December 2014 -

Implant or Bridge?

Posted by | Dental Implants | No Comments

Dental Implants Beverly Hills

Making quick decisions about our teeth has to be the worst feeling in the world. You go in to see the dentist because you have a slight tooth ache, and the next thing you know, you are being bombarded with information, options, and fees. You know you have to do something, but you’re not quite sure what or how soon. On top of that, you are hit with the bad news that your tooth has to be extracted. YIKES!!!!!!!

My recommendation is to NOT make a snap decision, especially if you don’t have a long standing relationship with the dentist and the office. Instead ask the dentist to help you buy some time, perhaps prescribe some antibiotics and pain medication to make sure things don’t worsen. Gather all the facts, define your options, and ask for your records (including x-rays, treatment plans, and estimates).

Now that you have a clear mind and you are not in immediate pain or discomfort, take a look at all of your options. If your 2nd and 3rd opinions have recommended the same treatment, narrow down the dentist you want to be treated by. Your realistic options after an extraction are to have a bridge put in or to have an implant placed followed up with a crown. So let’s break down both options.

First, let’s go over what a bridge is and the pros and cons of that option. A bridge is used to cover the space from a missing tooth. It requires at least two teeth on either side of the missing tooth to anchor the bridge. Structurally, it’s the same as most crowns, with metal substructure covered by porcelain, except there are at least three units fused together. The most common materials used for this procedure is metal with porcelain over it. The pros: The aesthetics, if done well are very acceptable and well constructed bridges look very natural. The part that covers the area where the tooth is missing is called the pontic and the anchors that are attached to the adjacent teeth are called the abuptments. This procedure on average takes 2-3 weeks to complete and the dentist will place a provisional bridge while you wait so you will never really be without a tooth in place. These restorations can last for many years with good oral hygiene and regular check-ups. Here is the down side to this option. To place a bridge, you have to use and cut on two other healthy teeth to anchor the bridge. Since the bridge is fused together, you will not be able to floss easily in that area, causing concern for decay under the bridge to develop. If anything happens to either anchor, like decay or a fracture, the whole bridge will fail and need to be replaced. The anchor teeth are usually weakened due to the amount of extra force they endure. The cost of this option is what ever the dentist fee is for a crown times three, this is not including other possible procedures the abuptment teeth might need (like root canals or core build up)

Now let’s look at the implant option. This is the more conservative option because it does not involve other teeth. Each tooth has two main parts to it: the crown and the root. The crown of the tooth is the part that is above the gum line, the root is the part that is below the gum line and is not visible (unless with a scan or x-ray). The implant takes the place of the root and the shape is based on the design of your natural roots. It’s basically an artificial root placed inside the gum, with an attachment that connects the implant to the crown. The implant is made out of titanium, which our body normally accepts. The process usually takes at least two visits, although it can be completed in one visit if the conditions are favorable. The cost per implant is comparable to the cost of a bridge. A well placed and restored implant looks and functions just like your natural teeth. The implant will not decay and they rarely need to be replaced (they have a success rate of 90-95% rate). The main concern with implants is that not everyone is a perfect candidate for implants (due to health conditions or lack of bone support). Cost and time it takes from when the implant is placed to when it is completely restored.

Now that we’ve discussed all the facts, pros and cons of both options, I would highly recommend going with the implant option. The main reason is that each implant stands alone and does not require the support of other teeth. With new technology and research, dental implants are more common than ever.

What to Expect from Teeth Whitening

Posted by | Teeth Whitening | No Comments

Before & AfterIn the early nineties, I worked in a dental office in the heart of Hollywood, California, home to the stars and glamour. I remember the doctor that I worked for explained to me how his office worked, what type of clientele his patients are, and what procedures were the norm. He went on to say how the patient’s main concern was to have nice white teeth and how we must cater to that. Veneers, white fillings, and teeth whitening were the procedures we did most often. I still remember whitening was about $1,000 and the procedure was long and painful. I recall the solution was packaged in two dark bottles, with a poison warning label and skull to emphasize that it was a dangerous chemical.

Fast forward some 20 years or so and boy have things changed. You can buy over the counter whitening products or go on Youtube for home remedies to have your teeth whitened with strawberries. I’ve even seen whitening booths at the mall, which amazes me how much the procedure has evolved. Or you can go to your local dentist and have your teeth professionally whitened. Any solution you choose will be cheaper and faster than it used to be 10, 15, 20 years ago. With the market so saturated with whitening products and techniques, it’s hard for the average consumer to know which one is best for them.

The truth is most of the options I mentioned above work to some degree. The best option is still to have your teeth examined by a licensed dentist so that they can determine if whitening is a good option for you before whitening, its best that the dentist checks that your enamel is thick enough for whitening, that your gums are healthy and that you are cavity free. What this does is ensure that you will have the best results with the least amount of discomfort.

Before any type of whitening, the patient should be plaque and tartar free, a cleaning is usually recommended at least one week prior to whitening. There are two ways that most dentists recommend you whiten your teeth. In-office whitening or take home whitening. What’s the difference? Let’s dive into to the differences.

With the In-office whitening most patients can see a difference of 2-6 shades lighter after one visit (usually 3 twenty minute sessions). The complete visit takes about one and a half hours. The procedure is somewhat invasive as it requires complete isolation which includes gauze and a dam around the soft tissue so that only the teeth are exposed. Once the procedure starts, the patient can’t move or close their mouth. The immediate concern with this method is post operative sensitivity because of the high concentration of peroxide used and soft tissue irritation because the gel sometime leeks into the soft tissue. Although the patient sees immediate results, the concern with this method is fade back because the patient fails to comply with the post operative instructions (the tubules on the teeth remain open for 48 hours after whitening, leaving the teeth vulnerable to re-staining from eating or drinking dark foods). Cost for this method varies but on average is about $200-$500 per session

The second method is to make custom fit trays for the patient. This process requires two visits. The first visit is about half hour to take impressions. The dental assistant then fabricates the custom fit trays. The patient is then brought back about a week later. The second appointment is also about half an hour. This appointment is not invasive at all, it consist of fitting the trays and giving the patient whitening gel to dispense into the trays, and post operative instructions. Pros and cons with this method: Patient compliance. For best results, patients are to wear the trays for 10-14 consecutive days over night or for at least 1 hour each day (wear time depends on strength of gel). Usually that’s a tall order for even the most compliant patients. While whitening, the patient is instructed to stay away from any foods or drinks that stain, which is tough to do for such a long period of time. What I love about this method is the contact time of peroxide on the teeth as opposed to the in-office whitening. Clinically, the longer the peroxide is in contact with the teeth, the better and longer the results are. I also like that you can control how white your teeth get. With the in-office whitening, it’s a little bit of a crap shoot (the results are not as predictable). I like the long term results with the custom trays. Cost for this method also varies but on average the cost is between $99-$300.

So what is the best method? In my opinion, the best method is a combination of both. Do the in-office whitening and send the patient home with gel and custom made trays. Think of whitening like dying your hair, eventually your natural color will come back and you will have to redo your hair again. With whitening, it’s the same thing, no matter what the results, your teeth will eventually return to their original color. The combination method works great because you see immediate results with the in-office method and then you have the trays to “touch up” when the teeth begin to fade back. You will get more bang for your buck this way. The cost for the combo technique is either the same price as the in-office whitening or some office increase the fee by $100-$200.