The first thing noticed about a person is his/her face. A confident smile invariably enhances the appeal of a person’s facial beauty. Not all persons are gifted with that perfectly brilliant smile. Cosmetic dentistry offers a solution to those issues. Our patients seek cosmetic services for a variety of reasons. Some seek a dental facelift (since it makes their smile look younger), while others would like to correct crooked, overlapping, widely spaced or damaged teeth. Drs. Carrington and Henry provide a full scope of cosmetic dentistry services including simple bonding, complete veneer makeover, orthodontics (braces)/Invisalign or some combination of all of the disciplines.
There are a wide variety of options and materials at our disposal. These include:
- Tooth whitening
- Porcelain veneers
- Contouring or re-shaping teeth
- Dental implants for missing teeth
- Braces/Invisalign
Visit our office and learn which options may work for you.
Tooth Whitening
Of all cosmetic dentistry procedures, tooth whitening is the most frequently used. Whether as the in office one-hour session or as tooth whitening home kits, tooth whitening is often the first choice of our patients. Research reveals that only 15% of the population has tried this procedure. That is surprising. Virtually everyone who tries tooth whitening will see some moderate to a significant improvement in the brightness and whiteness of their smile. It is not a permanent solution and requires maintenance or touch-up treatment for any long term effect.
One question frequently asked by our patients is, what is the difference between bleaching and whitening? The Food and Drug Administration (FDA) uses the term bleaching when teeth can be whitened beyond their natural color while whitening is restoring a tooth’s surface color by removing dirt and debris. As a result products like toothpaste that cleans tooth surfaces may be classified as whiteners.
To understand tooth whitening, we need to first understand why teeth stain. Our teeth are covered by a porcelain-like surface called enamel. This crystalline surface, called enamel, is designed to withstand the forces of chewing, grinding and acid attacks from bacterial products. As we grow older, our enamel becomes thinner, develops millions of micro cracks and spaces between the crystalline structures. As a result the second layer of the tooth, dentin shows through the thinner enamel more prominently. Furthermore, the micro cracks may fill up with stain from dark-colored beverages, food, tobacco etc.
Staining of the dentin layer may occur from trauma, minerals and certain drugs or medications taken for illnesses and aging. The dentin and its stain will show through the enamel more and it becomes thinner over time. Thus teeth tend to be yellower or brownish-yellow with age.
From this brief explanation we can see that there are two types of tooth staining.
- Extrinsic (external) staining which involves the micro cracks and surface defects of the enamel. Tooth brushing and cleanings in our office will remove minor stain. However, more stubborn stains would require tooth whitening products. As expected, the in office session which uses a more concentrated bleaching solution will work faster than the home kits which, in turn, work faster than the over-the-counter products. Over time these stains will penetrate into the dentin and become embedded if not removed earlier.
- Intrinsic (inside) staining is from inside the tooth towards the outside versus outside in for extrinsic staining. It is thought today that these stains may be addressed by supervised bleaching that is maintained over a period of months or years. It has been our experience, that patients prefer a faster more predictable outcome and usually turn to other treatment modalities for this type of staining.
Teeth Whitening Options
Our office offers two teeth whitening options. Bear in mind that a professional cleaning should always be your first encounter. After any hard or soft deposits are removed and minor staining erased to show the true color of you teeth, then the options of whitening may be discussed.
In-Office Whitening
Dramatic color change in a single visit is the major benefit of our in-office whitening. The procedure involves the controlled use of relatively high concentrations of a peroxide gel. The gums and root surfaces of the teeth are protected by a special isolation technique. Then the bleaching agent is applied and activated by a special light. The gel is allowed to sit on the teeth for 15 minute intervals after which it is removed and fresh gel applied. After therapy, the patient is given a home whitening solution and custom fitted trays to continue the treatment at home. This will treat the particularly stubborn stain. The system used in out office is ZOOM plus®.
Call our office (916) 393-1363/(916) 774-1113 or contact us for an appointment and estimate of cost.
Doctor dispensed take home Whitening
Our take home tooth whitening kits employ a lower concentration bleaching agent than the in-office system. This allows our patients to apply the gel on the teeth for about one hour per treatment. After the examination and necessary x-rays to determine tooth health, the teeth are professionally cleaned to remove surface deposits. A color charting is done for the teeth. Impressions (molds) are made of the upper and lower teeth and jaws and bleaching trays are fabricated. The patient will then take the kit and trays home to get started. Our doctors may request to see the patient weekly, bi-weekly or monthly to monitor their progress. The system we have used successfully is Nite White Turbo™.
Call our office (916) 393-1363/(916) 774-1113 or contact us for an appointment and estimate of cost.
Risk associated with teeth whitening
Although tooth whitening is safe when procedures are followed, there are risks, which are associated with the use of bleaching products, that patients should be aware:
Tooth sensitivity: Bleaching may cause increase tooth sensitivity to temperature changes and to pressure and touch. The chances will increase as more concentrated products are used. Patients with gum recession, significant cracks in teeth or leaking faulty fillings and/or crowns are at greater risk of sensitivity. It has also been reported in the literature that read-heads, even with no risk factors, are at particular risk for tooth sensitivity and ‘zingers’ (shooting pains down the middle of the front teeth).
Whitening sensitivity usually last no more than one or two days, but in a few cases may last up to a month. We recommend the use of prescription fluoride for sensitivity.
Gum irritation: Review of the literature revealed that over half of people who use bleaching agents experience some degree of gum irritation. This may occur if leakage occurs around the home trays or around the isolation dam in the in-office procedure. The irritation may last up to several days. Should this occur, call our office for professional assistance.
Different colored teeth: Bonding, tooth colored fillings and veneers do NOT change color with tooth whitening. As a result, the surrounding teeth may be whitened while the restorations maintain their color. This will produce teeth of different colors. This needs to be considered before bleaching is started. Patients should have tooth whitening and then restorations to match. Since the final tooth whitening shade in unpredictable, it is impossible to make restorations with a particular shade and then expect tooth whitening will match that shade.
Other Concerns
- No amount of tooth whitening will result in “white teeth”.
- Patients should have tooth whitening and then restorations to match. Since the final tooth whitening shade in unpredictable, it is impossible to make restorations with a particular shade and then expect tooth whitening will match that shade.
- Patients should wait about two weeks after tooth whitening to have cosmetic restorations done. This will allow time to determine the final color of your teeth.
- Exposed roots from receded gums are difficult to bleach. The risk of sensitivity and other maladies often outweigh the benefits. Other treatment modalities should be considered.
- Pregnant and nursing women should avoid tooth whitening since the effect of inadvertently swallowed bleaching material on the fetus is not yet known.
Veneers
Veneers are custom made thin shell of dental material that are bonded over teeth to hide worn, cracked and fractured teeth, uneven tooth alignment or spacing, mild to moderate crowding and intrinsic or extrinsic staining which is resistant to tooth whitening. The translucency and esthetic quality of today’s dental ceramics provide a much more natural took than what was available in the past. Regardless of the cause of your unattractive smile, porcelain veneers may solve your cosmetic tooth issues.
The most common materials used for veneers are composite and dental ceramic. Composite veneers may be done directly in the patient’s mouth or like ceramics, indirectly in a dental laboratory. Direct composite veneers, because of the curing method necessary, tend to be the lease resistant to future staining, wear and do not last as long. Porcelain veneers are the longer lasting and more expensive, but the results are typically well worth the investment.
Veneers may in some cased be used to protect damaged teeth rather than a crown. This may eliminate the need for more invasive tooth preparation. Porcelain veneers are durable and relatively strong once bonded into place. However, patients need to be aware that the thin porcelain shells may be damaged or broken. Patients who have had veneer restorations are usually placed on some diet restrictions such as avoiding almonds and carrots etc. Some patients may have to wear a custom night guard, especially in cases where patients grind their teeth (bruxers).
Procedures
Veneers may often be completed in two dental visits. However, the examination and preparatory phases may require several hours of work and two or three visits. Depending on the complexity of the case, the doctors may have the dental lab make a mock-up of the final presentation in wax. This is done on stone models which are made from moulds (impressions) of your teeth and gums. Once the patient and doctor are satisfied with the final look, an appointment is made for preparation of the teeth. Again, depending on the complexity of the case, this may require little tooth reshaping or more extensive preparation to allow room for porcelain. The procedure may or may not be done using anesthetic. Again, this is on a case by case basis and will be discussed with you before the procedure is started. An impression is made of the upper and lower teeth and an appropriate shade (color) is selected. The impressions are sent to the dental lab where the veneers are made by a ceramist. In the interim, temporary veneers and made based on the mock-ups discussed earlier. This gives an idea of the final shape, size and feel of the final veneers.
During the delivery appointment, the temporaries are removed and the veneers are bonded into place. Adjustments may be made to the occlusion (bite) of the veneers as needed to ensure optimal fit.
After bonding of the veneers, some patients may experience some sensitivity for a few days after. The longevity of your veneers will depend on how well you take care of them.
Other Porcelain Veneer Alternatives
Recent advances in technology and materials have provided patients with the options of minimal and “no-prep” ceramic veneer options. These include Lumineers, Vivaneers, Durathin Veneers etc. These are not a cure all for all case types. For example, the degree of crowding will determine whether this is an alternative for you. These options require little to no filing of the tooth enamel for bonding unto the teeth. In most cases, this requires no injection of anesthetic. In some cases reshaping of the enamel may be required before impression. These alternatives may be suitable for patients who present with:
Chipped or cracked teeth
Very slightly discolored or stained teeth
Gaps or spaces between teeth
Small teeth with spaces between them
Teeth that are worn down
A smile make-over for teeth that already well aligned
Slight crowding
Misshaped teeth (e.g. too pointy, too square etc.)
Slightly misaligned teeth
Although some may offer veneers as a solution for severely misaligned teeth, that may not be the healthiest solution of you. Despite the greater cost and longer treatment time, orthodontics (braces and/or invisalign) may be advisable. Remember, a quick fix is not always the best solution. A thorough examination with necessary x-rays and consultation visit will be necessary to truly make an informed decision. Once you know the risks, benefits and alternatives you will be more comfortable with your course of action. At this time, dental benefit providers (insurances) consider veneers a cosmetic procedure and offer no financial assistance. You may discuss various payment and financing options with us to determine what is best for you before committing to the procedure. Contact us now at (916) 393-1363/(916) 774-1113 or e-mail us for an appointment.
Dental Implants
Dental implants are artificial replacements (prosthetics) for missing teeth. For the baby boomer generation this may be dentistry’s arrival in the age of bionics. There are a number of replacement options for missing teeth. These include a variety of denture options and fixed bridges. The major advantage of implants is the effect on preserving the bony supporting structure of the jaw. Implants have also evolved from the obvious fake appearance to a place in the cosmetic conversation. Implants are not only used to replace a single missing tooth. They are also used to replace multiple missing teeth and increase the stability of dentures and therefore reduce gum irritation by the denture.
Dental Implant Procedure
Implant placement is essentially a two phase process. First the replacement equivalent of the tooth root is surgically placed in the bone by the oral surgeon or periodontist (gum specialist). This is usually done in one appointment. Following placement of an implant, a cover screw is placed on top of the implant. A period of time is required for the bone to anchor to the implant. During this time, the bone grows into and around the implant. This process is called ossoeintegration. In essence the implant becomes integrated into the bone (osseous tissue). Typically this takes about six months for upper teeth and four months for lower teeth. This is because the upper bone is spongier than the lower bone. In some instances, implants may be places in the socket where teeth were recently extracted. This may speed up the process of osseointegration.
After the allowed time for healing, the healing cap is removed and another screw (healing abutment) is placed for a few weeks. The healing abutment helps the gum to heal with an open access to the implant and helps the final crown to appear to grow naturally from the gum like normal teeth.
After the implant placement has been deemed to a success, the crown and necessary components are then fabricated by our doctors to complete the tooth replacement. Implant tooth replacement is typically 90% (upper jaw) to 95% (lower jaw) successful. Dental implants may fail for a number of reasons. The cause is often associated with failure in the osseointegration process. For example, if the implant is placed in the wrong place, osseointegration may not take place. Crowns may come loose or implants break as a result of the patients bite (occlusion). Smokers will be advised to give up the habit before investing in implant reconstruction. Good oral healthcare is necessary since implants are also susceptible to gum disease. One great advantage is that caries will not be an issue.
Call our office (916) 393-1363/(916( 774-1113 or contact us for an appointment. We will perform a thorough examination with necessary x-rays to determine the amount and quality of bone. Let us determine if implants are an option for you.