Q.Tell us about yourself and your practice.
A. My name is Daniel Ludwig. I am a general dentist in private practice in Cupertino. Our office has been treating patients for over forty years in Cupertino. My father John Ludwig started the practice in 1969. He practiced for 34 years. I joined the practice in 2001 and took over the ownership of the practice in 2003. We still treat many of those original patients who first came to see my father in 1969 and the early 70’s. Many of those early patients were young families moving into the south bay to work at the fast growing company of Hewlett Packard at the time.
We have a newly remodeled office with state of the art equipment. In addition to myself, we have a receptionist and office manager, three registered dental hygienists, and two registered dental assistants. Most members of the staff have worked here for many years. We work with patients of every age including seniors and children.
Q. Please explain the main services you offer.
A. Our dental office offers a variety of dental services including: periodontal (gum and teeth) evaluation, teeth cleanings and deep cleanings (if needed), localized antibiotic placement in problem periodontal pockets, oral hygiene instructions and training, tooth colored fillings, crown and bridgework including all ceramic materials, implant crowns and restorations, dentures, partial dentures, cosmetic tooth colored bonding, porcelain veneers, take home tray and in-office teeth whitening, basic oral surgery (extractions), brush biopsy, root canal therapy, night guards and athletic guards, TMJ and clenching appliances, snoring appliances, retainers, and more.
In addition to local anesthetic, we offer nitrous oxide and oral anti-anxiety medications as needed. We have digital intra-oral cameras used in the mouth for patient education. We have a panoramic x-ray machine that we use in conjunction with smaller x-rays. We also have an air abrasion machine that allows us to clean out small cavities without local anesthetic.
We do refer some of our patients to some of the most competent specialists in the area. These include: endodontists, oral surgeons, periodontists, and orthodontists. On rare occasion, we will refer a child to a pediatric dentist. We treat almost all the children in our office. This has always been a family oriented practice.
Q. Do you accept insurance? If yes, what types?
A. We will bill any dental insurance as a courtesy to our patients. The only dental insurance program we participate in is Delta Dental Premier Plan. We are a Delta Premier provider. We do not participate in any PPO or DPO dental plans. We are an out of network provider for all dental insurance plans except for Delta Dental Premier.
Q. What payment options do you offer?
A. We accept cash, check, and all major credit cards (Visa, MasterCard, American Express, and Discover). We also offer Care Credit as a payment option for our patients. Care Credit offers No Interest Payment Plans.
Q. What are Dental Implants?
A. A dental implant is a titanium post that is surgically placed into the jawbone. An implant crown or prosthesis is connected to the post to replace a tooth or multiple teeth. It was discovered by accident many years ago that animal bone has a great affinity for titanium. Titanium implants placed into bone undergo a process called osseointegration. This means the bone heals around the titanium during the healing period and locks onto it very strongly. No other metal or material has this kind of reaction with bone. This is why we use titanium.
Q. What are Dental Implants Used For?
A. Implants are used for a variety of reasons. The most common use of dental implants is to replace missing teeth. We may place one implant and a crown to replace a single tooth. We may place multiple implants attached to crowns or bridges replacing multiple teeth. We can even place implants in a patient who has complete dentures. Implants can significantly stabilize a loose denture when they are attached. Implants are also used for more complicated restorations and rehabilitation. They are even used by orthodontists to move teeth in desired positions.
Q. What Are the Benefits of Dental Implants?
A. The benefits of dental implants are numerous. The success rates are high (usually 95+%). Once an implant and restoration are successfully placed we can expect them to last longer than any restoration placed on natural teeth. We do not see as much prevalence of gum disease around an implant, and we know it will never decay.
In general, implants are easier for patients to clean and maintain. For example, a single missing tooth was traditionally replaced with a three-tooth bridge that was cemented on to the adjacent teeth. Patients have to use a special floss threader to floss and clean under the bridge. An implant crown replacing a single tooth is similar to a natural tooth and can be cleaned the same way.
Q. Why is Crown and Bridge Treatment necessary?
A. Many people had large fillings placed in their teeth when they were young. Those fillings breakdown over time, and they are replaced with larger fillings. If a filling becomes too large for the tooth, we have to consider covering the tooth with an indirect restoration like a crown (also called a cap) or an onlay (a partial coverage crown). We make the decision to place a crown based on the amount of healthy tooth structure remaining on a tooth. A good example is a molar tooth with a large amalgam (silver) filling that fractures off a portion of the tooth. This will usually need a crown to properly restore the tooth.
As I mentioned earlier, a bridge is the traditional method to restore a missing tooth. The missing tooth must have at least two healthy teeth next to it for the bridge to be successful. The bridge is made just like crowns connected to one another. The remaining teeth act as anchors to hold the bridge in place, and the missing tooth space is restored with a fake tooth connected to the crowns over those anchor teeth. The bridge is cemented permanently into place like a crown. It is possible to replace more than one tooth with a bridge as long as the anchor teeth are strong enough. If it is possible we almost always recommend replacing teeth with implants. That does not mean we do not make bridges anymore. We still do them, but most of them replace existing bridges.
Q. What are the benefits of crown and bridge treatment?
A. Crowns are extremely beneficial to patients, because they allow us to restore teeth that have broken down due to existing fillings, decay, and cracks. We save a lot of teeth by placing crowns on them. In addition, we can do some dramatic cosmetic improvement with crowns on the front teeth or on any tooth.
Replacing teeth with bridges have been successful for many years. We almost always recommend replacing teeth, because it allows us to stabilize the bite and to provide better biting function. Teeth will move and shift over time into empty spaces where teeth used to be. Bridges definitely allow us to prevent this problem. As mentioned above, we have a superior method of replacing teeth now with dental implants.
Q. What are inlays and onlays?
A. Inlays and onlays are both indirect restorations.. A direct restoration is one that is placed in the same visit that it is cleaned out – all performed inside the mouth. Most common examples are composite resins (white or tooth colored fillings) and amalgam (silver fillings). An indirect restoration is made from a mold or impression or even a special digital camera. The restoration is then made outside the mouth in a laboratory or with a milling machine. In either case the restorations has to be cemented onto the tooth.
Inlays and onlays are either made of gold or some kind of ceramic material. Inlays run through the middle of the tooth replacing only the walls that touch the adjacent teeth. An onlay is usually larger than an inlay, because it covers at least one of the cusps (or hills) of a tooth. There are many variations of both of these restorations. An onlay becomes a crown when it covers the entire tooth.
Q. What is root canal treatment?
A. All teeth develop with nerve and blood vessels inside them. We call this the dental pulp. There are tiny little canals connected to the pulp that run down all the roots of the teeth. These are called root canals.
Sometimes the dental pulp and root canal becomes infected with bacteria. Decay, cracks, large fillings or restorations, and trauma can cause this. Often times a tooth that has a long history of dental work will make it more likely to become infected. If a tooth becomes infected beyond the point of its ability to heal, we usually treat it with a root canal therapy or treatment. We also consider this kind of treatment to treat a tooth that is symptomatic. A patient may have a crack in a tooth that causes constant pain to chewing even with a crown on it. A root canal therapy is usually considered at that point.
Q. Are there alternative treatments for root canal?
A. The key to this question is diagnosis of the problem. We have several different ways to determine the status of the nerve in a tooth. Some of the tests used to determine the health of the nerve include: tapping on the tooth, cold and heat, pressure, and probing around the gum area. X-rays are also used to see infections developing at the end of the roots. All these things help us diagnose the need for root canal therapy.
If we are able to make a definitive diagnosis that a given tooth needs a root canal, then it is unlikely any alternative treatment outside of extracting the tooth will be very effective. Teeth infections do not heal well like other parts of the body. Not even the best antibiotics can clear up a localized infection inside the tiny nerve space of a tooth. We save a lot of teeth and potential resulting complications by performing root canals on infected teeth.
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