In modern society, a bright, white smile conveys optimal health, youth and sound teeth. However, various influences including age, wear, diet, and lifestyle may prevent you from having and maintaining the glistening smile you long to share with the world. Luckily, there are many safe, inexpensive, and successful treatment options for discolored or stained teeth.

We can perform a “power bleaching” in our office to whiten teeth that are severely stained or discolored. This procedure whitens the external surfaces of the teeth by using a high concentration (35-45%) hydrogen peroxide solution, which is sometimes activated by a specialized light. To prevent irritation of the mouth's soft tissue lining during this procedure, we will isolate your gums and membranes with a rubber dam, a silicone or other effective barrier. Professionally applied in-office power bleaching provides control, speed, and predictability capable of lightening teeth up to ten shades in an hour. Don't try this at home! Our staff will take precautions in the office to avoid side effects and possible tooth sensitivity.

We can also provide you with custom-made, vacuum-formed, plastic bleaching trays for use with a take-home whitening application. In this instance, a gel made from carbamide peroxide (4-7% hydrogen peroxide, safe for home use) is delivered to the tooth surfaces in the bleaching trays. You will need to wear the tray for 30 minutes twice a day, which is a longer process than in-office bleaching. The first subjective signs of whitening will occur after three or four sessions, allowing whitening of up to eight shade units.

Another home-based option, whitening strips, essentially look like band-aids for the teeth. They are capable of lightening teeth by about three shades after being worn directly on the surface of the teeth for 30 minutes twice a day for one week.

If you have always wanted whiter teeth, schedule an appointment so we can determine which of these treatment options would work best for you. For more information on the fundamentals of teeth whitening, read the informative Dear Doctor magazine article “Teeth Whitening: Brighter, Lighter, Whiter...”

Creating a dental crown that looks good and wears well is not an easy achievement. It is the result of good communication you, the patient, have with us, your dental professionals, and that we have with the dental lab that manufactures the crown. In addition, it reflects the quality of work done by us and by the lab technician.

What is a dental crown?
A crown is a dental restoration that surrounds the remains of a damaged tooth or is attached to a dental implant so that it resembles a natural tooth as it extends above the gum line. The choice of materials and appearance of the crown depend upon many factors. One is the location of the crown. If it is in the back part of your jaw, strength and wear will be a major factor. If it is in the front, a life-like appearance will be important.

What goes into making a good-looking and functional crown?
Options for crown materials include porcelain, gold, porcelain fused to metal (called PFM) and some newer materials such as “pressed-ceramic” restorations and computer-milled-ceramics.

You as the patient can have a say in choosing the crown's color and appearance. Before it is cemented into its final position, make sure you are happy with the feel and appearance of your new crown.

Gold is often chosen for crowns on back teeth because of its superior wear qualities. Gold crowns have been known to last more than 50 years. They also cause minimal wear to the teeth that they touch on the opposing jaw.

Crowns made of porcelain (a glass-like substance fired in an oven at a high temperature) look good but may be too brittle to stand the wear and forces given to back teeth. Like glass, they can fracture under pressure. But because of their lifelike appearance they make a good choice for visible front teeth.

PFM (porcelain-fused-to-metal crowns) are a good combination of the best of gold and porcelain, but they sometimes lose the stains applied to make them look natural, and occasionally they fracture away from the metal.

A provisional crown can help you make sure you are getting a crown with the qualities you want. With the provisional crown all the details are worked out ahead of time, and you get a chance to try them out to make sure the crown looks good and that you can eat and talk normally. After you give your approval on the provisional crown, the final crown will be made to match it, in longer-lasting and better quality components.

Contact us today to schedule an appointment 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.”

Time to tune up the brightness on your teeth? Here are six modern methods of whitening and brightening your smile.

• In-office “power” bleaching under the supervision of my staff and me is recommended if your teeth are badly stained, or if you are about to have veneers or crowns made. It's quick, safe, and effective. Gels containing high concentrations of bleach are applied to your teeth in our office, often with the enhancement by heat and light to make them act faster. Results show teeth becoming up to ten shades lighter in about an hour.
• “Take home” whitening solutions and trays are designed to fit your mouth and can also be provided by my office. The technique is easy to perform and is less expensive than in-office power whitening system, although it takes longer to see the same results. General recommendations are for 30 minute applications twice a day. You can usually see a change after two to four sessions. This requires patience, because it is important not to exceed recommended exposure in order to avoid damage to your teeth, gums, and the inside skin of your mouth. After two weeks of use, teeth can be expected to be about eight shades lighter.
• Whitening strips look like clear Band-Aids that are applied to the tooth surfaces. They should be worn twice a day for 30 minutes each time, for seven days. On average, they claim to lighten teeth more than three shades. They take about two weeks to work at 30 minutes per day.
• “Paint on” or “Brush on” whitening formulas are also available. These are gels that are painted onto the teeth every night at bedtime, for two weeks. Some claim that this line of home whitening can whiten teeth two to five shades. These gels may make your mouth feel goopy, but they are relatively inexpensive. Some gels come with a small brush to scrub them onto the teeth.
• Over-the-counter “mouth-tray” whiteners use mouth trays that are not designed for your particular mouth, so they may not fit well and may be messy or uncomfortable. They are filled with gel and worn 45 minutes a day for one week. On average, teeth become two shades whiter.
• Whitening gum is a relatively new product. It requires chewing two pieces for at least 20 minutes, four times a day, to see an effect.

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

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.”

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.