Before we discuss cosmetic options for transforming your smile, and before any preparations for treatment, there’s one question that needs to be answered: What do you want to be different about your smile?
There’s a common misconception that cosmetic changes to the teeth and gums — a “smile makeover” — is primarily a technical achievement based on rigid principles of beauty. Patients believe they must defer to their dentists for what will look best. But that’s not the entire picture: what’s often lost in the understanding is that it’s your smile — the smile at the end of the process you must be comfortable showing with confidence.
In this regard, there are two types of patients, with no right or wrong view — simply what a patient perceives as the smile they want. Some want the “perfect” smile — the greatest level of regularity between teeth shape, size and alignment and the maximum level of brightness. Others are more comfortable with a “natural” smile, a more subtle look with just enough change to create something new and different. The latter may even desire a less than perfect look that doesn’t “fix” all their imperfections — the ones they believe give their face “character.”
Knowing to which side you lean is important at the outset. It’s then important for you to communicate those expectations with us. While we’re focused on the technical aspects of treatment — tooth length, the lineup of teeth with other facial features or the gum-to-lip distance — only you can express what’s going to be a beautiful yet comfortable smile for you. By meshing the technical requirements with your personal desires, we’re able to formulate a makeover plan that fits you.
It all begins with a comprehensive examination to determine the exact health state of your mouth, and it may be necessary to first perform dental work to improve it. From there we can discuss what is and isn’t possible to change the appearance of your teeth and gums. In the end, we want the same result as you — a beautiful smile you’re happy and confident to show the world.
If you would like more information on smile makeovers, 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 “Great Expectations: Is what you get what you want?”
Making sure children are comfortable when visiting the dentist is an essential part of creating a lifetime habit of dental care. We recommend children start dental visits around their first birthday.
But for some children this may not be enough — despite parents’ and dentists’ best efforts they may still develop an inordinate fear of dental visits and even routine procedures. This kind of anxiety could inhibit them now and later in life from receiving needed dental care.
To relieve this anxiety, dentists have developed sedation therapy for children. Not to be confused with anesthesia, which numbs pain, sedation uses drugs to place a patient in a relaxed state. Depending on the drugs and dosage used, we’re able to achieve anywhere from a light state of relaxation to a deep suppression of consciousness. The approach is similar to one used with adults, although drug dosages and applications will differ with children.
If we’re planning to use sedation with your child we recommend you feed them a low-fat dinner the night before and then refrain from any other foods or liquids until after treatment the next day. Just before the procedure (and after we’ve evaluated them physically to be sure they’re healthy enough for the sedation medication), we’ll administer the sedative, usually Midazolam and Hydroxyzine. Taken by mouth in a syrup form, this places them in a mildly relaxed state.
During the procedure a designated staff member will continually monitor their pulse, breathing, blood pressure and other vital signs. We may also take other protective measures like special chair positioning or immobilization to keep movement to a minimum.
After the procedure, your child will remain in the office until their vital signs return to pre-sedation levels. Once at home, you should keep an eye on them for the rest of the day. They should not return to school or regular activities until the next day.
As sedation medication and techniques continue to advance, they’re becoming a routine part of dental care. If your child experiences anxiety, this can help make dental visits more pleasant and more likely to become part of their life from now on.
If you would like more information on taking the anxiety out of children’s dental care, 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 “Sedation Dentistry for Kids.”
Tooth decay and periodontal (gum) disease pose the most common dangers to dental health. But there are some rare conditions that can also place teeth at risk to be on the lookout for during regular dental checkups.
One such condition is root resorption in an adult tooth, in which the root itself or its surface breaks down and is absorbed by the body. Resorption occurs naturally in a primary (“baby”) tooth so it can loosen and give way for an incoming permanent tooth. Resorption still occurs in a limited form with young permanent teeth but should eventually stop.
Sometimes, though, it doesn’t, either from the inside of the tooth out (internal resorption) or more often from the outside in, usually around the neck-like (or “cervical”) portion of the tooth. This more common occurrence, External Cervical Resorption (ECR), can first appear as pink spots on the enamel and then progress into cavity-like areas. If not found and treated promptly, damage can occur quickly and lead to tooth loss.
We don’t fully understand the exact nature and causes for ECR, but we have identified risk factors for its development. Excessive orthodontic force on the teeth or any other trauma can cause damage to the periodontal ligament (which holds teeth in place with the jaw bone). Teeth grinding habits and some dental procedures like internal tooth whitening can also be risk factors.That being said, though, the vast majority of people who experience these issues don’t develop ECR.
Although the causes aren’t fully understood, we can still treat it: the key to success is early detection. You probably won’t notice early signs of ECR, but we can often detect spots from routine x-rays. We can then remove the tissue cells within the lesions causing the damage and restore the area with a tooth-colored filling material. If ECR has extended near the tooth’s interior pulp layer, then a root canal treatment may be needed.
Needless to say, the more extensive ECR occurs in the roots, the less likely the tooth can be saved and may need to be extracted. It’s important, therefore, to maintain regular dental checkups (at least twice a year) to increase your chances of catching a developing problem early.
If you would like more information on root resorption in adult teeth, 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 “Root Resorption: An Unusual Phenomenon.”
If you’re undergoing your first root canal treatment, it’s understandable if you’re apprehensive. So, let’s cut to the chase about your biggest fear: a root canal treatment doesn’t cause pain, it relieves it — and saves your tooth too.
You need this procedure because decay has spread deep into your tooth’s inner pulp. The infection has already attacked the nerves bundled within the pulp chamber, the source of the pain that led you to us in the first place.
The real concern, though, is the infection continuing to travel through the canals of the tooth root. If that happens, you’re in danger of not only losing the tooth, but also losing surrounding bone, adjacent teeth or damaging other important structures close by. Our goal is simple: remove the infected pulp tissue and seal the empty chamber and root canals from further infection with a special filling.
We begin by numbing the tooth with local anesthesia — you won’t feel anything but slight pressure as we work. After placing a dental dam — a thin sheet of rubber or vinyl — around the affected tooth to maintain a clean work area, we drill a small hole through the biting surface of a back tooth or in the rear surface of a front tooth. We’ll use this hole to access the pulp, where we’ll first remove all the dead and diseased tissue from the chamber. We’ll then disinfect the chamber and root canals with antiseptic and antibacterial solutions.
After some shaping, we’ll fill the chamber and canals, usually with gutta-percha that’s malleable when heated and can be compressed into and against the walls of the root canals to completely seal them. We’ll then seal the access hole.
You may have a few days of mild discomfort afterward, which can be managed generally with pain relievers like aspirin or ibuprofen. Later, we’ll permanently restore the tooth using filling to seal the root canal inside the tooth followed by a custom crown that’s fit over and bonded to the tooth. This will further minimize chances of a re-infection.
If we’ve recommended a root canal, then we think your tooth should be saved instead of extracted. The procedure will end the pain you’ve been suffering and give your tooth a new lease on life.
If you would like more information on root canal treatment, 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 “A Step-By-Step Guide to Root Canal Treatment.”
For most dental procedures you’re usually back to your regular routine in no more than a day or two (or even hours) afterward. For the most part, the mouth heals rather quickly.
But there may still be a short period of discomfort after tooth extraction, gum surgery or similar invasive procedures. The good news is you will most likely have no need for strong narcotic painkillers — milder, over-the-counter pain relievers are usually sufficient to manage your discomfort.
The most common of these are known as non-steroidal anti-inflammatory drugs (NSAIDs). This group of pain relievers — which include aspirin and ibuprofen — block the release of substances in the body known as prostaglandins that stimulate inflammation that increases pain in damaged tissues. They’re much preferred for mild to moderate pain because they don’t have the side effects of steroids or narcotics like morphine or codeine. They also tend to be less costly than these other prescription drugs.
But while they’re reasonably safe, they can cause problems if you exceed the recommended dosage or use them for prolonged periods. Their blockage of certain chemicals reduces the clotting mechanism in blood leading to a blood-thinning effect. Not only will this increase bleeding, it can also damage the stomach lining and cause ulcers if used over a period of weeks. Improper dosage of NSAIDs has also been linked to miscarriages and repeat heart attacks, which is why they’re not recommended for use during pregnancy or with patients with a history of heart or intestinal problems.
But if taken as directed by your physician or dentist — usually no more than 2,400 milligrams a day and only for a few days — such side effects are quite rare. The benefit is much more common: about five hours of pain relief from a single dose for most people. With the help of ibuprofen or similar drugs, you’ll be on your feet after your dental work in no time.
If you would like more information on managing pain after a procedure, 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 “Treating Pain with Ibuprofen.”
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