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

Crowns: An Overview

Why would I need a crown (cap)?
1. A tooth has been so badly damaged by decay or so heavily restored by fillings that it can only be saved with cast restoration
2. A tooth has been treated endodontically (root canal treatment). These teeth are almost always restored with a cast restoration because they have lost a great deal of tooth structure from fracture, decay, or the drilling process. These teeth are prone to fracture under normal and light chewing forces.
3. The tooth needs to be used as an abutment (anchor) for a bridge to replace missing teeth.
4. Grinding your teeth, an improper bite, age, fillings and tooth decay can all be contributing factors in the wearing down, cracking or breakage of your teeth. 

What are dental crowns?
Dental crowns cover the entire visible surface of your affected tooth and add strength, durability and tooth stability. Click here to learn about the difference between crowns, bridges, and implants.

What kinds of crowns are there?
Expect to pay more for porcelain crowns because they are usually more time-consuming than gold crowns. Porcelain, porcelain over metal and gold crowns average between $600 to $3100 each in total cost. The new reinforced resin or bonded all-porcelain type costs more than other types, require more skill from your dentist and the lab, and may exceed your insurance plan coverage for crowns.

• Resin and Porcelain Crowns

• The new reinforced resin or bonded all-porcelain type of crown as the nicest appearance. This crown can be made from pure ceramic or a new reinforced composite resin, and is almost indistinguishable from natural teeth. Thew new bonding technology involved provides an exceptional bond to your tooth. It is metal-free, and thus satisfies the needs of patients with metal sensitivities. When correcting your back teeth with bonding, the cosmetic dentist will perform a tooth colored onlay. This type of procedure is used to correct only those parts of the tooth that are in need. This is a metal-free procedure. 
• Advantage: Porcelain crowns or new reinforced resin are considered to be the most aesthetically pleasing, as it is so easily matched in color to the surrounding teeth
• Disadvantage: The thickness of the porcelain required for pleasing aesthetics also requires that more tooth structure needs to be removed. It is more difficult for your cosmetic dentist to get an ideal fit where your gum meets the crown. Gingival inflammation appears to be more common with porcelain crowns that gold crowns. All-porcelain crowns require a higher skill level from your dentist and lab.
• Crowns Made of Gold

• Gold crowns are appropriate when appearance is not a priority to you. The gold metal is extremely workable, making gold crowns a more precise fit than any other type. While there exists a slight possibility of chipping with porcelain crowns, gold crowns provide no such possibility.
• Advantage: The preparation of a tooth for a gold crown is the simplest and least complicated preparation as there is minimal tooth structure removal with as much as possible of the healthy tooth structure remaining untouched. While porcelain is hard by comparison, it may cause wear on opposing teeth over the years where goal is not as likely to do so. Gold is also easier to fit to the area where the tooth and crown meet for a better fit. Gold is also a healthier environment for the gum tissue.
• Disadvantage: The cosmetic aspect, unless it is being used in the back of your mouth
• Porcelain and Metal Crowns

• For a very natural appearance, porcelain fused to metal crowns are the answer. However, they have a metal substructure and require an opaque below the porcelain. This can make the translucency of natural teeth difficult to replicate. Occasionally, a darker line will be visible at the edge of the crown, near to your gum when it recedes with age. 
• Advantage: Porcelain fused-to-metal crowns have a very natural appearance
• Disadvantage: They have a metal substructure and require an opaque below the porcelain. This can make the translucency of natural teeth difficult to replicate. Occasionally a darker line will be visible at the edge of the crown, near to your gum when it recedes with age
• Types of Porcelain
• There are two types of porcelain - felspathic and pressed ceramic porcelains. The felspathic type is the original method that has been around for 20 years. Ceramist in a dental lab bakes porcelain onto tin foil and then heats it in an oven. The Ceramist is able to create tints and opaques inside the porcelain to give the natural look we seek.
• Pressed ceramic is created from a single ingot. The single ingot is milled in one piece to create the desired shape. The stains and opaques are applied only to the surface of the porcelain to give a natural look.

How do I choose a color for the dental crowns - how white should it be?
Whiten your natural teeth to either the level of whiteness you want or to the brightest they can be. Your cosmetic dentist will then have the crowns made to that color. Teeth are of course not monochromatic, so typically more than one color is used to used a very natural look. This color variation is critical in avoiding fake or artificial looking teeth. It is the internal contrast of colors that help create vitality. The internal play of light on the porcelain in the restoration helps to create this vitality. Surface texture is also very important, and helps to break up light reflections and make the crown look more natural.

There is no one standard system in the dental field to measure and determine tooth color. The most often heard about, however, is the Vita shade guide. This guide divides tooth color into four basic shade ranges:

A (reddish brown)
B (reddish yellow)
C (gray)
D (reddish gray)

In the A range, there are five level of darkness. Ranges B, C, and D, each have four levels.

Not all of your teeth are the same natural color. Usually your eye teeth tend to be darker than the others, your front teeth are typically the whitest, and molars tend to be a shade between the two. The goal for everyone is to achieve their individual optimum whiteness while still looking natural.

Most dentists will show you a shade chart for your to pick from. Keep in mind, with a good cosmetic dentist, this is merely a starting point. Other considerations when determining the color of crowns for each patient are your complexion, hair color, the color of your natural teeth and even your eye color.

What is the procedure?
- Preparing (drilling) the tooth in an appropriate fashion for the type of crown chosen
- Making impressions of the prepared tooth, opposing teeth, and the occlusal (bite) relationships
- Selecting a shade for tooth-colored crowns
- Fabricating a provisional restoration that will remain in place while the crown is being constructed
- Cementing or bonding the completed crown into position. If the work to be done is extensive, there may also be several appointments needed for preliminary seating (try-in) of the crowns or castings

What do I need to do BEFORE I get the crown?
It is important for the ultimate success of the crown(s) that you understand and can perform thorough plaque removal. You should immediately begin following the oral self-care instructions that you have been given. It will make the procedure more comfortable and efficient, and the resulting restorations will look better. Final impressions cannot be taken until the gum tissue is healthy. Crown lengthening is an oral surgery treatment that involves removing excess gum tissue around the upper teeth to make them look longer. Your cooperation is appreciated and necessary.

What do I need to do AFTER I get the crown?
As is true with your natural teeth and especially with teeth that have been restored with any dental material, you should avoid chewing on excessively hard or sticky foods after the crowns have been cemented. It is especially important not to bite down on hard foods with just one tooth. The porcelain material can fracture from the metal substructure under extreme forces. Anything you chew that could break a natural tooth could break a crown!

Be sure to brush and floss daily as instructed. We also advise using a fluoride mouthrinse as part of your daily routine. Please be sure to return for your regular examinations and prophylaxis (cleaning) appointments at the time intervals we suggest.

After observing these types of procedures for many years, we note that the gingiva (gums) can recede from the crown margins and the surrounding tooth structure may become visible. This recession usually takes place over a period of several years and may require restoration replacements or a periodontal plastic surgery procedure to correct it.

We expect that you will receive many years of service from the cast restoration.

If you have any questions about crowns and bridges, call our office and ask or set up an appointment. We have 3 convenient locations around Austin.