Joshua C. Merrell, DDS, PLLC

 SERVICES
 
We are pleased to offer the following services and technologies to our patients:
Oral Hygiene Care
Dental Cleaning
Bonding
Fillings
 
Tooth Whitening
 
 
ORAL HYGIENE CARE
Maintaining good oral hygiene is one of the most important things you can do for your teeth and gums.  Healthy teeth not only enable you to look and feel good, they make it possible to eat and speak properly.  Good oral health is important to your overall well-being. Daily preventive care, including proper brushing and flossing, will help stop problems before they develop.

In between regular visits to the dentist, there are simple steps that each of us can take to greatly decrease the risk of developing tooth decay, gum disease and other dental problems. These include:

  • Brush and floss thoroughly twice a day
  • Eat a balanced diet and limit snacks between meals
  • Use dental products which contain fluoride, including toothpaste
  • Rinse with a flouride mouth rinse if advised to do so
  • Make sure children under 12 drink fluoridated water or take a fluoride supplement if they live in a non-fluoridated area
  • Visit your dentist regularly for professional cleanings and oral exams
  • Replace your toothbrush every 3-4 months

The following are indications of good oral hygiene:

  • Your teeth are clean and free of debris
  • Gums are pink and do not hurt or bleed when you brush or floss
  • Bad breath is not a constant problem
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DENTAL CLEANING

A dental cleaning is a professional cleaning you receive from a dentist or dental hygienist. Most dental cleanings take only between 25 and 30 minutes.  Cleanings should be performed every six months to prevent excessive plaque buildup.  Plaque left untreated can lead to unhealthy gums and tooth decay.  A routine dental cleaning should include scaling, root planing and polishing.

Scaling: this is the process of removing plaque and tartar from all tooth surfaces in a variety of methods, depending on the amount of plaque and tartar.

Dental hygienists traditionally perform scaling by hand. However, new and advanced technology has led to more modern methods such as ultrasonic scalers.  This sophisticated tool allows dental cleanings to be performed more efficiently and in less time. To achieve best results, both electric and manual scaling methods are combined for dental cleanings.

Root planing: this is the process of cleaning pockets in the gums to treat and prevent gum problems.

Root planing is used to treat moderate to advanced gum diseases. When the gum is inflamed, gum pockets become deeper and may lose connections to the bone inside.  The deeper the pockets, the easier it is for plaque deposits to become trapped and worsen gum problems.

Root planing involves inserting a pointed dental tool called scalers into the gum pockets to clean plaque buildup. Depending on the degree of difficulty, root planing may take several appointments and a local anesthesia may be used to prevent pain.

Polishing: this is the last step in tooth cleaning and involves finishing the surface of the teeth to make them shiny and clean. 

There are two kinds of polishing: air polishing and rubber tip polishing. Air polishing works by spraying high pressured water mixed with baking soda paste onto the surface of your teeth.  This powered water washes away residue and plaque while baking soda removes stains. Rubber cup polishing uses a low-speed and gentle handpiece that contains a polishing paste made of abrasive ingredients ideal for removing stains.  Back to top

SEALANTS


Sealants are used to fill narrow grooves in a tooth that cannot be adequately cleaned by brushing.  In some cases, the tooth structure has fine grooves or pits which accumulate plaque, not because the person doesn't brush, but because they're too narrow to allow even one bristle into them.  To avoid cavaties developing over time, the dentist will brush on a coating that seals the grooves and pits, making it possible to brush off all the plaque and keep your teeth healthy.  Back to top

BONDING
Bonding involves adhering composite resin material that is matched to the color of the tooth, to the front of the tooth. This is performed to repair damage caused by decay, to alter the alignment of the tooth, close gaps between the teeth, or for other cosmetic purposes. 

First the surface of the tooth is roughened in order to accept the bonding.  A gel is applied so the resin will adhere to the surface of the tooth.  The composite is then placed on the tooth and the bonding agent hardens with intense light. The last step is shaping and polishing to give a lustrous finish.  Back to top

FILLINGS
A filling is a way to restore a tooth damaged by decay back to its normal function and shape.  If you have a tooth that requires a filling, the dentist will first remove the decayed tooth material, clean the affected area, and then fill the cleaned out cavity with a filling material.  A filling helps prevent further decay by closing off any cracks or spaces where bacteria can enter.

There are a variety of filling materials available including gold, silver, plastic and porcelain. The dentist will work with you to determine which material is best, depending on the extent of repair, where in the filling is needed, and cost.  Each filling material is briefly explained below:

· Gold fillings are custom made in a laboratory and then cemented into place.  While gold fillings are often the most expensive choice, many consider it the best filling material.  Gold inlays are well-tolerated by gum tissues and may last more than 20 years.

· Amalgam (silver) fillings are a more inexpensive choice and are tolerant to wear.  However, due to their dark color they are more noticeable than porcelain or composite restorations and are not recommended for fillings in very visible areas such as front teeth.

· Composite (plastic) resins are custom made to the exact color of your natural teeth, creating a more natural appearance. While white fillings may be less noticeable than other materials, they usually only last between 3 and 10 years and may not be ideal for large fillings as they may chip or wear over time.  They can also become stained from coffee, tea or tobacco.

· Porcelain fillings are called inlays or onlays and are custom created in a lab and then bonded to the tooth.  They can be matched to the color of the tooth, resist staining, and are about the same cost as gold fillings.  A porcelain restoration generally covers most of the tooth, making the filling nearly undetectable.

If decay or a fracture has damaged a large portion of the tooth, a crown (or "cap") may be recommended.  Decay that has reached the nerve may be treated through root canal therapy or through a procedure called pulp capping.  Back to top

NON-SURGICAL GUM TREATMENT
The gums, ligaments, and bone around the teeth form the foundation for  teeth. All structures are also referred to as the periodontium. When the periodontium is not healthy, it jeopardizes the teeth just as a bad foundation would threaten the stability of a house.  Signs of unhealthy periodontium include: gums that are red and bleed easily, persistent bad breath, gums that are pulled away from the tooth, loose teeth, and changes in the position or bite of the teeth.  With proper gum treatments,  it may be possible to return gum tissue to a healthy state.  If you're having a problem, come in and see us so we may treat it right away. The treatment usually involves a deep cleaning or root planing done under a local anesthetic, along with local antibiotic agents.  It is important to have gum problems checked promtly, as gum disease left alone may eventually need treatment through sugery or extraction.  Back to top

 ADVANCED PROCEDURES
CROWNS AND BRIDGES
Crowns and bridges are used to restore and enhance teeth that are damaged or to take the place of missing teeth. A crown (also referred to as a cap) is used to entirely cover a damaged tooth.  A crown not only strengthens a tooth, but it can dramatically improve a tooth’s appearance, shape and alignment.

Crowns may be used to:

                • Replace a large filling when there is little tooth structure remaining
                • Protect a weak tooth from fracturing
                • Restore a fractured tooth
                • Attach a bridge
                • Cover a dental implant
                • Cover a discolored or poorly shaped tooth
                • Cover a tooth that has had root canal treatment

A bridge is an ideal method to fill the space created by missing teeth. A bridge is one or more artificial teeth cemented into place using the teeth on either side for support. This is an option for filling the space created by a missing tooth.  Bridge work is as much an art as it is an exact science since it replaces a missing tooth both functionally and cosmetically. The materials used may be gold alloys, porcelain bonded to metal alloy, or all ceramic material made to match your natural tooth color.  The choice of material depends on requirements for strength, wear, and aesthetics.

It is important that a missing tooth be replaced as soon as possible.  If not treated, the teeth surrounding the gap begin to shift inward. Since teeth use their neighbors for support, if one is missing they begin to "fall” and shift into the open spaces. This may worsen the bite because of the changes in pressure and can eventually result in problems with the jaw such as TMJ.

Bridges and crowns are made by first taking an impression of your mouth.  The impression is sent to a dental lab where your crown or bridge will be custom made to fit your mouth and match your natural tooth color.  A temporary crown or bridge will be placed into your mouth until your permanent crown or bridge is ready and cemented into place. 

Bridges and crowns are very durable and can last a lifetime with extra care and good oral hygiene. Back to top

TOOTH EXTRACTIONS
Good oral hygiene should always be practiced since the loss of a single tooth can have major impact upon your oral health and appearance.  Although dentists will use every measure to prevent tooth loss, there still sometimes necessary occasions when a tooth may need to be extracted.  A tooth may need to be extracted for the following reasons:

  • Severe decay
  • Advanced periodontal disease
  • Infection or abcess
  • Orthodontic correction
  • Malpositioned teeth
  • Fractured teeth or roots
  • Impacted teeth

After careful examination and treatment, the dentist may advise to have a tooth extracted.  Before a tooth is removed, the dentist will take an x-ray in order to understand the shape and position of the tooth and surrounding bone.  Based on the degree of difficulty, we may refer you to a specialized oral surgeon.

For a simple extraction, we will first apply a local anesthetic to prevent pain and discomfort. The tooth will be loosened with a tool called an elevator and then removed with dental forceps. Once the procedure is complete, the area may be closed with one or two stitches.  We will then provide you with care instructions to alleviate discomfort and ensure proper healing.  Back to top

ROOT CANAL TREATMENT
Root canal treatment (also referred to as root canal therapy or endodontic therapy) is made necessary when an untreated cavity reaches all the way to this pulp.  Treatment may also be needed when deep restorations or trauma to a tooth cause nerve damage.  Once the pulp becomes infected, and can begin to eat away at the surrounding bone (this is known as an abscess).  If the pulp is infected, not only is it painful but it will require treatment as it cannot heal on it's own.   Symptoms that indicate the pulp has become infected may include sensitivity to hot/cold or sweets, pain, swelling, pain to biting or pressure, and a bad taste in the mouth.  However, sometimes no symptoms are apparent and you may be unaware of any problem until a checkup.

A root canal is performed to clean out the infected tooth pulp and disinfect the canals of the tooth.  Alternate treatment would be to extract the tooth.  Once the infection is resolved, the canal is filled in to prevent any further infection. Usually a core build-up and crown is recommended for restoring a tooth that has undergone root canal therapy.  Back to top

 

 

DENTAL IMPLANTS
A dental implant is an ideal tooth restoration for people who are missing one or more teeth as a result of injury, periodontal disease, or any other reason.  A dental implant is a metal post that a periodontist or oral surgeon surgically positions into the jaw.  Once in place and bone surrounding the implant has had time to heal, a replacement tooth is attached to the post.  While implants are typically more expensive than other methods of tooth replacement, they provide superior benefits.  Implants are stronger than natural teeth and generally last 10-20 years.  They are also a more favorable approach than bridgework since they do not depend on neighboring teeth for support.

To receive implants, you need to have healthy gums and adequate bone to support the implant.  You must also be committed to excellent oral hygiene and regular dental visits as these are critical to the long-term success of dental implants.  Back to top

DENTURES
A denture is a removable replacement for missing teeth and surrounding tissues.  There are two types of dentures available, including partial and complete dentures.  Partial dentures are used when some natural teeth remain, while complete dentures are used to completely replace all teeth.  Dentures are made to resemble your natural teeth so there should be no noticeable change to your appearance. In fact, dentures may even improve your smile!

This restoration method is used to restore your smile and mouth function if all your teeth have been lost.  The dentures are custom created to resemble natural teeth and are positioned to take the place of natural teeth.  Complete dentures are removable and may require adjustments in order to create a proper fit with the gums and mouth.

A removable partial denture is a device used when one or more natural teeth still remain in the upper or lower jaw.  They usually consist of replacement teeth attached go a gum-colored plastic base which is held in place in the mouth.  A fixed partial denture acts the same as a removable denture, but it is cemented into place using adjacent teeth for support.

New dentures may feel awkward or loose for the first few weeks until the muscles of your cheek and tongue learn to keep them in place and you are comfortable eating and speaking. Although this may require some practice you will adjust and enjoy the benefits a full mouth of teeth can provide.  Back to top

NIGHTGUARDS AND MOUTHGUARDS
Custom designed mouthguards and nightguards are made of flexible plastic and molded to fit the shape of your teeth. Mouthguards are recommended to protect the jaw and teeth during physical activity and sports such as boxing, football, basketball, or other activities where your mouth may be hit.  Guards also protect the soft tissues of your tongue, lips and cheek lining.  Nightguards are recommended for patients who clench or grind their teeth at night as a way to protect their teeth and bite.

If you have decided a guard is right for you, we will take an impression of your teeth which will then be sent to a lab to make a custom fit guard.  In most cases you can choose from a variety of colors and styles. On average, guards last between 3 and 10 years.  Back to top

 COSMETIC DENTISTRY
COSMETIC DENTISTRY
Cosmetic dentistry includes procedures correct imperfections or enhance the appearance of the mouth.  Tooth color, alignment, spacing as well as regularity of the teeth are the characteristics that give the overall appearance.  Any of these can be enhanced to provide a stunning new smile.
 
WHITENING
Tooth whitening is a popular procedure to make teeth whiter and brighter, and therefore more attractive. Bleaching can be used to whitening stained and discolored teeth, or simply to enhance a dull smile.  Either way, tooth whitening is a safe and relatively painless procedure ideal for most patients.  Our office offers two methods of whitening: in-office whitening and tray whitening.

In-office whitening is an ideal for anyone wanting immediate results.  The entire process takes place in our office in about an hour, making it the perfect choice for busy individuals.  In this process, a protective gel is applied to your gums to protect the soft tissue.  A special light-activated gel is then applied to your teeth and a special light or laser is used to enhance the action of the agent - making your teeth whiter and brighter.  As a final step, we take impressions of your teeth to create custom trays for at home touch-ups, and give you instructions for keeping your smile bright. The result is dramatically whiter teeth that will last for years.

Tray whitening is a less expensive whitening treatment you can use while in the comfort of your own home.  We will first take an impression of your mouth to create a customized clear whitening trays for you to wear.  Within a few days your trays will be ready to be picked up and we will show you how to apply the special bleaching material to the trays.  The whitening gel trays should be worn 30-60 minutes up to twice a day.  At the end of this period, you will see maximum whitening results that are nothing short of dazzling.  Occasional treatment can be used at your convenience to maintain your new smile.  Back to top

 

VENEERS
Veneers are a dental procedure in which a covering is placed over the outside (visible area) of the tooth. Veneers are usually only applied to the part of the tooth that is visible when talking or smiling. The procedure can be direct or indirect.

The direct technique usually involves placing composite resin on the outside of the tooth using bonding. This method is usually referred to as bonding.

The indirect technique usually involves two appointments because the veneers will be fabricated at a dental laboratory.  At the first appointment the teeth are prepared, impressions taken, and the teeth are given a temporary covering. In two to three weeks the veneers are back from the laboratory, the temporaries are removed and the veneers are bonded to the teeth. The laboratory fabricated veneers are usually made using porcelain or pressed ceramic and are very aesthetic.

The advantage of veneers versus crowns is that much less tooth material is removed, and the procedure is generally less uncomfortable. Veneers are recommended for teeth that have large fillings or little tooth structure. 
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 DENTAL TECHNOLOGY

 

In order to provide nothing but the best to our patients, our office uses state-of-the-art technologies in all our procedures.  When you visit our office you can be confident that you are receiving on the finest and most advanced in dental care.  We proudly offer and use the following advanced equipment:

X-RAYS AND DIGITAL X-RAYS

X-rays are a focused beam of x-ray particles passed through bone which produce an image on special film, showing the structure through which it passed.  This provides the familiar black and white images doctors and dentists use to diagnose problems and disease.  Without an x-ray of the whole tooth and supporting bone and gum tissues, there would be no way to detect infection or pathology that requires attention.  Back to top

 

PAPERLESS CHARTING
Our office is a completely digital (paperless) dental office. This means all x-rays and charting are made and recorded with the aid of the computer. This technology allows us to maintain your dental records electronically, and cuts down the unnecessary paperwork used with traditional paper charting.  Traditional paper charting is difficult to keep standardized from doctor to hygienist to assistant.  Even handwriting differences and coding make the charts look different. The computer eliminates this problem by using consistent charting methods that are accurate and precise, making it easy to read your dental chart and see up-to-date information.  Digital charting standardizes the charting process so it is clear, easy to understand, and enables us to provide on the most accurate and precise care to our patients. When needed, this method also allows us to quickly and securely share information with your other health care providers. Back to top

 

 

 

ELECTRONIC CLAIM PROCESSING
Our office utilizes electronic claims processing. This means that rather than sending your dental claim through the mail, it is sent electronically to your insurance company with the click of the button. By filing your claim electronically, information is submitted more efficiently and with fewer errors.This benefits our patients because the turn around time on claims is faster and fewer claims are returned or denied. We are happy to submit your dental claims to your insurance company on your behalf.  Back to top

713 Oakland St.

Hendersonville, NC 28791

(828) 692-1210