We all know that dentistry can do amazing things these days to give you the smile you've always dreamed of. With the latest cosmetic and restorative dental techniques, it is possible to achieve amazingly natural-looking results. But how do we map out the best route to a better smile? And how do we know that the results will hold up over time?

Every individual has a unique set of conditions in his or her mouth and it is our job to figure out how you have come to your present state, dentally speaking. We need to correct or at least manage any factors that could risk the success of your treatment. These risk factors fall into four basic categories:

Periodontal Risk — This involves the condition of the structures that support your teeth, including your gum and bone tissue. It's important to establish good periodontal health before we perform any restorative or cosmetic procedures.

Biomechanical Risk — This has to do with the structural integrity of your teeth. We will look at whether any tooth structure has been lost due to decay, and take steps to reduce your susceptibility to decay if necessary.

Functional Risk — This relates to your bite: how your teeth, muscles and jaw joints are functioning. For example, do you have excessive tooth wear or joint pain? If so, you are at a higher risk in this category and we need to figure out why.

Aesthetic Risk — This is the most subjective of the categories as beauty is in the eye of the beholder. Still, if you display a lot of your teeth and gums when you smile, any issues you have (gum recession, for example) will be that much more visible and affect your smile more. We will have to take this into account when we plan your treatment.

Only when we have determined how best to minimize your risk in all four of these categories can we restore or enhance your smile in a way that will not only look great but also last as long as possible.

If you have any questions about cosmetic or restorative dental treatment, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine article “Successful Dental Treatment: Getting the Best Possible Results.”

If you've recently had a dental implant placed, congratulations! You have made a good investment in your smile that should last for a lifetime — if you take proper care of it. This is easy to do with a good oral hygiene routine and regular professional cleanings. Here are some important things to keep in mind about implant care:

1. Implants can last as long as teeth. A dental implant made of titanium will fuse to the bone surrounding it and function just like a natural tooth. It is a highly successful method of tooth replacement that succeeds more than 95% of the time.
2. Implants and natural teeth attach to surrounding bone and gums very differently. A natural tooth does not actually fuse to the bone that surrounds it. Instead, it is held in place by a periodontal ligament (“peri” – around; “odont” – tooth) made up of tiny fibers that insert into the bone on one side and into the tooth on the other. Farther up, these collagen fibers attach the tooth to the gum tissue. Implants and the crowns that go on top of them are not anchored to the gum in this way. An understanding of this biology is important for maintaining good periodontal health when implants are present. We will go over this with you so can care for your implants correctly.
3. Infection is the enemy. Bacterial infection is a concern with both natural teeth and implant-supported teeth. A bacterial biofilm (plaque) builds up daily on implant teeth, just as it does on natural teeth. If it is not regularly cleared away, various oral infections can develop. In the case of natural teeth, this might result in tooth decay, gum disease, and the loss of tooth-supporting bone. Implants can't decay, but they can be threatened by a rapidly progressing infection known as peri-implantits (“peri” – around; implant “itis” – inflammation), which can lead to a well-like or dish-shaped loss of bone around the implant. The implant can become loose as greater amounts of bone is lost.
4. Good oral hygiene is as important as ever. Daily removal of bacterial biofilm is key to preventing peri-implantitis. You'll want to make sure you brush your teeth twice daily with a soft brush and fluoride toothpaste, and floss gently at least once per day.
5. Your dental hygienist has an important role to play. Professional cleanings here at our dental office are also still as necessary as ever, if not more so. Dental hygienists have special instruments they use to clean areas around your implant that can't be reached by your brush or floss — without scratching the surfaces of your implant components.

If you would like more information about dental implants, please call us or schedule an appointment. You can also read more by reading the Dear Doctor magazine article “Dental Implant Maintenance.”

A “crown” or a “cap” is the term used to restore a decayed or broken tooth that needs to be completely encased to protect the tooth beneath it. A crown's dual purpose is to restore the tooth's form and function. Decades ago gold was the material of choice for a crown. What we ultimately choose depends on a particular crown's requirements with regard to the tooth's appearance and function, and to some extent what you want.

Gold: Gold crowns last the longest and wear the best (at about the same rate as natural teeth), but they are not used as frequently today, especially if they are visible in a person's smile. Gold crowns are made of cast gold, a technique that has been in use for over a hundred years. They can last for decades, and have been known to last 50 years or more. They tend to cost less per tooth than porcelain or other materials.

All-Porcelain: “All porcelain” crowns have a natural appearance and as technology improves they are gaining popularity. Dental porcelains are composed of ceramic substances that are variations of glass. This gives them their translucent, lifelike appearance — but it makes them brittle and subject to fracture. Therefore all-porcelain crowns may not be a good choice for back teeth because they frequently fail under the biting forces applied during chewing and especially adverse habits like tooth clenching or grinding. Porcelain crowns are made of material that doesn't wear. Consequently, it can cause excessive wear to the teeth they bite against.

Porcelain-Fused-to-Metal (PFM): PFM crowns have been in use for more than 40 years. They combine a substructure of gold or platinum for strength and have porcelain “facings” for the visible surfaces. In some ways they combine the best of both worlds, but they do have some problems; the metal can show through the porcelain, detracting from its life-like appearance. These crowns can have a functional lifespan of about 20 years or more.

New and Future Materials: Newer “pressed-ceramic” restorations and computer-milled ceramics have received good reviews for aesthetics and service. These new materials are being intensively researched. Initial results look good, but we'll have to see how they last over time.

Contact us today to schedule an appointment or to discuss your questions about crowns and other dental restorations. You can also learn more by reading the Dear Doctor magazine article “Gold or Porcelain Crowns?”

Do you have silver dental fillings that you wish you didn't have? Wouldn't it be nice if no one could look in your mouth and see how many cavities you had as a kid? Tooth-colored fillings may offer a solution to the problem of too much metal in your mouth. How much do you really know about non-metallic tooth-colored fillings? Take our quiz and find out.

True or false: Tooth-colored fillings are a radical new technology.

False. A variety of dental porcelains and composite resins have been successfully used in tooth restoration for many years. These materials have been designed to mimic the properties of the two major components of teeth: the hard outer enamel, and the bone-like inner dentin. Our increasing understanding of tooth structure and composition has led to better and more natural-looking filling substances.

True or false: Teeth must remain rigid under the pressure of the bite.

False. At one time, metal amalgam (silver) fillings were preferred because of their extreme hardness. But we now know that the crowns of our teeth actually flex under the forces of the bite. This discovery has spurred the development of new methods and materials to stabilize the restored tooth and reduce the incidence of premature failure.

True or false: It's usually more complicated to put in a tooth-colored filling than a metal one.

False. Regardless of which material is used, the basic process of filling a tooth is the same. The dentist prepares the tooth for treatment, removes decay, and places a filling directly into the tooth. If the filling is moderately deep, a tooth-colored filling may be set in several layers which are successively “cured” or hardened. More extensive restorations may require more than one visit, but the natural-looking results generally justify the extra time.

True or false: Regular metal fillings make the tooth structure stronger.

False. Properly securing an amalgam filling may require the tooth to be “undercut,” meaning that a greater amount of healthy tooth material must be removed. This can weaken the tooth structure, eventually leading it to chip and crack. Non-metallic fillings don't require undercutting, so more tooth structure is left intact. This more conservative treatment can result in a stronger, longer-lasting restoration.

True or false: Non-metallic (tooth-colored) fillings are safer than silver fillings.

False. While each method has advantages and disadvantages, and may not be an appropriate treatment in every situation, both methods have been deemed safe and effective by major U.S. and international science and health organizations. While there have been recent concerns about mercury in amalgam fillings, there is presently no reason to believe that it presents any cause for concern.

If you would like more information about tooth-colored fillings, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “The Natural Beauty of Tooth-Colored Fillings.”

What does the term “two-implant overdentures” mean?
For more than a century, complete dentures were the only care option for edentulous (toothless) people. As a solution, these left a lot to be desired, particularly for the lower jaw. Now dental technology has developed a better alternative that combines two strategically placed dental implants and a traditional lower denture that has been modified to fit over the two implants — thus the term.

What are the problems with traditional dentures?
The problem is that when you lose teeth, the bone that supported the missing teeth begins to shrink away. This is known as resorption, and it is the reason that dentures fitted too soon after teeth are lost quickly become loose. Bone loss happens most rapidly during the first year and is four times greater in the lower jaw than in the upper.

Why not just use dental adhesives to hold dentures tightly to the lower jaw?
Zinc, a major ingredient in most dental adhesives, has been associated with neurological disorders and may be unsafe. In addition, dental adhesives are expensive and the cost of frequent usage adds up.

Besides dental adhesives, are other health problems associated with dentures?
Yes, edentulism has been related to poor nutrition. Many edentulous people switch to soft foods with high fat content because they find healthier foods like vegetables and proteins difficult to chew.

What are dental implants?
Dental implants are replacements for the roots of teeth, the parts that are below the gumline and anchored in bone. They are usually covered with a crown that shows above the line of the gums.

What are the benefits of implants?
Most importantly, implants reduce the amount of bone resorption. Studies have shown about 75% less resorption in parts of the jaw with implants compared to areas without them. Since most of the bone loss occurs within the first year after tooth loss, it is important to place implants within this time period.

Is a complete set of dental implants a good solution for edentulism?
Yes, it can be a good solution, but it is not for everyone. Some patients, who have lost a great deal of bone support, need another solution for cosmetic reasons that offer more facial support like an implant overdenture. In addition, depending on their resources and insurance, some people require a less expensive solution.

Why does the two-implant overdenture work better for the lower jaw?
Based on differences in bone volume, density and other factors, we think that four to six implants are needed to retain an upper implant overdenture. Thus a two-implant overdenture is a good solution to consider for a lower jaw, but other options might be preferred for an upper jaw.

Contact us today to schedule an appointment to discuss your questions about dentures and implants. You can also learn more by reading the Dear Doctor magazine article “Implant Overdentures for the Lower Jaw.”

If you don't like your smile when you look in the mirror, or feel self-conscious because your teeth are discolored, there are a variety of whitening procedures that can help you obtain the smile of your dreams.

Choosing the Right White: With strips, trays and toothpastes all claiming to be the best tooth whitening systems, it can be hard to choose how to whiten your teeth. Our office can help you decide the best approach based on your individual needs, time constraints and budget. Whiteners may not correct all types of discolorations.

Whitening in Our Office: This procedure is called chair-side or professional bleaching and may require more than one office visit. Each visit may take from 30 minutes to one hour. We use an in-office whitening gel that is professionally applied to your teeth and activated by a light source, giving you significantly whiter teeth in less than an hour. Typically, teeth with a yellowish hue respond best to whitening.

Whitening Your Teeth at Home: If you are an adult who practices good oral hygiene and doesn't suffer from periodontal disease, our office can help you decide whether an at-home whitening system, or having your teeth whitened in our office best meets your needs. If you decide to go with an at-home system, you will wear a custom-made whitening tray that looks like a thin, transparent night guard. You fill the tray with a mild whitening gel and need to wear the gel filled tray for a specified period of time each day (per our office's instructions). This procedure must be continued over a period of time that generally extends from 2-4 weeks.

Whitening Products Found in Stores: If you are considering over-the-counter whitening products we can also recommend products that will offer you the best results. Whitening toothpastes that have the American Dental Association (ADA) Seal of Acceptance contain special chemical or polishing agents that generally provide some stain removal effect.

Contact us today to schedule an appointment or to discuss any questions that you may have regarding teeth whitening. Read more about this topic in the Dear Doctor magazine article “Teeth Whitening.”

Even with modern knowledge about oral health and how to prevent tooth decay and gum disease, more than 25 percent of Americans have lost all their teeth by the time they are 65. Perhaps they did not have access to dental education, quality care or treatment. Whatever the reasons, those who suffer from “edentulism” — the complete loss of all permanent teeth — also suffer from poor self-image, impaired nutrition, and reduced quality of life.

Removable full dentures are often the solution of choice for those suffering from edentulism. Dentures can be made to look good and feel great; but successful denture-wearing demands the collaboration of a skilled dentist and a willing patient.

A set of well-fitting full removable dentures starts with detailed planning. We need to work out where each tooth will be placed and how the upper and lower teeth will meet together. To do this, we make use of photos taken before the teeth were lost, as well as using the facial features as a guide. You as the patient have to decide whether you want your dentures to look much like your natural teeth did, including any gaps and uneven areas, or whether you want to make your new teeth more regular and uniform than the originals.

In addition to the size, spacing and locations of the teeth, decisions must be made regarding the colors and textures of the part of the denture that fits over and looks like gum tissue. Photos can help with this aspect as well. Ridges can be added to the section of the denture behind the upper front teeth to aid in natural speaking and chewing.

The upper and lower dentures must be designed so that in the process of biting they stabilize each other. This is called “balancing the bite.” This is necessary for normal function and speech.

All this careful planning and design are only the beginning. The dentures will be created in a wax form, tested and modified. They are then completed in a dental laboratory, where the new teeth and gums are created out of a special plastic called methyl methacrylate. With careful planning, skill and artistry they are made to look like natural teeth and gums.

At this point the role of the denture wearer becomes vitally important. He or she must relearn how to bite, chew, and speak while wearing the dentures. As the dentures press down on bone and gum tissues, over time some bone will be lost. This will require coming in for frequent checkups and modifications to make sure the dentures continue to fit well and comfortably.

Contact us today to schedule an appointment to discuss your questions about dentures. You can also learn more by reading the Dear Doctor magazine article “Removable Full Dentures.”

Protecting your children is one of your most important roles as a parent or caregiver. Dental sealants are one way you can protect your children's teeth from the ravages of tooth decay, drilling and fillings — and they can be applied simply, comfortably and quickly right here in our office.

What is a dental sealant?

A dental sealant is a thin, plastic film that is painted onto the tiny grooves on the chewing surfaces of the back teeth (usually the premolars and molars) to prevent caries (cavities) and tooth decay. And by allowing us to use sealants to seal these little nooks and crannies where your child's toothbrush can't reach, you will dramatically reduce their chances for developing tooth decay. This one, simple and quick office visit could save you both money and time with fewer dental visits and healthier, cavity-free teeth.

So will sealants guarantee no (or no more) cavities?

No, just like life, there are few guarantees. Your child's oral hygiene, regular dental visits, fluoride, sugar consumption and genetics are the other important factors that will determine to what degree your child experiences tooth decay. However, research shows that pit and fissure (chewing surface) decay accounts for approximately 43% of all decayed surfaces in children aged 6 to 7, even though the chewing surfaces (of the back or posterior teeth) constitute only 14% of the tooth surfaces at risk. This demonstrates the vulnerability of the chewing surfaces of the posterior teeth to decay. By placing a protective seal over the areas of teeth at risk, you can effectively and proactively protect your children's teeth.

How long do sealants last?

Research has shown that some sealants can last up to 10 years. However, if you opt for sealants for your children's teeth, we will closely monitor them with each office visit to ensure that they are still doing their job. As needed, we can apply more sealant.

Being unhappy with your smile can impact your life in ways that you might not even realize. Are you awkward in social situations that require smiling? Do you shy away from becoming romantically involved? You may even miss out on a better job because you don't want to be forced to endure a live interview for fear of smiling!

If you've decided that the time is right to regain some self-confidence by having your smile redesigned, we can help. We will begin with a consultation, during which we will discuss a number of factors that will influence the process and the final result of your smile makeover including:

• What do you want from a new smile?
• How do you want your new teeth to look?
• How we can use photographs and computer simulations to show you what your new smile will look like before we even start.
• How we work with dental technicians to test shapes, sizes, and colors to personalize teeth so that they closely match your natural teeth.
• How we use “customized temporary restorations” to let you test-drive the look and feel of the final crowns and veneers so that we can guarantee success.

We can even show you “before and after” photos taken of our many patients throughout the course of their makeovers. And, of course, we will discuss the costs to you with respect to both time and money based on the extent and type of work that is necessary to give you your ideal smile.

The tools that are now at our disposal can make the entire smile redesign process an essentially painless and highly creative collaboration that includes constant interaction between you, us, and dental laboratory technicians as we all work together to create your new smile. If you think you are ready to start exploring the possibilities, please call our office to set up a consultation. To learn more about cosmetic dentistry, read the Dear Doctor magazine article “Cosmetic Dentistry: A Time For Change.”

If you are pleased with your smile except for that one front tooth that appears darker, then we have good news for you. Often a tooth appears darker as a result of trauma that may have occurred years ago. Your tooth may need root canal treatment or may have already had root canal treatment in the past. Regardless, you can whiten this tooth via a process called internal bleaching. And as the name suggests, the tooth can be bleached from the inside out. Here's a brief summary of how this entire process works:

1. Performing an x-ray exam: The first step is to take a radiograph (x-ray) to make sure that your root canal filling is intact adequately sealing the root canal and the surrounding bone is healthy.
2. Making an access hole: To apply the bleaching agent, a small hole will need to be made in the back of your tooth to apply the bleach. However, before doing that, the area must be thoroughly cleaned and irrigated.
3. Sealing above the root canal filling: This step is critical to prevent the bleach from leaking into the root canal space.
4. Applying the bleach: To obtain the whitening needed, it typically requires between one and four office visits for additional bleaching.
5. Applying a permanent restoration: Once your tooth has lightened to the desired color, a permanent filling will be placed over the small hole to seal your tooth's dentin. This is then covered with tooth-colored composite resin (filling material) so that the access hole is undetectable to the naked eye.

To learn more about this procedure and see amazing before and after images, continue reading the Dear Doctor article, “Whitening Traumatized Teeth.” Or, you can contact us to discuss your questions or to schedule an appointment.

Dental crowns are excellent tools that we use to restore functionality, color and/or beauty to teeth and your smile. And while many people may have heard of them, often times there are many questions surrounding the process, costs and their maintenance. This is why we have put together this list of some of the questions we are commonly asked on this subject. Our goal is to provide you with straightforward answers so that you have a clearer understanding of the treatment and are comfortable making the decision to go forward with these excellent tooth restorations should they ever be required.

What Is A Crown?

A dental crown is a tooth-shaped “cap” or cover that a dentist places over a tooth that is badly damaged from trauma or decay in order to restore its color, strength, size and functionality. They are also used for cosmetic reasons to improve discolored or misshapen teeth.

Why Can The Cost Of Crowns Vary?

The reason the cost of a crown can vary greatly, even from dentist to dentist is quite simple. The most beautiful crowns require the artistry and years of experience of a team of dental professionals; your dentist and the laboratory technicians that handcraft crowns. To meet higher expectations of some individuals requires more experience, artistry and skill. And great art just tends to cost more. A customized temporary crown may even be used as a preview to see what a final crown will look like. Another critical factor is the choice of materials used. For example, while all porcelain crowns are made from high-quality ceramic (glass) material, they are not equal. It is therefore more expensive in terms of time, skill and expertise to produce the most natural looking results.

How Long Will A Crown Last?

Most dentists expect a crown to last at least 7-10 years with normal wear and proper maintenance. However, depending on the materials used and location of the tooth, they can last upwards of 50 years or more. For example, a gold crown has the longest lifespan because gold is such a durable material that has little to no negative impact on surrounding teeth. On the other hand, porcelain produces a completely natural look but can cause wear to adjacent teeth.

What Materials Are Most Often Used For Crowns?

The three most common materials used to make crowns are as follows:

• Gold
• Porcelain-Fused-to Metal (PFM)
• All porcelain

To learn more on this topic, read the Dear Doctor article, “Porcelain Crowns & Veneers.” You can also contact us to discuss your questions or to schedule a consultation.

Thinking or knowing you have an impacted wisdom tooth can be alarming news for some people. Unfortunately, one of the main reasons for this feeling is due to the mythology surrounding wisdom teeth...and especially impacted wisdom teeth. While an impacted wisdom tooth can cause intense pain, some people are quite shocked to learn that they even have impacted wisdom teeth, as it is causing no pain at all.

By definition, an impacted wisdom tooth is a third (and last) molar that gets jammed against an adjacent tooth or other important structures such as gum, bone nerves, blood vessels. And having an impacted wisdom tooth does have its consequences — even if you are unaware you have one. The most common issue is gum (periodontal) disease. This is the main reason why it is so important to have a problematic wisdom tooth removed early when you are young and before periodontal disease has started. If left untreated, you risk damaging and/or losing the impacted tooth and adjacent teeth.

The key to managing wisdom teeth is to monitor them closely through thorough routine examinations and x-rays between the ages of 17 and 25, the time when wisdom teeth typically appear. This is so vital because it allows us to predict the way your wisdom teeth will erupt (become visible) or come into proper position with useful biting function. We can use these visits and x-rays to monitor development so that we are best equipped to determine if or when wisdom teeth need to be treated or removed.

It is also important to contact us as soon as you think you may have an impacted wisdom tooth that is causing pain, swelling or even infection. We can put your mind at rest with the facts of what needs to be done after we've completed our exam.

If you feel that you or a family member has an impacted wisdom tooth, contact us today to schedule an appointment to discuss your questions. Or you can learn more now about the symptoms and treatment options of impacted wisdom teeth by continuing to read the Dear Doctor magazine article “Wisdom Teeth.”

If you've lost one or more of your teeth due to tooth decay, trauma, gum disease or a failed root canal, there are a variety of ways that our office can help you to restore your smile and increase your confidence. Crowns, conventional bridges and dentures aren't your only options for replacing missing teeth. Dental implants, surgically placed below the gums, are another alternative for replacing missing teeth.

Getting Started: If you would like to explore the option of having dental implants to replace one or more teeth, you will first need a comprehensive exam. The ideal candidate for implants is in good general and oral health. Adequate bone in your jaw is needed to support an implant. Smokers and those with uncontrolled chronic diseases like diabetes may not be good candidates for dental implants because healing may be impaired or slow. In addition, dental implants aren't appropriate for children or teens until their jaw growth is complete.

The Process: Dental implant surgery can be performed in our office using either a local or general anesthetic. The implants actually replace tooth roots; they are placed into the bone surgically. Generally made of commercially pure titanium, this metal has the remarkable ability to fuse with the bone as it heals forming a union known as osseointegration (“osseo” – bone; “integration” – to fuse with). This process takes two to six months depending upon many factors of which bone quality is the most important.

The next step is to place an abutment (a small connector) which attaches the implant to the crown. The crown is the part of the tooth that is normally seen in the mouth above the gums.

Assessment of your individual situation and deciding if dental implants are right for you takes knowledge and experience. Contact us today to schedule an appointment to discuss any questions you may have regarding dental implants. Read more about this topic in the Dear Doctor magazine article “Dental Implants: Options for Replacing Missing Teeth.”

Wisdom teeth are the third set of molars that erupt in the late teens or early twenties — so-called because they come in around the age of maturity or “wisdom.” While teeth are designed to last a lifetime, wisdom teeth are often problematic requiring early removal because they frequently become impacted, meaning they are not able to erupt fully through the gums to become healthy functioning teeth. However, not all wisdom teeth need to be removed if they are fully erupted and functional.

Prevention: Having a tooth submerged below the gum, pressing on the roots of neighboring teeth can cause damage and decay even though you may not be feeling any discomfort. By the time the tooth becomes painful, significant damage may already have occurred. In addition, the ability of the body to heal following oral surgery tends to decrease with age. A recent study sponsored by the American Association of Oral and Maxillofacial Surgeons and the Oral and Maxillofacial Surgery Foundation strongly recommends that wisdom teeth be removed in young adulthood in order to prevent future problems and to ensure optimal healing.

Reasons for Removal: If your wisdom teeth are impacted against (pressing on) the roots of other teeth, damage can occur. To prevent infections, gum disease, decay, or damage to other permanent teeth, our office may recommend removal of your wisdom teeth.

What to Expect: If wisdom teeth removal is recommended, it can generally be done in the dental office as a surgical procedure with local anesthesia and conscious sedation (twilight sleep). After the surgery, you may experience some moderate discomfort and swelling depending on the degree of impaction and difficulty. Taking non-steroidal anti-inflammatory medication like ibuprofen, or prescription medication for several days after surgery will provide pain relief and control swelling.

Contact us today to schedule an appointment to discuss any questions you may have regarding removal of your wisdom teeth. Read more about this topic in the Dear Doctor magazine article “Wisdom Teeth: To Be Or Not to Be?”

If you are unhappy with your smile or the way some of your teeth appear, porcelain veneers may be the solution to your concerns. They are a fast, effective, and well-proven method for cosmetically enhancing your smile — and a secret that Hollywood and other celebrities have been taking advantage of for years. To help you determine if they are right for you, here are some questions we typically receive.

What is a veneer?

A veneer is a custom made thin “shell” or thin layer of a dental ceramic material (usually porcelain) used to replace the front, visible surface of the tooth. They are artistically and hand-crafted using a precise model of your mouth and teeth to achieve a natural look.

What can they do for me?

Veneers are the optimal choice for correcting small to medium gaps between teeth; slight rotations of teeth causing them to be misaligned; oddly shaped, chipped, or “short” teeth; as well as teeth that are discolored or unevenly colored. However, veneers have their limitations, too. They cannot correct bite issues, poor tooth position, or profile issues. It is also important to note that if you have this procedure, we will typically need to remove a small amount of enamel from your teeth to accommodate the veneer and produce dramatic improvements to your smile.

How long will they last?

While they can vary widely from person to person, porcelain veneers usually last from 7 to 20 years. Factors that impact this timeline include your oral hygiene habits, diet, lifestyle, as well as how well you protect your veneers during sleep and while playing sports.

Have more questions?

Contact us today to discuss your questions or to schedule an appointment. You can also learn more about veneers by reading the Dear Doctor article, “Smile Design Enhanced With Porcelain Veneers.”

A veneer is a cosmetic dental procedure that we use in some situations to correct discolored teeth, small spaces or gaps between teeth, small chips or oddly shaped teeth, and teeth that are slightly misaligned by placing a thin shell covering over the teeth. They are artistically hand-crafted by lab technicians out of tooth-colored porcelain using precise molds that we have made in our office. We attach veneers to the tooth's surface using a special adhesive that creates a chemical bond. Veneers are often a key component in a smile makeover.

Traditional veneers will require some tooth preparation, a process where we reduce or file down some of the facial (front, visible) portion of your tooth by 0.3 to 0.7 millimeters. For this reason this cosmetic procedure is not reversible.

How Long Do They Last?

Veneers can last from 7 to 20+ years depending on how you care for them. This may include sleeping in a protective, professionally made mouthguard. And while porcelain is a durable material that can withstand a great deal of pressure, you must remember that they are a type of glass. You could possibly shatter a veneer if you bite into anything that requires a hefty amount of twisting movement and biting pressure.

By using the latest technologies and procedures, we will create the naturally beautiful smile of your dreams and we will restore your mouth to full functionality and optimal health. Contact us today to discuss your questions or to schedule a consultation.

Want To Learn More?

Learn more about veneers when you continue reading the exclusive article from Dear Doctor, “Smile Design Enhanced With Porcelain Veneers.”

A veneer is a thin layer of dental ceramic tooth-colored restorative material, usually made of porcelain, which replaces some of the tooth's enamel and is physically bonded to it.

You might want to consider porcelain veneers:

10. If your teeth are severely discolored. (For best results we may recommend that your teeth be whitened before veneering them.)
9. If your teeth cannot be evenly whitened or matched by other means.
8. If your teeth are misshapen or worn, you can change their size or shape for optimum aesthetic appeal.
7. If you don't want to have your teeth prepared (drilled), prepless veneers may be an option to change your smile.
6. If you want as little natural tooth structure prepared as possible to improve your smile.
5. If you would like something temporary first to “test-drive” your new smile, then:
4. “Provisional veneers” allow you to try out your new smile and give us feedback before the final permanent veneers are placed.
3. If you want to improve your smile for just one tooth or even multiple teeth.
2. If you want long-lasting restorations — veneers can last from seven to twenty years or more.

And the top reason is:

1. Porcelain laminate veneers are among the most aesthetic ways to create a more beautiful, yet normal, looking smile.

Tell us what you want to change about your current smile, and we can tell you whether veneers are right for you. Contact us today to schedule an appointment or to discuss your questions about cosmetic dentistry. You can learn more by reading about porcelain veneers in Dear Doctor magazine.

Your smile is one of the first things people notice, but if your pearly whites have lost their luster, chances are you might be hesitant to show them. As we age, our teeth naturally darken, and certain substances can leave teeth stained or discolored, making you appear older. One easy way to turn back the clock is to have your teeth whitened; a safe, painless, and non-invasive way of achieving a young, healthy-looking smile.

Causes of Tooth Discoloration: Exposure to high-levels of fluoride and taking tetracycline antibiotics during childhood can stain the teeth's structure. Smoking cigarettes and using chewing tobacco can also cause tooth discoloration, as well as foods containing tannins such as red wine, coffee and tea. In addition, poor brushing techniques and not flossing regularly cause bacteria to build on teeth resulting in yellow stains.

The Whitening Process: Our office can help you to achieve a brighter smile using either an in-office procedure or an at-home whitening kit. We can help determine the best treatment for your budget, time frame and individual needs. If you choose to have professional whitening done in our office, we will utilize a prescription strength gel sometimes even activated by a concentrated light source. This procedure offers immediate and long-lasting results in less than an hour. After a single treatment, teeth are typically six to ten shades lighter and with proper maintenance, can last five years or longer.

At-Home Results: For those seeking more gradual results, another option is to use custom-fit trays, which our office will make for you to use at home to whiten your teeth. This is generally less expensive, and is very effective at lightening teeth several shades, although it may take a week or longer to see optimal results.

Choosing the Best Procedure: For some people, teeth whitening may not offer adequate results. If you have thin enamel, chipped, uneven or crooked teeth, we may recommend applying porcelain veneers to restore your damaged teeth. Veneers are bonded to the front of teeth to give your smile a straighter, more uniform appearance.

Contact us today to schedule an appointment to discuss any questions you may have regarding teeth whitening. Read more about this topic in the Dear Doctor magazine article “Teeth Whitening: Brighter, Lighter, Whiter.”

Of all the of amazing procedures in today's dentistry, surgery that causes new bone to grow — in places where it had previously been lost — is high on the list of the most extraordinary. (When bone is lost or resorbed, it is broken down into its mineral components, which are dissolved into the bloodstream. Resorption of tooth-supporting bone often takes place after teeth are lost.) Dental techniques that cause new bone growth are important because a certain amount of bone is needed to replace lost teeth with dental implants.

Today's dental implants themselves are an amazing innovation. Implants consist of a replacement for the tooth's root, usually made of a metal called titanium. A replacement for the crown, the part of the tooth that is visible above the gums, is attached to the titanium root. Titanium has the remarkable quality of being able to fuse with the bone in which it is anchored. This process, first discovered in the 1950s, is called osseointegration.

In the case of missing upper back teeth, many people who wanted dental implants in the past were told that they did not have enough bone to anchor the implants and that they had to get removable dentures instead.

But now a new surgery called maxillary sinus augmentation can cause your body to regenerate bone where it was lost and is needed to anchor dental implants.

Bone in the upper jaw or maxilla usually supports your upper back teeth. Inside the maxilla, on either side of your upper jaw, are air spaces in the bone, which are lined with a membrane. These spaces, called the maxillary sinuses, are generally shaped like pyramids; but their shape and size is different in each person. The new surgical procedures involve lifting up the sinus membrane in the area where bone is needed and filling the space thus created with a bone grafting material. Your body then creates new bone to fill the space. This usually takes about six months. If you have almost enough bone to stabilize the implants, they can be placed simultaneously with the graft, thus saving time and avoiding a second surgical procedure.

All grafting materials used today are approved by the Food and Drug Administration (FDA) and must be prepared according to their guidelines. They are specially treated to render them completely safe for human use.

After the surgery there is usually no more than mild to moderate swelling and some discomfort, about the same as having a tooth removed.

If you are missing upper back teeth, contact us to schedule an appointment to evaluate your upper jaw. You can also learn more about this procedure by reading the Dear Doctor magazine article “Sinus Surgery.”

The embarrassment of having discolored and/or stained teeth can be monumental and negatively impact your love life, work career, interactions with others, on top of undermining your self-esteem. And it is this reality that urges many people to wonder what teeth whitening could do for their specific needs. However, before obtaining any “fix,” you really should get an understanding of what causes staining of your teeth. This important step will enable you to make the necessary lifestyle and behavioral changes to prevent future issues.

For example, letting us know which of the following common causes for staining teeth apply to you can be an excellent first step towards building an optimal action plan for brightening your smile.

Which of the following questions about discolored teeth apply to you?

• Staining from tobacco use?
• Staining from coffee, tea and/or wine?
• Your teeth have become progressively discolored and yellow with age?
• Staining from red (tomato-based) sauces, sodas/colas and blueberries among other things?
• Other family members have stained teeth so it seems to be genetic?
• Staining from medications such as the antibiotic tetracycline given as a child?

Your honest responses to the above, along with your medical history will enable us to formulate the appropriate therapy for brightening your smile. And for most people this includes bleaching, an inexpensive yet effective method for whitening teeth. It is most often accomplished using a gel that is between 15% and 35% carbamide peroxide, a type of hydrogen peroxide. Years of research have proven that this whitening agent does not damage tooth enamel or the nerves inside the teeth. The only side effect that some people experience is slight tooth sensitivity and irritation of the gum tissues. However, they both are usually temporary, often occuring when you first start bleaching and generally subside after a few days. You can learn more when you continue reading the Dear Doctor article, “Tooth Staining.” Or, you can contact us to discuss your questions or to schedule an appointment.

Your self-image has a lot to do with how you feel about your appearance — and particularly your smile. If you are unhappy with the way you look, cosmetic dentistry may be the answer to your problems.

1. What do we mean by cosmetic dentistry? The word “cosmetic” refers to beneficial changes in appearance. Thus cosmetic dentistry is all dental work that restores or improves a person's appearance.
2. What is a cosmetic dentist? Every dentist learns to do procedures in a way that conserves or improves a patient's appearance. Some dentists continue to study and specialize in procedures that are done specifically for the purpose of enhancing a person's appearance.
3. What is a smile analysis? The first step to improving your smile, this analysis involves a study of all the elements of your smile — teeth appearance and alignment, gums, jaws — and also your facial features and how they all fit together.
4. How can I choose the right cosmetic dentist? Ask your dentist about his or her training and experience. Ask for photos of previous work. You may need to select more than one person, working as a team to take best advantage of each one's experience, skills, and training.
5. What can be done to improve a smile using 21st century techniques? We are fortunate to live in times in which numerous options are available. These include making teeth whiter; altering their size, shape, balance, color, and alignment; filling in parts of teeth that are missing because of decay or injury; and even replacing teeth that are missing entirely.
6. How can chipped or discolored front teeth be restored? This can often be done by bonding with composite resin.
7. How can damaged back teeth be restored? Back teeth with cavities or traumatic injuries can now be repaired with non-metallic tooth-colored material that bonds to the tooth substance.
8. What techniques can be used to correct more severe problems? Porcelain veneers, thin layers of porcelain material, can be used to change the appearance of misshapen or undersized teeth. Porcelain crowns can be used to replace the part of the tooth that rises above the gums.
9. How can we change the position of teeth that do not meet together well? Orthodontists are dentists who specialize in correcting malocclusions (bad bites). They use traditional braces or clear aligners to move teeth into more attractive and functional positions.
10. What if some teeth are missing? A dental implant replaces the root of a missing tooth. A porcelain crown that looks just like a natural tooth can then be connected to the implant.

Contact us today to schedule an appointment to discuss your questions about cosmetic dentistry. You can also learn more by reading the Dear Doctor magazine article “Cosmetic Dentistry: A time for change.”

Designing a better smile sometimes requires a change in the size, shape, or color of your teeth. Porcelain laminate veneers (thin layers of dental ceramic material) enhance your appearance by replacing the natural enamel on the outside of your teeth. A veneer is physically bonded to the surface of a tooth, in essence, becoming part of it.

Traditionally, a small amount of the natural tooth enamel is drilled away to allow room for the veneer. But today, in some circumstances, it is possible to use an approach where enamel reduction or preparation is not necessary because the veneers can be bonded directly onto the tooth's natural surface. These are called “Prepless” or “No-prep” veneers, and are used to create aesthetically pleasing and natural looking restorations. An advantage of the prepless procedure is that the process is reversible so that you can give your new smile a “test drive.”

You may be a good subject for Prepless veneers if:

• Your smile is narrow because the teeth in the sides of your smile are positioned inward and do not show from a frontal view.
• There is spacing between your teeth, and the teeth appear too small.
• You have a fairly common genetic condition in which one or both of the teeth directly next to the two upper front teeth are very small and peg-shaped.
• There is an imbalance between the size of your lips and teeth (large lips and small teeth), which are not in proportion to show off your best smile.

Prepless veneers are probably not for you if:

• Your teeth are not aligned properly in your bite.
• Your teeth are very crowded, resulting in poor facial profile.
• Your teeth are already relatively large or positioned forward.

In these cases you may need to have some form of orthodontic treatment to move your teeth into better position. Sometimes veneers can be used to create an illusion of proper tooth alignment, but some amount of tooth reduction may be required.

We can assess whether prepless veneers are right for you. There is no substitute for an expert dentist's talent and expertise with the various cosmetic techniques available today. These skills combined with a thorough diagnostic evaluation, and a clear understanding of your goals, are the keys to providing you with a successful and beautiful smile.

Contact us today to schedule an appointment or to discuss your questions about cosmetic dentistry. You can also learn more about prepless veneers by reading the Dear Doctor magazine article “Porcelain Veneers Without the Drill.”

Three quarters of people surveyed have admitted to having some fear about going to the dentist. About 10% to 15% are so afraid that they never go. Because they put off checkups and treatment they end up with toothaches, infections, and even lost teeth.

You should know that even those who are most afraid of the dentist can learn to reduce their fear and have dental treatment in comfort.

How does fear of the dentist get started?
Fear is learned behavior. People may learn it from stories they have heard from their parents or others, or they may learn it first hand by having a bad dental experience. Once the fear is planted, they avoid going to the dentist, so there is no way for them to learn that a visit can be a positive experience.

If you are among those who fear going to the dentist, the fearful feelings you have can be enough to reinforce themselves. Sweaty palms, rapid heartbeat, and a queasy stomach are not pleasant, and if you experience such feelings they may be your main memories after an appointment, even if the visit was not frightening in itself.

Dental fear can be a subconscious automatic response. This means that you can't control it and make it go away. But there are things you can do to reduce your fear and feel comfortable during your appointment.

Move slowly and get help to conquer your fears.
You need to have new, positive experiences to counteract the bad experiences you had in the past. Realize that you are not alone, many people share this fear. Then talk about your fears with our office. We will start by doing things that cause only mild or no anxiety. You want each visit to be a good experience, so you are able to leave our office with a feeling that this was okay, and you can do it again. It may take a while to train yourself to get over your fears, but we have helped many people accomplish this — and you can, too.

Contact us today to schedule an appointment to discuss your questions about any fears you may have. You can also learn more by reading the Dear Doctor magazine article “Overcoming Dental Fear & Anxiety.”

Having a whiter, brighter smile can do wonders for improving self-confidence, career opportunities, and interpersonal relationships, as demonstrated in numerous scientific studies. In fact, according to a poll conducted on behalf of the American Academy of Cosmetic Dentistry (AACD), the following was revealed:

• 99.7% of Americans believe a smile is an important social asset.
• 74% feel an unattractive smile can hurt chances for career success.
• 50% of all people polled were unsatisfied with their smile.

These statistics demonstrate why you should have a solid understanding about any cosmetic procedure — even teeth whitening — before making your decision to proceed. To help you ensure that you have the facts, we created the following list of questions.

• Am I a good candidate for tooth whitening?
• How much will the entire process cost?
• Does my insurance cover the cost (or any portion of the cost)?
• How does teeth whitening work?
• Is bleaching teeth safe?
• Will the bleaching agents damage tooth enamel?
• Can whitening treatments make my teeth sensitive?
• How does your professional bleaching differ from home whitening?
• What type of bleach and strength will you use?
• How long can I expect the results to last?
• What will the bleach do to my gums, filings, crowns, veneers, and/or bridgework?

Please note that we may cover most or all of these questions during your initial consultation; however, we encourage you to bring this list with you to ensure you get the answers you need so that you can make the best decision. To learn more now, continue reading the Dear Doctor article, “Teeth Whitening: Brighter, Lighter, Whiter....” Or, you can contact us to discuss your questions or to schedule an appointment.

“Impacted wisdom teeth.” The term alone sounds ominous. What are wisdom teeth, why do they become impacted, what is the best way to treat them? These are questions people often ask.

What are “wisdom teeth” anyway?
Your third molars, located in the very back of your jaws, are your wisdom teeth. Most people have four of them.

Why is their name associated with wisdom?
They usually begin to come in when a person is 17 to 25 years old, a time when he or she can be said to begin to reach an age of wisdom.

Doesn't everyone get wisdom teeth?
While some people have more than four, others have fewer, and some have no wisdom teeth at all. Some people have wisdom teeth that can be seen in x-rays but do not erupt (grow up through their gums) and become visible.

What does “impacted” mean?
In normal usage, the term “impact” means “influence or effect.” In dental vocabulary, it means that a tooth is affecting another tooth or a nearby structure such as gums, nerves or blood vessels. Often an impacted wisdom tooth grows sideways into an adjacent tooth instead of growing upwards to come through the gums normally. This may be caused by a lack of room in your jaw for your third molars.

What kinds of problems can impacted wisdom teeth cause?
A wisdom tooth can impact the gum tissues surrounding nearby molars, leading to infection called “periodontal disease” (from the root words for “around” and “tooth.”) They can also cause root resorption in adjacent teeth, a process by which the tooth’s roots are slowly dissolved and eaten away.

What are the symptoms of impacted wisdom teeth?
Sometimes impacted teeth are asymptomatic — you feel nothing, even though damage is being done to gums and teeth surrounding the wisdom teeth. That's why it's a good idea to have regular checkups even if you are feeling no pain. Other times, impacted teeth can lead to acute inflammation and infection in surrounding gum tissues that is very painful.

Should I proactively have my wisdom teeth removed if they are not giving me any trouble?
Not necessarily but your wisdom teeth need to be evaluated. Generally speaking, however, it's better to remove wisdom teeth early, before they begin to cause dental problems. By the time a wisdom tooth starts to hurt, its neighboring teeth may already be in big trouble. In addition, younger people's wisdom teeth have undeveloped roots that make them easier to remove with fewer complications.

Contact our office for a full assessment and consultation about your wisdom teeth. You can also learn more by reading the Dear Doctor magazine article “Wisdom Teeth: To Be Or Not To Be?”

If you are dissatisfied with the way your smile looks, and your dentist is unhappy with the way your teeth fit together — but you don't like the idea of wearing braces — clear aligners may be your best solution. How much do you know about this teeth-straightening alternative? Below are some FAQs on the subject.

What do we mean by clear aligners? Clear aligners are a system for straightening teeth that uses clear plastic removable “trays” that fit over your teeth. As the teeth move to fit the trays, new trays are substituted that are designed to continue to move your teeth into the desired position. This system is an alternative to the traditional system of brackets and wires known as braces.

How can teeth be moved to new positions? The connection that holds a tooth in place in your jaws — the periodontal ligament — is not immobile. It constantly changes its position based on the normal forces of your bite. As the ligament is pushed on one side and pulled on the other, the living cells of your mouth respond by depositing bone and cementum (the protective covering of the tooth's root) on one side and dissolving it on the other. Normally this happens in a balance, maintaining your teeth in their position. We can manage these slight changes by applying constant light forces to move teeth in a predictable way.

How long does it take to move teeth to their optimum position using clear aligners? As with braces, the process is gradual. Total treatment time can range from six months to two years.

Do the trays have to be worn all the time? As you move through the sequence of trays, each is worn for 20 hours per day for two weeks. They may occasionally be removed for important social occasions.

How does an orthodontist design the sequential trays that are used? The trays are designed using a computer, based on an assessment and images of your mouth, teeth and jaws.

What kinds of problems can clear aligners correct? This method works well to correct mild to moderate crowding or spacing. If your back teeth already fit together as they should, the system may be ideal. If you have an extreme overbite or underbite, braces might work better.

Are clear aligners an alternative for everyone? Clear aligners are recommended for adults and recently, teenagers. They are not usually recommended for young children.

Why is it important to have your teeth straightened? Besides the obvious benefit of feeling better about yourself and your appearance, straight and well-aligned teeth work better. You will experience a better-functioning bite and can improve your oral health.

Contact us today to schedule an appointment to discuss your questions about orthodontics and clear aligners. You can also learn more by reading the Dear Doctor magazine articles “Clear Orthodontic Aligners” and “Moving Teeth With Orthodontics.”

If you have discolored teeth, the cause is often staining on the enamel surfaces from foods, beverages, or smoking. But tooth discoloration may also originate deep within the root of a tooth. Sometimes this happens to a tooth that had to have earlier root canal treatment because of injury or decay.

In such cases the living pulp tissue and its blood vessels and nerves had to be removed from the root canals, resulting in the death of the dentin layer, which makes up most of the tooth's body. Over time this caused the dentin to darken. The color may come from remains of blood that was left in the tissue, or from filling materials left in the root canal that are showing through.

Since these stains are caused internally (intrinsic) and not on the outside of the tooth (extrinsic) they must be whitened from the inside. This is usually done by putting a bleaching agent into the empty chamber from which the pulp was removed. Usually the bleaching agent is a substance called sodium perborate.

When it is mixed with a solution of hydrogen peroxide, sodium perborate slowly bleaches the color from the tooth's internal material. It is considered to be safe and reliable for this use.

The work begins by taking x-ray images to make sure that the root canal is correctly sealed and the bone is healthy. After this, we will make a small hole in the back of the tooth through which the root canal space will be cleaned. The root canal space will be sealed and the bleach will be applied in a putty-like form and sealed off from the rest of your mouth. Every few days this procedure will be repeated until the bleaching reaches the desired level.

At this point a tooth-colored composite resin will be used to seal the small hole that was made in the dentin to insert the bleach. After the tooth has reached the level of whiteness that matches it to your other teeth, veneers or crowns must sometimes be used to repair the surface if it is chipped or misshapen, for example.

Contact us today to schedule an appointment to discuss your questions about whitening internally discolored teeth. You can also learn more by reading the Dear Doctor magazine article “Whitening Traumatized Teeth.”

Dentists often recommend bone grafting to ensure the success of dental implants. And it is likewise common for people to squirm a bit at the thought. Bone graft? That sounds serious. And maybe a bit, well, unappealing. These feelings are completely understandable. After all, this may be something you've never had to consider before. But there's no reason to worry. Here’s why:

1. Bone grafting is not new or experimental. It is actually a very routine part of the implant process, as well as other types of oral and periodontal surgery. And it is very successful when performed by an experienced doctor.
2. Bone grafting materials are processed for safety. The grafts used — whether synthetic or from a natural source, such as cow or human bone — have been specially treated for medical use.
3. Only a small amount of this bone-grafting material is needed. Once placed in the site of the missing tooth, it serves as a helpful scaffold your body uses to build more of its own bone in that spot.
4. Your implant will be more ideally positioned and may work better. It needs a good, strong foundation with which to fuse. But when teeth are lost, this supporting bone is often lost, too. This loss is often unpredictable and bone grafting limits the change that occurs. In fact that's one of the main benefits of replacing missing teeth with implants: they help prevent bone loss just as a natural tooth does.
5. Your implant will look so much better! Think about it: Your original tooth was supported to a certain height by the underlying bone. If that bone is now gone, the replacement tooth is going to be much longer because of the missing bone height. It may not look quite right without that additional support.

So if you want the best-looking and best-functioning implant possible, have no fear of bone grafting. And please contact us to discuss any of your concerns, or schedule an appointment for an implant consultation.

You can read more about this topic in the Dear Doctor magazine article “Can Dentists Rebuild Bone?”

Unfortunately, going to the dentist may still be a fear and anxiety provoking experience for some people even with modern dental techniques — an interesting phenomenon given the fact that no one is born with fear. It is either a learned response based on personal experience or one that is literally imagined based upon hearing of another's treatment. However, regardless of how it develops, a person's perception is their reality. The good news is that we are here to both listen and to offer our patients the benefits of oral sedation (sedation dentistry) that allows relaxation of mind and body. Thus you can focus on feeling peaceful rather than anxious.

While research has shown that 75% of all people surveyed have at least a little fear about going to the dentist, 10-15% have a great deal of fear. In fact, some of these people experience so much fear that they will cancel dental appointments or never schedule in the first place. If the latter describes your feelings, we encourage you to ask us about sedation or comfortable dentistry so that you can receive the oral healthcare you need and deserve to maintain optimal dental health.

And this good news gets even better when you understand that oral sedation does not even involve injections (shots)! We typically administer oral sedation in one of two methods: by giving you a pill to swallow whole or by giving you a tablet to place under your tongue (sub-lingually) where it dissolves. Once the prescription medication takes effect, you will remain awake and aware of your surroundings; however, the medication will help you transition from feeling nervous to a more comfortable state of being. Most of our patients describe their experience as “comfortable” or “relaxation” dentistry due to how they feel during their treatment. Simply put, the anti-anxiety (anxiolytic) medication almost literally dissolves away your fears.

Want to learn more?

Contact us today to discuss your questions or to schedule an appointment. You can also learn more by reading the article “Overcoming Dental Fear & Anxiety.”

If you have a tooth that just doesn't look good because of decay or injury, a porcelain laminate veneer is probably a good way to make it look as good as it ever did — and maybe even better! Dental veneers are composed of thin layers of dental ceramic material. They essentially replace the original tooth enamel and require preparation of the tooth by removing a small amount of enamel to allow room for the placement of the veneer.

Recently, more and more dentists have been using minimal prep or prepless techniques that do not require this preparation. In such cases, the porcelain is bonded directly to the outer layer of the tooth's enamel. Highly skilled dental technicians can design a custom-fit veneer that feathers into the tooth just short of the gum line.

Prepless techniques cannot be used in all situations, but when they are used appropriately the results are beautiful and very stable. Should you get prepless veneers? The following is a list of advantages and disadvantages of prepless veneers.

Advantages of prepless veneers include:

• Tooth preparation or reduction is not needed, leaving the original tooth whole.
• They are not placed under the gum tissue, eliminating the possibility that the restorations negatively impact the gum tissue.
• They can be used to change the appearance of teeth that are too small or misshapen making the teeth look larger and eliminate unwanted spacing.
• They can be used to “lengthen” teeth that have been worn down by grinding.
• Since the underlying tooth has not been reduced, prepless veneers are reversible and practically risk-free.

Disadvantages include:

• There are many cosmetic situations in which they cannot be used, and traditional veneers (requiring preparation) must be used instead.
• Prepless veneers cannot be used in cases in which orthodontic treatment is recommended to move the teeth, such as improper tooth position, poor bite, or a poor facial profile.
• Since they are added on to existing tooth structure, they do not work for teeth that are relatively large or in a forward position in a smile.
• They do not usually work for lower teeth because of space restrictions.
• They cannot replace lost or damaged enamel.

Working with prepless veneers requires special skills and training. Please discuss our credentials and experience with us when you inquire about this technique. We can assess your specific situation and let you know whether restoration without the drill is appropriate for you.

Contact us today to schedule an appointment to discuss your questions about prepless veneers. You can also learn more by reading the Dear Doctor magazine article “Porcelain Veneers Without the Drill.”

Most people think of bone as rock-solid, but it's actually a living tissue that's constantly changing. This has significant implications for your oral health, general health, and appearance — if you are one of the 70% of Americans missing at least one tooth.

Throughout the day, your top and bottom teeth make hundreds of fleeting contacts with each other. These small stresses are transmitted though the periodontal ligament (“peri” – around; “odont” – tooth) that supports each tooth in its socket like a hammock. Think of it as a gentle push on the hammock, which causes the tooth to gently bump the underlying bone. The bone then builds up in the spot that's receiving stress to counteract it. This constant remodeling of bone is what allows bone to stay healthy and strong.

When a tooth is lost, the bone does not receive that gentle stress. It reacts by literally melting away. Sometimes this happens fairly quickly — in a matter of months. After the tooth-supporting bone is lost, the jawbone itself begins the same process of deterioration. This could eventually change the shape of the face, as the distance from nose to chin can decrease — even if only a few back teeth are missing. The results aren't pretty. But the good news is, there's a way to prevent all this.

Dental implants, which function as substitute tooth roots, actually save underlying bone when teeth are lost. They do this because they are made of titanium, which fuses to the bone in which it's set, stabilizing it. The implant is topped by a realistic-looking crown, which replaces the part of the missing tooth that was visible in the mouth. Together, they look and function just as your natural tooth did.

If you are missing a lot of teeth, implants can also be used to anchor bridges or even removable dentures while providing that same bone-saving benefit. And when you consider that they are so durable they should never need replacement, implants are a great investment.

If you have any questions about dental implants, please contact us, or schedule an appointment for an implant consultation.

You can read more about this topic in the Dear Doctor magazine article “The Hidden Consequences of Losing Teeth.”

Projecting a healthy, radiant smile can help boost self-confidence and lead to increased comfort and success in both personal and career-oriented situations. Yet, many people are unhappy with their less-than-pearly whites, causing them to avoid social interaction and even lose out on opportunities because they are too self-conscious.

Your dissatisfaction with the appearance of your teeth may also be causing you to stifle one of nature's most endearing and intrinsic impulses, simply smiling!

For example, do you:

• Avoid posing for pictures that require a smile?
• Cover your mouth when speaking or laughing in public?
• Avoid dating because you feel unattractive?
• Feel that people think less of you because your smile is flawed?
• Think your smile makes you look older than you are?

If you've answered yes to any of these questions, you are certainly not alone. A poll conducted by the American Academy of Cosmetic Dentistry found that, while a whopping 99.7% of respondents said they considered a good smile to be a highly important social asset, only 50% of those same respondents indicated that they were satisfied with their own smile. In addition, the Academy reported that people between the ages of 31 and 50 are most unhappy with their smile, are most concerned with making a good first impression through a strong smile, and most frequently seek out information on cosmetic dentistry.

The good news is that advances in cosmetic enhancement and restorative dentistry, including treatments like teeth whitening and the application of porcelain veneers to correct tooth crowding, make it possible for anyone to enhance or improve their smile and boost their self-image. And a complete “Smile Makeover” has been shown to positively impact the perception that others have with respect to attractiveness, popularity, and even wealth — all based on the quality of a person's smile.

Our office can work with you to determine just what it will take to improve your smile and self confidence from as little as a minor enhancement to a complete smile makeover — anything that would best match your idea of the perfect smile. To get started, give us a call.

To read about others who have regained their confidence after brightening and whitening their smiles through cosmetic dentistry, read the Dear Doctor magazine article “The Impact of a Smile Makeover.”

When asked about her dazzling white smile, Cat Cora, the first female iron chef on the hit television series Iron Chef America, freely admits to maintaining the brightness of her smile with professional whitening sessions.

“With what I do, whitening your teeth is like getting your hair done, your nails done and everything else you have to do to be on television,” Cat recently told Dear Doctor magazine. However, she does have her limits. “I want my teeth to be white and healthy looking — but not stark white or looking like they could glow in the dark,” she said with a laugh.

Cat's perceptions and experiences with tooth whitening may accurately describe Hollywood, but through the power of media, celebrities and their respective fan bases, having attractive white teeth has become a goal for most people. This is because white teeth are subconsciously associated with youth and virility.

Here in the dental office, we can use professional-strength “power bleaching” to whiten teeth several shades in a single visit. To prevent irritation to the area surrounding the teeth being treated, we isolate the gums and skin of the mouth with a protective gel or a rubber barrier known as a dental dam. After the whitening solution is placed on the teeth, the process may be supplemented by heat or a light source to activate or enhance peroxide release.

For bleaching teeth at home, our office can make custom-fitted bleaching trays that you fill with a gel form of carbamide peroxide. Sometimes this whitening gel can cause a temporary tooth sensitivity to hot and cold, but this normally lasts for no more than four days after you stop bleaching your teeth.

To learn more about tooth whitening, you can continue reading the Dear Doctor magazine article “Teeth Whitening.” Or you can contact us today to schedule an appointment so that we can conduct a thorough examination and discuss what treatment options will be best for you. And to read the entire interview with Cat Cora, please see the article “Cat Cora.”

Fracturing back molars is an experience no one ever wants to have. But when a helicopter crashed during a back country ski trip, supermodel Christie Brinkley soon discovered that she had fractured two molars. Fortunately for Christie, her oral health was restored with two dental implants. As she said during an interview with Dear Doctor magazine, “I am grateful for the dental implant technology that feels and looks so natural.”

While Christie's dental implants replaced back teeth, we routinely use them to replace both back and the more visible front teeth. But best of all, we have demonstrated expertise at making dental implant crowns look real. This is where we meld science and artistry.

What drives the most natural and beautiful result is how the crown (the visible, white portion of a tooth) actually emerges through the gum tissues. We also match the adjacent teeth identically in color, appearance, shape and profile. But we can't take all the credit, as it takes an entire “behind-the-scenes” team to produce dazzling results. Choice of materials, the laboratory technician (the person who actually handcrafts the tooth), the expertise we use in placing a dental implant crown and the total quality of care we provide are the ingredients necessary for success.

Another critical factor required is ensuring there is enough bone volume and gum tissue to support an implant. Both of these must also be in the right position to anchor an implant. However, if you do not have adequate bone volume, you may be a candidate for a minor surgical procedure to increase your bone volume through bone grafting or other regenerative surgical techniques.

To learn more about dental implants, continue reading the Dear Doctor magazine article “Matching Teeth & Implants.” Or you can contact us today to schedule an appointment so that we can conduct a thorough examination, listen to your concerns, answer your questions and discuss treatment options. And if you want to read the entire feature article on Christie Brinkley, continue reading “The Secret Behind Christie Brinkley's Supermodel Smile.”

Test yourself on your knowledge of this dental procedure.

1. A root canal is
1. A canal shaped structure in the root of your tooth
2. A blood vessel carrying blood from your gum to your tooth
3. An instrument used by your dentist in performing dental surgery
2. Which of these are symptoms of root canal infection?
1. Sharp, acute and intense pain, which is difficult to pinpoint
2. Sharp pain when biting down on your tooth or on food
3. Lingering pain after eating hot or cold foods
4. Dull ache and pressure
5. Tenderness (accompanied by swelling) in the nearby gums
6. All the above
3. If you don't feel any pain you do not have a root canal infection.
1. True
2. False
4. Root canal treatment is a very painful experience.
1. True
2. False
5. Root canal treatment is called endodontic therapy. What does this word mean?
1. Bringing the end of your problems
2. Inside your tooth
3. Fighting gum disease
6. You need root canal treatment if
1. The inside or pulp of your tooth becomes inflamed or infected
2. Your tooth needs to be gently moved in order to correct your bite
3. Acid erosion is damaging your tooth
7. During root canal treatment the canals in your teeth are cleaned out and sealed off.
1. True
2. False
8. Who is qualified to perform root canal treatment?
1. General dentists
2. Endodontists
3. Both of the above

1. a. A root canal is a canal shaped space within the root of a tooth that holds the tooth's pulp — which contains the tooth's nerves and blood vessels.
2. f. — all of the above
3. False. It is possible to have an infection that has stopped hurting but is still present and causing damage.
4. False. Root canal treatment doesn't cause pain, it relieves it.
5. b. The word comes from roots meaning “inside” and “tooth.”
6. a.
7. True. A small opening is made in the chewing surface of your tooth to gain access to the pulp. Dead and dying tissue is removed and the pulp is cleaned and disinfected. The canals are shaped and then sealed with filling materials to prevent future infection.
8. c. All general dentists have received training in endodontic treatment and can perform most endodontic procedures. They often refer people needing complicated root canal treatment to endodontists, who have had specialized training in endodontic diagnosis and treatment.

If you cringe at the appearance of your less than pearly whites when you look in the mirror, you are not alone. A frequently requested cosmetic procedure, teeth whitening is a very successful and relatively inexpensive way to enhance your smile. We can determine which whitening treatment will work best for you after performing a basic oral examination in our office. When will it work and when won't it? Here's some background:

Teeth most commonly become stained or discolored due to surface (extrinsic) changes, the most common of which are dietary and smoking. Foods including red wine, coffee, and tea can cause extrinsic staining. Teeth can also commonly become discolored or stained due to intrinsic (internal) reasons, such as changes in the structure of enamel or dentin or by incorporation of chromogenic (color generating) material into tooth tissue during formation or after eruption.

1. Toothpastes that claim to whiten teeth are only effective in removing plaque and other surface stains. Although most of these products contain mild abrasives that remove the plaque, they aren't capable of changing the underlying color of stained teeth.
2. Tooth polishing by your dentist or dental hygienist is effective in removing superficial staining, but will not change tooth color.
3. Teeth whitening systems work by bleaching, generally with the use of hydrogen peroxide. Using bleaching gels in custom made trays or whitening strips can be done at home, but is slow and the changes are gradual. We can perform quicker and more effective “power bleaching” in our dental office when precautions can be taken to ensure safety due to the higher concentrations of bleaching gels used. Teeth with intrinsic (internal) staining may need internal bleaching to whiten them and this can only be done in the dental office.
4. Teeth whitening results fade over time, but optimally last from six months to two years. Taking care of your newly whitened teeth by avoiding the foods, beverages, and habits that cause staining will help them remain whiter for longer.
5. If you have had previous cosmetic dentistry performed, including the placement of composite restorations, porcelain veneers, or crowns, teeth whitening may not be for you. Bleaching agents have little to no effect at all on the materials used to create these restorative products.

If you would like to discuss whitening your teeth with us, call today to make an appointment. To learn more about the various teeth whitening procedures, read the Dear Doctor magazine article “Teeth Whitening: Brighter, Lighter, Whiter…”

Some of the most popular smile enhancers on the market today are both over-the-counter (OTC) and professional teeth whitening products. And while studies indicate that bleaching can successfully achieve noticeable increases in whitening of stained teeth, there are some facts you need to know about these products and the results that they can deliver.

• Nearly all bleaching products contain the same basic ingredient, carbamide peroxide or its breakdown product, hydrogen peroxide. However, the products our office uses to professionally whiten your teeth are much stronger without compromising the health and safety of your teeth, gums, and mouth.
• OTC bleaches typically contain no more that 10% carbamide peroxide while professional bleaches can contain between 15% and 35%. And to make professional bleaching even more effective, we may use them in combination with specialized lights or lasers.
• Bleaching is NOT a permanent solution and thus results will diminish over time. The “fade rate” begins to occur 6 to 12 months after treatment.
• While you can't avoid the fading process, you can extend your bleaching results by avoiding foods and drinks that stain your teeth, such as red wine, red (tomato-based) sauces, coffee, tea, sodas/colas, and blueberries to name a few.
• Another method for extending your results is to use a straw when drinking beverages that can stain your teeth so that the liquid does not come in contact with your teeth.
• If you have visible crowns and/or veneers mixed with your natural front teeth, it may be quite difficult for you to bleach your natural teeth so that they perfectly match your veneers or crowns. Remember, tooth whitening is not effective on crowns, veneers, bridgework, or any type of artificial tooth.
• One of the most common side effects of whitening teeth is tooth sensitivity and irritation of the gum tissues. They both are usually temporary and often occur when you start bleaching; however, they generally subside after a few days.

Overall, bleaching your teeth is an effective way to brighten your smile with minimal side effects. If it is something you are interested in pursuing, talk it over with us first — even if you plan to use OTC products — so that you have a clear understanding about your specific options and projected outcomes. Or, learn more by reading the Dear Doctor article, “Teeth Whitening: Brighter, Lighter, Whiter....”

“Smile, and the world smiles with you,” the old saying goes. For people who are afraid to smile because they don't like how their smile looks, the twenty-first century offers a myriad of solutions. Smiling shows your teeth in their various shapes, colors, and sizes, your gums and gum line, your tooth alignment, spacing, and bite all in relation to the rest of your face. Any of these can now be improved.

Through the knowledge, skills, and combined experience of our dental team, it is now possible to make teeth whiter, brighter, and more evenly aligned, to alter tooth shape and size, and to make the teeth and gum line more proportionally balanced. Here are some options for cosmetic dentistry:

• Polish. Remove unwanted stains on outside tooth surfaces by having your teeth polished.
• Teeth Whitening. If teeth are stained or have just lost their luster, whitening is a safe and effective way to lighten a smile.
• Porcelain veneers. Applying a thin layer of dental porcelain restorative material to replace stained or damaged tooth enamel can truly change a smile.
• Porcelain crowns. If teeth are damaged by decay or trauma, porcelain crowns can replace the parts of the teeth that show above the gum line.
• Orthodontics. For teeth that are not in their correct and functional position, a variety of orthodontic techniques can be used including traditional braces, clear aligners and more—to improve crooked teeth or a malaligned bite.
• Dental implants. Nothing ruins a smile more than missing teeth. Entire teeth can be replaced, including the roots and the crowns, using dental implants. These are exact replicas of the natural teeth and can be made to match their neighbors exactly.

To learn more about all types of cosmetic dentistry, read “Cosmetic Dentistry, a Time for Change.” Or if you prefer, you can contact us to discuss your questions or to schedule an appointment.

When it comes to replacing missing teeth, we have numerous options. However, two of the most common treatment options include bridgework and dental implants. See how much you really know about dental implants and bridgework by taking our quick and easy true/false self test.

1. When it comes to costs, dental implants may initially cost more than bridgework but are less expensive than bridgework over a lifetime.
   True or False
2. Both bridgework and dental implants can last a lifetime when properly maintained.
   True or False
3. Prior to placing a three-unit fixed bridge, if the surrounding teeth have crowns, they must be redone so that the bridge fits and wears properly.
   True or False
4. Replacing a single tooth with a three-unit bridge, requires removing the enamel on the adjacent teeth even if these teeth are disease-free.
   True or False
5. In addition to being permanent tooth replacements, another advantage of dental implants is that they don't decay like teeth supporting bridgework.
   True or False
6. It is not uncommon for root canal treatment to be required to save teeth that support bridgework if they have been subjected to severe decay and their nerves become infected.
   True or False
7. Placing a dental implant requires more time when compared to placing a three-unit bridge.
   True or False
8. Both bridgework and dental implants require minor surgery to replace a missing tooth.
   True or False
9. Dental implants are more desirable than bridgework because placing them does not affect the adjacent teeth.
   True or False
10. Studies indicate that bridges are only 67% successful at 15 years whereas dental implants have success rates into the 90s.
    True or False

Answers: 1) True. This fact shocks many people. 2) False. This is more commonly true for dental implants. 3) True. 4) True. This is one of the disadvantages of bridgework. 5) True. This is just one of the advantages of a dental implant. 6) True. 7) True. 8) False. Dental implants require surgery to be placed. 9) True. This fact is a significant advantage for dental implants. 10) True. Your results may vary; however, this statistic represents what you might expect.

To learn more, continue reading the Dear Doctor magazine article “Implants vs. Bridgework.” Or, you can contact us today to schedule an appointment or to discuss your questions.

The third molars, called “wisdom teeth” because they usually become visible when a person is 17 to 25 — supposedly the time we achieve wisdom, may have adverse effects on adjacent teeth. Most adults have four wisdom teeth, although some people have more; and some, none at all. The wisest thing to do about wisdom teeth may be to have them removed if they are poorly positioned.

What is an impacted wisdom tooth?

If a wisdom tooth is pushing against gums, other soft tissues, or adjacent teeth at an awkward angle, it is referred to as “impacted.” Usually this occurs when there is not have enough room in the jaws for these last molars to fit next to their adjacent teeth. They can disrupt the gum tissue attachment of their neighboring teeth and the surrounding bone leading to periodontal disease and, ultimately, their loss.

In many cases, impacted teeth are painless, and those who have them have no warning of the problem. Thus it is important to have routine dental exams during the time when the third molars are coming in.

When should wisdom teeth be removed?

It is better to remove wisdom teeth early rather than waiting until periodontal (gum) disease has set in. As individuals age, keeping their wisdom teeth may lead to more serious problems. Periodontal defects tend to get worse in the presence of retained third molars. Furthermore, there is a higher incidence of postoperative symptoms in people over 25.

What are the pros and cons?

Removing impacted third molars can have a negative influence on the periodontal tissues of adjacent second molars. A number of techniques, such as scaling, root planing, and bacterial plaque control, can be used to minimize periodontal problems and promote healthy healing.

Surgical removal of wisdom teeth will involve some mild to moderate post-operative discomfort. Use of aspirin or ibuprofen for a few days after surgery will provide pain relief and control most swelling and symptoms. Antibiotics may be prescribed to ensure infection-free healing. It is important to keep the socket area clean by washing and rinsing with saline or antibacterial rinses. Careful surgery will promote good healing with minimal periodontal consequences to adjacent second molar teeth.

To decide whether your wisdom teeth should be removed, you will need an evaluation to assess the clinical health of the wisdom teeth, the neighboring teeth, and other vital structures. X-ray and digital imaging techniques play an important role in determining the exact position of the wisdom teeth in the jaw. A full assessment and consultation will include all the risks, benefits, likely consequences, and alternative treatment options. This will provide you with the wisdom you need to determine what is best for your wisdom teeth.

To learn more about wisdom teeth, read “To Be or Not to Be: What are the consequences of an impacted wisdom tooth?” Or contact us today to discuss your questions or to schedule an appointment.

When it comes to cosmetic dentistry, we have numerous techniques that we can use to produce a dazzling smile while restoring or helping you maintain optimal oral health. From tooth whitening and gum contouring to bonding and veneers, see how much you really know about cosmetic dentistry by playing our matching game.

1. Whitening
2. Bonding
3. Enamel shaping
4. Orthodontics
5. Veneers
6. Crowns and bridgework
7. Implants
8. Gum contouring

1. ______ is a minor surgical procedure in which we alter the position of the gum tissue and sometimes even the underlying bone.
2. ______ is a treatment option that is not permanent and may require several applications to achieve the desired color results.
3. ______ is a restorative technique that involves applying an a tooth colored filling material (composite resin) to a tooth that is color-matched and shaped to restore a decayed or damaged tooth.
4. ______ is a treatment option for restoring heavily damaged teeth or replacing missing teeth.
5. ______ is a procedure in which small amounts of enamel, a tooth's outer layer, is removed to reshape it to improve the look of a tooth.
6. ______ is a minor cosmetic procedure in which we apply a peroxide-based material to bleach out minor stains and discoloration from teeth.
7. ______ is a procedure in which we permanently replace a missing tooth by attaching a crown (artificial tooth) to a titanium post that has been surgically placed within the jaw.
8. ______ is a treatment option in which teeth are aligned into a proper position giving a more attractive appearance. It is often used in conjunction with other cosmetic procedures.
9. ______ is a cosmetic technique where we place a custom-designed, thin shell of tooth-colored material (usually porcelain) to the front surface of a tooth.
10. ______ is the most common technique for repairing chipped, broken or decayed teeth. It may also be used to alter the shape of a small or irregular tooth.

Answers: 1) H. 2) A. 3) B. 4) F. 5) C. 6) A. 7) G. 8) D. 9) E. 10) B

To learn more about cosmetic and restorative dentistry, continue reading the Dear Doctor magazine article “Beautiful Smiles by Design.” Or you can contact us today to schedule an appointment to discuss your specific questions.