Dental Information

Whether we like it or not, personal appearance is rapidly becoming one of the most important factors in our society today.  Americans spend billions of dollars on clothing, jewelry, hair, and other items in an attempt to “look good.”  With all of the hype given to these other products, we often tend to overlook our most important asset of all, our SMILE!

A person’s smile forms the basis of a first impression, and its importance cannot be overstated in almost any line of business.

Because of this fact, smile enhancement through cosmetic dentistry has become one of the most cost-effective means of achieving personal attractiveness, and a great emphasis has been placed upon it in recent years, in large part due to the myriad of technological advances which have allowed for predictable and dramatic results.

Listed below are the most popular procedures done to give you a brighter, healthier smile.

Bleaching

Whitening of the teeth by bleaching is done by the application of a peroxide based gel to the teeth.  There are many over-the-counter preparations available ranging from peroxide-containing toothpaste, to actual bleaching kits.  These methods are rarely successful, mostly due to the very low concentration of peroxide provided, and the limited time during which the peroxide is in actual contact with the teeth.

In contrast, when bleaching is done under the supervision of a dentist, one can usually expect significant results, because a dentist may use much higher peroxide concentrations (usually carbamide peroxide 10-25%) and of much higher product quality than those available elsewhere, and will fabricate a bleaching tray which will precisely fit your teeth.   Additionally, the bleaching trays in our practice are made with a reservoir to hold extra bleaching gel on the outer surface of each tooth in order to maximize exposure of the tooth to the peroxide.

Limitations and disadvantages of bleaching:

Bleaching only works on natural tooth structure, therefore if you have bonded fillings or porcelain crowns, these will not whiten along with your teeth.  Your teeth will get whiter, but these restorations which may now blend in with the rest of your teeth will retain their original shade.  This often necessitates replacement of bonded (tooth-colored) fillings with new lighter-shaded ones.

Severely stained teeth may take much longer a time frame to achieve desired results, or a higher concentration of peroxide can be used.  Bleaching usually results in some temporary sensitivy, but higher concentrations and longer courses of treatment can prolong or magnify sensitivity.

White spots, or areas of  “hypocalcification” on teeth may be enhanced by bleaching, creating an undesirable result.

Bleaching of the teeth usually does not permanently whiten the teeth.  You may notice some fading after about a year, but this is easily corrected by wearing the bleaching tray for a few days.

Bonding

Bonding is the process by which a hard, tooth-colored, resin-based material calledcomposite is applied to the teeth.  Composite fillings have been in existence for more than thirty years, however, recent advances in adhesive technology (hence the term “bonding”) and composite durability have greatly improved the predictability and long term success for this material.

Composite material is generally used as a cosmetic filling for cavities and chips in the front teeth, but can also be applied as a direct veneer to the face of a tooth.

Direct veneering of composite to teeth can be used to mask discolation, to reshape broken down or worn teeth, close gaps (called diastemas) between teeth, or can make twisted or malposed teeth appear straight.

The results are instantaneous and often dramatic.

Limitations and disadvantages of direct veneer composite bonding:

All of the disadvantages of cosmetic dentistry using composites are related to limitations of the material itself.  Although the new generation of composites are considerably stronger and more stain-resistant than their predecessors, they usually only carry a life expectancy of about an average of three to five years before they have to be touched-up or redone due to staining and/or chipping.  Although they often last much longer, it is important that one has reasonable expectations regarding longevity.  Factors which may adversely affect long term success include smoking, coffee, tea (staining), and hard chewing, nail biting, etc. (chipping).

Porcelain Laminates

Porcelain laminates are currently the “gold standard” in cosmetic dentistry. Porcelain laminates, also called porcelain veneers, are laboratory-fabricated facings which are bonded to the outer surfaces of the teeth.  They are analogous, and similar in thickness to, false fingernails.  Each laminate, however, is custom-made to fit each individual tooth, and made from very high-strength porcelain.

Porcelain laminates are used for the same puposes as direct veneer composites; that is to mask discoloration, reshape broken or worn teeth, close gaps, or make crooked teeth appear straight.  Porcelain laminates offer many advantages over direct composites both in terms of durability (usually 10+ years, similar to that of crowns) and esthetics. They can create beautiful, natural smiles, and are the choice of many, if not most, Hollywood stars.

The porcelain used to fabricate these veneers will not absorb any stains, and is extremely fracture resistant. This porcelain is so durable it is often used to reinforce teeth with stress-fractures which may have become weakened due to trauma or age.

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Disadvantages and limitations of porcelain laminates

There do not seem to be any absolute disadvantages to porcelain laminates, however, in contrast to crowns and other types of restorations, we do not know how well past 10-15 years they can be expected to last.  This is because most of the first porcelain laminates were done about 10 to 15 years ago, and for the most part seem to hold up well over time, but there is no definitive data to prove this since not enough time has elapsed since they were first introduced.  Also during this period, there has been an explosion of technology in both bonding and development of high impact-resistant porcelains, which has most certainly enhanced the life-expectancy of these restorations.

It is now generally believed that the longevity of porcelain laminates will rival that of conventional crowns, which can be anywhere from five years to a lifetime.

There are several limitations to placing porcelain laminates.  Since they are intended to serve as only a facing to a tooth that will usually only wrap over the biting edge, severely broken down teeth, or teeth with cavities are usually not good candidates. For these situations, usually a crown, which covers and protects the entire tooth will be recommended.

Crowns

A crown, often referred to as a “cap”, is a tooth restoration that fits over an entire tooth (the area above the gumline, that is).   Before the advent of bleaching, porcelain laminates, and bonding, crowns were the only option for cosmetic enhancement of the teeth, and remain the treatment of choice whenever those more conservative approaches are deemed inappropriate.  Crowns are usually placed on teeth which are badly broken down or weakened.  Most crowns done today are either all-porcelain, or porcelain fused to a metal substructure to add strength.  Invariably,  the cosmetic results are excellent, especially using the exceptional materials now available.

Disadvantages and limitations of crowns:

As discussed earlier, crowns done primarily for cosmetic purposes are usually only done if the tooth structure is weak or broken down, therefore, the placement of the crown will almost invariably strengthen the tooth.  Occasionally, the misalignment of the existing teeth is so severe that the condition is best corrected by orthodontic treatment (braces).

Dental Emergency First Aid

Below is a list of common emergencies that may arise when a dentist or hospital is not immediately available, and what can be done until the problem can be professionally treated.  It is important to emphasize that these are only immediate, temporary measures, and are in no way a substitute for professional care provided in a timely manner.

1. Tooth knocked out of mouth:  Trauma to the mouth often results in “avulsion” of one or more teeth.  If the tooth is clean, if possible, it should be carefully placed back into its socket until you can get to a dentist.  If the tooth is contaminated, or if it cannot be replaced (as is often the case with small children), then it should be placed in milk (or even water if necessary).  The patient should be seen by a dentist as soon as possible, because the longer the tooth is left out of the mouth, the less of a chance it has to be saved.

2. Toothache:   If one experiences a toothache in a tooth with a cavity exhibiting symptoms of cold and heat sensitivity, this usually indicates that the nerve in the tooth is dying.  Sometimes, temporary relief can be obtained by placing a temporary filling in the hole in the tooth that has the ingredient Eugenol in it.  This product is available in most drug stores.  Never place an aspirin against the gum around the tooth.

If the pain is accompanied by swelling, however, this indicates an infection, and a  temporary filling may only make it worse.  In such a case, it is best to go to a hospital if you cannot reach a dentist, especially if the swelling is obvious outside of the mouth.

3. Broken Tooth:   In many cases, a small or large piece may break off of a tooth.  If there is no pain presently, then that typically means that the crack did not occur through the nerve.

If a front tooth breaks off at the gumline, however, usually you will be able to see the exposed nerve, which looks like a pinkish dot in the center of the remaining tooth root.  If you cannot get to a dentist right away, or on your way to the dentist, some soft wax (obtainable at most drug stores) may be placed gently over the cracked tooth root.  This usually protects the sensitive exposed nerve from the cold air.

4. Cold sores or denture sores:  Temporary relief for these problems can usually be obtained by the use of an over-the-counter product containing the active ingredientBenzocaine.

5. Swelling of the gums:  Most swelling is caused by underlying infection.  Rinsing with hot salt water can give some temporary relief by helping to draw out some of the fluid which is creating the pressure.

6. Bleeding in the mouth:  If an area of the mouth is bleeding persistently, there are two remedies which may used alone or in combination:  Application of pressure, usually using some cotton gauze or a clean rag if no gauze is available, and; Application of coldto the affected area.  It is also important to remember that a small amount of blood, when mixed with saliva can appear to be a large amount of blood.  Do not take aspirin, as it can also worsen bleeding due to its blood-thinning properties.