By Dr. Belinda Gregory-Head, Dental Implant Partners – San Francisco
As a general dentist in San Francisco, I practice general dentistry as systems-based medicine, not a sequence of isolated procedures. The mouth reflects airway quality, muscular balance, immune tone, and metabolic control, so diagnosis must map these interactions. I quantify microbiologic, inflammatory, mechanical, and structural risks, then stage care to reduce total disease load. Minimally invasive methods are prioritized until clear biologic thresholds justify escalation. This approach preserves tooth structure, avoids treatment fatigue, and lowers lifetime cost. When we design for prognosis rather than episodes, stability compounds year over year.
Longitudinal pathways replace one-off appointments in my San Francisco practice. I begin by stabilizing biology-caries control, periodontal decontamination, salivary support, and load management before committing to definitive prosthetics. Rehabilitation proceeds only after metrics trend favorably, using adhesive, enamel-preserving designs that respect pulpal physiology. Maintenance becomes individualized rather than calendared, with recall intervals tied to bleeding indices, buffering capacity, and bruxism patterns. We review photographs and numbers together so progress is visible and actionable. The result is fewer emergencies, smoother appointments, and restorations that age gracefully.
Prevention is the most powerful treatment I deliver, because chemistry, behavior, and biomechanics outcompete handpieces. High-fluoride protocols, calcium-phosphate boosters, and custom trays extend remineralization contact time. Dietary timing flattens Stephan curve excursions, limiting demineralization after fermentable carbohydrates. Nightguards and habit-reversal reduce non-axial loading that fractures ceramics and natural cusps. Micro-invasive techniques-sealants and resin infiltration-convert incipient lesions from surgical to medical. Prevention succeeds when measured, so I track bleeding, pH, and plaque scores, adjusting tactics with evidence rather than opinion.
Comprehensive Examination and Diagnostics
A comprehensive examination is a structured data collection that must change decisions. I capture high-resolution photographs to document wear facets, crack lines, soft-tissue tone, and restorative margins. Transillumination and optical caries detection reveal early enamel lesions that bitewings often miss. Periodontal charting records bleeding, suppuration, recession, and furcations, creating a baseline for future comparisons. Functional screening evaluates joint loading, muscle tenderness, range of motion, and mandibular pathways. Salivary testing quantifies pH, buffering, and flow, forecasting caries risk and material selection.
Imaging is ordered to answer questions, not by ritual. Low-cage-risk adults often need judicious bitewings, while symptomatic molars or implant planning may benefit from limited-field CBCT. Periapicals remain essential for endodontic triage, crack investigation, and post-treatment healing. Panoramic views help screen for gross pathosis or assess third molars with a prudent dose. I document the rationale for every exposure and interpret images within a clinical context to avoid overreading artifacts. When a radiograph does not change the plan, we don’t take it.
Risk stratification organizes complex findings into solvable workstreams. I assign scores across microbiologic, inflammatory, mechanical, and structural domains, then synchronize interventions to prevent conflicts. A high microbiologic score triggers remineralization chemistry and varnish cadence, while inflammatory burden dictates maintenance intervals and interdental tool prescriptions. Mechanical risk legitimizes deprogramming, occlusal guards, or selective equilibration before ceramics. Structural vulnerability guides cuspal coverage and adhesion strategy, emphasizing enamel preservation. With explicit targets and timelines, sequencing becomes efficient choreography rather than guesswork.
Preventive Care and Remineralization
Preventive visits in my operatory prioritize biofilm disruption with minimal collateral damage. Instrument selection considers calculus tenacity and tissue reactivity, while air polishing with glycine or erythritol protects root surfaces and implants. I use chemotherapeutic adjuncts only when evidence and site characteristics warrant them. Chairside coaching is specific: I size interdental brushes to individual embrasures and rehearse technique. Prophy pastes are selected for abrasivity appropriate to the substrate. The appointment ends with measurable goals to anchor home care.
Remineralization is applied chemistry powered by contact time and habit design. I prescribe high-fluoride dentifrices and, for high-risk patients, custom tray delivery of calcium-phosphate boosters to extend ion availability. Early white-spot lesions respond to varnish programs paired with carbohydrate timing strategies that dampen pH drops. Xerostomia from polypharmacy or oncology care is managed through sialogogues, substitutes, hydration habits, and humidification. I retest salivary pH and buffering to verify effectiveness. Success is lesion arrest or regression, not simply product use.
Micro-invasive interventions preserve enamel while altering disease trajectory. Properly isolated resin sealants protect deep fissures in susceptible molars and premolars. Resin infiltration arrests non-cavitated proximal lesions and improves esthetics without anesthesia or burs. I never seal over active disease; validation includes clinical inspection, adjunctive detection, and radiographs. Margins are audited at recall, and touch-ups occur before breakdown. These conservative steps defer or eliminate surgical intervention and maintain restorative optionality for decades.
Periodontal Therapy and Maintenance
Periodontal care begins by reducing pathogenic biofilm while moderating host response. Scaling and root planing are paired with targeted home-care training, smoking cessation support, and medical coordination for diabetes or immunosuppression. Locally delivered antimicrobials or short systemic courses are used selectively with stewardship in mind. In phenotypes with elevated collagenase activity, low-dose doxycycline can support attachment stability. I measure bleeding on probing, pocket depths, and mobility at baseline and re-evaluation. Numbers, not adjectives, determine next steps.
Surgical decisions are restorative-driven and anatomy-aware. I perform functional crown lengthening to achieve cleanable emergence profiles and soft-tissue augmentation in carefully selected thin biotypes. Defects unsuitable for non-surgical therapy or minor resection are co-managed with periodontists for regenerative potential. Margin placement, contour, and materials are chosen to minimize plaque retention and inflammatory insult. Post-operative protocols emphasize gentle hygiene, appropriate rinses, and early biofilm disruption. The objective is a shallow, maintainable sulcus that patients can own daily.
Maintenance is the backbone of periodontal success. Recall intervals flex with bleeding scores, residual pocketing, dexterity, and systemic variables. I assign specific devices-interdental brushes, water irrigators, tufted floss-to specific sites, then verify technique. We celebrate measurable improvements and troubleshoot plateaus with re-instrumentation or behavior resets. Maintenance visits also reassess medications and stressors that can rekindle inflammation. Stability emerges from iterative coaching, disciplined debridement, and transparent metrics reviewed together.
Direct Restorations with Biomimetic Composites
Selective caries removal preserves remineralizable dentin and avoids needless pulpal exposure. Adhesive strategy is substrate-dependent: enamel rewards selective phosphoric etch, while deep dentin benefits from mild self-etch or universal adhesives to temper sensitivity. Caries-detecting dyes guide excavation but are interpreted in context, not obeyed blindly. Rubber dam isolation is mandatory for predictable bonding; contamination is the chief saboteur of adhesion. I routinely air-abrade or pumice to cleanse surfaces, and I manage solvents to ensure monomer infiltration before curing.
Polymerization stress is engineered rather than endured. I manage C-factor with oblique increments, adapt irregular floors with flowable bases, and reserve bulk-fill for geometries that justify it, capping for wear. Modern matrices, separation rings, and calibrated wedges produce anatomical contacts that resist impaction and protect papillae. Curing time and angulation are calibrated to depth and manufacturer guidance, then finishing closes microcracks and polishes to a plaque-resistant luster. Occlusion is refined to eliminate high spots that accelerate marginal breakdown under load.
Composite’s superpower is repairability, which I plan from day one. When margins chip or shades drift, I roughen, re-etch, and bond add-on composite rather than replacing the entire restoration. Photographs document repair interfaces for longitudinal monitoring. This strategy conserves tooth structure, reduces chair time, lowers cost, and spares pulps repeated insult. Patients appreciate quick, minimally invasive solutions; biology appreciates fewer bur passes and less heat. Repair-oriented dentistry aligns ethics with economics.
Indirect Restorations: Onlays and Crowns
Cuspal coverage is indicated when cracks, endodontic access, or extensive MODL loss compromise residual strength. I favor adhesive onlays over circumferential crowns whenever enamel and ferrule permit, preserving axial walls and proprioception. Preparations feature rounded internal line angles, conservative reduction calibrated to material requirements, and margins in cleansable zones. Material selection is individualized: monolithic high-strength ceramics for posterior load, layered glass ceramics for anterior optics, and hybrid ceramics where minimal thickness and resilience help. Provisionalization protects pulp and shapes tissue before definitive delivery.
Cementation strategy follows preparation geometry and field control. With favorable enamel margins and isolation, adhesive cementation yields superior retention and marginal seal; protocols include airborne abrasion, appropriate etching or priming, silanization when indicated, and substrate-matched adhesives. Where classic retention is strong or moisture control is limited, resin-modified glass ionomer remains dependable and kinder on technique sensitivity. Try-ins confirm fit and shade so cementation proceeds calmly. Timed gel-phase cleanup protects gingiva and margins.
Every indirect case concludes with occlusal verification in centric and excursions. I confirm stable bilateral stops, smooth anterior guidance, and absence of destructive interferences. Parafunctional patients receive occlusal guards designed to distribute forces and encourage protective guidance, with early follow-ups to read wear tracks. When discrepancies are skeletal or orthodontic, I coordinate care instead of masking problems with aggressive enameloplasty. Documented occlusal baselines enable early detection of change. Harmony protects ceramics and joints alike.
Endodontic Therapy in General Practice
Endodontic diagnosis must separate pain generators from mimickers. I combine thermal and electric pulp testing with percussion, palpation, periodontal probing, and sinus tract tracing to classify pulpal and periapical status. Cracked tooth syndrome can imitate irreversible pulpitis, so I add bite tests and transillumination, reserving limited-field CBCT for persistent or ambiguous cases. Radiographs are interpreted alongside clinical signs, never in isolation. Accurate diagnosis prevents overtreatment, under-treatment, and wrong-tooth errors that erode trust.
Technique prioritizes conservative shaping and maximal disinfection. I establish a glide path, maintain patency, and shape canals just enough to permit irrigant exchange rather than for file bravado. Sodium hypochlorite is ultrasonically activated for penetration; EDTA removes smear layer before obturation. Warm vertical compaction with bioceramic sealers achieves three-dimensional fills while preserving dentin. Rubber dam isolation is non-negotiable, and a prompt coronal seal prevents reinfection from the top down. Occlusal relief can reduce post-op tenderness on hyper-occluded teeth.
Referral is judgment, not capitulation. Severe calcifications, complex curvatures, resorptive defects, or iatrogenic complications warrant endodontic microscopy and specialist workflows. After endodontic therapy, many posterior teeth benefit from bonded cuspal coverage rather than posts and full crowns when ferrule allows, lowering fracture risk. Timely definitive restoration is essential; temporaries cannot resist long-term occlusal forces. Radiographic follow-ups confirm healing and inform maintenance. Retained, comfortable natural teeth remain the gold standard.
Occlusion, Parafunction, and TMD
Occlusal disease represents cumulative micro-trauma expressed as wear, fractures, abfractions, muscle fatigue, and joint sounds. I evaluate contact timing and intensity with shimstock and digital tools when indicated, correlating findings with muscle palpation and load testing. Airway screening matters because sleep bruxism often coexists with snoring and fragmented sleep, altering force vectors and frequency. Tooth position, prior orthodontics, and restorative topography can create interferences that localize destructive load. Mapping causes enables targeted therapy rather than symptom chasing.
Appliance therapy often provides the simplest, most protective intervention. I deliver well-fitted guards that distribute forces and encourage anterior guidance, then review them early to read wear tracks and adjust design. Daytime clenching responds to habit-reversal, posture work, and scheduled micro-breaks, sometimes paired with physical therapy for cervical and masticatory muscles. Certain TMD phenotypes benefit from phased anti-inflammatory protocols or collaboration with sleep physicians and ENT colleagues. Education about why improves adherence and outcomes.
Selective equilibration and restorative reshaping are used when structure drives instability. I remove interferences producing fremitus or destructive working and nonworking contacts, proceeding conservatively after mounted or virtual planning. In full-arch rehabilitations, occlusal scheme selection-mutually protected or group function-reflects anatomy, guidance potential, and parafunctional risk rather than dogma. When position is the root problem, orthodontics is favored over heroic enameloplasty. Harmonized occlusion calms muscles, protects ceramics, and extends restorative lifespan.
Special Populations and Medical Considerations
Pediatric and adolescent care focuses on risk mitigation and growth guidance. I emphasize sealants for high-risk molars, resin infiltration for early lesions, and silver diamine fluoride when cooperation or access limits conventional care. Caregiver coaching targets frequency and timing of fermentable carbohydrates, not merely quantity. Fluoride exposure is calibrated to risk and monitored to avoid fluorosis. Early orthodontic screening addresses crowding, crossbites, and airway concerns before they snowball into functional disorders. Positive experiences build lifelong trust.
Geriatric dentistry must account for xerostomia, reduced dexterity, and complex prosthetics. I coordinate with physicians to adjust xerogenic medications when feasible and prescribe sialogogues or substitutes when not. Moisture-tolerant materials like resin-modified glass ionomer serve cervical lesions and recession margins well, while designs emphasize repairability to minimize retreatment burden. Hygiene plans adapt with powered brushes, enlarged handles, interdental brushes, and caregiver training. Recall cadence tightens as risk rises, catching small issues before cascade.
Medically complex patients can receive definitive dentistry safely when communication is disciplined. I verify A1C, anticoagulant status, and immune competence before invasive care, then tailor anesthetic choice, vasoconstrictor dose, hemostasis, and analgesics accordingly. Stress-reduction protocols-short morning appointments, profound anesthesia, and clear post-operative instructions-reduce complications. Antibiotic prophylaxis follows current cardiac indications, not habit. With thoughtful coordination, even high-risk patients access durable, comfortable outcomes without avoidable setbacks.
Digital Dentistry and Materials Science
Digital workflows enhance accuracy, speed, and collaboration when indications align. Intraoral scanning avoids impression distortion and gag triggers while preserving precise occlusal records. Virtual wax-ups and digital articulators preview guidance before tooth reduction, reducing surprises. Chairside milling enables same-day onlays or crowns in suitable cases, limiting provisional time and microleakage exposure. Even with lab fabrication, scans accelerate communication and cut remakes. CBCT-guided procedures improve precision for implants or complex endodontics, clarifying anatomy near sinuses and nerves.
Material selection is applied engineering matched to biology. I balance modulus, fracture toughness, wear profile, translucency, and bonding affinity against load environment and moisture control. Monolithic zirconia serves high-load posterior cases with limited thickness, while layered glass ceramics reward anterior esthetics. Resin-modified glass ionomer tolerates moisture and releases fluoride at cervical margins prone to flexure. Low-shrinkage posterior composites reduce stress in deep Class II preparations. When materials and protocols match the case, margins stay sealed and restorations endure.
Adhesion is a system, not a bottle. Surface preparation with pumice or air abrasion, selective enamel etch, dentin-appropriate primers, controlled solvent evaporation, and calibrated light energy work together. Rubber dam isolation elevates bond predictability far more than any chemistry tweak. When isolation is compromised, I pivot to moisture-forgiving materials rather than forcing resin into hostile conditions. Documentation of shades, stump hues, and photos supports future repairs. Discipline in adhesion repays with longevity.
Patient Comfort and Practical Benefits
Comfort is both humane and strategic because it shortens procedures and improves healing. I tailor anesthesia to anatomy and duration, using buffered solutions and supplemental intraligamentary or intraosseous techniques when blocks underperform. Aspiration and slow deposition protect tissues, and warmed solutions reduce sting. I adjust occlusion meticulously at delivery to prevent hyper-occlusion soreness. Clear expectations and rescue pathways make patients feel safe and in control throughout care.
I minimize post-operative discomfort by honoring tissues during procedures and planning recovery. Sharp instruments, temperature-controlled irrigation, and gentle soft-tissue handling reduce inflammation at the source. Written instructions with photos guide home care, and early check-ins intercept complications for surgical and endodontic cases. Anxiety management includes roadmaps, noise-cancelling options, and, when appropriate, minimal or moderate sedation within monitored protocols. When patients feel respected and informed, adherence rises and outcomes improve.
The benefits of comprehensive general dentistry extend far beyond aesthetics. By calming periodontal inflammation and arresting caries, we reduce systemic inflammatory load that burdens glycemic control and cardiovascular risk. Reliable chewing supports nutrition and immune competence, while airway-aware occlusal management can improve sleep quality and daytime function. Predictable maintenance reduces emergencies, time off work, and financial shocks. At Dental Implant Partners, my commitment is precision guided by data, delivered with compassion, and anchored in prevention.
About Dental Implant Partners
For more than 25 years, Dental Implant Partners has been my prosthetic practice and the home base for a team that now includes experienced prosthodontists and general dentists who share my commitment to meticulous, evidence-guided care. Our hygienists are uniquely trained as dentists, and their tenure with us means patients benefit from consistent hands, seasoned judgment, and warm familiarity. From diagnostics to maintenance, the philosophy you just read is the philosophy we live by, with careful sequencing that protects biology, respects budgets, and delivers durable function and esthetics.
Our clinical scope spans the full continuum of restorative care, from conservative composite fillings and esthetic veneers to comprehensive dental rehabilitations on dental implants. For patients who are not candidates for implants, we are true experts in precision dentures, crafted to restore comfort, speech, and chewing efficiency. Every plan is individualized and data-driven, and every restoration is designed for repairability and long-term service, so you spend more time enjoying your smile and less time in the dental chair.
We value long-term relationships, ethical decision-making, and a calm, beautiful environment in our suite overlooking the San Francisco Bay. If you are ready to translate the preventive and restorative principles in this article into a personalized plan, we would be honored to partner with you. Schedule a consultation with our team today, and let us help you build a healthy, confident smile that lasts.
