Root Canal

Root canal treatment is a very successful procedure and permits the patient to keep a tooth that otherwise would require extraction. Treatment is necessary when the pulp tissue inside the tooth (nerve) becomes diseased and is irreversibly damaged. Frequent causes for injury include bacteria from dental caries (decay), trauma, and coronal cracks. During treatment the dentist makes an opening in the top of the tooth and cleans the diseased or necrotic (dead) nerve tissue and bacteria from inside the root. The resulting space is sealed with an inert filling material to prevent future leakage of bacteria from saliva. Following the root canal treatment, a new filling or crown is required.

Yes. Even though your tooth feels better since your dentist prescribed antibiotics, the underlying disease process did not change. Patients sometimes believe that antibiotics will “cure” a dental infection in the same way they can cure a medical infection such as strep throat. However, this is not the case. Once the inside (pulp) of a tooth becomes diseased, a root canal (or extraction) is necessary even if you are not experiencing pain or swelling.

That ‘rubber thing’ is called a Dental dam, or rubber dam and it is an absolute requirement for root canal treatment. The dental dam is important for many reasons. First, the dam protects the patient from swallowing or aspirating instruments or materials. It also keeps the operating field aseptic and improves visualization for the dentist. During root canal treatment, one of the main objectives is to eliminate bacteria in or around the root canal system. Having rubber dam isolation greatly improves disinfection because it prevents bacteria from the oral cavity from entering the tooth during treatment.


Fluoride has reduced the rate of cavities more than any other method of decay prevention. However, too much ingested fluoride can cause unesthetic spotting on teeth. Most community water supplies in our area are optimally fluoridated, so between using fluoridated toothpastes and using community water supplies, additional fluoride might not be needed for most people. However, for added cavity protection for teens and adults, daily rinsing with fluoride mouthrinses also can be beneficial. We also perform a risk analysis to identify individuals that are at high risk for development of cavities, which is treated with a prescription dispensed fluoride that is even more concentrated.


In order to protect your smile during athletic activities a mouthguard is crucial. A properly fitted mouthguard will help cushion an impact to the mouth. Mouthguards can protect you from broken teeth, jaw injuries, or cuts to the lip or tongue. Dental health professionals can fabricate a mouthguard for you or your child which will offer a custom fit.

When a child has a permanent tooth knocked out, the most important thing is to put the tooth back in the socket as soon as possible. This should be done immediately if possible by someone at the scene of the accident. The tooth should be picked up by the crown (don’t touch the root) and if dirty it should be quickly rinsed off. Then the tooth should be placed back in the socket and the child should be transported to a dentist who will splint the tooth in place. If it is impossible to get the tooth back into the socket, it is important to store the tooth in a liquid that will keep the cells on the root surface alive. Cold milk is one of the best storage media for this.

A frequent trauma related dental injury is a fractured tooth. To increase success with this emergency situation, we should be contacted immediately. If possible the tooth fragments should be found, rinsed with water and kept moist. In some situations, the fragments may be reattached to the tooth. If this is not possible, the tooth often can be restored with resin composite with excellent esthetic results and minimal removal of the tooth structure. If the fracture is severe, root canal treatment and eventual crowning may be necessary. Remember that most sports related dental injuries may be prevented by using a mouthguard.

Oral Cancer/Mouth/Tongue

We look for signs of oral cancer in your mouth at every routine checkup. You can help us by advising us of any unusual color changes in the tissues in your mouth (red or white areas), abnormal growths, ulcerated areas that don’t heal, areas of numbness or pain, or any problems with chewing or swallowing. Oral cancers often are found on the sides of the tongue, under the tongue, and on the soft palate, though they can occur on any soft tissues throughout the mouth. People who drink alcohol or smoke are more likely to get oral cancer, but anyone can get it, which is why early detection is so important.

Oral and maxillofacial surgeons are well trained in the identification and treatment of pathologies of the oral and perioral hard and soft tissues. After taking your history and a careful clinical exam, they can advise you on the need for further tests or observation or the need for a biopsy to determine the exact diagnosis and need for treatment of the lesion. Their training and expertise can provide evaluation, management and possible surgical care for all the pathologies which present in the oral cavity and perioral tissue.

Common symptoms after oral piercing include pain, swelling, and occasionally infection. It may also induce a slight change in speech and periodically contribute to chipped or cracked teeth. The oral cavity is very vascular, especially the tongue. If a blood vessel is penetrated during the piercing severe bleeding can occur which may be difficult to control. As mentioned earlier, swelling of the tongue can be a common side effect. In extreme cases the swelling can become so severe that it can compromise the airway and prevent breathing. I would advise against it. She may think it’s fashionable now but many young people are not aware of the potential complications that can occur.

A bump on the lips or within the oral cavity should be evaluated by your dentist. An area that swells periodically and then decreases in size is most typically a mucocele. It forms due to blockage of minor salivary glands. This creates a swelling filled with mucous from the gland. Treatment of a mucocele requires removal of the soft tissue enlargement and underlying minor salivary gland tissue. An oral and maxillofacial surgeon would evaluate the area and perform removal in their office.

Cavities/Regular Visits/Toothache

As long as you have teeth, you can get cavities. Cavities result from bacteria in your mouth that feed on carbohydrates in your diet. As the bacteria feed on the carbohydrates, they release acid that dissolves away tooth structure. As people age, they tend to get cavities around old fillings or crowns, or on root surfaces that have become exposed due to receding gums. People with dry mouth tend to have more problems with cavities than other people who have normal salivary flow. Everybody has bacteria in their mouth, so if you still have teeth and still eat carbohydrates, you can still get cavities.

Most often, cavities don’t start to hurt until they are very large; most people who have had fillings had them before they knew there was a problem. Also, most often gum disease doesn’t hurt at all, so you would only know there was a problem when a tooth became loose, and by then sometimes it’s too late to deal with. Oral cancer sometimes can hurt but many times it doesn’t. If it’s been a long time since you’ve seen a dentist, it’s a good idea to have a comprehensive oral examination and dental radiographs (x-rays) made, just to be sure you haven’t developed any problems that you don’t know about.

Dental Sealants are a plastic coating placed on the biting surface of the teeth. They are very effective in preventing tooth decay. Sealants work by filling in the crevasses on the chewing surfaces of the teeth. This shuts out food particles that could get caught in the teeth, causing cavities. The application is fast and comfortable and can effectively protect teeth for many years.

Canker sores are also called aphthous ulcers. They appear within a day or two, usually heal in 7-14 days, and can be painful and annoying. We do not completely understand what causes canker sores, but they are not an infection and are completely different from fever blisters which occur on the outside of the lips and are caused by a virus. The discomfort caused by canker sores can be controlled by using topical steroid mouth rinses and ointments.

Tooth sensitivity can be due to a variety of causes. These can include decay, faulty fillings, and exposed root structure. It is best to visit your dentist to determine the cause. If it is decay or defective fillings, the problem should be fixed by the dentist. If it is exposed root structure, there are a variety of options including varnishes or solutions that the dentist can apply in the office. There are also other at home options such as fluoride gels and desensitizing pastes. Some sensitive situations will resolve and not return, but others may have to be retreated periodically.

High frequency consumption of soda pop is one of the major risk factors that cause dental decay. A twelve ounce can of soda such as Mountain Dew has eleven teaspoons of sugar and is very acidic. The acid can dissolve enamel and when combined with sugar provides the perfect environment for bacteria which cause decay. Diet soda does not have the sugar, but has the same acidity and therefore can create erosion. High acidity can be found in many canned and bottled beverages including water or tea with fruit flavoring and many energy drinks. If drinking pop, minimize its use, choose diet over regular, and drink it quickly with a meal or snack. Brushing your teeth immediately after drinking pop will not help. Brushing after acid exposure will erode even more enamel. It is preferable to select water or other sugar-free non-acidic beverages.


The ideal candidate for dental implants is in good general health and has healthy gum tissues with adequate bone in their jaws to support the implant. If insufficient support is not present, soft and/or hard tissue grafting may be needed. Dental implants are one of the options to replace missing teeth. We can work with you to establish if you are a candidate for dental implants and help you decide what your best option to replace missing teeth is.

In order to achieve optimal results, treatment with dental implants requires planning. At your initial visit we will assess your suitability for implant treatment by evaluating the volume of your available bone with X-rays; checking your bite; taking impressions of your teeth; and discussing your expectations. Sometimes, more sophisticated imaging procedures such as a cone beam CT may be required to provide more information. The information gathered is used to visualize the final result in order to allow for ideal placement of your implant(s).

Dental implants are a titanium implant that is placed into the bone of the upper or lower jaw. It replaces the root of the missing tooth. The bone integrates, or heals directly to the surface of the implant, which gives it longevity. Once this healing has occurred, we make a crown, or tooth, to go on top of the implant.

Your Oral Surgeon can advise you if there is sufficient bone to allow dental implant placement by examining you and reviewing your x-rays. Bone grafting is an option to make you an implant candidate. Various bone grafting materials can be used including your bone, bank bone, bovine bone mineral or other bioactive substance that promotes bone growth. Bone grafting for dental implants has become common and quite successful, enabling you to move ahead with dental implants versus conventional restorations such as a bridge.

Smile Options

Many options are available nowadays to improve people’s smiles, such as braces, whitening or bleaching, crowns and porcelain veneers. Every smile change needs to start with a proper diagnosis to evaluate individual considerations and desires, your bite and your smile. We believe in minimal and conservative intervention to improve your smile. We have all the diagnostic knowledge, experience, and state-of-the-art tools to provide you with an understanding and with realistic treatment options so that we can help you select the best way to achieve the smile you seek.

There are excellent options for placing tooth colored fillings in the teeth in the back of the mouth. These include restoration with directly placed composite resin, porcelain inlays, or crowns. Silver fillings can provide excellent long term service in the mouth. Research studies have not shown silver fillings containing mercury to cause health related problems. Their replacement should be for reasons due to restoration failure, decay or esthetic improvement purposes.

Before we can present you with appropriate options, we first need to determine why you have those spaces. Depending on your individual circumstances, the options may range from braces to bonding. If the reason for you space is because of the position of your teeth, the best solution may be orthodontics (braces). If the reason is the teeth themselves are too small, the best solution may be “bonding” or porcelain veneers to give your teeth the proper size and shape. New materials are capable of imitating natural tooth structure very realistically, so nobody can tell you have had anything done!


Bisphosphonate drugs have been used intravenously to help cancer patients and orally for patients with osteoporosis. These drugs have improved the quality of life for patients with metastatic cancer that involves the skeletal system. They have also been extremely effective in the prevention of bone fractures in patients with osteoporosis. Unfortunately,there have been reports of an increasing number of cases of osteonecrosis of the jaw. This condition is characterized by an area of nonhealing, exposed jaw bone which can lead to severe loss or destruction of the jaw bone. The majority of these cases have been related to the injectable form of bisphosphonate however there has been a small percentage related to the oral form. Most cases of osteonecrosis have been diagnosed after dental procedures such as tooth extraction however the condition can occur spontaneously. Patients who have been taking bisphosphonates and are considering elective dental surgery should speak with their prescribing physician, family dentist, or oral and maxillofacial surgeon about the risks and benefits of continuing treatment.

Baby Teeth/Children

You should make an appointment with us to evaluate your child’s teeth if a loose tooth does not come out on its own or if the permanent teeth proceed to erupt when the primary teeth is still in place. We will examine the area and take radiographs, and may recommend removal of the primary tooth to facilitate the eruption of the permanent tooth in a timely fashion.

“Baby bottle tooth decay” refers to cavities caused by drinking liquids containing sugar from a baby bottle. The teeth most likely to be damaged by this are the upper front teeth, but other teeth can also be affected. To avoid baby bottle tooth decay, don’t put your child to bed with a bottle containing anything other than water. Other liquids contain varying amounts of sugar ranging from very high amounts (Kool-Aid and juice drinks) to lower amounts (cow’s milk). Children are also at risk of developing “Baby bottle tooth decay” if they use a bottle or sippy cup for prolonged periods during the day.

X-rays (radiographs) are a vital and necessary part of your child’s dental visit. Without them certain dental conditions can and will be missed. They detect much more than cavities. X-rays may be needed to learn more about erupting teeth, diagnose bone disease, evaluate an injury or plan orthodontic treatment. Missing or extra teeth are commonly found on X-rays. Many times if dental problems are found and treated early, dental care can be more comfortable for your child and more affordable for you.

Yes, flossing once a day before brushing removes plaque and food particles that can’t be removed by brushing alone. The dental floss cleans between the teeth and below the gumline. To floss properly, wrap an 18-inch strand of floss around your middle fingers leaving a 1 or 2 inch section of floss to work with. Holding the floss tightly between your thumb and index finger, gently ease the floss between the teeth. Curve the floss around the tooth, making sure you go beneath the gumline. Slide the floss up and down several times to clean the tooth. Always remember to floss behind the last tooth.

Enamel discoloration can lead to negative self-image and is a valid reason for bleaching, but you are right to be concerned with safety and the appropriate age to bleach. There are a wide variety of over- the counter or professionally applied products. It is wise to have professional advice before using these in children. There are many reasons for discoloration such as stain, trauma, enamel defects, or tooth complexion. We can determine the best method for each situation or possibly spot bleach single teeth. Full arch bleaching is not recommended until after eruption of all permanent teeth and is best done after orthodontics.

Dentists are particularly careful to minimize the radiation exposure that their young patients receive during dental examinations that involve x-rays. With contemporary safeguards, the amount of radiation received in dental x-rays is extremely small. The risk is negligible. In fact, the dental radiographs represent a far smaller risk than an undetected and untreated dental problem. Lead aprons and shields will help protect your child. Modern equipment and the newest technology like digital x-rays, high speed films, and filters are designed to help in minimizing even the small amount of radiation that your child will receive.

Children’s teeth begin forming before birth, and begin appearing in the mouth around six months of age. There is a lot of variation in this timing however, with some children getting teeth as early as four months of age, and others not getting their first tooth until after their first birthday. This wide variation is normal. The American Academy of Pediatric Dentistry recommends that your child’s first visit to the dentist be at age one or within six months of the first tooth coming in. At this visit, you can discuss any concerns you have about your child’s teeth, including the delayed emergence.

One of the healthiest snacks for your child’s teeth is cheese. Research has shown that Cheddar, Swiss, Mozzarella and Monterey Jack stimulate saliva production which protects teeth from acids. Because of this, cheese actually disrupts the development of cavities especially when eaten between meals or immediately following a meal. Other “teeth healthy” snacks include fresh vegetables, fresh fruit, and yogurt. For beverages, water and low-fat milk are the healthiest for teeth. Snacks to avoid include sticky candy and sugar-containing drinks such as soda pop and Kool-Aid. If your child is going to eat sweets, it is best to have them eat them with a meal rather than between meals.

“Teething” refers to the process when new teeth break through a child’s gums. Many children do not experience difficulties with teething, but some children experience discomfort, irritability, and increased drooling. Home remedies that can help with discomfort include giving your child something to chew, such as a teething ring or a cool damp washcloth, and massaging your child’s gums with your finger. Over-the-counter teething gels can be helpful but they should not be over-used. Follow package instructions carefully. Pain relievers such as tylenol or ibuprofen can be used for children experiencing significant discomfort. It is important to understand that high fevers and diarrhea are not normally associated with teething and could be an indication of a systemic problem or an ear infection. You should contact your doctor if your child exhibits these symptoms.

Children usually lose their first baby tooth around age 5 or 6 years, although the timing can vary widely from one child to the next. As baby teeth get ready to fall out, the developing permanent teeth cause the roots of the baby teeth to dissolve. Children usually wiggle the baby teeth loose with their tongues and fingers. By the time the permanent tooth is ready to come in, there is often little holding the baby tooth in place besides a small amount of tissue. If your child wants you to pull out a loose baby tooth, grasp it firmly with a clean tissue or gauze and remove it with a quick twist. Apply gentle pressure to the site with a clean washcloth or gauze to stop any bleeding.

Wisdom Teeth

Wisdom teeth, also known as third molars, are the last teeth to erupt in your mouth. Third molars however frequently become impacted due to a lack of space in the dental arch and their growth and eruption may be prevented by overlying gum, bone, or another tooth. Impacted third molars can be painful and lead to infection. However, not all problems related to third molars are painful or visible. These teeth may eventually crowd or damage adjacent teeth or roots. Sometimes they may even be associated with the growth of certain cysts or tumors. As wisdom teeth grow, their roots become longer and therefore more difficult to remove. This is why it is often recommended to remove impacted third molars when the roots are one-third to two-thirds formed, usually between the ages of seventeen and twenty.


There are various causes of loss of gum tissue resulting in root exposure. The most common causes are aggressive tooth brushing or gum disease. The first step in treatment of recession is to correct the cause. For patients who have healthy gums and normal support for their teeth, it may be possible to cover exposed root surfaces with gum grafts. For individuals with a history of gum disease, root coverage will be less predictable. Gum grafting involves the use of either your own tissue from another spot in your mouth or the use of commercially available tissue materials. For these procedures, the gum graft is stitched in place at the site of recession. With current techniques, post treatment discomfort is usually minimal, and the healed tissues usually provide a good match with the adjacent tissues.

There are several potential causes for excess gum tissue or “gummy smile.” This situation can be caused by certain medications, genetics, tooth wear, the position of the teeth in the jaw, or the growth pattern of the jaw bones. The situation can be worsened by poor oral hygiene. It is important that your periodontist determine the cause to select the proper treatment, which may include removing small areas of excess gum tissue and reshaping of the smile line. Because the results are immediately visible, patients are often surprised at how much their smile has improved.

Yes, tobacco users are more likely to get periodontal diseases and suffer from the more severe forms. Healing following the various forms of periodontal therapy may take more time. Tobacco use is associated with a number of detrimental effects to the mouth and the body as a whole. There can be a decrease in a patient’s immune response (their ability to fight off infections), constrictions of blood vessels in the gum tissue around the teeth, an increased risk of certain types of mouth cancers and bad breath. On average smokers are four times as likely to exhibit signs of periodontal disease as were those persons who had never smoked. The good news is that research suggests that those persons who quit can reverse many of the adverse risks caused by the use of tobacco products.


The answer is yes. When teeth are pulled the bone that once supported those teeth resorbs, or shrinks as it heals. The denture you have made will fit for awhile, but as time goes on will loosen. This can be problematic as the dentures can rub and irritate the soft tissues that the denture rests on. Overgrowth of the tissue, inflammation, and sore spots can follow because of poor fit. So it is advised that you continue to see your dentist every 3-6 months during the first year and then yearly for recall after that. We will check the bite and fit to determine if a reline is needed.


A crown is a restoration that covers the entire visible part (crown) of a tooth. Crowns can be cemented onto a natural tooth or onto an implant. The color of a crown depends on the material that is used to make it. A gold crown is yellow in color, although in can be silver in color if less gold is used and if more platinum or palladium is used. A porcelain crown is white and is characterized to match the shade of your natural teeth. Traditionally, a crown takes two or more visits to make and requires an impression (mold) of your mouth be made. Now with new technology, crowns can often be made in a single visit using a “CAD CAM” computer and mill.

Our office is proud to be one of the few in the Riverside area that uses the Cerec system to fabricate computer designed and milled crowns in one day. We prepare the tooth the same way, but instead of taking an impression of your tooth, a digital image is taken. A computer is used to design your new crown, and the design is sent to the milling station in our office. You can even watch while the crown is being milled! Your new crown will then be cemented onto your prepared tooth – all in a single visit.

New Patient – First Visit

It is important that you are comfortable at our office, develop a rapport with our dental team, and trust the dental care you are receiving. We will discuss your dental history and your dental goals and fears, followed by a comprehensive dental examination. This includes a complete examination of the inside of your mouth. We look for any signs of oral cancer, periodontal disease, and tooth decay. We also look at how the teeth are positioned and how this may affect your occlusion (how you bite) or the esthetics (how great your smile is) of your smile. We often take photographs or intraoral pictures of your teeth or smile so we can better see small problems and discuss them with you. Once Dr. Middleton has completed the dental exam he will prepare a customized treatment plan for you.

We see patients from 8am to 5pm Monday through Thursday and from 8am to 2:30pm on every other Friday.

We ask that you complete your forms online before your first visit. If that is not possible, then please arrive before your appointment time so that you have time to fill them out in our office. Specific information that we request includes your past dental history, a record of your current medications, and any concerns you have about your mouth or smile.

Your visits are very important to your dental and overall health, and we encourage you to make every effort to keep your appointment. However, we understand that sometimes life gets in the way and you must change your appointment. In that case, we kindly request that you call our office at least 24 hours in advance so that we may offer that appointment time to another patient. Without the courtesy of a call, we do charge a missed appointment fee.

We confirm appointments using email, text message, and telephone. If you would like us not to use one of those methods let us know and we will use only the method you are most comfortable with. We typically send out a reminder 1 week prior to your visit, and then again an hour prior to your appointment time.

You will need to contact your prior dentist to give them permission to send us your records. They may require that you provide written authorization to them. Give us a call and we can help you with this.

Any one of our friendly team members will be happy to answer your questions if you call our office.

General Dental Questions

Yes. Oral sedation is a method of conscious sedation where we use a pill to sedate a patient. Most healthy adults are good candidates for oral sedation, allowing you to be comfortably sedated through an entire dental visit using just a small pill.

Tooth decay and/or periodontal disease can develop quickly, so we like to see our patients at least every six months. Some patients are put on a more frequent interval if we identify that they are at a higher risk of developing problems.

Anything that goes in the mouth is put in an autoclave, a high heat and humidity sterilizer. We utilize spore testing in our autoclave, which ensures that all instruments are sterile. All of our instruments are placed in an ultrasonic cleaner prior to the autoclave to disinfect them and remove debris. Frequently touched items are covered in plastic, which is changed between patients, and all uncovered items are sprayed with disinfectant. All treatment providers wear gloves and mouthcovers.

Yes, we will get you in on the same day that you call our office during regular office hours. If a patient calls the after -hours emergency number, Dr Middleton will assess your symptoms and determine whether you need to be seen before regular office hours, either by him or another dentist, and will advise you of what you can do to keep you comfortable until you can be seen.

Yes, we cater to our young patients by providing gentle dental care in a fun and relaxing environment. We will refer children to a specialist (Pedodontist) if a child is fearful or if the extent of the dental problem requires multiple visits to treat. Our goal is that all children have a positive experience so that they can enjoy a lifetime of good dental health.

Financial Questions

When we develop a treatment plan for you, it outlines the charges for each procedure, and an additional “office visit” fee is not charged when you have the treatment done.

We will submit all claims to your insurance company for you electronically and will work to optimize your benefits.

We accept all major credit cards (Visa, MasterCard, American Express, Discover), as well as Care Credit and Springstone Health Care Financing.