Treatment Philosophy

There are more than 3000 licensed dentists in Oregon. You can go to any of them. Why come to Pinecone Dental Care?
I can tell you about the elite institution I graduated from.
I can show you how advanced our in-office technological suite is.
I can say I obtained advanced training in the full scope of restorative dentistry at the prestigious Kois Center.

But reality is all of that mean very little if you and I disagree on what should be treated and what should be left alone. How should we decide on what treatment in what situations is not always black and white. It is crucial that both sides understand the why behind these recommendations.

The Framework

Every decision made regarding your treatment needs at Pinecone Dental sits under this framework of risk-based assessment adapted from my training at the Kois Center.

• Periodontal Risk : Gums and bones, the foundation
• Biomechanical Risk: How susceptible are you to cavities and what did the treatments for those fillings do?
• Functional Risk: How much bite force are you generating and how is this force distributed?
• Aesthetic Risk: How visible will the dental work be?

 Periodontal Risk

Periodontal risk involves the structural foundation of the teeth: The root and the bone. We follow the 2017 Classification of Periodontal and Peri-Implant Diseases and Conditions, which organizes periodontal  disease into Stage (Current seriousness of the disease) and Grade (The rate of progression.)

To cut to the point, the reason gum disease is important to prevent and to treat properly, is that a healthy tooth is useless if it is not embedded in your jaw. Once bone loss occurs, there is no possible way to reverse this process and “grow the bone back” in any meaningful amount. We measure how much supporting bone and attachment you’ve lost, then weigh that against your age, because losing 2 millimeters of bone support when you’re 75 is a completley different trajectory than losing the same two millimeters by 30. Alongside that measurement we look at active inflammation in the gum and the risk factors that accelerate it, including smoking, diabetes, family history, and how effectively you’re able to clean at home. By making accurate assessment of the risk of periodontal disease, we can determine whether periodontal treatment, closer maintenance intervals, or simple monitoring is the correct course of action. Getting this risk assessment right is what keeps the treatment recommendation right.

Biomechanical

This is the category most people think of as “cavities,” but it’s broader than that. We’re assessing everything that removes or weakens tooth structure over time: decay, acid erosion from diet or reflux, cracks, and the cumulative volume of old fillings and crowns already in place. A tooth that has been restored three times has far less sound structure left than its appearance suggests, and a mouth where erosion is still actively occurring needs the cause addressed before anything gets rebuilt.

The two teeth pictured above show why the size of a cavity matters more than whether one exists at all. The upper tooth has a small cavity in an easily accessible spot, and the preparation needed to remove it is shallow and narrow, following the outline of the decay itself and taking almost nothing beyond it. A filling here is a good option: very little sound structure is sacrificed, so the tooth walks away essentially as strong as it was before, and the restoration is being asked to do a job it can comfortably handle for a long time.

The lower tooth tells a different story. The cavity is much larger, so the preparation is wide and deep and no longer traces the decay alone. Removing the disease in this situation requires removing healthy structure around it, and the walls that remain are thinner and less able to resist the forces of chewing. The filling itself is therefore more likely to fail, and the tooth around the filling is now at real risk of fracturing, sometimes in a direction that costs you the tooth entirely. This is the point where decisions stops only being about the cavity and starts being about the tooth: once this much structure is gone, a filling alone is no longer the right tool, and we have to consider coverage that protects the remaining walls rather than simply plugging the hole. That progression is the whole argument for catching problems early. The same lesion, found two years sooner, is the upper tooth. Found late, it’s the lower one, and no amount of skill at the restorative appointment gets that structure back.

Scaling that logic up to the entire mouth and we arrive at a situation we see often. A patient comes in with eight or ten large fillings, most of them placed years ago, none of them actively failing. An exam would show that nothing needs doing today. But every one of those teeth has already spent most of its structural budget, with the seals slowly opening, decay working its way underneath where it isn’t yet visible, and thin remaining walls absorbing chewing forces they aren’t able to carry alone.  Calling that mouth “fine” because nothing hurts today mistakes the absence of symptoms for the absence of risk. What high biomechanical risk means is that we can see the failures coming, and it gives us the chance to sequence the work deliberately, avoiding the unpleasant reactive emergency fixes. By the way, reactive dentistry also has a cost beyond the stress: a mouth rebuilt one crisis at a time ends up as a collection of unrelated repairs done in whatever condition the tooth happened to be in that day, rather than a coherent result where the bite, the shade, and the materials were all planned to work together.

Functional Risk