Teeth stains can be either extrinsic or intrinsic.  An example of the latter is from treatment with tetracycline as a baby (it used to be common for ear infections, not anymore!); or ingestion of too much fluoride during tooth formation.  Trauma to a tooth can cause internal darkening, and teeth simply get darker as we age.

Extrinsic stains can be from smoking, black coffee, dark tea, red wine, and blueberries.  These types of stains can often be removed during routine professional teeth cleaning.  If these stains continue for years however; they may not come off this way!

For the most part, the stain on your teeth is made up of long chain molecules.   The bleaching gels that we use for teeth whitening contain either hydrogen peroxide or carbamide peroxide which deliver oxygen to these molecules; breaking them down into shorter molecules that are white.  The degree to which teeth will bleach depends on their permeability to oxygen.  This permeability is affected by age (older teeth are less permeable, and harder to bleach than younger teeth) and is simply variable from person to person.

This variability from person to person is the reason why some teeth respond well to a one hour zoom bleaching procedure (better response for younger teeth) and other teeth may not.  This is why the Deep Bleaching ™ process that I talked about in a preceding blog post is the most consistent and predictable technique a dentist can use. 

Because the bleaching trays we make fit so well, there is not much penetration of saliva to dilute the bleaching gel.  Also, bleaching at night during sleep is always better because the flow of saliva is way less than it is during the daytime.  Lastly, the duration and intensity of the deep bleaching technique overcome any “permeability” problems described above.

So, younger people (under 30 I’d say) whose teeth are not really that dark to start with can often whiten their teeth quicker (zoom procedure) with less maintenance.  Patients over 50 and those with fairly dark teeth to start with will probably get better and longer lasting results with the Deep bleaching procedure.

If you have already bleached your teeth, and simply need a touch up, you can either do it in one hour with the Zoom rapid whitening procedure, or you can bleach at home a few times; provided you have excellent fitting bleaching trays.  Your cosmetic dentist can best make this recommendation for you.

These restorations are used in many situations when a regular filling will be too big, and there is a risk that the tooth will break.  However, we’re trying to avoid drilling down your tooth for a crown; which requires more tooth removal than any other procedure.

These inlays and onlays  can be made from Porcelain or composite resin.  (Also gold, but we are speaking of esthetic restorations in this blog!.  Most of my patients don’t want gold teeth these days, and I can’t say I blame them) Porcelain is best for larger restorations, or cases where the opposing tooth has porcelain to bite against.  Resin inlays/onlays are indicated for small to medium size restorations that bite against natural teeth (or resin).

For me, the resin inlays offer a restoration that has an incredible fit; and they virtually disappear into the remaining tooth structure, often times making it difficult to distinguish them from the adjacent natural tooth. (truly invisible).  They are very easy to carry out, and most often result in zero sensitivity.

As far as I am concerned; there is no better restoration to replace an old amalgam filling, when adequate tooth structure remains.  I have one myself, as  I recently broke an old filling by biting on a sunflower seed!

First, this technique utilized a home bleaching tray that is meticulously crafted. The dental staff truly spends a good 5 times more time than with previously made bleaching trays. The procedure takes three office visits and the first one is spent taking impressions for these home bleaching trays.

The 2nd visit is a “conditioning” visit, where the patients dental trays are used to condition the teeth to receive the home bleaching gel. This visit takes less than an hour; which includes precise instructions for home delivery of the bleaching gel. The patient must bleach at home for 14 nights. One of the other KEY differences from common home bleaching is that a very effective desensitizing agent is applied prior to each home usage. This way, nearly all patients can use a very effective bleaching gel at home w/ little or zero sensitivity.

After 14 days at home is the 2nd In Office visit is when we see results that are often astonishing. Just look at some of the results that have been achieved in these photographs below.

These spectacular results must be maintained in order to endure. We advise our patients to use their home trays no less than once every 2 months to keep this dazzling white smile!

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.

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.

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.

 The major problem with Lumineers lies in the advocated technique: Unless you remove tooth structure, the resulting restoration is going to be bulky and lack the color properties desired for a nice result.

The technique is desirable to the public because it advocates that “no shots or no drilling” are necessary.  Of course this is the case if zero or little tooth preparation is needed; but I believe most people would gladly accept the needed local anesthetic to accomplish the tooth preparation needed for a proper set of veneers.  It is up to the experienced, confident cosmetic dentist to set the public straight about Lumineers.

Most people are familiar with the term “chicklets”: a slang term denoting bulky, overcontoured dental restorations.  This is the most likely outcome with Lumineers.  I believe that the proper amount of tooth reduction is a concept better understood by experienced cosmetic dentists; along with the dental laboratories and technicians that fabricate porcelain veneers. 

There very well may be select indications for lumineers, but my opinion is they are few and far between; and the public should be informed of this.