoring natural teeth and in replacing missing teeth. How is a bridge attached? A fixed bridge is commonly cemented to the natural teeth next to the space left by the missing tooth. A false tooth (called a pontic) replaces the lost tooth. The pontic is attached to the crowns (restorations that cover a tooth). Crowns, which are cemented onto the natural teeth, provide support for the bridge. Are there different types of bridges? Yes. Implants attach artificial teeth directly into the jaw or under the gum tissue. Because they require surgery, candidates for implants should have good general health and have adequate bone to place an implant. In some instances, a resin-bonded bridge, frequently called a "Maryland Bridge," can be used to replace one or more missing teeth. Because the bridge is attached by a special procedure called bonding, it doesn't require the use of crowns or extensive tooth preparation. Your dentist can determine whether this treatment method is appropriate for you. What materials are used? Appearance and function are considered when selecting materials for bridges. Bridges are made from gold alloys, non-precious alloys, porcelain, or a combination of these materials. Porcelain is often bonded to either precious or non-precious metal. Your dentist will discuss which materials are best for you. How do I take care of my bridge? It is very important to keep your remaining teeth healthy. Brush twice a day, and clean between the teeth with floss or interdental cleaners (specially shaped brushes as well as rubber, plastic or wooden items). These measures help remove a sticky film of bacteria called plaque. Plaque causes gum disease and dental decay. A bridge can lose its support if the teeth or the bone that holds it becomes damaged by dental disease. Be especially careful to clean the areas under, around and between the bridge and your natural teeth. Dental floss threaders and special brushes can help you reach these areas. It is also important to visit your dentist regularly. Remember, the ultimate success or failure of a fixed bridge depends on its foundation. Help keep your gums and remaining teeth healthy. Your dental health and your appearance are worth the effort! Dental Imaging What is dental imaging? Dental imaging is a process that allows the patient to be educated on the dental work about to be performed. Using a mini-camera, the dentist inserts a probe into the patient's mouth and projects a color image that is magnified by thirty-five times onto a television screen. The process allows the patient to see first-hand, in magnification, any problems with their teeth and understand completely the procedures that may be necessary to correct these problems. Enamel Shaping What is enamel shaping? Enamel shaping is a process of contouring natural teeth to improve their appearance. When teeth become slightly crowded or uneven, or eye teeth seem too long, enamel shaping may be used to correct the flaw. The process cannot solve all problems, however. Severely crowded teeth may need braces. Enamel shaping involves modifying teeth by removing or contouring enamel to create harmony and balance in the mouth. Enamel shaping, which is often combined with bonding, is usually quick and painless. No anesthesia is necessary when shaping the enamel, and the results can be seen immediately. It should be approached with caution, however, because enamel cannot be replaced. Porcelain Veneers What are porcelain veneers? Veneers are thin preshaped shells made of tooth-colored materials that are designed to cover the front side of teeth. They are fabricated by a dental technician, usually in a commercial dental laboratory, from the impression provided by the dental office. Veneers are used to cover gaps or teeth that are stained, poorly shaped or slightly crooked. They may last from 3 to 12 years. Dentistry’s Role in the Treatment of SDB The role of the sleep-disorders dentist in the management of sleep-disordered breathing is expanding. Most medical sleep teams now include a properly trained dentist. Duties of the dentist include: 1. Case detection (not diagnosis) 2. Assessment of candidacy for oral appliance (OA) therapy 3. Selection of OA design 4. Construction, delivery of OA 5. Titration of OA 6. Treatment follow-up and monitoring 7. Collaboration with medical doctors Technologies Dr. Rogers’ and Mary Beth Rogers’ experience with oral appliance design and associated technology stretches back to its early days. They have seen the field steadily progress over the past 20 years, and are well-versed in its latest advances. The appliances and screening/titration monitors used in Dr. Rogers’ practice have been thoroughly researched and documented to produce positive results for patients. All appliances and devices are FDA approved. Oral Appliances Unlike most offices that use a single appliance, Dr. Rogers offers several different oral appliances, choosing the one that is best for you. The choice of oral appliance is made after a thorough medical history and oral examination. Oral Appliance Therapy Types of Oral Appliances Of the many appliances available today, each falls under one of two categories based on mode of action. The first and largest category is that of the "mandibular repositioning device." The vast majority of appliances in use today fall into this category. These devices gently reposition the lower jaw forward during sleep. The second category is that of the "tongue retaining device." These appliances are seldom used but can be especially effective for people with few to no teeth or jaw joint problems. Tongue retaining devices function by protruding the tongue forward during sleep. Appliances used in our office TAP -Thornton Adjustable Positioner The Thornton Adjustable Positioner (TAP®) oral appliance is a mandibular advancement device composed of two separate arches (maxillary and mandibular) containing an advancing mechanism that permits unlimited advancement of the lower jaw. The arches are custom fitted to a patient's models. The advancing mechanism is engaged, and the screw mechanism in the upper tray is then turned to advance the mandible until the patient begins to feel any discomfort in the temporomandibular joint or in the facial muscles (maximum mechanical protrusion which is an average of 2.5mm beyond maximum protrusion). The advancing screw is then turned back until patient is comfortable. PM Positioner The Adjustable PM Positioner™ utilizes materials and design to minimize office chair-time and provide the patient control of adjusting the jaw position under the dentist’s supervision. Research studies have shown that this appliance is successful in treating 77% of patients with moderate OSA. The appliance fits over all maxillary and mandibular teeth and is made of a special acrylic material (Bruxeze™) that softens in hot water to provide a combination of comfort, strength, and retention. This material has proven to be very durable. Expansion screws are located on the right and left buccal areas to allow maximum space for the tongue and easy anterior-posterior positioning of the mandible to achieve optimal effectiveness. This design permits ample lateral and protrusive movement to maintain jaw comfort. The device uses a unique method of retention consisting of small projections of acrylic within the device that comfortably grip the undercut areas of two posterior teeth in each quadrant. Therefore, no metal clasps are necessary. Elastomeric Constructed in a dental laboratory, this device is made of a pliable, soft, custom-injected silicone and is tooth retained. There are no clasps or wires to adjust. The flexibility of the material lends itself to a high degree of patient comfort. The Elastomeric appliance is not protrusively adjustable. The vertical opening is five mm and the mandible is afforded some limited movement due to the high flexibility of the material. The Elastometric has been proven effective by the University of Kentucky Medical Center Sleep Apnea Laboratory, and is recommended for partially edentulous patients and non-bruxers. TRD - Tongue Retaining Device The TRD is lab constructed of a flexible polyvinyl material adapted to the general contours of the teeth and dental arches. It does not depend on teeth for retention. Rather, the tongue is held forward by the negative pressure created in the vacuum bulb on the front of the appliance. The appliance is available in four tongue extensions and with or without air way tubes for patients with compromised airway patency. It is constructed in conjunction with the Kel Gauge (described in another section of this program.) Since the mandible is not rigidly or firmly held by the appliance, freedom of movement is possible during use. This would seem to make the TRD a good choice for the edentulous patient, the patient with periodontal disease and the patient with temporomandibular joint dysfunction. There is ample research available documenting the effectiveness for treatment of snoring and OSA in certain patients. Screeners / Titration Devices The Remmers Sleep Recorder (RSR) is routinely utilized to monitor the effectiveness of the jaw position during trial procedures of the oral appliance. The RSR measures snoring, breathing, blood oxygen, heart rate, pulse, tooth grinding, body position and leg movements. Use of this device allows us to accurately set the oral appliance to the proper therapeutic jaw position prior to final assessment in the sleep lab. Sleep-Disordered Breathing (SDB) Sleep and Breathing During normal breathing, air passes through the nose and the flexible structures in the back of the throat, such as the soft palate, uvula and tongue. While you are awake, the muscles in these structures hold the airway open. When you fall asleep, these muscles normally relax but still hold the airway open, and healthy sleep can occur without disruption. What Is Sleep-Disordered Breathing? Sleep-disordered breathing is a term that means breathing is restricted due to the sleeping process itself. When the throat muscles relax during sleep, they collapse and prevent adequate breathing. This, in turn, disrupts sleep, creating a condition in which both sleep and breathing are dangerously affected. The three most important basic fundamentals of life are eating, breathing and sleeping. Those who suffer from sleep-disordered breathing are lacking in two of the three! When breathing and sleeping are disrupted night after night, adverse health consequences are more frequently seen, including high blood pressure, heart attack, stroke and diabetes. Snoring and Obstructive Sleep Apnea Snoring and obstructive sleep apnea are both considered sleep-disordered breathing events. Sleep Apnea is a treatable disorder in which a person stops breathing many times during the night. OSA is associated with serious health problems and a diminished quality of life. Snoring is a strong indication that OSA may be present. Snoring is the sound of obstructed breathing during sleep. It occurs when 1. the structures of the throat are large, and 2. the muscles relax enough during sleep to cause the airway to narrow, partially obstructing the flow of air. As air tries to pass through the partially collapsed airway, the throat structures vibrate causing the sound we know as snoring. Large tonsils, long soft palate and uvula, certain jaw formations, and excess fat deposits contribute to the collapsibility of the airway. Sometimes the cause of snoring can be harmless, but generally it is a danger sign that indicates a serious problem which progresses from upper airway resistance syndrome (UARS) to Sleep Apnea. Obstructive Sleep Apnea (OSA) Obstructive sleep apnea (OSA) occurs when the airway completely collapses during sleep and airflow stops entirely. Because no air can be drawn into the lungs, the oxygen level in the blood drops. Eventually, this signals the brain to partially awaken so that the sleeper can stimulate the throat muscles to open and clear the obstruction. This waking usually occurs with a loud gasp or choking sensation. Once the airway is open, breathing and sleep can resume. However, the relaxing influence of sleep affects the throat muscles as before and this process starts again, repeating throughout the night. People with OSA experience disrupted sleep and periodic drops in oxygen levels each night. This is associated with cardiovascular disease and excessive daytime sleepiness. A condition known as upper airway resistance syndrome (UARS) lies midway between snoring and true OSA. People who suffer from UARS suffer many of the symptoms of OSA but do not really have OSA. Prevalence of Obstructive Sleep Apnea Everybody knows someone with diabetes or asthma, but did you know that obstructive sleep apnea (OSA) is as prevalent as these common problems? * Roughly one out of five adults has at least mild OSA * 90% of OSA sufferers remain undiagnosed and untreated * Almost as many traffic accidents are caused by sleep apnea as DUI * The risk is two to three times greater in men than women * The risk to women greatly increases after menopause * Pregnancy may be a time of particular risk for women * OSA is the most common chronic disease in industrialized societies * 27% of all children are affected by habitual snoring * 2 to 3% of all children have OSA * The problem is getting worse due to the trend in obesity Car and Work Accidents People with obstructive sleep apnea (OSA) syndrome have high rates of motor vehicle crashes. This finding is based on crash records, as well as self-reporting and poor performance on driving simulators. Because traffic safety is under governmental regulation, there are legal implications for both private and commercial drivers if OSA is a significant cause of impaired driving. In addition, recent research shows that accidents and injuries in the workplace are increased when workers suffer from fatigue and sleepiness from obstructive sleep apnea. Sleep Apnea in Pregnancy According to some researchers, the airway of pregnant women narrows in the last trimester of pregnancy. It has been found that if a woman has severe snoring or sleep apnea, the health of both the mother and the fetus can suffer. In pregnant women, blood pressure rises as the airway becomes narrower. Data indicates that pregnant snorers have an increased risk for preeclampsia. Sleep Apnea in Children Sleepy kids Witnessed apneas occur in approximately 5% of children. Although obesity is a less important risk factor in children than adults, symptoms of sleep-disordered breathing occur two to three times as often as they do in non-obese children. Studies suggest that a minimum prevalence of obstructive sleep apnea (OSA) of 2 to 3% is likely, with prevalence as high as 10 to 20% in children who snore habitually. Daytime sleepiness is reported in 25 to 30% of children. According to the American Sleep Apnea Association, children may present with hyperactivity, inattentiveness, aggressive behavior, irritability and mood swings. "OSA in children is a serious disorder that, untreated, may result in health problems as well as behavior and academic problems." Down Syndrome It has been reported that the incidence of upper airway obstruction may be as high as 31% in children with Down Syndrome. ADHD A 2002 study found that children who frequently snore or have sleep disorders are almost twice as likely to suffer from ADHD as those who sleep well. Tonsils and Adenoids Large tonsils and adenoids are often responsible for snoring and sleep apnea in children. When large tonsils and adenoids are removed, the snoring and apnea resolves approximately 80% of the time. Orthodontic Treatment In many instances, snoring and sleep apnea in children can be caused by dento-facial abnormalities. Often, the upper airway can be widened through orthodontic expansion of the dental arches (a routine procedure done in most orthodontic offices). Prevention Some researchers suggest that breast-feeding serves to shape the dental arches in infants in a manner which increases the likelihood that the upper airway becomes adequately formed for proper breathing and sleeping. Conversely, many clinicians feel that most commercial pacifiers and thumb-sucking serve to cause malformation of the dental arches so as to increase the risk of snoring and obstructive sleep apnea. Do You Have Sleep-Disordered Breathing? Self-test How do you know if you have sleep-disordered breathing (SDB)? Take the simple test below, This self-administered test measures daytime sleepiness, not specifically snoring or sleep apnea. However, if you or someone you know snores each night and is sleepy during the day, there is an increased likelihood that OSA is present. Whether you take the test or not, be sure to visit your physician if you think you have a problem. The only way to know for certain whether you have OSA is to have a sleep test either at home from a qualified sleep physician or in a hospital sleep center. Feel free to print this test, fill it out and take with you to your physician. The Epworth Test How likely are you to doze off or fall asleep in the following situations? Choose the most appropriate number for each situation: 0 = would never doze 1 = slight chance of dozing 2 = moderate chance of dozing 3 = high chance of dozing Activity Score Sitting and reading Watching TV Sitting, inactive in a public place (theater, meeting) As a passenger in a car for an hour without a break Lying down to rest in the afternoon when circumstances permit Sitting and talking to someone Sitting quietly after lunch without alcohol ToothAche Pittsburgh, Tooth ache Pittsburgh, Toothpain Pittsburgh, Tooth pain Pittsburgh, Dentist Pittsburgh, DentistPittsburgh, Dental clinic Pittsburgh, DentalclinicPittsburgh, Dental office Pittsburgh, DentalofficePittsburgh, Emergency dentist Pittsburgh, EmergencydentistPittsburgh, Emergency dental Pittsburgh, EmergencydentalPittsburgh, Emergency dental treatment Pittsburgh, EmergencydentaltreatmentPittsburgh, Miller, Werrin, Gruendel - Pittsburgh's Leading Dentists Devoted to Excellence, Emergency Dental Treatment Pittsburgh, Emergency Dentist Pittsburgh, Dental Clinic Pittsburgh Bleaching Pittsburgh, Binding Pittsburgh, Bridges Pittsburgh, Crowns Pittsburgh, Dental implants Pittsburgh. 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TOTAL A score of nine or above indicates you may be having a problem with daytime sleepiness, but a score below nine does not necessarily mean that you don't have a problem. See your health care professional for advice if you snore, have been told that you awake gasping for breath, or if you feel sleepy during the day. Night after night of improper sleep and breathing takes its toll on our quality of life. Signs may include: 1. Constant fatigue, no energy 2. Feeling of depression 3. Easily irritated 4. Falling asleep at inappropriate times 5. Difficulty concentrating 6. Forgetfulness 7. Waking up with headache 8. Decreased sex drive Unfortunately, the effects of snoring and obstructive sleep apnea expand beyond the person with the problem. Anyone who has slept with a snoring partner knows it can disrupt his or her sleep as well. This "second-hand snoring" can cause the bed-partner to suffer the same daytime sleepiness problems that their partner experiences, which may lead to marital discord and adverse health consequences. Treatment Options Sleep-disordered breathing (snoring and obstructive sleep apnea) can be managed in several ways: Behavior Modification Modification of certain behaviors can help reduce the tendency of snoring and obstructive sleep apnea (OSA), but generally does not cure the problem unless it is very mild. These modifications include weight loss, sleeping on your side instead of your back, avoiding alcohol and sedatives before bedtime, and eliminating smoking. Positive Airway Pressure Considered the "gold standard," continuous positive airway pressure (CPAP) or bi-level positive airway pressure (Bi-PAP) work very well to manage snoring and OSA in the vast majority of people. This treatment requires the use of an air compressor at bedside to deliver forced air into the nose via a nasal mask. Air pressure keeps the airway open while you sleep. However, the treatment is intrusive and cumbersome for many people, and therefore rejected in a significant number of cases. Learn more about CPAP problems Surgery There are several surgical options to treat snoring and OSA ranging from relatively simple to very invasive and complex. Depending on the severity of the problem and the type of surgery done, the results can vary from person to person. The process can be painful and expensive; however, when it is successful, surgery can provide a good solution to the problem. Oral Appliance Therapy Oral appliances have been used since the mid-1980’s to successfully manage snoring and OSA. Many scientific studies have been published that demonstrate the effectiveness of these appliances when utilized by experienced sleep-disorders dentists. Oral appliances are small devices placed in the mouth, much like an orthodontic retainer or athletic mouth guard. They are utilized during sleep to prevent collapse of the tongue and soft tissues in the back of the throat so that the airway stays open during sleep. The appliances promote adequate air intake, helping to provide normal sleep for those who suffer from snoring and/or OSA. Oral appliances can be used alone or in combination with CPAP or after surgery. Although oral appliances are effective for many people, they do not work for everyone. Recent research and official medical practice parameters indicate they are best utilized for mild to moderate conditions and whenever CPAP is not tolerated. Determination of proper therapy can only be made by joint consultation between your sleep-disorders dentist and your sleep physician. Currently, more than 40 different appliance designs are available to specially trained dentists for this use. Read more about different types of Oral Appliances. What to Expect During Treatment The first step in being treated for snoring or obstructive sleep apnea (OSA) is to obtain an evaluation by a sleep physician who will provide a formal diagnosis, usually based on a medical sleep study. Following diagnosis, an evaluation by a sleep-disorders dentist will determine whether you are a good candidate for oral appliance therapy and which appliance will be most effective. The first dental appointment will involve a discussion of the problem, the advantages and limitations of oral appliance therapy in your case, the extent to which your insurance will cover the recommended procedures, and an oral examination including an X-ray of your teeth and jaw joint. If you choose to proceed with the therapy, a simple in-home baseline dental sleep study will be done initially to compare to a second study to be done once the appliance is thought to be effective. After the selected appliance is created, you will return for a second appointment for a custom-fitting and instructions on use and care of the oral appliance. You will return for approximately two additional follow-up visits to monitor the effect of the appliance and to make any necessary adjustments. Effectiveness will judged by resolution of your symptoms (snoring and daytime sleepiness) and a second simple in-home dental sleep study. When the snoring and tiredness have been resolved and the second in-home dental sleep study shows good improvement, you will be referred back to your sleep physician for final evaluation. Most often it will involve another medical sleep study. Ultimately, you will be followed by Dr. Rogers on a twice per year basis to ensure adequate treatment to monitor any possible side effects. Read instructions given to patients during treatment Continuous Positive Airway Pressure (CPAP) is generally considered the mainstay of treatment for obstructive sleep apnea. However, in almost half of the cases where it is prescribed, it is poorly tolerated or simply rejected due to its unwieldy and intrusive nature. Other objections include: * Inconvenience * Nasal congestion * Sinus problems * Skin irritation * Claustrophobia * Mask leaks Now there is an effective way to control snoring and obstructive sleep apnea (OSA) without resorting to cumbersome CPAP devices. A small device, similar to an orthodontic appliance, can offer an alternative to CPAP machines. In some cases, oral appliance therapy may be the first choice for treatment of mild to moderate obstructive sleep apnea. Oral Appliance Therapy If you or a loved one snores or has had difficulty wearing his/her medically prescribed CPAP, Dr. Robert Rogers has had the years of experience necessary to offer a unique dental solution. Dr. Rogers is happy to consult with those who feel that they are having a problem with snoring or sleep apnea but have not been diagnosed and as well as those who are unable or unwilling to wear a CPAP unit. Dr. Rogers also works closely with other dentists in the tri-state area and with family physicians and sleep specialists. Monitoring Appliances Dr. Rogers will carefully follow and guide your progress throughout your treatment. You will be seen in the office several times to ensure acceptance, comfort, and effectiveness of the therapy. Instructions will be given on proper adjustment of the appliance and any areas of discomfort will be addressed. The objective of your treatment is to resolve snoring and daytime tiredness through gently and gradually repositioning the lower jaw. Your personal feedback and two simple in-home dental sleep studies will provide guidance. Care of Oral Appliances Your oral appliance is easy to care for. Each morning, simply brush it with a toothbrush and toothpaste. Rinse it well and allow it to sit in its case all day with the top open. Be sure your oral appliance is high above the ground, out of the way, where no curious dogs can chew on it. Also avoid extremes of temperature—especially heat, which may cause the appliance to distort. Twice each week, your appliance should be soaked for 15 minutes in the ultrasonic cleaning container using the cleanser tablets. This will disinfect and keep the appliance looking its best. Examine your appliance frequently and call Dr. Rogers if you observe any broken areas. Exercises Patients often find that they are unable to close their teeth completely in the morning immediately after removing the appliance. This is normal—it is caused by a temporary jaw joint change. Generally, this will resolve on its own within 10 or 20 minutes as the joint drifts back into its normal position. After 20 minutes, jaw exercises are helpful to re-establish joint position and good tooth contact. This can be accomplished by clenching the teeth together and holding for several seconds and then releasing and then repeating the “clench/release” for a minute or so. Or, you may "clench/release" on the soft plastic exercise tabs that were provided to you. Side Effects Most of the side effects encountered during appliance use are minor and temporary. They include tenderness to teeth, muscles and joints. Dry mouth and increased salivation is also noticed frequently. In addition, teeth will not meet properly for 10 to 20 minutes after first removing the appliance after a night’s use (see "Exercises"). Dr. Rogers will work with you to manage these occurrences and minimize any problems. It should be noted that in many cases, a permanent bite change will occur over the years due to a small, permanent change in jaw joint position and/or minor tooth movements due to the pressures placed by the appliance each night. It is critically important to keep up with twice yearly evaluation visits allowing Dr. Rogers to monitor any possible changes in your bite. They are most easily managed if discovered in the early stages. When to Call the Office Please feel free to call the office any time you have a concern that you feel needs personal attention by Dr. Rogers or his staff. For most instances, however, it is most convenient to email your concerns to us at rrrogers@pittsburghdentalsleepmedicine.com. We check emails often and will respond within 24 business hours or less. In this way, we can quickly and easily answer any questions or suggest you schedule an appointment to make an office visit. Insurance The cost of therapy may vary slightly among patients, depending upon differing circumstances. Presently, most insurance companies are covering the majority of expenses for SDB treatment. Your personal out-of-pocket expenditures should be reasonable in most cases, but is subject to your insurance policy. An accurate determination of total cost can only be made after evaluation/consultation with Dr. Rogers. Dr. Rogers has the necessary training and experience and uses appropriate therapeutic protocol to maximize your insurance coverage. articles by dr. rogers * Oral Appliance Therapy for the Management of Sleep Disordered Breathing: An Overview - Sleep and Breathing, Vol. 4, No. 2, 2000 * Review of Oral Appliance Therapy - Sleep Review, Sept. 2000 * Dental Sleep Medicine: Coming of Age - General Dentistry, August 2001 * Word of Mouth - Sleep Review,May/June 2006 * Sleep, Breathing and Orthodontics - Orthodontic Products Online, Aug. 2006 * Practice Parameters for the Treatment of Snoring and Obstructive Sleep Apnea with Oral Appliances: An Update for 2005- Sleep, VOl. 29, No. 2, 2006. 240-243 * Sleep-Related Obstructive Respiratory Disturbances in Childhood New Technologies * CEREC * Sleep Medicine For Patients Why patients are choosing CEREC CEREC by Sirona Dental Systems is the world's only system for the fabrication of all ceramic dental restorations in one office visit. With CEREC at your dentist's side, you can be in and out in a single visit with a permanent, all ceramic crown, onlay, or veneer! For you, the patient, this means fewer injections, less drilling, and less time out of your hectic schedule for dental care. So, why are thousands of people world wide choosing the CEREC restorative technique for their dental needs? Single Appointment Dental Care Most dental restorative methods require more than one visit to the dentist. This means that on the first visit, you get an injection of anesthesia, your tooth prepared, an impression taken, and a temporary restoration put on your tooth. You make a second appointment for a couple of weeks later, get another injection, have the temporary pried off (if it hasn't fallen off already), and have a permanent restoration put on. Why go to the dentist a second time when you don't have to? With CEREC, the procedure is done in a single appointment, start to finish. Finest Dental Materials A CEREC tooth restoration isn't just convenient, it is also healthy. Many years ago, dentists had few options to repair decayed and damaged teeth other than amalgam, gold, and other metals. With CEREC, your dentist can use strong, tooth colored ceramic materials to restore your teeth to their natural strength, beauty, and function. These materials closely match the composition of natural tooth structure. This means when you eat hot food and then drink something cold, the restoration and tooth expand and contract at almost equal rates. So, your tooth does not crack, and you can go on enjoying your evening. Also, the materials are chemically bonded to your tooth, so your dentist can save as much healthy tooth tissue as possible while providing you with a dental restoration that strengthens your tooth. Smile Enhancement Your dentist can use CEREC for more than just crowns and fillings. CEREC is capable of producing any single tooth restoration. Chipped or discolored front teeth can be repaired with beautiful CEREC porcelain anterior crowns or veneers. Your smile makes a lasting first impression. Enhance it with CEREC. Worldwide, a CEREC restoration is placed every 20 seconds. With a history of nearly 20 years, this equipment has helped dentists place over 6 million restorations. Using metal free materials that are the closest to your natural enamel, CEREC gives you the highest quality restorative care. Ask your dentist today about single visit CEREC restorative care! The CEREC Procedure Because Your Dentist Values YOUR Time Let's face it, very few of us have perfect teeth, free of decay and fillings. You can probably see a filling or two in your own mouth, which do just that -- "fill" a cavity, or hole, in your tooth left from the excavation of decayed tooth structure. In many cases, those fillings are made of metal material and can go bad, weaken the tooth, or get additional decay under or around it. In fact, 1.2 billion of these metal fillings will need to be replaced in the next 10 years.* CEREC is a method used by thousands of dentists worldwide since 1987 not only toreplace these fillings, but also torestore any tooth that is decayed, weakened, broken, etc. to its natural strength and beauty. Better yet, it's done with all-ceramic materials that are tooth colored in a single appointment! So, how does the CEREC procedurework? Exam and Preparation First, your Dentist examines the tooth and determines the appropriate treatment. It could be a simple filling, or a full crown, depending on how much healthy tooth structure is remaining and the clinical judgement of your Dentist. Next, he or she administers an anesthetic andprepares your tooth for the restoration, removing decayed and weakened tooth tissue. This preparation is just like he or she would do for many other restorative techniques. Optical Impression Then, your Dentist takes an Optical Impression of the prepared tooth. Instead of filling a tray with impression "goop" that you must biteinto andhold in your mouth until it hardens, your Dentist coats the tooth with a non-toxic, tasteless powder. A camera is then used to take a digitalpicture of your tooth. This whole Optical Impression process only takes aminute or two. Watch a quick video to learn more about CEREC Technology here. New Technologies * CEREC * Sleep Medicine For Patients Why patients are choosing CEREC CEREC by Sirona Dental Systems is the world's only system for the fabrication of all ceramic dental restorations in one office visit. With CEREC at your dentist's side, you can be in and out in a single visit with a permanent, all ceramic crown, onlay, or veneer! For you, the patient, this means fewer injections, less drilling, and less time out of your hectic schedule for dental care. So, why are thousands of people world wide choosing the CEREC restorative technique for their dental needs? Single Appointment Dental Care Most dental restorative methods require more than one visit to the dentist. This means that on the first visit, you get an injection of anesthesia, your tooth prepared, an impression taken, and a temporary restoration put on your tooth. You make a second appointment for a couple of weeks later, get another injection, have the temporary pried off (if it hasn't fallen off already), and have a permanent restoration put on. Why go to the dentist a second time when you don't have to? With CEREC, the procedure is done in a single appointment, start to finish. Finest Dental Materials A CEREC tooth restoration isn't just convenient, it is also healthy. Many years ago, dentists had few options to repair decayed and damaged teeth other than amalgam, gold, and other metals. With CEREC, your dentist can use strong, tooth colored ceramic materials to restore your teeth to their natural strength, beauty, and function. These materials closely match the composition of natural tooth structure. This means when you eat hot food and then drink something cold, the restoration and tooth expand and contract at almost equal rates. So, your tooth does not crack, and you can go on enjoying your evening. Also, the materials are chemically bonded to your tooth, so your dentist can save as much healthy tooth tissue as possible while providing you with a dental restoration that strengthens your tooth. Smile Enhancement Your dentist can use CEREC for more than just crowns and fillings. CEREC is capable of producing any single tooth restoration. Chipped or discolored front teeth can be repaired with beautiful CEREC porcelain anterior crowns or veneers. Your smile makes a lasting first impression. Enhance it with CEREC. Worldwide, a CEREC restoration is placed every 20 seconds. With a history of nearly 20 years, this equipment has helped dentists place over 6 million restorations. Using metal free materials that are the closest to your natural enamel, CEREC gives you the highest quality restorative care. Ask your dentist today about single visit CEREC restorative care! The CEREC Procedure Because Your Dentist Values YOUR Time Let's face it, very few of us have perfect teeth, free of decay and fillings. You can probably see a filling or two in your own mouth, which do just that -- "fill" a cavity, or hole, in your tooth left from the excavation of decayed tooth structure. In many cases, those fillings are made of metal material and can go bad, weaken the tooth, or get additional decay under or around it. In fact, 1.2 billion of these metal fillings will need to be replaced in the next 10 years.* CEREC is a method used by thousands of dentists worldwide since 1987 not only toreplace these fillings, but also torestore any tooth that is decayed, weakened, broken, etc. to its natural strength and beauty. Better yet, it's done with all-ceramic materials that are tooth colored in a single appointment! So, how does the CEREC procedurework? Exam and Preparation First, your Dentist examines the tooth and determines the appropriate treatment. It could be a simple filling, or a full crown, depending on how much healthy tooth structure is remaining and the clinical judgement of your Dentist. Next, he or she administers an anesthetic andprepares your tooth for the restoration, removing decayed and weakened tooth tissue. This preparation is just like he or she would do for many other restorative techniques. Optical Impression Then, your Dentist takes an Optical Impression of the prepared tooth. Instead of filling a tray with impression "goop" that you must biteinto andhold in your mouth until it hardens, your Dentist coats the tooth with a non-toxic, tasteless powder. A camera is then used to take a digitalpicture of your tooth. This whole Optical Impression process only takes aminute or two. Watch a quick video to learn more about CEREC Technology here. Close Specially Trained Dentists Can Treat Snoring and Obstructive Sleep Apnea With Oral Appliances We all know snoring can be obnoxious and quite embarrassing. More importantly, though, we need to realize that snoring is often a warning sign of a serious illness called Obstructive Sleep Apnea (OSA). Snoring and OSA both occur as a result of breathing passages in the throat collapsing during sleep. Snoring is the sound tissues of the throat produce when breathing passages are partially collapsed. OSA occurs when the airway completely closes and breathing ceases entirely for a period of time. During this time of complete obstruction, no air can be drawn into the lungs and oxygen concentration in the blood falls until the brain stimulates the sleeper to awaken allowing the airway to open again. Improper breathing and disrupted sleep can lead to very unhealthy consequences. The frequent falls in oxygen have been recently linked in the scientific literature with high blood pressure and increased risk of heart attack and stroke. In addition, the resulting sleep deprivation can lead to excessive daytime sleepiness, depression, diabetes, increased appetite and diminished libido as well as increased accidents on the highway and in the workplace. Now, specially trained dentists can manage snoring and OSA with small plastic oral appliances (similar to an orthodontic retainer) that can be used during sleep to keep the breathing passages open. Research over the past 15 years has proven that oral appliances are effective in resolving snoring and treating OSA in many people. The oral appliances function by gently holding the lower jaw forward which opens the breathing passages during sleep. Alternative treatments include Continuous Positive Airway Pressure (CPAP) and surgery. Dr. Robert Rogers has recently joined our practice with an exclusive focus in dental sleep medicine (the management of snoring and obstructive sleep apnea). He has been treating patients with custom oral appliances since 1991 in conjunction with area sleep physicians. Dr. Rogers is the founding president of the American Academy of Dental Sleep Medicine, is well published in the professional literature and is board certified by the American Board of Dental Sleep Medicine. He is available for free consultations for those with snoring and OSA problems or those who cannot tolerate CPAP. Please call this office to schedule an appointment. At Miller, Werrin and Gruendel, we can offer you a wide variety of different dental services, all of the highest quality available. For a brighter, whiter smile, we can provide you with a range of different teeth whitening options, including chemical bleaching and OpalescenceT tooth whitening. If you're interested in a smile makeover that includes the shape, size or health of your teeth, we also offer services such as bonding, crowns and porcelain veneers. If you have a tooth that needs replacing, you may be interested in reading more about our dental implants. As your dentists, we can also help you with headache management and weight loss. If this is something that concerns you, please read more about tooth grinding and the DDS Weight Management Appliance. * Bleaching * Enamel Shaping * Bonding * Full & Partial Dentures * Bridges * Headache Management * Crowns * Onlays and Inlays * Dental Imaging * Opalescence™ Tooth Whitening * Dental Implants * Porcelain Veneers * Dental Hygiene * Weight Management Appliance Our unique in-house dental laboratory also assures you of the very finest in dental technology and artistry. We are able to meticulously supervise the progress of your case as it flows through the laboratory process. Many years of expertise on the part of the four talented dental laboratory technicians work to your best interest to assure that the service rendered to you is of the finest quality. Morphing Before & After Your smile can also have a metamorphosis like the examples shown below. Click inside the frame to begin the transition. Chipped Tooth: Bonding / All Teeth: Diastema: Decay: Before and After Gallery Images Our smiles and appearance affects our self-esteem, our moods and how we function in social and business relationships We can help give you a better, more beautiful smile that can have a powerful impact on your lifestyle and comfort level. * Crowded Teeth Before This patient was unhappy with the crowding of her lower teeth and the shortness of her upper teeth. After Porcelain crowns were used to straighten out and lengthen several teeth to make her smile more beautiful. * Worn Crowns Before This patient was wearing all acrylic crowns that has been in place for 30 years, were worn out and needed to be restored with more modern materials. After The completed smile shows all porcelain jacket crowns that restored her smile and her self-confidence. Close * Baby Tooth Retention Before This patient had a retained baby tooth that made her very self-conscious when she smiled broadly. After A porcelain veneer was placed to restore this unattractive tooth. It enhanced her beautiful smile and truly made her very happy. * Diastema [Space] Closure Before This patient was bothered by this diastema all his life. When it was suggested that it could be eliminated without a lot of fuss and bother, he was enthusiastic to have treatment. After The diastema was closed with resin bonding to his great satisfaction. Before This patient was always troubled by the large space between his front teeth. He had been told about "capping" but did not want to have his teeth "cut down" and also did not want to spend a lot of money. After bonding was explained to him and how simple and relatively inexpensive was the procedure, he elected to proceed. After Completed diastema closure and a very happy and satisfied patient. Close * Discolored/Mal-Positioned Teeth Before This patient was embarrassed by his discolored and mal-arranged teeth. Veneers were explained to him and all the benefits that would accrue to him after this dentistry was completed. After With porcelain veneers that are less invasive than crowns a beautiful smile was achieved for a very happy patient. Close What does all this mean? The above are the most common search phrases used by patients while searching for dentists online. Services Patient Safety To protect our patients and ourselves, our staff wears masks, gloves, glasses, as well as hospital scrub uniforms. We strictly observe all Occupational Safety and Health Administrations (OSHA) guidelines. All instruments are cleaned, disinfected, and routinely sterilized as recommended by the American Dental Association and Centers for Disease Control. Whenever possible, disposable single use items are used to ensure your safety. Handpieces (drills) are sterilized in a state-of-the-art sterilization unit specifically designed for this purpose. All surfaces in the treatment rooms are cleaned and disinfected after each patient. Patient Comfort You are not alone if you feel anxious about a visit to the dentist. We understand and share your concerns and strive to make every dental visit comfortable. If there is anything else we can do, let us know. In addition to topical and local anesthetic, nitrous oxide ( laughing gas ) is available for those patients who may need a little more. We offer headsets, videos, and in-office cable television, so you can sit back, relax and watch your favorite show. Convenient free parking with security is readily accessible and in close proximity to the entrance of the building. Emergencies can occur any time. Our 24-hour answering service can alert the doctor of your need. With early morning and late afternoon appointments, you can be seen at a time that is convenient for your busy schedule. Hygiene An integral part of maintaining your teeth for life is the removal of plaque and tarter on a regular basis. The frequency of your visits is based upon you individual needs and oral health. During your visit we will update your medical history, perform an oral cancer-screening exam, check your teeth for cavities, review oral hygiene instructions, and monitor your periodontal (gum) condition. Fluoride treatments are provided for children under age of thirteen and for adults when appropriate. High Tech Diagnostics Our office uses Computer Dental Radiography or CDR. With CDR, we are able to capture x-ray images of your teeth using 90% less exposure to x-radiation, while at the same time being able to enhance, enlarge, and manipulate the images for better diagnosis. With the immediate on-screen results, patients get much more involved in understanding their treatment needs and options for care. Utilizing an Intra-Oral Camera gives both you and us the opportunity to see potential problems occurring in your mouth, such as decay or fractured teeth. Often a tooth will not start bothering you until there is significant loss of tooth or structure. With the help of the intra-oral camera, problems can be detected earlier, before you experience a toothache. Implants Before After A remarkable procedure, implants can replace any or all of your teeth. The implant becomes integrated with the bone and acts like a "bolt" which will ultimately support a new tooth. The advantages of implants for patients with dentures are: denture stability, increased patient comfort and confidence. While an oral surgeon inserts implants themselves, our role is planning placement of implants and restoring the integrated implants after surgery. Oral Surgery The goal of modern dentistry is to prevent tooth loss. When a tooth cannot be saved, extraction (removal) of tooth may be the only course of treatment. A panorex x-ray allows us to see a complete picture of the alignment of your jaw, the positioning of your teeth and if there is sufficient space for your third molars (wisdom teeth) to fully erupt. In addition, it is an excellent diagnostic tool for evaluating the supporting bone for possible cysts or tumors. Most minor surgeries are performed at our facility, however the doctor may choose to refer to a maxillofacial surgeon for more complicated cases. Periodontal Disease While seldom painful and frequently free of any obvious signs or symptoms, periodontal disease can progress, undetected, to the point where supporting bone is destroyed. With 80 to 90% of all teenagers having some form of gingivitis (inflamed gums) and 75% of adult tooth loss for people over the age of 35 due to periodontal disease, early treatment and prevention is essential. While periodontal disease is caused by plaque, a number of other factors including poorly fitting bridges, badly aligned teeth and defective fillings contribute to the development of this condition. Childrens Specialist Children's specialist (Pedodontists) have a very important function in the dental office. They are doctors that have completed additional training to become children's specialists. As a child's dental needs are different from adult's and are constantly changing, the pedodontist can more accurately aid in the process of children's dental health both in prevention and treatment areas. Cosmetic Dentistry For the smile you have always wanted, cosmetic dentistry can include reshaping your teeth, veneers or bonding, natural looking tooth-colored fillings and bleaching. PORCELAIN VENEERS BLEACHING TEETH "WHITENING" FULL MOUTH RECONSTRUCTION "DRILL-LESS" FILLINGS Our office now offers a gentle new "drill-less" technology that can frequently be used in place of or in conjunction with the drill to make procedures more comfortable. There is no vibration, no whining sound and less need for anesthetic. This technique uses a stream of kinetic particles to prepare teeth for restorations. Instead of grinding away tooth structure like a drill, this technique gently and precisely sprays away decay. This technique allows for early intervention and conservation of healthy tooth structure, it eliminates the need for acid etching when preparing tooth for bonding and it safely modifies dentin and doubles bond strength. While reducing the need for anesthesia, this allows the dentist to treat multiple sites in the mouth during a single visit, adding to efficiency. Laser Dentistry Laser Dentistry is a widely accepted form of advanced treatment. The laser used in dental offices generates a beam of concentrated light into your month. This helps the dentist remove infection and tooth decay with great precision. Lasers are primarily used in dentistry to perform oral surgery and apply treatments to the gum tissue as in periodontal disease. Benefits include less bleeding, decreased sensitivity and a reduced need for injections. These advancements also allow for more patient comfort by providing faster healing, a lower risk of infection and less time in the dental chair. Dentures Before After ToothAche Pittsburgh, Tooth ache Pittsburgh, Toothpain Pittsburgh, Tooth pain Pittsburgh, Dentist Pittsburgh, DentistPittsburgh, Dental clinic Pittsburgh, DentalclinicPittsburgh, Dental office Pittsburgh, DentalofficePittsburgh, Emergency dentist Pittsburgh, EmergencydentistPittsburgh, Emergency dental Pittsburgh, EmergencydentalPittsburgh, Emergency dental treatment Pittsburgh, EmergencydentaltreatmentPittsburgh,Miller, Werrin, Gruendel Many people believe that once they have dentures, they no longer need regular dental care. Denture wearers require regular dental exams to ensure their health, comfort, and appearance. Gum tissues are in constant state of change. Periodic relining of dentures may be necessary to ensure tight and comfortable fit. We provide the services of ONE DAY DENTURES. We have a Dental lab on premises and we can make your dentures in ONE DAY. Crowns A "cap", "jacket", or "crown" will restore a broken, heavily filled or cracked tooth to its original size and shape. This may also be recommended after root canal therapy has been completed, as the tooth tends to become brittle and is more apt to fracture. Crowns strengthen and protect remaining tooth structure and improve the appearance of your teeth. Root Canal Therapy If a tooth's pulp (nerve and blood supply) becomes infected or inflamed, root canal treatment may be the only way to save the tooth, short of removing it. Root canal treatment consists of removing the nerve that lies within the root of the tooth. Bridges A non-removable bridge can restore your teeth to normal function by replacing missing teeth. It will improve the entire health of your mouth by keeping the surrounding teeth in position and can also help maintain the structure of your face and jaw. ORTHODONTICS "BRACES" For patients, adults and children who have crowded or crooked teeth, spaces between their teeth or misaligned teeth and jaws, orthodontic therapy can help reduce the risk of tooth decay, gum disease and trauma due to protruding teeth. The American Association of Orthodontists recommends children have an evaluation by 7 years of age. More than 25% of all orthodontic patients are adults. Ninety percent of all people who need orthodontic treatment have crowded or protruding teeth (9 out of 10). You or your child may be in this ninety percent and ready to make an important decision about orthodontic treatment. For many years the traditional method of treating crowded and protruding teeth has included removal of premolar, or bicuspid teeth. While this method has saved many patients form disfiguring overbites, a new and superior method of treating crowded and protruding teeth, based on careful research and analysis, has been adopted by a growing number of doctors in both Europe and North America. Another advantage of this treatment is the relatively short span of time takes to see results. Average treatment last anywhere from one year to eighteen months. You deserve a smile that is not only beautiful but functional, smile that reflects a healthy confident self-esteem. Our goal is to provide comprehensive orthodontic care in a friendly fun-loving environment. We hope to enhance self-confidence by creating a harmony amongst facial form, teeth, and jaws, joints and muscles that reflect attractiveness and health. A healthy attractive smile is priceless. The greater portion of the population remembers your smile when they look at you. We want to help make that first impression count. It is our belief that every patient's case is unique and that no one type of orthodontic treatment fits everybody. Our goal is to treat each patient as an individual to the most esthetic, functional and stable result possible in the shortest possible time with comfort and care. We as an ortho team continually strive to provide, with the cooperation of our patients and their family dentist, beautiful smiles and healthy bites, by performing excellent orthodontic treatment with state of the art appliances, techniques and skilled employees in an office environment where, the patients and parents, doctors and staff will enjoy coming everyday. Orthodontic Services CONVENTIONAL BRACING TREATMENT Full fixed brace treatment. Ceramic "Clear" braces. Lingual "INVISIBLE" braces. FUNCTIONAL JAW ORTHOPEDICS Palate (upper jaw) widening. Removable appliances: l Bionator. l Activators. l Schwarz Appliance. ADULT ORTHODONTICS l Full and partial treatment l Ceramic "Clear" braces. l Lingual "INVISIBLE" braces (see section below for more info.) CHILD INTERCEPTIVE THERAPY l Space maintainers. l Serial Extraction Guidance. l Growth supervision and analysis. l Early crossbite correction. l Mixed dentition treatment (ages 4-11). SURGICAL ORTHODONTICS l The orthodontist and oral surgeon work as a team to correct major facial disharmonies. COSMETIC ORTHODONTICS The orthodontist and the cosmetic dentist work as a team to improve tooth appearance: l Space closure. l Minor tooth movement. l Redistributing space for replacing missing teeth. LINGUAL "Concealed" " Invisible" BRACES Lingual braces also known as Concealed, Invisible braces are the only non-visible form of fixed orthodontic therapy. Special instrumentation, equipment, doctor and staff training are required for this technique. These braces can be used on both arches or on combination with outside clear braces on the lower teeth as shown in the following picture. Lingual braces is a highly technical (and therefore very demanding) method of treating crooked teeth, offered routinely only by four or five other orthodontists in the Southern California area. Usually braces are glued on to the front surfaces of the teeth where you can readily see them. Most adults are really embarrassed by crooked teeth. Crooked teeth with braces on them are a nightmare for adults. When I first began to offer clear transparent braces my adult patients breathed a sigh of relief. But when I began to offer them lingual braces they were not only relieved they were ecstatic! Imagine braces that were glued to the back of the teeth. Adults who put them on would tell me how they would go to a party and tell people who were virtually strangers about their new lingual braces and then casually show them of like a kid with a new bicycle. Lingual braces had become a fashion statement, something to be proud of, a badge of distinction, in a word - "classy". Six years ago when I first started to offer lingual braces it was like being a pioneer exploring an exciting and dangerous new frontier. It demanded unusually long appointments (30-90 minutes), new sorts of instruments (more expensive), and totally different head and hand positions (awkward and cramped), and getting used to another kind of patient (quirky). Even today when I'm setting up to insert or adjust lingual braces on a patient in mentally morph myself as though preparing for competition in an Olympic event. It's like a jeweler trying to work on the inside of a small watch that is wet, dimly lit, moves, and has an attitude besides! Initial discomfort with lingual braces (sore tongue and minor speech problems) is more of a problem, but patients seem to readily leap those hurdles. One problem that is sometimes bothersome to me occurs when patients forget they have to refocus their brushing efforts on the inside of the teeth and gums become swollen and interfere with adjustments. On the other hand, the lingual brace appliance is a particularly useful tool for correcting problems involving very deep overbites, which are frequent in an orthodontist's office. CASES TREATED WITH LINGUAL (INVISIBLE) BRACES Before After ToothAche Pittsburgh, Tooth ache Pittsburgh, Toothpain Pittsburgh, Tooth pain Pittsburgh, Dentist Pittsburgh, DentistPittsburgh, Dental clinic Pittsburgh, DentalclinicPittsburgh, Dental office Pittsburgh, DentalofficePittsburgh, Emergency dentist Pittsburgh, EmergencydentistPittsburgh, Emergency dental Pittsburgh, EmergencydentalPittsburgh, Emergency dental treatment Pittsburgh, EmergencydentaltreatmentPittsburgh,Miller, Werrin, Gruendel Frequently Asked Questions ( FAQ's ) about Lingual (Concealed) Braces ARE LINGUAL BRACES MORE UNCOMFORTABLE THAN OUTSIDE BRACES? Initial discomfort is similar to that of outside braces. The difference is that the lingual braces will affect the tongue and conventional braces affect the cheeks and lips. Patients take approximately 1-4 weeks to achieve a good comfort level. DOES TREATMENT WITH LINGUAL BRACES TAKE LONGER THAN OUTSIDE BRACES? No, treatment time is comparable to that of outside braces and sometimes even shorter. Some cases respond more efficiently to lingual braces due to certain mechanical advantages of the appliance. CAN ANYONE GET LINGUAL BRACES? Most patients are good candidates for lingual braces. There are a few exceptions. Your orthodontist will determine the type of braces most beneficial for your treatment. WILL LINGUAL BRACES AFFECT MY SPEECH? Yes, initially all orthodontic appliances have some effect on the patient's speech. The amount will vary depending on arch form and tongue position. In most patients this will be temporary and of short duration. For any other Questions (FAQ 's ) about l Orthodontics please click www.aaortho.org and you will be linked to the American Association of Orthodontists website. l Dentistry please click www.ada.org and you will be linked to American Dental Association website. KCP® - Treating Tooth Decay KCP® is a new instrument that can be used as an alternative to the drill in many procedures. A microscopically fine powder is carried to the tooth by a stream of air, gently spraying away decay. In a simple sense, you could say it works like a precise miniature sandblaster. STRAIGHT TEETH. NO BRACES Very few people have naturally straight teeth. And for years, braces were the only option. Until now. Introducing Invisalign™. A Revolutionary new way to straighten teeth-- without braces. So Invisible, you'll be the only one that knows. Invisalign™ uses a series of nearly undetectable aligners instead of brackets and wires. So it's really hard for people to tell you're wearing Invisalign™ even up close. Invisalign™can give you the smile you've always wanted without the braces you've always avoided. No braces. Nothing to hold you back. Because there are no metal wires and brackets, Invisalign™ is comfortable. And because it's removable, eating, brushing and flossing are no problem. You can still enjoy your favorite foods and smile without holding back. With Invisalign™, there's nothing to hide. The latest technology makes it possible. Upon an initial examination, your orthodontist decides if Invisalign™ is right for you. Your doctor will write a treatment plan and take an impression of your teeth, which are submitted to Invisalign™. Using the latest advances in 3-D computer technology, Invisalign™ carefully translates your doctor's instructions into a series of precisely customized aligners. You then wear each set of aligners for about two weeks, moving your teeth gradually - week by week , millimeter by millimeter - until you've achieved the intended result:straighter teeth. Generally, you visit your orthodontist no more often than you would with braces and the length of treatment is about the same. Emergency Dental Treatment We have Oral Surgeons, Prosthodontists, Periodontists, Cosmetic - Implant Dentists, providing emergency treatment for abscess pain, dental abcesses, root canals, extractions, denture, tissue swelling, crown problems or any other kind of tooth ache. Emergency Dental Care If you are suffering from a dental emergency, then obviously, you need emergency dental care. There are many kinds of dental emergencies. You should get yourself to a dentist as soon as possible in case of a dental emergency. A dental emergency can be a knocked out tooth, a dislodged tooth, a cracked tooth, severe pain or even a broken jaw. If you're suffering from any of these or any other major tooth-related emergencies you need to get to a dentist immediately. Please give us a call.Choose a clinic nearest to you. Choose a Topic Below Patient Safety Patient Comfort Hygiene High Tech Diagnostics Implants Oral Surgery Periodontal Disease Children's Specialist Cosmetic Dentistry Drill-less Filling Laser Dentistry Dentures Crowns Root Canal Therapy Bridges Orthodontics "Braces" Orthodontic Services Lingual "Concealed" "Invisible" Braces Cases Treated with Lingual (Concealed) Braces FAQs About Lingual (Concealed) Braces KCP® - Treating Tooth Decay Invisalign Dental Emergency Home | About Us | Services | Gallery | Directions | Forms | Contact Us Services Patient Safety To protect our patients and ourselves, our staff wears masks, gloves, glasses, as well as hospital scrub uniforms. We strictly observe all Occupational Safety and Health Administrations (OSHA) guidelines. All instruments are cleaned, disinfected, and routinely sterilized as recommended by the American Dental Association and Centers for Disease Control. Whenever possible, disposable single use items are used to ensure your safety. Handpieces (drills) are sterilized in a state-of-the-art sterilization unit specifically designed for this purpose. All surfaces in the treatment rooms are cleaned and disinfected after each patient. Patient Comfort You are not alone if you feel anxious about a visit to the dentist. We understand and share your concerns and strive to make every dental visit comfortable. If there is anything else we can do, let us know. In addition to topical and local anesthetic, nitrous oxide ( laughing gas ) is available for those patients who may need a little more. We offer headsets, videos, and in-office cable television, so you can sit back, relax and watch your favorite show. Convenient free parking with security is readily accessible and in close proximity to the entrance of the building. Emergencies can occur any time. Our 24-hour answering service can alert the doctor of your need. With early morning and late afternoon appointments, you can be seen at a time that is convenient for your busy schedule. Hygiene An integral part of maintaining your teeth for life is the removal of plaque and tarter on a regular basis. The frequency of your visits is based upon you individual needs and oral health. During your visit we will update your medical history, perform an oral cancer-screening exam, check your teeth for cavities, review oral hygiene instructions, and monitor your periodontal (gum) condition. Fluoride treatments are provided for children under age of thirteen and for adults when appropriate. High Tech Diagnostics Our office uses Computer Dental Radiography or CDR. With CDR, we are able to capture x-ray images of your teeth using 90% less exposure to x-radiation, while at the same time being able to enhance, enlarge, and manipulate the images for better diagnosis. With the immediate on-screen results, patients get muc