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, 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!

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