To Veneer or Not to Veneer Tuesday, Jun 21 2011 

Veneers for teeth are hot right now. Their popularity was enhanced by some of the extreme make over shows and a great ad/marketing campaign by one of the manufactures of the Veneers used on that show. Since most veneers are porcelain, the effort to promote one type over another was amusing to most dentist. Porcelain is used to make most crowns or veneers and the material has fairly consistent properties. Some materials are harder and stronger than others, but the ultimate appearance of the porcelain veneer is the same. In other words it is going to match the shade or color the dentist selected with the patient’s input as to what color they wanted their teeth to be. Colors or shades, to the dentist, can be “tweaked” at cementation by the dentist.

Veneers are a versatile means to improve the appearance of many teeth. The shape, color and arrangement can be changed with veneers. In fact one of the most versatile things about veneers is that in some situations they can be placed on teeth without  drilling on the teeth at all.  This process does use a special porcelain and a high pressure pressing technique. The result can produce a very thin veneer–0.3mm in thickness, which is not much at all. The final color of a veneer can be adjusted by the dentist at cementation using different color cements. This can enhance the existing color of the teeth, or mask more serious discoloration in certain cases.

But not all teeth can be veneered. In some situations, the bite or occlusion on a tooth or teeth can make the veneer weak, or likely to pop off the tooth due to the chewing forces exerted on it.  It is important to keep in mind, that unlike a crown, the veneer is bonded onto the tooth. It does not rely on any mechanical retention, or friction to hold in it place– only the wonders of chemistry. Prior to cementation, the tooth is treated with chemicals to aid in the bonding process. The veneer itself must also be treated with some of the same chemicals including silane–another amazing product from the space program. Silane bonds inorganic substances to organic substances–for example the ceramic titles used to dissipate heat on the surface of a  space shuttle. For teeth this means a porcelain veneer to the surface of the tooth.

Another situation which might present some problems are badly discolored teeth. Teeth that suffer from enamel damaged by excess fluoride or other chemical discoloration from drugs like tetracycline might present some challenges for the veneer process. Another type of staining that can be a problem is teeth that suffer from discoloration due to a patient who had a high fever as a young child.  Depending on the severity of the process, a veneer may or may not work. In those difficult situation, a full coverage crown would be indicated.

When discussing veneers with your dentist, it is best to be very specific about what results you are looking for . Many times a diagnostic wax up is indicated. This utilizes a stone cast of your teeth, which the dental laboratory waxes up teeth to look like what can done with veneers to change the appearance of your natural teeth. This way you can see the results before anything is done and you have the flexibility to make changes prior to starting work on your teeth.

Veneers are another option in improving your smile or restoring broken down and decayed teeth.They can be used with conventional crowns, or removable partials to provide you with a versatile part of the puzzle piece to put things back in order so you have a better bite and a dazzling new smile

So, Exactly Why Do I Need that Crown? Thursday, Jun 16 2011 

What a common question in the dentist office. Whether it is for a single crown or twenty to restore an entire mouth, patients like to know the specific reason they are being asked to spend that much money. The reason for the diagnosis for a crown has many answers, but in most situations they focus on supporting the tooth and making it stronger.

From previous post, I pointed out that teeth that have had a root canal are prime candidates for a crown. The tooth has been weakened and needs some additional support to function properly in your mouth. If we continue along that path of making a tooth stronger, it is easy to see why a tooth that has a large cavity or filling which is begining to break down or has decay needs a crown. Enamel is very hard, but the dentine under the enamel is not. Once decay starts to eat away at the dentine, the enamel becomes undermined and is weakened. It will begin to crack and break away from the tooth. A tooth has five parts or surfaces–top, or chewing part, cheek side and tongue side and a front and back. If three or more of those parts are broken down or missing the tooth is in bad shape.  A crown can replace those parts and with a core build up the dentine part of the tooth which has been eaten by decay or removed in the process of placing a filling is also replaced making the tooth strong once again.

Fillings do not last forever. They are good replacements for missing or damaged parts of a tooth, but with time they fail. Now it is true that with proper brushing and flossisng, you  can make a filling last years, if not decades. But when they begin to fail, decay can start around the edges where the tooth and filling meet. With time, the decay will penetrate into the tooth itself and create more problems–more tooth parts destroyed and possible damage to the nerve of the tooth, which might lead to needing a root canal. When a tooth with a large filling reaches that point, it is time to consider a crown. 

Sometimes, crowns are used to change the color or shape of a tooth. The tooth might be in decent condition, but the patient wants things  changed. A better color, a more natural shape or a new smile would require crowns to accomplish those goals.  A crown is versatile, it can be made to do many things in the mouth. Teeth that are worn from chewing or grinding would benefit from crowns.  Crowns can make teeth look longer and more youthful; they can make a mouth which has broken down and worn teeth, look better and more healthly as well as function properly. Crowns are placed on teeth which will support  a fixed bridge which allows the dentist to replace missing teeth like they were still part of the mouth.

Crowns can be made any color, or shape and from a variety of metals. Diamonds, rubbies and other precious stones can be placed in the crown.  Intials, and designs or other shapes can be incorporated into the crown. So, when a tooth is damaged or needs serious help, the crown is the best bet.

So, You Want White teeth? Monday, Jun 13 2011 

Theoretically, one in a hundred people have white teeth. By this I mean that their teeth are noticeably lighter than most people. However, by todays standards, their teeth are not white enough. Today white means the color of a piece of copy paper or a bleached white shirt.

Well, you can get your teeth that white, but it will involve some effort, money and possibly pain. The cheapest method would be Crest White strips. A good method but you must follow the directions perfectly and be consistent with wearing the strips. There can be some problems with bleaching the areas between your teeth with the strips, but that can be solved. I should mention that the whitening mouth wash and tooth paste can help lighten your teeth, but it is a slow process and will produce only modest results.

The next upgrade in whitening is bleach trays made by the dentist (best method but I am a dentist ) or some kit you can purchase at the pharmacy or Wal-Mart. The dentist trays will fit the best and last the longest and will bleach all of your teeth, even the spaces between them. Also, the bleaching solution the dentist provides is strong, 22%  carbamide peroxide. An hour or two a day wearing the trays and you should be really white in seven days. A better method is to start with the Crest strips and then use the bleaching trays. This works well with super results. The bleaching pens that you apply to each tooth also work well with the trays. In short a combination of methods will provide good results.

The final whitening up grade is the Zoom and other light activated techniques which use a strong carbamide peroxide solution in the hight 20’s or low 30’s.The gums have to be protected with a coating and eye protection worn. These techniques produce results, but there are a coupe of caveats. First, sensitivity will be an issue with all bleaching techniques, but the high power ones can produce some problems. Next, all bleaching techniques require that you “refresh” the bleach every few months to maintain the results. Yes, your teeth will betray you and slip back to their orignal color.

There are a few tricks to work  with these problems. Trays are easy to use and can last a long time– years, so they can be worn any time you need a recharge. It is easy to get more bleaching solution from the dentist and keep some on hand. Next,before you bleach start using a toothpaste for sensitive teeth a week or two before you plan to bleach. A fluoride rinse can also help but has to be used daily. The dentist can provide treatments for the sensitive teeth if it is severe and chemicals that can be worn in the bleaching trays to make the teeth more resistant to the sensitivity.

All of these methods will work, but the most important thing to keep in mind is that old fillings and crowns in your front teeth will not bleach. They have to be replaced. If you chose to bleach, wait until you have the results you want and then have the fillings or crowns replaced to match your new teeth. Of course, you can  just have crowns or veneers put on your teeth and not bleach at all!

Anxiety in the Dental Chair 2 Tuesday, Jun 7 2011 

The previous blog talked about anxiety in the dental chair

in some general terms as to what can be done to help

the patient who is fearful. But there is some additional

information about what can be done, particularly by the

patient.

First, make sure you tell the dentist that you have some anxiety about your dental treatment, or that you are just plain scared or petrified of the thought of having dental treatment. This helps more than you will ever realize. Once the dentist knows you are not happy about sitting in the chair, he can begin the conversation to offer some suggestions on what can be done to help you. The worst thing that you can do is not to tell the truth. Men are the worst about this. They will not admit to any fear or apprehension about what is going to be done. Nothing is worse than starting a procedure and suddenly have the patient begin have a melt down. Everybody loses when that occurs. I have had to stop work on many people and tell them that we were finished with todays treatment and that they would have to return sedated to complete the procedure.  

In most cases they are relieved with this and return sedated and have an excellent experience and are glad that they learned there was an alternative. The dentist is much more comfortable working on someone who is relaxed and not jumping around groaning about how much they don’t like what is happening to them. So be honest and tell the dentist exactly how you feel about things.

Once you start the discussion, listen to the choices which are suggested to help you deal with the treatment. Ask questions and get all of the information you need to help you make a decision. Remember, treatment for dental work can range from no anethetic for the procedure to going to the outpatient surgery center for general anesthesia. That is a very large range. You can always start out on the low end of the spectrum. If the local anesthetic or nitrous oxide is not working for you, tell the dentist and let him or her know you need some help and that would be sedation.

Another situation that occurs some times is the local anesthetic not seeming to work as well as it should. There are a number reasons that this can happen. It can range from the dentist missing the block on a lower nerve (this is very common since the dentist can not see the target and it is very small and the actual location can vary), to infection around the tooth or teeth, or the anesthetic  does not work due to some chemical problem with the solution. When any of these things happen and the patient begins to feel some pain or discomfort it is bad for everybody.

There are ways around the situation. The dentist can use a series of different injections at different sites in the mouth in an attempt to block or numb the nerve at various locations where it is located. Using a selection of different local anesthetics for the injections can also help with this problem. If these fail, then sedation solves the problem in most cases.

If a patient is nervous and has alot of anxiety about the dental treatment, it can create problems with the anesthesia working. A relaxed and happy patient has a better experience and everything seems to flow smoothly.  So speak up and let the dentist know how you really feel. It will make everyone’s dental visit much better.

Anxiety in the Dental Chair Monday, Jun 6 2011 

Most people are not very happy to come and sit in the dental chair for treatment.  Their reasons are numerous, but can fall into a few main categories;

1. Childhood bad experience

2. Adult bad experience

3. General fear based on stories and other tales of dental horrors.

I have found that the easiest and quickest method of dealing with these problems is some sedation. By sedation I mean nitrous oxide, or some oral medication like Halcion that is taken before the appointment. The goal of these treatments is to relax the patient or in the case of Halcion, to actually induce a very light stage of anesthesia which also results in amnesia.

Nitrous Oxide has been around for a long time –1800’s– and is a very safe inhalation gas particularly with the modern analgesia machines. It provides the patient with a relaxed warm feeling which helps most people tolerate the dental appointment with little difficulty. The patient should not feel like they are spinning around in the chair. That is too much of the Nitrous Oxide and the flow needs to be reduced.

Halcion and the other oral drugs used for sedation in dentistry provide a different sort of analgesia. With these medications, the patient will be drowsy, or in some cases asleep, and have little or no memory of the visit to the dentist. For patients who are very nervous, or terrified of the particular procedure, such as pulling teeth or having a root canal, this is the way to go. They know nothing, feel nothing and do not remember their visit. This makes them very happy.

The oral medications are safe in that they do not depress the heart rate or breathing. Intravenous medicines do depress the heart rate and breathing, so the patient has to be monitored and watched closely. Oral Surgeons and a few other dental specialist use intravenous medications for sedating their patients, but most general dentist use the oral medications.

With any form of sedation, other than Nitrous Oxide, the patient must be under constant supervision and care once they leave the office. It can take several hours in some cases for the patient to recover from the procedure and medication used. In fact with the oral medications, the patient will have to be brought to the office for treatment by a family member or friend. The oral medications begin to work within  fifteen minutes in some cases which makes  the patient unable to drive or take care of themselves. When the oral sedation medicine is combined with pain medications, the patient will be very sleepy.

Sedation is a great way to deal with anxiety and fear in the dental office. The patient can have a great deal of work done quickly and efficiently, and remember little if any of the time spent in the office. It is cheaper than using the operating rooms at the hospital with general anesthesia, yet can provide an experience which even the most fearful will be able to deal with quickly and efficiently.

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