You Can Have Whiter Teeth!

The least damaging and most conservative way of making your teeth lighter is with the use of a whitening solution. Contrary to what you might think, brushing your teeth harder with an abrasive toothbrush will not make your teeth whiter, but rather may darken them faster. The tooth-whitening concept has been around for many years, and the techniques have become easier and less expensive to accomplish. Tooth whitening was noted in the dental literature in the 1920s. the technique has become easier and the cost has decreased. Today, there are two convenient methods to whiten dark teeth: At-Home Whitening and In-Office Whitening.

Why Do Teeth Get Yellow?

The intrinsic color of your teeth is related to the color and thickness of the enamel and dentin, as well as the types of foods and liquids you ingest. The thinner the enamel, the darker the underlying dentin; the more coffee, tea, cola beverages, and red wine you drink, the darker your teeth will be. Cracks that are commonly found in the enamel of your teeth may provide a pathway for discoloring fluids to reach the underlying dentin.

If you have a yellow, brown, or orange shade to your teeth, in most cases it can be made lighter by the whitening procedure. Whitening works very well in removing age-related darkening of your teeth. This age-related darkening is most likely due to years of drinking darkening beverages, or other environmental factors, rather than genetics. No drilling or anesthesia is required for whitening. Your teeth will not become weaker. Because the mineralization of teeth varies so much from person to person, there is no way to determine how many office visits it will take to effect the color change or how white the teeth will get. The darker your teeth are, the more time required for the change and the more distinctive the color change will be.

The whitening procedure will also work to a lesser degree on teeth with tetracycline discoloration. We have seen several fair to good results from both in-office and at-home whitening. It does take more time to achieve good results on this type of stain, and unfortunately, sometimes the change is minor.

Two Available Techniques

There are two types of whitening available. One is done by the patient at home, and the other is done by us during an office visit. They can be done separately or in conjunction with each other. The at-home technique involves using a soft, thin, comfortable mouthguard-like tray. An impression is made of your teeth, and custom whitening trays are fabricated. Then at home, you place the whitening solution in the trays and wear them for an hour or two each day or sleep with them in place at night. With in-office whitening, you come to the office for 1 to 2 hours, and a stronger whitening solution is applied by us and activated for that time. Usually only one visit is required.

The color change should last for 3 to 7 years in most people. The color change you see immediately after the whitening is completed will regress one shade over the course of 1 to 3 months, with most of the change taking place in the first week. If you drink a lot of coffee, tea, cola beverages, red wine, or if you smoke, the teeth may begin to turn darker again. When this happens, the whitening process can be repeated.

The possible side effects include temporary white discoloration of the gum tissue if the office whitening solution comes in contact with the gum. This goes away quickly. The teeth may become slightly sensitive to temperature changes for a short time. This also goes away quickly. There is no damage to the tooth enamel, dentin, or pulp from the whitening process. Fillings and crowns do not whiten. When your teeth change to a lighter color, you may need to have those fillings and/or crowns redone. We will let you know whether this is a possibility before we whiten your teeth. There are no other adverse effects known.

The teeth that show when you talk, smile, or eat are the teeth that would benefit your appearance most if whitened. Usually the top teeth are whitened because they are much more visible than the bottom teeth, but both arches can be successfully whitened. The lower teeth take about three times as long to reach the color change of the top teeth.

If you have any questions about enamel recontouring, please feel free to ask us!  

Hymeadow: (512) 250-5012

Jollyville: (512) 346-8424

West William Cannon: (512) 445-5721

Enamel Recontouring

Most people want straight, beautifully aligned, white teeth. Unfortunately, most people are not that lucky. When teeth are in poor alignment, rotated, tilted, and/or crowded, the obvious way to correct the problem is by orthodontics (braces or Invisalign aligners). However, there are situations in which it may not be possible or desirable to use braces to straighten teeth. You might feel that you are too old (although this is rarely the case), the cost of the orthodontics may be beyond your current means, you may not want to wear braces, or perhaps there are only a few areas that need attention and full orthodontics are simply not indicated.

In certain select cases, the appearance of your top and bottom teeth can be slightly or dramatically improved by recontouring the enamel. The four top and four bottom incisors and canines can be routinely altered. Sometimes teeth further back in your mouth can also be cosmetically improved. Recontouring is useful when there is slight to moderate overlapping of the front teeth, uneven wear, or teeth that do not have their biting and incising edges in harmony, creating an uneven “picket fence” look.

Enamel recontouring is usually a painless procedure and no local anesthetic is needed. The enamel that is overlapping or poorly shaped is removed, recontoured, and polished. Depending on your individual needs, one or several teeth may require some reshaping. Different amounts of enamel may be removed from different teeth. The recontoured teeth do not become more prone to decay, are not made more sensitive to temperature changes, and they are not made significantly weaker or damaged by the procedure.

Many times, the recontouring is all that is necessary to significantly improve your appearance. Other times, when the poor alignment is more pronounced, it may be done in conjunction with bonding of resin or porcelain to teeth. Your treatment will depend on your present conditions and on what you would like to see changed.

The procedure is not difficult for the patient and can often be done in only one appointment. The change is immediate and permanent. It does take an artistic flair on the part of the dentist to see what possibilities for change exist. We need to determine what enamel needs to be removed, where we must add, and where orthodontics is the treatment of choice. The fees are reasonable and depend on the extent of the treatment.

If you have any questions about enamel recontouring, please feel free to ask us!  

Hymeadow: (512) 250-5012

Jollyville: (512) 346-8424

West William Cannon: (512) 445-5721

Cosmetic Tissue Recontouring

It is not uncommon for us to suggest to a patient who has absolutely no sign of periodontal (gum) disease to seriously consider having elective periodontal procedures performed. In these cases, the procedures are almost always needed to improve appearance. Sometimes they are suggested to promote future periodontal health or to attend to a potential problem that might develop.

When you smile or talk, your teeth are framed by your lips and the visible gum tissue. People looking at you notice your teeth. People notice missing teeth, tooth alignment, gum color, discolored fillings, silver fillings, toot color, and how much of your teeth actually show. If everything is integrated well and looks natural, people say you have a nice smile. If something does not look natural, it may be easy to define, such as crooked, stained or yellow teeth; periodontal disease shown by red-colored gum tissue; or discolored fillings. Or it may be something not as readily to determine. It’s just something that does not look right.

That “something” may be related to the teeth and gum architecture. The position of the gums where they meet the teeth is esthetically important. If your teeth look too short, there may be more gum tissue covering them than is considered attractive. You may show too much gum tissue when you smile. There may be a difference in height of the gum of one tooth versus an adjacent tooth or its partner on the other side of the mouth. This could be caused by recession from brushing too hard; gum disease; poor or defective restorations, especially crowns; or just a problem with the way the tooth erupted into place. All of these things can detract from your appearance.

Several different periodontal procedures, simple to accomplish, can correct most of these routine problems. Some involve removal of unwanted tissue; some involve grafting of tissue. Orthodontics might be helpful in some cases. The more expensive procedures will require referral to our specialists.

In one common type of cosmetic periodontal plastic surgery, the gum tissue is reshaped and recontoured without the use of sutures (stitches). This procedure is done in the office. One tooth or several teeth may benefit from treatment. Postoperative discomfort is usually minor. There may be tooth sensitivity when gum tissue is removed, but this usually disappears. The improvement generated by this type of procedure can be startling.

We will show you and describe in detail how you can benefit from cosmetic periodontal procedures. In many cases, the cosmetic periodontal surgery will complete the treatment you need. In some cases, it will be part of a larger treatment plan including crowns, veneers, or bonded restorations. 

If you have any questions about cosmetic tissue recontouring, please feel free to ask us!  

Hymeadow: (512) 250-5012

Jollyville: (512) 346-8424

West William Cannon: (512) 445-5721

Acid Reflux (Gastroesophageal Reflux Disease)

Teeth are so hard you would think they would be indestructible and that they would not be adversely affected by anything. Due to the strength of enamel and bone, they should remain the same from the day the teeth come into the mouth to the day they are no longer needed. Unfortunately, this is far from true. While we would like the think of teeth as being strong and unchanging, most people know that teeth can be damaged by tooth decay-causing bacteria. We know, too, that teeth can be damaged by mechanical means—attrition caused by tooth grinding and clenching and abrasion caused by improper toothbrushing. However, few people know that there is a third factor that can destroy teeth—chemical erosion.

Chemical erosion is caused by excess acid coming in contact with a tooth for extended periods of time. The acid attack can be self-inflicted (bulimia) or more commonly from a problem with acid reflux. In acid (gastric) reflux, the acidic and partly digested contents of the stomach are returned back into the throat and oral cavity. Normally, the lower esophageal sphincter muscles (LES), connecting the esophagus with the stomach, closes once food passes into the stomach. This closure prevents the stomach contents from flowing back up into the esophagus. Acid reflux occurs when this sphincter does not work properly and allows acidic fluid to return to the esophagus and higher—the mouth.

This condition can actually be noted by a dentist long before it is acknowledged by a patient or physician. The dentist will see a characteristic smooth and circular erosion of the cusp tips of the lower first molars. The cusp tips (bumps on a tooth) lose their peak, flatten, and become concave. Soon the enamel cover is broached and the underlying dentin is exposed. Because dentin is “softer” than enamel, the erosion can progress more quickly. This acid erosion has a very different appearance from tooth loss due to a mechanical etiology. Attrition and abrasion have a very sharp, edged, and well-delineated look. Chemical erosion has a softer and more rounded presentation and is localized first to lower first molars (lower first molars are the first permanent molars to erupt into the mouth) so that the permanent teeth have the longest potential exposure. When the acid refluxes (returns) to the mouth, it pools mostly around the first lower molars. This is the site of the most erosive features.

A significant portion of the population experiences acid reflux at least once a month. About 25% of those who are affected are aware of their problem. Infants and young children can be affected, and there may be a genetic component to the disease. Early diagnosis from erosion of the permanent lower first molars can be made as early as 7 or 8 years of age. A hiatal hernia may weaken the LES and cause reflux. Diet and lifestyle contribute to acid reflux. Chocolate, peppermint, citrus, tomatoes, fried or fatty foods, coffee (especially acidic coffee), alcoholic beverages, garlic, and onions are foods to avoid. Weight gain (also weight gain associated with pregnancy) and smoking (by relaxing the LES) may be contributing factors. Further information may be obtained from the Internet by going to a search engine and typing in “acid reflux”, “gastric reflux”, or “gastroesophageal reflux disease (GERD)”.

As is true with most medical and dental problems, the earlier the diagnosis is made, the easier it is to treat. If we have brought this condition to your attention, we ask that you speak to your physician. Variable factors include the nature and severity of the problem, as well as frequency and type of fluid that refluxes from the stomach. Change in diet, eating habits, and/or medication (over-the-counter or prescription) can be effective. Dentally, once the enamel is broached and the dentin becomes visible, it is recommended that the affected areas be protected by covering them with an enamel replacement—a tooth-colored bonding material. This material not only protects the dentin and enamel but it also may be more resistant to the acid than is naturally occurring dentin. Many times, drilling preparation is not needed.

If you have any questions about acid reflux, please feel free to ask us!  

Hymeadow: (512) 250-5012

Jollyville: (512) 346-8424

West William Cannon: (512) 445-5721

Xerostomia: Dry Mouth Syndrome

Xerostomia (dry mouth) is not a condition everyone should expect. You may notice it as you age due to a change in hormones, medication, and/or radiation therapy in the head and neck region.

Why Xerostomia Is a Problem

Saliva is important to oral health for several reasons. The flow of saliva helps clear debris from the oral cavity. It provides minerals necessary to support the process of remineralization. Tooth enamel daily undergoes acid attack that removes inorganic minerals from teeth. This is called demineralization. Remineralization is the opposite of demineralization. It occurs when inorganic molecules flow into a region of weakened enamel and make it stronger.

When the salivary flow is reduced, a chain of events occurs. The natural cleansing action is diminished, as are the buffering action and remineralization properties of saliva. People with diminished salivary flow experience a very fast rate of decay, many times faster and over several teeth. This type of dental decay is typically noted along the gumline, around existing dental work, and on exposed root surfaces.

Prevention

You can help prevent dental decay that can result from xerostomia:

• Brushing and flossing correctly twice a day becomes very important.
• Frequent sips of water during the day can help moisten the mouth and can help clear debris.
• Daily use of a mouthrinse containing fluoride can help remineralize teeth.
• Use a toothpaste containing sodium fluoride.
• We recommend a daily brushing with a prescription, high-concentration sodium fluoride gel or paste. We will either dispense this or give you a prescription for it.
• Chew sugarless gum or a rubber band to stimulate salivary flow.
•  In moderate to severe cases, special fluoride delivery trays can be made for you to use at home. These will keep the high-concentration fluoride in a position to “soak” your teeth with fluoride for several minutes at a time.
• We recommend that you have your teeth cleaned, polished, and an office-applied topical fluoride treatment every 3 months while the condition persists.

Dry mouth can have serious dental consequences and must be treated accordingly.

If you have any questions about xerostomia, please feel free to contact us at any of our three office locations:

Hymeadow: (512) 250-5012

Jollyville: (512) 346-8424

West William Cannon: (512) 445-5721

Sedative Restorations

Sedative restorations are placed for several different reasons. The most common reason is tooth pain. The pain may be constant, intermittent, or a reaction to sweets or a cold or hot stimulus. If the sensitivity is due to decay and it is very deep and close to the nerve, there is the possibility of exposure of the pulp (nerve) once all the decay is removed. If the cavity is especially deep, as much of the decay as possible will be removed, and a medicated, sedative filling will be placed in the tooth. This will serve to calm the nerve and give it a chance to heal. The sedative restoration, if done for this reason, should stay in your mouth for a number of weeks. Then the sedative restoration will be removed and the tooth will be examined to determine the need for further treatment. It may be able to be restored with a filling or cast restoration. However, if the decay was quite deep and the nerve does not heal, endodontic treatment (root canal therapy) will be required to alleviate pain and save the tooth.

If you have multiple large cavities and/or other serious dental problems, we may choose to first restore all the teeth with sedative restorations. This will quickly stabilize all the teeth so that they do not continue to deteriorate from the decay. Then the other, perhaps more serious dental problems, can be addressed and treated. Once you are out of an emergency situation, we will have the time to thoroughly plan the best methods to restore the teeth.

A third use of sedative restoration is an aid in diagnosing sensitive teeth. You may have a problem with a single tooth, or perhaps you are unable to specifically pinpoint the exact tooth. If the tooth (or teeth) already has a restoration in it, we may need to remove the restoration and directly look at the prepared portions of the tooth. If we do not feel that it is appropriate to place a final restoration at that time, we will place a sedative restoration to be in place for a few weeks. Occasionally, the tooth feels better as soon as the sedative restoration is placed. However, it will still be necessary to observe the tooth for a few weeks before placing a final restoration.

Infrequently, the placement of the sedative restoration offers no apparent relief. In this case other possibilities must be explored. Most often the tooth will require endodontic treatment. Other times, it just takes several days to get a positive result. If possible, give the sedative restoration time to work. But under no circumstances must you live in constant pain. Do not be afraid to call and ask to be seen if the sedative restoration does not appear to be effective.

If you have any questions about sedative restorations, please feel free to contact us at any of our three office locations:

Hymeadow: (512) 250-5012

Jollyville: (512) 346-8424

West William Cannon: (512) 445-5721

Altered Passive Eruption: Hard Tissue

Teeth are composed of two basic, visible parts—the root portion and the crown (enamel-covered) portion. The term crown does not refer to the type of tooth replacement fabricated by a dental laboratory. Rather, it is the part of the tooth that is normally seen when you speak.

The present-day esthetic dental philosophy, demonstrated by people who have beautiful teeth and smiles, shows that there must be a certain amount of enamel-covered tooth visible for an attractive smile. The ratio is about 1.6:1, length to width. Teeth that are shorter than this look progressively less attractive. They look short and stubby. If they are actually worn down from a clenching or grinding problem, this is a different type of problem. But it may not be that the teeth themselves are too short. It could be that there is not enough of the crown of the tooth that can be seen. The remainder that should be seen is covered with gum or gum and bone tissue. This is known as altered passive eruption. It is not entirely clear why this happens. It may become obvious as early as age 14. The teeth may have a pleasing color and be very straight, but they still leave something to be desired because they are too small and too much gum shows when you smile.

This can be a severe cosmetic problem when coupled with the type of lip line that frames the teeth. A low lip line will probably hide most or all of the gum covered part of the tooth, so there is less of a need to correct the defect. A medium or high lip line, especially a high lip line, will show all of the tooth and gum. As the lip line gets higher, the attractiveness of the smile goes down. The situation can be so severe that the patient will train his or her muscles to artificially hold the upper lip stiff or cover the mouth with a hand when smiling. In this way, the short teeth or the great expanse of gum tissue will be hidden from view. It can cause significant psychological problems.

The solution can be easy or complicated, depending on the exact nature of the problem. If there is only a small amount of gum tissue to be removed from a single tooth or multiple teeth, and there is a medium lip line, then the tissue is easily removed with a laser or electrosurgical cutting device. Scalpels and stitches are not needed in small cases. As more gum must be removed and more tooth is exposed, there may be some underlying bone that must be reshaped. Bone removal will be followed, about 2 months later, by the soft tissue removal mentioned earlier. The first surgery must heal long enough for the tissue to reach its final position before the second can be completed. Remember, you are looking at differences of several millimeters to a fraction of a millimeter that will cause the case to be a success or failure. A two-step procedure is better than a one-step procedure.

The biting edges (enamel and/or dentin) of one or more teeth may be reshaped if there is a need not only to lengthen the teeth but also to make it appear that they have actually been placed higher in the smile line. This is for top teeth, of course. If a great deal of tooth must be reshaped to accomplish the desired effect, root or dentin may be exposed, making the tooth sensitive. These teeth will need to be covered with porcelain veneers or crowns to achieve the proper esthetics. Even if only a little amount of tooth is reshaped, the veneers or crowns may be indicated to get the exact appearance you want. We will discuss this with you before you begin treatment. It is important that you know what is being done, how long it will take to complete, and what you will look like when it is finished,

We will make the veneers or crowns and reshape the teeth. We will determine what can be done. We may also do the soft tissue contouring. This is most common. For procedures that involve a reshaping of the bone, you may be referred to our periodontist. Since we will do the restorative treatment, we know exactly where the soft tissue should be. We are the cosmetic specialists. We will establish the final position of the gum line. In extreme cases, the problem will be corrected with a combination of the above-mentioned procedures and orthognathic surgery to reposition the jawbone and teeth. This can be done by our oral surgeon. With a comprehensive examination, we can tell you what is appropriate for you. You do not have to live with an unattractive smile because you have short-looking teeth due to showing too much gum tissue. These problems can be corrected. Let us know what you do not like about your smile or teeth. More than likely, the smile you now have can be made into something you will like to show off.

If you have any questions about altered passive eruption, please feel free to ask us!  

Hymeadow: (512) 250-5012

Jollyville: (512) 346-8424

West William Cannon: (512) 445-5721

Porcelain Inlays and Onlays

Porcelain

When a tooth has been moderately to extensively destroyed by decay, previous drilling, or fracture but there is still sufficient enamel remaining, one innovative way it can be restored is with a porcelain inlay or onlay. An inlay is a restoration in which a portion of occlusal (biting) surface is replaced with porcelain. An onlay will restore a larger portion of the biting surface of the tooth. These are considered very conservative restorations. The porcelain allows an excellent esthetic result. It is attached to the tooth using a bonding procedure, allowing it to become very strong. It can be used with wonderful results in small, medium, and even with large restorations lasting more than 12 years, relatively trouble free.

A dental laboratory is involved in the construction of the restoration. There is a 2- to 3-week delay while the inlay or onlay is being made, so the tooth must have a temporary restoration in place during that time.

They have some disadvantages. They are moderately to very expensive to make and place. They take two appointments to complete. They must be adjusted and polished well or they can cause wear of the opposing enamel, similar to a porcelain fused to metal crown. Of course, we make sure they are adjusted and polished to begin with. Porcelain biting surfaces cause more rapid wear of opposing natural teeth, especially in the posterior areas where a metal biting surface may be advised.

Advantages include the excellent esthetics, high strength, predicted longevity, and conservative preparation, 

that is, less drilling than a crown. If the porcelain does chip, it can be repaired. However, you should not chew ice cubes, “jaw breakers”, or any other hard candy with these or any other type of restoration.

For those who want the strongest, longest-lasting, conservative restoration that very closely matches a tooth, porcelain is possibly the best choice. Once it is finished, the tooth, if cared for properly, should not have to be restored again for years. It does allow the conservation of most of the natural tooth.

Resin

Resin inlays and onlays are used in the same areas as the porcelain inlays and onlays. They are very natural in appearance and, like porcelain, are bonded into place. They are considered an extremely conservative restoration. Two appointments, approximately 2 weeks apart, are required to fabricate the inlay/onlay. The tooth will be protected with a temporary filling while the final restoration is being made. The wear of the resin is similar to that of enamel. So unlike porcelain, it will not have a tendency to wear the opposing natural tooth structure.

The resin may be considered slightly “weaker” than the porcelain. However, porcelain is more brittle and more difficult to repair. The difference in strengths is not significant. The resin is more forgiving and is more easily finished or repaired and resin is easier to work on.

With both types of materials, porcelain or resin, you can develop decay on unrestored surfaces, so excellent oral self-care is required. Neither material is advised for patients who have a bruxing (grinding) or clenching habit unless a protective mouthguard is constructed for you.

Unless you have a preference, we will select the most appropriate material for your dental needs. Cost of each is comparable. Both types are excellent choices and are considered highly conservative in the amount of drilling needed.

If you have any questions about porcelain or resin inlays and onlays, please feel free to ask us at any of our office locations:

Hymeadow: (512) 250-5012

Jollyville: (512) 346-8424

West William Cannon: (512) 445-5721