Case Presentation: Anterior Veneer Replacement

Today's patient came to us with a set of porcelain veneers on their two front teeth, where one had become cracked along the gum line. Defects in this location are particularly problematic, as they create an easy place for bacteria to enter the tooth and are cosmetically unpleasing. After discussing options with the patient, we decided to replace both veneers with new Emax lithium disilicate units. Lithium disilicate is an engineered dental material that is about five or six times stronger than porcelain, along with having more "natural" cosmetic properties. By replacing both veneers, we were able to repair the defect, add length to the teeth (the original veneers were short of optimal) and create overall more natural contours. The result is a beautiful and more youthful smile. If you are interested in veneers or any other cosmetic dental procedures, please give our office a call!

Dental Quesitons; Why aren't temporary crowns permanent solutions?

A typical temporary crown.

If you've ever had a crown placed in your mouth, you know the typical steps: one appointment to prepare the tooth and another to fit and deliver the final crown. In between, you were given a temporary crown as a placeholder to protect the tooth. Many patients love the look and feel of their temporary crowns and are curious as to why they can't be used as a permanent solution.

There are a few important reasons why we don't use temporary crowns as final restorations. First, they are made of a weaker material. The composites used to make temporary crowns are designed to be easy to cast and manipulate while remaining durable enough for short term use. They are not designed to stand up to years of biting, chewing and grinding. Only a permanent crown made from high strength metal, zirconia or composite can handle this task. Secondly, there is no was to adapt a temporary crown to a tooth as exacting as a lab made permanent restoration. The crown margin (where the crown meets the tooth) needs to be adapted to the tooth on the micron scale to seal out bacteria and prevent tooth decay. This level of precision can only be reached with the tools and techniques of an experienced dental lab.

You may have heard of "same day" crowns that skip the temporary crown step. While this option may sound attractive, our office feels that this technology still needs further improvement before it matches the quality of work we get from our dental labs. We only offer new procedures if we are absolutely sure they are the best options for our patients! If you would like to know more about crown procedures, temporary crowns or any other dental topics, please give our office a call.

Jonathan's First Birthday

What a time to celebrate! Our office manager Michael's son Jonathan turned one this week. Michael and his wife Katie definitely had their hands full with planning and preparing for the event, but it all payed off. Happy birthday Jonathan, we hope you got everything you wished for!

Case Presentation: Polishing an Existing Filling

Over time, dental fillings tend to pick up stains from the foods and beverages we consume. This isn't a big concern with the posterior teeth, where restorations are generally hidden during daily activities. However, discoloration can become a  genuine cosmetic concern in fillings on anterior teeth.

This patient had a filling placed years ago by a different dentist to correct for abfraction, or the loss of enamel near the gum line due to stress and clenching. This type of restoration is very common and usually affects the canines and premolars (both visible in a typical smile). They were dissatisfied with the dark line around the filling that drew the eye towards that tooth. With a 10 minute appointment to polish and recontour, the filling looked brand new! 

It is important to note that we checked the seal and fit of the filling first, to make sure we weren't just polishing a defective restoration. Many times, discoloration is a sign of recurrent decay, where the entire fillings needs to be replaced. If you would like to know more about fillings, their lifespans and how to care for them, please give our office a call!

Dental Questions: Do sensitivity toothpastes actually work?

Many of our patients complain of "sensitive teeth" and are curious if products like Sensodyne, Crest Sensi-Releif or Colgate Sensitive actually work. With all the brands of toothpaste available on the market, their skepticism is very understandable.

The short answer is yes, these toothpastes will help make your teeth less hypersensitive to hot, cold and other stimulation. They typically contain an active ingredient called potassium nitrate that helps block the nerve endings on exposed dentin. Dentin is the material between enamel and dental pulp, and is often exposed in areas of recession. This is why patients who brush vigorously at their gum lines will frequently develop sensitivity problems. The abrasion of the toothbrush causes the gum tissue to recede, revealing exposed dentin underneath. 

However, it is important to note that sensitivity toothpastes will not address other kinds of dental pain. Inflamed gums, severely cold sensitive teeth and teeth with active decay will not improve with the use of these products. Furthermore, you will need to use these toothpastes twice a day for about two weeks before you start to notice improvements. It is important to keep in mind the capabilities of these products and likewise manage your expectations. If you have any further questions about sensitivity, toothpastes or other over the counter dental products, please give our office a call or email! 

Dental Questions: What do probing numbers mean?

A periodontal probe in healthy gum tissue.

At your last dental exam, you may have heard the dentist or hygienist say numbers while scanning your teeth with an instrument. The numbers were grouped in triplets and called out after each tooth ("three-two-three, two-one-two"). These findings correspond to the space between your teeth and gums. They are typically measured using an instrument called a periodontal probe, which is pictured at the start of this article. Each color change corresponds to three millimeters, creating a sort of measuring stick for the mouth. 

The numbers you hear are the millimeters that the probe slips below the gum line. A reading from one to three millimeters is generally considered healthy. Measurements four and above indicate the presence of a periodontal pocket, where the bone has recessed away from the tooth. There are many different treatments for periodontal disease, ranging from deep cleanings to bone grafts, designed to halt or reverse increasing pocket depths. If you would like to know more about dental exams, cleanings or periodontal services, please give our office a call!

Case Presentation: Crown Delivery

Take a look at the amazing work we can accomplish with the help of our dental labs! This patient came to us needing a crown repaired in the front of their mouth. As always, our main concern was delivering a restoration that looked completely natural. After preparing the tooth and making impressions, we took a number of diagnostic photographs to capture the nature of the patient's smile. Using just the photos and impressions, our lab created an unbelievable new crown. The color, shaping and opacity are a perfect match to the existing teeth. If you would like to see more of the esthetic work we perform at our office, check out the "cosmetic dentistry" section on our blog index!

Case Presentation: Esthetic Crown Lengthening for Veneers

Today's patient came to us with complaints about the shape of their anterior (front) teeth. The teeth appeared too small or "boxy," and a large proportion of the smile was occupied by gum tissue. To correct these concerns, our office decided to utilize cosmetic veneers in conjunction with esthetic crown lengthening. 

Crown lengthening is a procedure performed by a periodontist where the gum tissue is contoured to reveal more tooth structure. Dr. Wilgus at Camarillo Periodontics worked with us to treat this patient and delivered phenomenal results. Even before veneers, the teeth have better proportions and the smile has a less "gummy" appearance. The next step will be to prepare the teeth and design a set of natural and uniform cosmetic veneers. We cant wait to see the final product!

Dental Questions: Is Dental Anesthesia Safe?

Dental anesthesia is packaged into carpules like these. The sizes and coloring is standardized to prevent any confusion between manufacturers. 

Note: In this article, we will only be discussing local anesthesia. For information on other forms of anesthesia/sedation, please contact our office.

Many patients come to our office with concerns about the safety of "Novocain" and other local anesthetics. Because these medications seem to work so quickly and powerfully, it is no wonder that they raise concerns in the general population. However, we are here to show you how and why local anesthetics are wonderful tools in dental treatment. 

First off, Novocaine is no longer used in general dentistry. Concerns of liver damage prompted pharmaceutical companies to develop a new generation of drugs. Now, we have products such as lidocaine, septocaine and carbocaine- a variety of compounds maximized for specific circumstances. They are metabolized safely and have predictable durations of numbness. Overall, these medications have very few side effects unless you are receiving large quantities (far beyond the amounts used in dentistry).

Anesthetics are frequently administered with epinephrine. This compound is made naturally by the human body and is essential to life. We use it to allow the anesthesia to better numb the intended tissue. Some patients may feel an increased heart rate or anxiety when exposed to epinephrine. However, it is impossible to have a true (medical) allergy to this substance. During exams, we take note of any contraindications or reactions you may have had with epinephrine in the past. This does a great job of minimizing unexpected side effects.

It is possible to develop an allergy to the preservatives used in dental anesthesia. However, these reactions are very rare and typically present earlier in life. By the time you are receiving dental treatment, you will most likely know if and how your body will react to these substances. As with all conditions and allergies, please inform us during your medical history/exam if you have a known problem with these substances 

In practice, most adverse reactions to anesthesia come from its method of administration. However, good technique and modern equipment (such as our wand systems) help mitigate any problems. If you would like to know more about dental anesthesia and it's safety, please give our office a call!

Operation Gratitude's Halloween Candy for the Troops

Dr. Kari and her three sons out for trick-or-treating!

Did your little ones get a big haul trick-or-treating this year? If you're stuck with more sweets than you know what to do with, consider sharing them with our troops! Operation Gratitude, a nonprofit that organizes support packages for our servicemen and women, hosts a yearly Halloween candy donation drive out of Van Nuys. Last year, we snapped a photo of a small portion of their donations: 

Just look at all those sweets! If you want to brighten a troops day (or cut back on the residual Halloween sugar in your household), click through to their website. Operation Gratitude is asking for all donations by November 15th (whether shipped or in person), so get those candies in!

Link: https://opgrat.wordpress.com/2013/07/18/halloween-candy-for-the-troops/