This informational article is provided to educate our clients and the general public on the dental process of bleaching & whitening. The teeth whitening and bleaching process is often poorly explained to patients prior to it being performed. This results in the process causing unnecessary teeth discomfort and has been found to lower the process effectiveness due to misuse. It is hoped this article will help educate and create a well-informed patient who understands how to make their teeth bleaching process as painless and effective in obtaining that perfect smile as possible.

Teeth Whitening & Bleaching – The Basics*

Teeth whitening has become the finishing touch in the art of building the perfect smile. Along with various tooth aesthetics enhancement procedures, teeth whitening has been proven to be a critical element in the overall improvement of a younger appearance. However, the process of teeth whitening is being sold to many an unsuspecting client as a simple “do it now and you’ll look better practice.” In reality, it is far from that simple a process.  Preparing for a proper tooth whitening is as critical, if not more critical than the process itself. Failure to properly plan out your teeth whitening can result in severe damage to your teeth and pain that will make you long to “undo the undoable.” As always, knowledge and planning is the key.  This article will help you to understand the process and the do’s and don’ts.

Long before you stick some chemical in your mouth to make yourself have that movie star smile, you need to understand the overall health of your teeth and gums. It is pointless to waste money on an expensive teeth whitening when all you are whitening is a mouth full of unhealthy and plaque covered teeth.  To start the process, a trip to your dentist is always step one. A complete dental examination and cleaning is critical before the whitening process is begun. Your teeth must be inspected to fill cavities, eliminate disease conditions and remove plaque and tarter. Think of it like painting your car prior to washing it. It’s always the other way around. After assuring your teeth and gums are in good physical condition and clean, step two begins; preparing the tooth surface for a bleaching. This involves conditioning your teeth with a professional fluoride treatment to protect the tooth surface and lower the possibility of post bleaching tooth pain.  After this process, you are ready for step three; the actual whitening. Before we dive into a bleaching tray, let’s talk for a minute about what got you here to needing that bleaching in the first place.

How did my teeth get to look like Captain Jack the Pirate?!*

Each of our teeth consist of a soft inner layer, called the dentin, which is covered by a hard outermost layer, called the enamel.  As strong as our enamel is, this layer is quite porous by nature, which will allow various staining agents (food, drinks, tobacco, etc) to work their way into the tooth.  When we consume food and beverages, especially those that have a darker pigment such as oranges, carrots, red wine, coffee, cola etc. a layer of acids and pigments in those foods/drinks, form over the enamel.  The longer this layer sits on the tooth the deeper the stain may become.  This is why it is important to adopt proper oral hygiene habits. You know mom’s old saying; “brush after meals young man!” Remember, Mom is always right.

A tooth stain is a tooth stain, right?….Wrong!*

All stains are not created equal. Let’s learn the difference. The result you get from teeth whitening will be impacted by the type of stain your teeth have.  In some cases, the bleaching might not even work! So, knowing your teeth’s stain type is critical. There are two major types of dental stains, extrinsic and intrinsic.  An “extrinsic stain” is caused from exposure to foods and beverages containing dark pigments such as red wines, coffee, teas, carrots, and other foods.  These stains can easily be removed with regular brushing and prophylaxis, which is a procedure used by dentists to eliminate plaque and tartar from your teeth.  Extrinsic stains must be dealt with early on so that they won’t become impregnated into the dentin (the softer inner layer of teeth).  The “intrinsic stain” however, happens from within a tooth outward.  Exposure to certain minerals in our diets, large amounts of fluoride consumption and certain antibiotics such as tetracycline, can cause this type of discoloration due to the interaction with the calcium hydroxyapatite crystals, a main component of the enamel.  Trauma to teeth or a specific tooth may also cause intrinsic staining. If the dental pulp at the center of the tooth hemorrhages, the resulting blood will enter the dentin’s dentinal tubules, which can result in a darker color of the dentin . Lastly and regrettably, simple old age can cause notable discoloration. Only your dentist will know what kind of stain you have. Knowing the stain type will drive the type of bleaching process you need to use.

Teeth Color – Genetics & Your Habits*

Genetics play a significant role in dental discoloration and NO, this does not mean you’re genetically inferior – so relax. We all have an inborn tooth color, which is driven by the color of your dentin. This color may range from a yellow-brown shade, which is more responsive to bleaching, to a greenish-grey shade.  If your enamel has a characteristic translucency appearance, your dentin color will show through more than someone that has a genetic opaque white enamel, which appears lighter in color.  The translucency of your enamel may be due to genetics. However, this translucency is also caused by erosion from acidic foods, or enamel that has been worn down through the years from improper dental care or even simply from general health issues.  The most preventable tooth discoloration effect of all, results from developing smoking habits and the use of pure tobacco.  As a general guideline, if you’re a heavy smoker, that teeth whitening plan should generally follow behind your quitting smoking plan.

Teeth Whitening – Picking the best Tooth Color*

When it comes to teeth whitening, you really want to know the before and after tooth color. This is critical to the natural smile appearance. Just getting the whitest teeth can make you look like you swallowed a can of gloss white paint….Woopsy -I’m in trouble!  Problem is, that freshly painted appearance will not come off with paint thinner. At your cosmetic dentist, you will find they use something called a dental shade guide to measure your natural tooth shade.  A shade guide has the 16 most common tooth colors, which are arranged from lightest to darkest and into four color groups that help the dentist decide the whitening approach.

Teeth Whitening – Alright, do I do it or not!?*

Of course you can get a whitening but, timing is the key! As stated earlier, there are some dental conditions that you should address before you begin any bleaching or whitening procedure. For example, if you have very sensitive teeth to heat or cold, worn enamel, cavities, exposed roots, fillings, crowns, other restorations, or dreaded periodontal disease, you have to make sure these
issues get treated by your dentist FIRST. What those quick whitening studios don’t always tell you is that whitening may actually complicate serious dental problems. They just want to sell you a whitening, they don’t always know if you are ready for it or not. Further, whitening your teeth is NOT recommended if you are under the age of 16, your pregnant or are lactating after delivery of a baby.  Your may also be an inadequate candidate for certain types of whitening if you have restorations such as bondings, veneers or crowns. This is due to the fact that these restorations maintain their initial intended color while the rest of your natural teeth will be whitened. This commonly results in a frequent condition called “technicolor teeth,” Teeth of varying shades.  Varying shades of teeth can also occur if you happen to use whitening strips that do not cover a tooth completely.

Teeth Whitening – The Various Methods*

Choosing a teeth whitening system on your own can be a difficult task due to the variety of selections available today. The options vary from the whitening toothpastes, oral rinses, do-it-yourself dental trays, whitening strips, to the over-the -counter gels. In the dental office the cosmetic dentist has nearly a dozen professional teeth whitening systems and options tailored to specific dental conditions and those conditions can be complex.  Some select in-office systems require a couple hours to perform and others can be done in a one-hour office session. Certain professional grade processes use custom made bleaching trays, which you can only obtain from your dentist.  Again, knowledge is the key to choosing the best option for you and starting with your dentist is always the right choice. The most beneficial aspects of starting at the dentist is coming to understand the side effects, that are not always discussed with over-the-counter products. They simply cannot cover all the possible dental conditions.

Teeth Bleaching versus Whitening*

The term “whitening” is used when your teeth color is restored back to what its natural color should be.  This means that any product that can remove stains and even just debris such as tartar from your teeth such as toothpaste, or baking soda can be called a “whitener.”  The term “bleaching” is used when teeth are whitened to color shades more than what their natural color is.  Only products that contain bleaching agents such as carbamide peroxide and hydrogen peroxide are permitted to use the bleaching term.  However, whitening is a term often used for the public to refer to teeth bleaching. This is simply because it sounds better that bleached teeth. That term sometimes scares people.  By the way, it is worth noting that the FDA does not regulate teeth whiteners since it is not a drug. So, you have to be careful with their use. Always use common sense with any dental product. Even a dental rinse can have serious health aide effects.

Teeth Whitening Agents – Hydrogen Peroxide*

In general, bleaching systems being used by dental offices contain either hydrogen peroxide or carbamide peroxide, though hydrogen peroxide is the active ingredient in both.  Hydrogen peroxide, when applied to your teeth begins an oxidation process that breaks down into oxygen and water, creating the bleaching effect.  Most dental offices use systems that contain hydrogen peroxide, in concentrations from 15% to 35%. This could be referred to as prescription strength. At this concentration, faster results are achieved in a shorter amount of time and the results are more pronounced. Hydrogen Peroxide could be considered slightly more powerful than carbamide peroxide, which (although being more effective) means that it may cause your teeth to be more sensitive and irritate your gums and other soft tissues of your mouth.  It is recommended that if you are going to use a product containing hydrogen peroxide you do so under the supervision of a dentist.

Teeth Whitening Agents – Carbamide Peroxide*

In products that contain carbamide peroxide, hydrogen is the active ingredient.  The difference is that a urea molecule is added to hydrogen peroxide that results in the compound we know as carbamide.  This means that it takes carbamide an extra step for the teeth whitening process to take effect.  While products containing hydrogen peroxide only have to break down into oxygen and water, carbamide has to first break down into hydrogen peroxide and then into oxygen, which is what whitens your teeth.  It takes about 15 minutes for the carbamide to begin to break down into hydrogen peroxide.  Since there is an extra chemical step for the peroxide to go through, it takes longer to work its magic on your teeth. However, the GOOD NEWS is that this extra chemical step is gentler on your gums and will in most cases cause less sensitivity effects in the teeth.  Carbamide is often found in most “over the counter” products because it is safer for consumer use. This is good, but, this means it has to be used over a longer period of time to get the results you want.

Over-the-Counter Teeth Whitening – Considerations*

When it comes to brightening your smile you always select a product that is safe for your teeth and most of all your health. Make sure the product is approved by the American Dental Association (ADA).   The ADA has strict guidelines for safety and effectiveness that a product must meet in order to receive their seal of approval.  It cannot be emphasized enough, it is always best to visit your dentist first. Teeth whiteners can worsen and accelerate various forms of dental disease. It should not even have to be said you must always follow the instructions to the letter. It is possible to misuse and overuse over-the-counter whiteners. The biggest concern you should be aware of right off is the potential for dental pain. A whitener can cause both gum and tooth pain. If misused or over used, the resulting pain may not go away for months! The bad news is, the dentist may not be able to make that pain go away any faster either. So BEWARE.  There is a potential for allergic reactions too, so start out slow.

Dental Office Teeth Whitening – Considerations*

Out of all the cosmetic teeth whitening systems on the market, in-office bleaching/whitening gives the most dramatic results in the shortest amount of time.   This is simply due to the use of prescription grade chemicals. This option is the most recommended because your cosmetic dentist will first examine and clean teeth with pumice, fill cavities, and make sure your health condition is ready for the process.  Don’t panic if a dentist determines you are not a good candidate for tooth whitening. If you are not, there are almost always alternative cosmetic dental options available.

The bottom line is, teeth and gums must be in good condition if whitening is to be performed.  This is simply because the peroxide may worsen any periodontal problems or other conditions present. In the dental office, the dentist will likely isolate your gums with the help of a device known as a rubber dam or a protective gel. When these protections are in place. the whitening solution will be applied directly on to your teeth where it will remain for a given interval of minutes.  Some products may require heat, laser, or an infrared light to activate the release of the oxygen molecules.  Keep in mind that everybody’s teeth are different and therefore respond differently to the bleaching process.

The best advantage of performing the process in the dental office is due to the dentists ability to deal with dental restorations that cannot be whitened. If you have  crowns, bridges, composites, veneers and other restorations that will not lighten with the whitening process, the dentist can successfully isolate those restorations and tailor the whitening process to give a perfect uniform color and shade across all teeth. This is almost impossible in the at-home products.

Prescription Teeth Whitening*

If your dentist determines that you are a candidate for at-home prescription whitening, this can be a significant cost saver for you.  This type of whitening can still help you achieve similar results to in-office whitening in a safe and effective way. You need to remember though, this process will take a longer amount of time and must be followed with high consistency.  These kits use a solution with a lower concentration of hydrogen peroxide than the in-office product.  Generally, they must be used once a day for a 10-60 minute period. The dentist will specify the period.  Keep in mind, the lower the concentration of hydrogen peroxide the longer it may safely remain in contact with your teeth. Other kits may contain carbamide peroxide, which is more stable than hydrogen peroxide and may, if in the right concentration, be used overnight. The key aspect of both of these products is the lowered chance of tooth sensitivity.  You are essentially trading time for comfort and safety.

For the prescription at-home whitening process, an impression of your upper and lower teeth is taken and sent to a dental lab where a set of custom-made dental trays will be prepared for you.  In about a week or two of your impressions being taken, an appointment will be made where you will be shown how to apply the solution to the trays and place them in the mouth.  As stated before, these are used for a maximum of one hour a day for about two weeks or in some cases overnight, depending on type of solution and concentration of peroxide.  You should wipe any excess solution, since it may irritate/damage your gums and it is always proper to brush and floss your teeth before using any type of whitening solution.  This overall whitening process is done over a period of two to four weeks.

Internal Tooth Bleaching*

Internal tooth bleaching is more commonly performed by certain general dentists or an Endodontist on a tooth that is discolored due to a root canal therapy (RCT) or trauma to the tooth.  Teeth may become discolored if a root canal is not performed correctly. The blood components may enter the root, which then decompose causing the darkening of the tooth from the inside.  This requires re-treatment of the root canal therapy to remove the source that is causing the discoloration of the tooth. Once the root canal is re-treated, a bleaching gel or crystal are then inserted in the cavity of the tooth for a certain period of time to whiten the root.  In some instances a method called “walking bleach” may be used. In this procedure the bleach crystals are left in the tooth and the patient is to return to office in a couple of days to get the bleaching agent removed.  You should note there are certain risks associated with internal bleaching. These risks can involve loosing the tooth due to a leaking root filling or damage of the crown or tooth when the tooth is opened.

Teeth Whitening is done – Now what?*

It should go without saying that to maintain your white teeth for as long as possible, make sure to keep practicing good oral hygiene. Translated – brushing and flossing your teeth at least two times a day.  Also at-home maintenance whitening may be implemented when you start noticing discoloration.  The avoidance of eating foods and beverages that are dark in color, such as coffee, cola, carrots, oranges, and such, for about one to two weeks after the whitening is advised. This is especially important within the first 24 hours after bleaching since your enamel has been compromised and will easily pick up a color from a film coating. CAUTION – in worst cases, failure to observe this first 24 hour requirement may permanently discolor your enamel!  You should also avoid smoking since it causes stains that in the long term become intrinsic stains.  Be aware that the consumption of certain pharmaceuticals may cause staining of the teeth as well and start the staining process all over again 

Teeth whitening – Risks & Side Effects*

The most common side effect from teeth whitening is the temporary sensitivity of the patients teeth and irritation of the gums.  It is a common side effect to have sensitivity to temperature and touch with in-office bleaching. This is simply because higher concentrations of peroxide are used in this process.  Other factors that may cause sensitivity are if the patient suffers from gum recession or significant cracks in their teeth that results in leakage. After cracks are repaired, the pre-treatment of teeth with a fluoride rise prior to the whitening process is shown to lower the level of tooth sensitivity. This is because the fluoride helps re-mineralize (seal) the tooth enamel surface and protect the dentin from the chemical exposure, which causes pain.

In certain patient cases, after the whitening process, they may feel a shooting pain or tingling sensation in the middle of their teeth.  If a hydrogen peroxide based system was used, these effects are the result of irritations to the gums due to the concentration of the chemicals.  In some cases a poor fitting whitening tray may be the cause of irritation.  Is should be noted, this condition is sometimes unavoidable simply due to a unique teeth condition such as tooth mis-alignment and a number of other factors outside the dentists control.  Though it is an inconvenience, the sensitivity and irritation will generally dissipate in typically seven to ten days. If the pain dose not subside, a immediate trip to the dentist is necessary.

Teeth Whitening – Reducing Risk & Pain*

As a minimum, the use of a toothpaste for sensitive teeth before, during, and after whitening is always advised.  Sensitivity toothpastes generally contain potassium nitrate that eases a tooth’s nerve endings.  If performing at-home prescription whitening to reduce the feeling of sensitivity, the patient may try reducing the amount of time the solution is in contact with their teeth or try skipping on one or two days of use as opposed to wearing the trays everyday.  The prescribing dentist may also recommend a prescription fluoride rinse to help re-mineralize the enamel of the teeth. Certain types of fluoride gels may be prescribed as well. Appling the fluoride gel on the custom whitening trays prior to the whitening process has proven to help reduce the discomfort of the process.

* – All information contained in this article is for “informational purposes only.” It is not to be interpreted as direction towards a diagnosis/treatment recommendation. Reader must directly consult a dentist for any evaluation/specific treatment advice. ©2012 Dental Aesthetics Professionals. No portion of this article may be reused without the written permission of the author.

The following article is provided to give a general introduction to art and science of cosmetic dentistry for our clients at Dental Aesthetics Professionals. Cosmetic Dentistry is both a combination of solid dental science and creative dental art. The science aspect comes from using the latest technologies and medical processes to create a healthy mouth and set of teeth. The art aspect comes from using the latest in techniques and dental materials to create a perfect smile that compliments the facial features of the specific client. The overall process is unique for every individual. Here are a few introductions and explanations of some of the overall process for your education.

Cosmetics & Smile Design*  

People have become more aware of the importance of their smile and the impact it has not only upon their appearance but, also on the perception other have of them for both daily social and business interaction.  When people possess an attractive and healthy smile, studies have clearly shown it is highly likely that it will drive a positive, welcoming image and an air of perceived confidence in communication.  This is why cosmetic dentistry has become of such critical importance from celebrities in entertainment to the movers and shakers of the business world.  People have become more conscious of the need for a professional appearance. We may not realize it but it is simple human nature and the smile is almost always the first aspect noticed in that appearance.

Cosmetic versus General Dentistry*

As opposed to dental health, which focuses more on oral health and hygiene, cosmetic dentistry focuses on the appearance of the teeth.  A cosmetic dentist will focus on the shape, color, straightness and appearance of both the teeth and gums.  With the many advances in the cosmetic dentistry field, people no longer have to settle for chipped, crooked, discolored teeth or the resulting poor quality smile.  When visiting a general dentist, the teeth and gums general health would be their main concern. However, a cosmetic dentist would focus additionally on the appearance relative to the clients facial features.  A cosmetic dentist has undertaken specific training and advanced education on dental aesthetics. If a dentist is capable of whitening/bleaching, implants, veneers, bonding, dental bridges, orthodontia and such, they can justifiably use the title of cosmetic dentist.

Cosmetic Dentistry & Bleaching/Whitening*

In the world of cosmetic dentistry, teeth whitening or bleaching is one of the most popular procedures.  With the surge of over-the-counter whitening products, whitening of teeth is more available to the public. However, bleaching via a professional dentist has the most effective and instant results and is actually much safer.  With teeth whitening, the user can restore the natural color of a tooth and that can be accomplished with everyday products such as toothpaste containing a tooth whitening agent. With teeth bleaching, the teeth reach a whiteness that goes beyond the natural tooth color.  A cosmetic dentist may recommend in office bleaching or may recommend a prescription take home system that can be used safely by the user on their own.  Products used by the dentist usually contain a compound known as oxygen peroxide which is chemically stronger than carbamide peroxide, which is commonly found in over the counter products.  Whitening is normally recommended for patients that have discolored teeth with stains and with little to no restorations. What clients need to know is that teeth whitening is not just a “do it and get a great smile thing.” It is a process that needs to be performed properly to avoid potentially serious damage to the teeth and equally serious – THE PAIN THAT COMES WITH IT! Failing to properly prepare for a teeth whitening process can result in dental pain for very long periods of time. Not to mention serious dental sensitivity to cold and heat. A conservative regiment of pre-preparation with your dentist through a careful dental cleaning and fluoride rinsing regiment is critical to getting the bleaching results that will last.

Cosmetic Dentistry – Bonding*

Dental Bonding is a composite resin filling that is placed on a tooth to improve its appearance.  This material is more often used to fill cavities though it is also used in cosmetic dentistry to change the color of teeth, close minor gaps or reshape teeth if chipped, broken, or irregularly shaped conditions exist.  To help the bonding material adhere to the tooth, the surface is roughened and coated with a conditioning liquid.   A thin layer of the bonding material, in the selected color, is then placed on the tooth or teeth and molded to the desired shape.  The material is then hardened with the help of an ultraviolet light.  Once hardened the cosmetic dentist will smooth out any bumps and finish off the appearance with a careful polishing.  Bonding is recommended as a correction of cosmetic defects, such as exposed roots due to abrasion and areas of low bite pressure since the bonding material can chip from the tooth.

Cosmetic Dentistry – Contouring and Reshaping*

Dental contouring, also known as tooth reshaping, is a technique used for minor defects such as chipped, irregularly shaped, mildly crooked, or overlapping teeth.  This is a cosmetic treatment that gives you instant results by removing a small amount of enamel from the tooth to change the shape. The enamel is reduced by fractions of a millimeter to eliminate imperfections, this procedure is often paired with bonding, a tooth colored composite that is sculpted to the desired shape on the tooth.  The tooth will then be polished and smoothed to a regular appearance.  Dental contouring is, in minor cases, an alternative to braces. Though contouring is low in cost, generally almost painless, and a possible substitute for braces, one must keep in mind the disadvantages of reshaping the teeth.  The enamel being removed is an important component of the tooth structure and removing too much enamel can result in tooth sensitivity.  Contouring and shaping must only be performed by a dentist after an evaluation of the impact to the tooth and overall dental health.

Cosmetic Dentistry – Crowns*

A dental crown, besides being required for functionality, can be considered part of cosmetic treatment.  Crowns are used by dentists to cover dental implants, protect a  tooth that is left weak due to endodontic dental procedures, repair a broken tooth, cover a misshapen tooth, support a tooth with a large filling, or as support for a dental bridge.  A crown basically covers the whole tooth.  Different materials are used to make crowns, such as metals, porcelain fused to metal, all porcelain or all ceramic, etc.  The process for obtaining a crown requires the natural tooth to be filed down from the chewing surface and around all sides. This is done to make room for the crown that is to cover the tooth.  If the tooth is missing a major portion of its surface due to damage or tooth decay, the dentist will need to “build up” the tooth surface with various dental materials since the crown will require support.  Once the tooth is filed, an impression of the tooth shape and as well as the opposing tooth surface will be taken, this is to ensure that the occlusion (the dental bite pattern) will not be affected by the crown device.  This impression will be then sent to a dental laboratory that will prepare the crown for the tooth.  Depending upon the complexity of the condition and the type of crown chosen, the crown is generally ready for cemented onto the tooth in about one to two weeks.  Some dental offices are equipped to make an in-office crown which can be prepared and installed in a single visit. However, this particular process generally incurs a much greater cost.

Cosmetic Dental Implants*

Dental implants can be used to replace either a single tooth or several missing teeth. Dental implants have become exceptionally popular in recent years due to their highly functional and natural appearance/fit as opposed to conventional bridges, dentures, or partials.  The reason implants are more functional than other procedures is because the tooth as well as the root are being replaced, giving the implant a generally much stronger support.  Dental Implants are a surgery that is performed in the mouth. Due to this, there are certain qualifications a potential recipient must meet, such as good overall health, healthy gums and enough dental bone within the jaw to support the implant.  The titanium implant is inserted into the jawbone where it is to begin a process called  osseointegration. This is a bio-physics process in which the implant and the bone bond together permanently.  This overall healing process takes between 3 to 6 months.  Once the dentist has confidence the implant is sturdy enough to support the enormous force placed upon it during eating, etc. the restoration will be placed on the implant.  The final product will appear like a normal healthy tooth.

Cosmetic Dental Gum Treatment/Lifts*

Cosmetic dentistry is about improving the smile and gum treatment is a part of this process. When an individual smiles and too much of the gums show, the balance and symmetry of the smile seems off.  However, the proper balance between the gums and teeth can be attained by actually removing a small portion of the gum. This will allow more of the tooth to show making the smile look proportional, attractive and balanced.  The problem can be additionally complicated not just from too much gum showing but, also that the gum line is asymmetrical and disproportional. This makes the smile appear crooked or slanted. To correct this condition, the dentist will apply anesthesia and carefully remove excess gum tissue that is necessary to balance the smile.  Stitches are usually needed for this procedure. Using modern dental laser technology, in some cases, even stitches can be avoided. When a laser is used to remove the excess gum tissue, generally minimal bleeding occurs and soreness may last for one to two days.  If the procedure is performed with conventional methods the patient may be limited to a soft food diet until the stitches are removed.  Gum reshaping is usually accompanied by dental veneers on certain teeth to closed gaps or change the shape of the tooth to create the perfect smile.

Cosmetic Dentistry & Papilla Regeneration*

I have a What!?  Yes, you have a Papilla – don’t panic everyone does and this is a good thing. The papilla is a structure that is essential to the appearance of a beautiful, healthy smile.  The papilla is the gum tissue that fills the contact point between the teeth.  The papilla can deteriorate or be lost as a result of untreated periodontal disease, smoking, flossing or even age.  The loss of the inter-dental papilla also called “black triangles” is not only aesthetically undesirable but can be very uncomfortable since food can easily get trapped there and foster tooth and tissue decay. There are both surgical and non-surgical solutions to treat this tissue deformity.  In the surgical approach to this issue, the dentist will perform surgery on the gum tissue. A process called debridement and root planning is also generally performed and a collagen barrier membrane will be positioned around the problem area. In some cases, a process known as bone graphing may also be required.  The surgery location is then stitched back together and ready for healing process to begin. A series of follow-up dental exams are performed to evaluate the process and assure healing is progressing.  Procedures to regenerate papillae vary, with each case different per individual. The ultimate result of regeneration of the papilla is a quality and more natural gum to teeth transition.

Cosmetic Dentistry & the “Invisalign©” Process*

Invisalign© is a dental cosmetic alternative to conventional metal braces, which are used to straighten teeth.  Unlike traditional braces, which consist of metal brackets and wires, Invisalign© is a series of clear, customized, removable, plastic aligners that go over the teeth and are designed by digital computer modeling.  This plastic aligner is to be switched every two weeks, with each new aligner progressively shifting the teeth the proper amount to the final aesthetic position for a uniform smile.  In a period of generally one year, 18 to 30 aligners may be required and each are to be worn for at least 20-22 hours per day in order to see progress.  The success of Invisalign© relies greatly on the patient’s commitment. which involves removing the alignments only to eat or brush teeth so that the treatment goes according to plan.  If the patient does not wear the aligner for the advised length of time, the treatment period will lengthen more and the cost will increase to an already expensive treatment.  It should be “clearly understood” the Invisalign© technique of teeth straightening is recommended for individuals who have only slight imperfections on the arch of their teeth yet, have a proper bite pattern or occlusion. Only a skilled dentist can determine if the Invisaline© process will work for each patient.

Cosmetic Dentistry – Orthodontics & Braces*

Orthodontics is a complicated dental science in which the prevention or correction of misaligned teeth, and/or jaw lines is promoted.  Dental misalignment (malocclusion), which is common to some degree in virtually all people, may prevent us from eating or speaking correctly and thereby affecting the functionality of our teeth. This malocclusion therefore makes orthodontics to be considered as a restorative process.  Orthodontics can also be considered cosmetic dentistry since the alignment of the teeth is a quintessential part of the perfect smile.  Whether receiving orthodontics for restorative or cosmetic reasons, the advantages, such as straight teeth, jaws and occlusion, better oral hygiene, clear speech, and better facial appearance are beneficial to the patient.  Many only see orthodontic treatment as a cosmetic benefit. In reality, it is so much more. There are many dental “health” aspects that are equally beneficial. The most common term branded to orthodontic treatment is “braces,” which consists of brackets being bonded on to each tooth and bands that are bonded to the molars.  The arch wire of braces is a thin, metal wire that runs through each bracket, applying light pressure on the teeth.  The wire is attached to each bracket with the help of elastics that come in a variety of colors.  These are generally changed at each visit in addition to the arch wire being adjusted or changed, according to the movement of the teeth. There are different types of braces available today as opposed to the old styles of braces from years past. Some of the processes of modern braces today (if the patient condition allows) are very comfortable and can be much less visibly noticeable. Depending upon the overall dental condition, some braces can even be placed behind the teeth thereby rendering them almost invisible.

Cosmetic Dental Veneers*

Veneers are a thin layer of composite or dental porcelain that is placed on the front of a tooth to create an aesthetically pleasant smile.   A veneer can help correct crooked or gapped teeth, chipped teeth, discolored teeth, shape of a tooth or worn down teeth. In some cases a veneer can improve your dental occlusion (the way you bite).  Your cosmetic dentist will remove about half a millimeter of enamel from the surface of your tooth, which is equal to the thickness of the veneer.  An impression will be taken of the tooth after which this will be sent to a laboratory that will design the perfect fit veneer.  Generally, it takes about 1 to 2 weeks for the final Veneer set to be delivered.  Veneers have a translucency and glass like appearance that allow them to create a very natural tooth like appearance.  The selection of the color of the veneer is very critical since once it is cemented into place on a tooth, the color can no longer be altered. It is recommended that if bleaching of ones teeth is planned, this process should be  performed first to assure that the final veneer will perfectly match the bleached teeth.  Porcelain veneers are very resistant to staining.  There are many advantages that veneers offer for dental smile improvement, however, the client must understand there are disadvantages as well.  Due to the removal of enamel on a persons tooth, the tooth may become sensitive to cold or heat. For those with high levels of tooth sensitivity, a veneer may not be the optimum solution. Since the veneer procedure is not reversible, the tooth must now always have a veneer. If a veneer happens to chip or crack it cannot be repaired, it must be replaced as a whole.  Additionally, if a client suffers from grinding of the teeth (bruxism), veneers are not recommended since this process can cause the veneer to crack or chip.

Cosmetic Dentistry – Smile Design*

The complete smile makeover or Smile Design (as cosmetic dentists like to refer to it), is a series of procedures used to improve the smile for purely aesthetic reasons, taking facial appearance, lips, and gum tissue into consideration. This process should not be confused with the process of full mouth reconstruction which is necessary for the functionality of the teeth rather than appearance.  In smile design, a variety of procedures are used in unison to change the tooth color, the alignment and spacing of teeth, changes to tooth length, replacement of missing teeth, and the balance of uneven, chipped, or cracked teeth.  If the teeth are discolored, the dentist and client will discuss the best options to achieve a white smile based on the overall condition of the teeth. Depending on the overall health of the client’s teeth, the dentist may want to use a teeth whitening procedure, porcelain veneers, or other specialized treatments “only after” teeth and gum health improvement. It is rather pointless to create a perfectly strait and white unhealthy tooth that is going to eventually have to be removed! If teeth   are misaligned, the client might need orthodontic treatment or if the ideal conditions of the particular teeth set exist, the dentist might consider a faster solution such as veneers implementation or specialty straitening methods such as the Invisalign© braces option.  Spacing in between your teeth might be treated with orthodontic treatment as well or veneers.  Missing teeth can be replaced with dental implants or bridges.  A smile makeover may also help you achieve a more youthful appearance by giving you fuller lips, and cheeks through cosmetic dentistry.

Cosmetic Dentistry – Full Mouth Reconstruction*

Full mouth reconstruction may sound “scary” but it is not. Don’t panic. In reality, it is a combination of several dental methods used to create an healthy relationship between the gums, bones, muscles and teeth in order to achieve not just an aesthetically pleasant smile but more so a functionality, health and comfort within the mouth. Remember, a healthy and comfortable teeth and mouth always comes first, the perfect smile comes second. If a client has teeth that have been lost to trauma, teeth severely worn due to acid erosion, severe jaw discomfort and muscle/headache pain caused by teeth misalignment (malocclusion), full mouth reconstruction may be required. The dentist will determine if full mouth reconstruction is necessary by conducting a specialty  examination where the condition of the teeth from aspects of alignment and bite, as well as jaw movement pain will be taken into account. This process is sometimes referred to as equilibration. This is a unique examination which is notably different from simple tooth health exams. From the results of this examination, the dentist will determine which procedure is necessary for a particular condition. The procedures may include processes such as veneers, crowns, bridges, or even dental implants to help establish proper dental occlusion and jaw alignment. The dentist will also take into account any existing periodontal conditions discovered which may require dental health improvements such dental scaling and root planning, as well as topical medication treatments to stop progression of periodontal disease.  Dental pockets (spaces between teeth and gums), mobility of your teeth (loose teeth), excessive or insufficient gum line, as well as assessment of bone density or deterioration will be part of the detailed periodontal portion of the examination contained within a full mouth reconstruction effort.  Another exam your dentist may conduct is of your Temporomandibular joints condition (TMJ), jaw muscles, and occlusion. If diagnosed with certain jaw or muscle conditions, you may require braces or even a night guard. In certain severe cases, orthognathic surgery (a form of jaw and muscle surgery) may be required. As can be seen, full mouth reconstruction can be considered a dental cosmetic procedure as well as a functional dental health condition. In all cases, it is simply part of the process for obtaining the perfect healthy smile.

* – All information contained in this article is for “informational purposes only.” It is not to be interpreted as direction towards a diagnosis/treatment recommendation. Reader must directly consult a dentist for any evaluation/specific treatment advice. ©2012 Dental Aesthetics Professionals. No portion of this article may be reused without the written permission of the author.

We offer the very best in regular and thorough dental
cleanings as well as early diagnosis of problems. Think of
oral care this way…..more is less…and less is
good because:

“Visit your dentist MORE – get LESS pain each time – and that’s GOOD!”

You’ve heard it before, visit your dentist at least
twice a year or the moment pain starts. This is not sales talk….
it is good, sound medicine! When you methodically maintain your teeth
like a dentist, your tooth enamel gets stronger, gums are healthier,
oral abnormalities are detected quicker and pain occurs less often.
Pain is the mouth is almost always the sign of something going wrong.
Whether it is sensitive teeth or a sudden sharp pain…so check it out!
By the way, contrary to what you might think, visiting the dentist more
often generally means less money too! The bottom line is, when you let
a little dental problem grow, the price “always” grows with it. We’re
talking simple logic here!!!! It is so much easier and less expensive to
fix a small cavity or remove some pesky tarter than to do a root
canal or pull a tooth. Even in today’s difficult economy, a simple
dental cleaning is always less expensive than periodontal
disease treatment. Look at it this way, one way or the other,
you will see the dentist, it’s only a matter of time, so make it
around your time!