Bleaching

Tooth whitening, also known as bleaching, is a very satisfying procedure. It appears to be both safe and effective and the technique that we use is approved by The American Dental Association as such. At our office we have been whitening teeth for over 8 years. No damage is done to the enamel and the results are stable for a long time. That is, you won't wake up one morning to dark teeth again. Of course, your teeth will darken with time, just as they darkened as you grew older, that process will take anywhere from 3-5 years. Most people like to do a touch up whitening procedure after 1 or 2 years just to insure that their teeth are as white as they can be.

Techniques

There are two basic ways to whiten teeth. You can use a take-home bleach or to do an in-office bleaching procedure. The in-office procedure can be further divided into visible light activated and laser light activated or self activated. All of the solutions used are basically the same material, a carbamide peroxide or hydrogen peroxide solution that has Ph stabilizers, emulsifiers and wetting agents in it. The peroxide supplies oxygen that is used as the bleaching agent. Many people ask about light activated techniques. Light activated is preferred because it is quicker, only one or two one hour office visits are needed. In our office we seat you in a dimmed room. You relax on a heated massage chair and watch your favorite DVD on a TV screen. The procedure is very safe, effective and comfortable.

Side Effects

The side effects from bleaching are mild and easily controlled for most people. They are cold sensitivity during the bleaching period, gum irritation and occasionally some people will complain of throat irritation. The most common side effect is cold sensitivity. This is usually controlled by using desensitizers during the bleaching period.

Over the Counter Kits

Resist the desire to save yourself money by purchasing a bleaching kit over the counter at the drug store or through a catalog. There are many dangers inherent with this. First and foremost is safety. You only get one set of permanent teeth in a lifetime. Bleaching kits that are sold over the counter are treated by the government as cosmetics, and thus aren't regulated, inspected or certified by any agency. You never know what's in them, how strong they are or if they are even effective. If the solution does contain carbamide peroxide, you haven't a clue about the additional ingredients. Carbamide peroxide exists best and is most stable in an acidic environment. However, an acidic environment is very harmful to your teeth. The acid dissolves them. The makers of the bleaching kits sold by dentists have gone to great pains to add special buffers to their ingredients and still maintain the effectiveness of the bleach. Colgate® has even done extensive testing and submitted the results to the American Dental Association for approval. All of this takes time and money. You'll be much safer using an approved and regulated product.

Bonding

People frequently talk about "bonding" when they are discussing cosmetic dentistry. The term "bonding" is actually a misnomer because it actually describes the procedure of sticking something on to the tooth. What most people think of as bonding is actually the placement of a layer of white plastic filling material over the top of the tooth to change its color or contour. There are actually two techniques used to do this. They are more properly described as direct or indirect veneers.

Direct veneers are thin layers of plastic filling material that a dentist places on the teeth and then shapes to a pleasing contour. Thus, the dentist has done them directly on the tooth. Indirect veneers are veneers, or thin shells, of porcelain that are fabricated by a laboratory and bonded in place by a dentist.

Indirect Veneers

Porcelain veneers, sometimes called laminates, indirect veneers or just veneers, are thin shells of porcelain used to change the contour and/or the color of teeth. To accomplish an indirect veneer the dentist starts by removing some of the enamel from the front side of the tooth. This step, known as the "preparation" of the tooth, is very important. It allows the dentist to change the contour and shape of the tooth and it prevents the end result from being too bulky or fat looking. You'll see further on in the article how this makes the procedure different from bonding. Not much of the enamel is usually removed, typically about 1/2 mm. Then the dentist takes an impression, selects a shade for the final restoration and sends the impression to the laboratory. Temporaries made of white plastic can be placed on the patient’s teeth. In about two weeks the patient returns to the office. The temporaries are removed and the veneers are bonded into place on the tooth. Because the veneers are made of porcelain, which has optical characteristics much like the enamel on a tooth, the results are very pleasing and lifelike. The veneers reflect and transmit the light that strikes them just like enamel does.

Direct Veneers

Direct veneers can also be cosmetically pleasing, but they have limitations. The filling material used is not like a white paint, which is how many people envision it, but more like a putty type of material. It is actually white plastic with small bits of quartz imbedded in it. The material is bonded to the tooth and then shaped and polished for a pleasing result. Because tooth structure is typically not removed, the result can be bulky looking if the conditions are not ideal. In order to be thick enough to cover the discolored tooth beneath the filling material, the layer has to be too thick to look natural. The material also lacks the optical qualities of enamel; it looks more opaque and not as vital looking as porcelain. An ideal case for direct veneers is when a tooth is positioned back from where it belongs. Then the layer of material can be added until the tooth is even with its partners. But there are some advantages to this technique, they are done in one visit, they don't require tooth structure to be removed and they are typically less expensive, at least half the cost of indirect veneers.

The choice between which type of restoration to use is not an easy one to make. It actually involves more technical considerations than I can discuss here. Come in and see us for a consultation or visit your own dentist to see which technique would suit you the best.

Adult Orthodontics

Orthodontics for adults is becoming more and more popular. People want to feel good and they want to look good, they exercise and diet more, they are spending more and more money on facelifts, eye lifts, laser peels and cosmetics. But what's the use of smooth beautiful skin if you have crooked teeth? People are realizing that the smile is one of the first things a person notices about you. Don't like the look of your teeth? Change them! Adult orthodontics is one way to do that.

There are some limitations to adult orthodontics. Movement of the teeth is slower, the end results can be compromised by the persons bone structure and some conditions can't be corrected. Let's address each one individually.

Because an adult is done growing and because the bone in an adult is harder, the teeth move slower in an adult. That means you will probably have to wear your braces for a longer period of time than a child would have to. Most adult orthodontic cases last about 2 years. This isn't always the case, but, if you go into it thinking that it will take about 2 years you won't be disappointed. The next problem also relates to the fact that adults are done growing. With children, the orthodontist can use the growth of the child's jaw to their advantage. Different appliances can redirect the amount of growth and the direction of growth in order to achieve a bone structure of the jaws that can support the teeth where they need to be. For example, if someone has a very small lower jaw and a normal sized upper jaw, the orthodontist can stimulate growth in the lower jaw and depress further growth in the upper jaw in order to get the jaw sizes to match. This makes it easier to get the teeth to articulate properly. However, with an adult in the same situation, small lower jaw and normal upper jaw, the orthodontist has to work within the confines of those jaws. All the growth is done. Aside from surgery to move the jaws into the proper relationship, (this is an option for some people that works out nicely), the orthodontist has to compromise the final result.

Aside from these problems, adult orthodontics works out nicely. Adults are generally highly motivated patients who will take care of their teeth during treatment and do as the doctor asks. The result is that they end up very satisfied with the outcome of their treatment.

Invisalign™  Orthodontics

A new orthodontic system is just being released to the dental world. It is called the Invisalign™ system and it looks like a very exciting development. It uses a series of clear plastic retainers to move the teeth instead of conventional braces and wires.

Dentists have known since the 1940's that teeth could be moved using retainers or "positioners". The problem was that the amount of laboratory work involved in order to make a new retainer or positioner every 3 or 4 weeks was prohibitive. Now, with the advent of computer technology and computer aided design, the laboratory can fabricate the appliances needed and keep the cost to a reasonable level.

The procedure involves the orthodontist taking a very accurate impression of the patient's mouth and sending it to the laboratory of Align Technology. The company uses a computer to digitize the patient's teeth. The computer then generates a series of clear retainers that are changed

every 3 or 4 weeks. Each retainer is a slightly different shape. This difference in shape pushes teeth into their proper position. The advantage is obvious. The system is very cosmetic, there are no metal brackets or wires. It is comfortable to wear and easy to speak with. The cost is about 1/3 more than conventional braces. Check out Invisalign's website for more information and a list of orthodontists who are trained to use the Invisalign™ system. Here in the Rochester, Michigan area, Dr. William Molloy uses the system.

Endodontics, also known as root canal therapy is a procedure by which the dead or dying nerve is taken out of the tooth in order to cure an infection in that nerve. It is a very useful and successful procedure. Don’t let old wives’ tales of pain prevent you from having a tooth saved. Modern endodontics can be remarkably pain free. The inside of a tooth is hollow and contains microscopic nerve fibers and blood vessels. Because your body’s circulation inside of a tooth is very poor, it is difficult for you to clear bacteria out of the pulp chamber of a tooth. So if a pulp chamber, (the nerve), of a tooth is contaminated with bacteria because of a break in the tooth or decay, the bacteria overwhelm the nerve tissue and kill it. That is what causes the pain of a toothache. When we do root canal therapy, we open into the chamber and clean out all of the dead tissue and bacteria. The empty space is then filled with a soft rubbery material called gutta percha. The space is obliterated and so bacteria can’t live there anymore, allowing the tooth to remain stable and comfortable in your mouth. Because the root canal therapy hollows out the tooth and because the tooth becomes brittle, it is essential that any posterior tooth should be crowned after root canal therapy. If the tooth isn’t crowned, it will break off and you will lose the tooth and will have wasted the money spent on the therapy. The American Dental Association has a nice animation on root canal therapy at this site. Flash Player is needed to view the animation.