Since October is National Dental Hygiene month; I would like to say that even the finest cosmetic dentistry can fail if good oral hygiene is not maintained.  Of course brushing and flossing are the one-two combination for most patients.  However: Many or our patients need a customized regimen of dental hygiene; depending on the type of restorations that are in their mouth; and their periodontal condition. 

If a patient exhibits periodontal disease; that must be addressed prior to any cosmetic dental treatment.  In my office we have a soft tissue management program that is quite comprehensive and successful in non-surgical treatment of periodontal disease.

The standard porcelain veneer or porcelain crown restoration is most often maintained by simple brushing and flossing as mentioned above; along with a recall visit for cleaning (prophylaxis) every 3 to 6 months.  When patients have bridges and dental implants; there are additional periodontal aids that are suggested to more thoroughly address their needs. 

A really nice product has just been introduced by ‘GUM’ called the “Soft-Pick”.  It is a very small brush that fits quite nicely between most teeth and cleans in this very important region; often better than dental floss.  I highly recommend this product!

 I need to mention that good dental hygiene starts VERY early on: as I have 2 twin boys at home that are 23 months old.  Interestingly enough, one of them loves to brush his teeth, he uses my electric toothbrush and often times I have to pull him out of the bathroom or he will spend what seems like an eternity brushing!  He is a total clean freak.  The other boy, however; hates to brush and I still have to almost do it for him.  I believe these habits should be instilled from this early age.

So, not only is good oral hygiene necessary to maintain cosmetic dentistry; it should be established before any cosmetic dentistry is carried out!  If I have a new patient that is anxious to have cosmetic dental treatment; but has terrible oral hygiene;  I feel it is very important to establish good oral hygiene by this patient prior to initiating any cosmetic dental treatment.

The other day I had a consultation with my long term patient, Chris.  Recently I had the opportunity to replace some old discolored crowns he had with one other porcelain crown on his upper front teeth; and the result we achieved was very pleasing to him.  He liked what I had done so much he started thinking about his crowded and discolored lower front teeth; and he wanted to know what, if anything, I could do for these teeth to improve his appearance.

As an experienced cosmetic dentist, the answer for his lower front teeth was quite simple really:  7 porcelain veneers or perhaps porcelain crowns in his case (see previous blog) would make a vast improvement and I knew he would be very happy with the result.

 Unfortunately, it was not quite that simple in Chris’s case.  Chris has been missing 2 molars on his lower right side.  Although he has managed adequately without these teeth; in the long term there would be consequences from not replacing these missing teeth:  his other teeth would shift, his unbalanced bite would lead to premature breakdown of other teeth or crowns, due to not having adequate support from his back teeth. 

Although Chris had the means and the desire to carry out the cosmetic dentistry on his lower front teeth; it would be imprudent of me to do so without addressing his missing lower back teeth.  I believe this is one of the factors involved in choosing a cosmetic dentist.  We should not focus entirely on esthetics without looking at the entire mouth as a whole.  Besides the factors I mention here, there are other dental areas that need to be addressed as well: such as the periodontal health of our patients.

In my office all patients that want cosmetic dentistry are first thoroughly screened for any other comprehensive dental problems that may exist.  This balance of ethics,integrity, and professionalism is a hallmark of a competant cosmetic dentist.

The creation of a beautiful smile often includes porcelain crowns rather than the prototypical porcelain veneer restoration.  Preexisting large fillings or crowns, a history of teeth grinding, challenging ‘bite’ problems and significant lengthening of teeth are some of the reasons why a crown would be preferred.

Crowns without a metal core inside offer the best esthetics because of the way they reflect light and the ability to manage the dark (blue) line that can be present at the gumline edge of a porcelain fused to metal crown.  The most popular Porcelain crowns are Empress crowns and the relatively new “Lava” crown. 

Lava crowns offer considerable strength over the typical all porcelain crown due to an inner core made from zirconium.  This core is ‘milled’ through a CAD/CAM process and is carried out at only a select few dental laboratories in Southern California.  Historically; porcelain crowns were significantly weaker than conventional PFM (porcelain fused to metal) crowns and cosmetic dentists were concerned about them breaking.  Also, if the underlying tooth was dark, the typical all porcelain crown might show this darkness through the crown, making it difficult to match adjacent teeth properly.  The strength and transparency issues are addressed with Lava crowns.  So far, the results are very promising! 

The Lava restoration can even be used for small bridges; giving dentists an opportunity to replace missing teeth without using any metal.

You can see some examples of Lava crowns on my website in the Porcelain crowns section of the gallery.