Services | Daniel A. Shalkey DDS


Welcome to our services section.  You may notice our list of services is a bit longer than you may have expected.  This reflects several things that Dr. Shalkey brings to his dental office in York, Pennsylvania every day.

First, he brings more than 34 years of experience as a practicing dentist.

Second, three years of formal post-graduate residency training has prepared Dr. Shalkey to practice at the highest level a general dentist can achieve.

Third, the commitment to excellence is illustrated by Dr. Shalkey's successful pursuit of the Federal Services Board Certification in General Dentistry.  This was not easy to do.  He had to take a written exam a year after his two year USAF residency in General Dentistry, and then pass an oral exam a year later.

Finally, Dr. Shalkey has a persistent love of high quality continuing education, both in courses he has attended as well as on line discussion groups in endodontics and implantology. These discussion groups offer the chance to post cases, ask questions, and seek and give advice about treatment challenges. The learning never stops.

Microscope Enhanced Dentistry

Why are loupes (magnifying glasses) not enough? Many dentists wear special magnifying glasses. These are wonderful but their magnification is limited compared with the microscope. I have 4.5x high quality magnifying glasses and they are great. From a normal working distance they put my eyes just outside the mouth of the patient.

Why are microscopes not used more? Less than 1 % of dentists use this wonderful technology, perhaps due to the expense of purchasing microscopes and the time and training needed to learn to use them.

Why are microscopes better? The higher magnification can put my eyes inside the mouth and even inside the tooth. This level of magnification and lighting makes it possible to evaluate defective restorations, inspect teeth for decay or cracks, and find tiny root canals inside a tooth that are the size of a human hair.

When do we use the Microscope? Most procedures are easier and more thorough when done under high magnification, so we use the microscope for most of our services, especially in restorative and endodontic services.

This is an example of using the microscope compared to viewing the tooth via the naked eye;  loupes at 4x; and the microscope at up to 16x. This tooth has all restorative materials removed to allow assessment of the integrity of the underlying tooth structure prior to restoring the tooth. Unfortunately there is a severe crack inside the tooth that is not obvious until seen under the high magnification of the Microscope.


Patient Interview:
This is the most important part. This is where we listen to you and determine your concerns, needs, and desires.

Review of Medical and Dental History:
Sometimes the history of either medical problems or previous dental treatment can impact our treatment plan.

We will look at your teeth, restorations, and soft tissues to evaluate immediate needs and identify potential problems. We do this with excellent light and magnification.

We will take the absolute minimum number of x-rays needed to establish a diagnosis. In the process of dental implant planning, we may need to send you out for three dimensional scans.

Diagnostic Tests:
We will do the appropriate diagnostic tests and measurements.

Study Casts:
In some cases stone models of your teeth will be helpful in planning your treatment.

Treatment Planning

Create and Evaluate a Problem List:
This is done using the information from diagnosis.

Review Patient Preferences:
Patients want their teeth to look good, feel good, and last a long time. They also want to know what treatment will cost, how long treatment will take, and how many appointments will be needed. There will be other specific concerns unique to each patient.

Create a Range of Treatment Options:
Carefully thought out treatment alternatives can often solve problems at significantly less cost and treatment time while providing lifetime benefits.

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This patient needed a central incisor extracted. Replacement was complicated due to adjacent teeth already being part of existing bridgework. Rather than redo all the bridgework we cut down part of the bridgework and slid a three unit bridge over the existing bridgework that neatly replaced the missing front tooth. The initial photo is before the extraction of the front tooth. The next photo shows the bridgework next to the extracted tooth cut down and ready for the three unit replacement. The next photo is of the replacement bridge from the back. The next photo is the replacement bridge cemented showing the cement coming out from where the bridges are joined together. The final photo is the finished case.


Treatment by the Book:
There are many shortcuts that can be taken in dental treatment where you can lose your way and not arrive at an excellent result. We, however, will adhere strictly to established guidelines for optimal results.

During treatment we will isolate teeth to prevent salivary contamination of bonding procedures and also to aid in capture and removal of particulate matter. Isolation methods include rubber dam, cotton products, special retractors, and high volume suction.

We will work under high magnification and light to carefully perform and evaluate our treatment.

Infection Control:
We will strictly apply appropriate cleanliness and infection control methods as specified by the Center for Disease Control Guidelines.

Preventive Services

This is the cleaning of bacterial and calcified deposits around the erupted parts of your teeth.

Fluoride therapy:
A fluoride varnish affords up to six months of increased resistance to decay by hardening the enamel and roots of your teeth. This is recommended for children and adults who have either a history of decay within the past two years or a lot of restorative margins to protect. Fluoride can also decrease tooth sensitivity in selected cases.

We also offer a brush on fluoride for unusually cavity prone adults.

When indicated flowable resin bonded into the grooves of the teeth will prevent decay on the biting surface of back teeth. (click for more about sealants)

Periodontal Services

Periodontal disease:
The teeth have a supporting structure comprised of bone and fibers that keep the teeth attached to the jaw. Bacteria can infect and cause the loss of this attachment.

Periodontal charting:
Measuring the pocket depth between the teeth and gums when attachment loss is suspected. Bleeding while probing is a sign of inflammation and may be a sign of active disease.

Scaling and root planning:
This is initial therapy for attachment loss. If there is measurable attachment loss, especially if active disease is suspected, the roots of the teeth may harbor calculus and bacteria. Removing these deposits with special instruments can stop the disease process. This is usually done non-surgically but can be done surgically in severe cases.

Periodontal maintenance: Cleaning the roots associated with attachment loss on a regular basis, usually at 3 or 4 month intervals, has been shown in many studies to slow or stop the progression of attachment loss.

Endodontic Services

Why do teeth need root canals?
Teeth are formed from the inside out, such that the mature tooth has a hollow space in the center filled with the tooth forming organ called the dental pulp. The pulp can be compromised by decay, cracks in the tooth, or traumatic blows to the tooth. When this happens the tooth can start to feel increasingly uncomfortable with time. To stop this process we enter the pulp space, remove the diseased contents, and fill the space down to the tip of the root.

Magnification is Imperative:
The anatomy of this space can be quite complex and the magnification of the dental microscope allows visualization of the canals that track down the different roots of the tooth.

Orthograde Treatment:
This is the initial root canal therapy for a diseased tooth done by access through the biting surface of the tooth.

Orthograde Retreatment:
Root canal therapy can fail for a number of reasons but the tooth can often be saved by addressing suspected reasons for failure with a new treatment.

Retrograde Retreatment:
In some cases a tooth can be saved by placing a filling at the root end by surgical access.

Intentional Replantation:
In a small number of cases it may be better to extract the tooth, do a root end filling outside the mouth, and then replace the tooth back in the original position. This has a surprisingly high success rate as long as the tooth is not initially cracked and not damaged by the extraction.

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X-rays of root canals: The first case shows a lower molar with a chronic infection seen as dark areas on the film. then our treatment, and a film showing healing of the chronic infection. Before and after x-rays showing the complexity of a root filling on curved roots An upper incisor with a chronic infection seen as dark areas on the film. then our treatment, and a film showing healing of the chronic infection. The first film shows a failing root canal filling as seen by the dark area at the root ends.  The second film shows the orthograde retreatment result, and the final film shows excellent healing at the root apex at recall.

Restorative and Cosmetic Services

Fillings and Veneers:
We can bond tooth colored composite resin or porcelain to your teeth to both strengthen and create a natural appearing result.

Full Coverage Resins:
This is a lower cost yet very esthetic alternative to a conventional crown. In some cases for various reasons we can even replace a defective crown with a full coverage resin. This can be converted to a conventional crown at any time.

Conventional Crowns:
This is the gold standard of restorative dentistry for teeth that need complete rehabilitation. These are custom made in the dental laboratory for optimal esthetics and function. Careful sculpting of the tooth structure at the crown preparation appointment under high magnification is imperative for natural appearance, fit and retention of permanent crowns.

Orthodontic Extrusion:
In some cases it is possible to restore a tooth with inadequate tooth structure by extruding the tooth a few millimeters using an orthodontic appliance.

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This is an example of three adjacent teeth completely rebuilt with tooth colored resin as a lower cost alternative to conventional crowns. The tooth was too short to retain a crown so we bonded an orthodontic appliance to the adjacent teeth and gradually pulled the tooth up to give us more tooth to add a crown to.  The first photo shows a lower right second bicuspid with an orthodontic extrusion appliance in place.  The second photo shows a porcelain crown placed on the tooth after extrusion gave us enough tooth to work with. The silver filling in this lower molar was leaking and defective, so it was replaced with a bonded tooth colored restoration. The first photo shows a tooth broken off below the gum. Rather than pulling this tooth, we decided to extrude the root of the tooth with an orthodontic technique where we bonded a wire to the adjacent teeth and stretched an orthodontic elastic from the wire to a threaded pin screwed into the root through the tissue. The second photo is the initial extrusion appliance, and the third photo is with extrusion complete. The final photo is the final restoration with a porcelain crown.

Surgical Services

Implant Placement:
A dental implant restoration can replace a missing tooth. It comes in three parts. First, we cut a channel and place a titanium artificial root in the jawbone. After healing we place an abutment into the implant. Finally a crown is placed over the abutment. (click for more about dental implants)

Guided Implant Surgery:
When indicated we order a three dimensional radiograph called a cone beam CT. This allows us to see how the implant will best fit in the available bone. We can even order a surgical guide that will guide the implant placement precisely when space is limited.

We do all types of extractions under local anesthesia. We will refer patients who want to go to sleep to have teeth removed.

Root Canal Surgery:
This is needed approximately 5% of cases where standard root canal therapy has not solved the original problem with the tooth. After surgical access to the root end we remove the root end and place a filling into the remaining root structure.

Root Coverage and Gingival Graft Surgery:
When the gum has receded such that the root of the tooth is exposed a gingival graft may be able to restore all or most of the tissue.

Crown Lengthening Surgery:
In some cases it is possible to restore a tooth with inadequate tooth structure by surgically uncovering a few more millimeters of the tooth.

Periodontal Surgery:
When indicated we can use surgical access to clean the root surface more thoroughly and even improve bony defects around roots with various graft materials.

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The first photo shows a lower left first molar with gum recession over the front root.  The second photo shows the excellent result after gingival grafting. Root exposure on two front teeth and a final photo after a graft to cover the roots. Implant case: first photo shows articulated stone casts with a clear plastic guide showing where the teeth need to be, next is a photo of the implants in place, then a photo of the implants restored with crowns, then an x-ray of the implants restored with crowns. Crown lengthening: a before photo of a lower bicuspid broken off at the gum line. The second photo shows the increased amount of tooth showing after a crown lengthening surgery was done. This was done to facilitate exposing enough tooth structure to retain a crown. This is a case where we sent the patient out for a three dimensional scan and had a precise surgical guide made.  The films show before and after implant placement and restoration.

Tooth Replacement

Single Tooth Implants:
Ideally each missing tooth should be replaced by one dental implant restoration. In some cases two implants can replace three or four teeth.

Fixed Partial Dentures:
When there are missing teeth between remaining teeth the remaining teeth can be crowned and replacement teeth can be connected to the crowns.

Removable Partial Dentures:
Removable replacement teeth that are clipped on to remaining teeth or attached to dental implants.

Complete Dentures:
These are removable prostheses that replace all teeth. They can be supported by the remaining edentulous ridge or where indicated can be stabilized by dental implants. We have had success on many patients who were not happy with their previous dentures.

The first photo shows the mini implants in place in the patient's edentulous area, the next shows the inside of the partial denture with the retentive o-rings that snap over the implants, and the last phot shows the partial denture in place.

TMJ Therapy

The TMJ is a very complicated joint. An articular disc sits on the mandibular condyle (ball) for all jaw movements and separates the condyle of the lower jaw from the socket on the skull. The most common cause of TMJ pain is when this disc slips off the lower condyle. This is thought to be caused by too much tension in the muscles that move the joint. Therapy may involve:

Custom splint therapy:
A resin appliance that is formed on a cast of the upper teeth. The splint is adjusted for even contact with the lower teeth with the goal of relaxing the muscles at an increased degree of jaw opening.

Drug therapy:
Ranges from pain medicine to steroids to low dose anti-depressants

Self care:
This can involve simple things you can do at home including keeping your teeth apart, using moist heat, and self massage of jaw muscles