My Blog
By Aaron S. Berger, DMD
May 22, 2020
Category: Dental Procedures
Tags: porcelain veneers  
Ultra-ThinVeneersMightHelpYouAvoidEnamelRemoval

Dental veneers—thin, life-like layers of porcelain bonded to teeth—can turn a so-so smile into a beautiful one. But most veneers have a distinct drawback: To make them look as natural as possible, the teeth they're bonded with must have some of their surface enamel removed.

Even though they're 1 millimeter or less in thickness, veneers on an unprepared tooth can look bulky. Removing some of the surface enamel remedies this, but doing so permanently alters the tooth. The tooth will need a veneer or some other protective restoration from then on.

Now, though, there's an alternative veneer available for many dental patients. Known as No-Prep or Minimal-Prep, these new veneers are often as thin as a contact lens.

These new types of veneers can often be placed directly on the teeth just above the gum line without any enamel removal and look natural. At the most, the enamel beneath them may need reshaping with an abrasive tool. And, unlike traditional veneers with tooth alteration, these low-prep veneers can often be applied without anesthesia, and in as few as two appointments.

No- or Minimal-Preps are better suited for certain kinds of patients: those with small teeth or teeth that appear small due to larger mouth features; worn teeth from aging or teeth grinding or with small gaps; narrow smiles where the side teeth aren't as visible; and teeth that are slightly misshapen or with minor staining.

On the other hand, patients with oversized teeth or front teeth that jut forward may still encounter problems with an unnatural, bulky appearance even with ultra-thin veneers. The latter situation can often be corrected with orthodontic treatment first to realign the teeth to their proper positions. Once the bite is corrected, no-prep veneers may then become a viable option.

If you'd like to consider these minimal preparation veneers, see your dentist for an examination. The exam results will help determine what type of veneer solution is right for you. And whether you go with traditional or No-Prep veneers, the change in your smile can be amazing.

If you would like more information on porcelain veneers without enamel removal, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “No-Prep Porcelain Veneers.”

By Aaron S. Berger, DMD
May 12, 2020
Category: Oral Health
Tags: oral hygiene  
4ThingsYouShouldDo-orNotDo-toMaintainYourOralAppliance

Millions of people wear some form of removable oral appliance. The range is pretty extensive, from orthodontic clear aligners and retainers to full or partial dentures. But while they may vary in purpose, they all require the same thing: regular cleaning and maintenance.

And there's a right way to care for them, and a wrong way. The right way ensures you'll get the most out of your appliance—the wrong way might drastically curtail their longevity. Here, then, are 4 things you should and shouldn't do to keep your appliance in tip top condition.

Clean it properly. Only use cleaning agents appropriate for an oral appliance's materials. That means avoiding the use of toothpaste—the abrasives in it won't harm tooth enamel, but they can scratch some appliance materials. Instead, use dish detergent, hand soap or a recommended cleaner with a little warm water. Also, use a different brush than your regular toothbrush.

Avoid hot water and bleach. Hot or boiling water and bleach kill bacteria, but they will also damage your appliance. Hot water can warp an appliance's soft plastic and alter its fit. Bleach can blanch plastic meant to mimic gum tissue, making them less attractive; even worse, it can break down appliance materials and make them less durable.

Protect your appliance. When you take out your appliance, be sure to store it high out of reach of curious pets or young children. And while cleaning dentures in particular, place a small towel in the sink—if they slip accidentally from your hand, there's less chance of damage if they fall on a soft towel rather than a hard sink basin.

Don't wear dentures 24/7. Dentures can accumulate bacterial plaque just like your teeth. This can increase your risk of an oral infection, as well as create unpleasant mouth odors. To minimize this, take your dentures out at night while you sleep. And be sure you're cleaning them daily by hand, soaking them in an appropriate solution or with an ultrasonic cleaner.

Your oral appliance helps keep your dental health and function going. Help your appliance continue to do that for the long haul by taking proper care of it.

If you would like more information on how best to maintain your oral appliance, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “10 Tips for Cleaning Your Oral Appliance.”

YouDontNeedtoPassaFootballLikePatrickMahomestoRemoveaLooseBabyTooth

Kids get pretty inventive pulling a loose primary (baby) tooth. After all, there's a profit motive involved (aka the Tooth Fairy). But a young Kansas City Chiefs fan may have topped his peers with his method, revealed in a recent Twitter video that went viral.

Inspired by all-star KC quarterback Patrick Mahomes (and sporting his #15 jersey), 7-year-old Jensen Palmer tied his loose tooth to a football with a line of string. Then, announcing “This is how an MVP gets their tooth out,” the next-gen QB sent the ball flying, with the tooth tailing close behind.

It appears young Palmer was no worse for wear with his tooth removal technique. But if you're thinking there might be a less risky, and less dramatic, way to remove a loose tooth, you're right. The first thing you should know, though: Primary teeth come out when they're good and ready, and that's important. Primary teeth play an important role in a child's current dental and speech function and their future dental development. For the latter, they serve as placeholders for permanent teeth developing within the gums. If one is lost prematurely, the corresponding permanent tooth might erupt out of position and cause bite problems.

In normal development, though, a primary tooth coming out coincides closely with the linked permanent tooth coming in. When it's time, the primary tooth lets you know by becoming quite loose in the socket.

If you think one of your children's primary teeth is ready, clean your hands first with soap and water. Then using a clean tissue, you should be able to easily wiggle the tooth with little tension. Grasp the tooth with the tissue and give it a little horizontal twist to pop it out. If that doesn't work, wait a day or two before trying again. If it does come out, be sure you have some clean gauze handy in case of bleeding from the empty socket.

Normally, nature takes its course from this point. But be on the lookout for abnormal signs like fragments of the tooth left behind in the socket (not to be mistaken for the top of the permanent tooth coming in). You should also look for redness, swelling or complaints of pain the following day—signs of possible infection. If you see anything like this, make a prompt appointment so we can take a look. Losing a primary tooth is a signpost pointing the way from childhood to adulthood (not to mention a windfall for kids under their pillows). You can help make it a smooth transition—no forward pass required.

If you would like more information about caring for primary teeth, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Importance of Baby Teeth” and “Losing a Baby Tooth.”

By Aaron S. Berger, DMD
April 22, 2020
Category: Dental Procedures
Tags: teeth whitening  
StainsfromWithinaToothRequireProfessionalWhitening

Whether performed in a dental office or using a home kit, teeth whitening applications are quite effective for bleaching exterior (extrinsic) stains on enamel surfaces. But what if your discoloration comes from inside the tooth? In this case, extrinsic teeth whitening won’t work — you’ll need to undergo an “internal bleaching” method, which can only be performed in a dentist's office.

There are a number of causes for “intrinsic” staining, including too much fluoride exposure or tetracycline use during childhood. One of the more common causes, though, occurs from root canal treatments used to remove the remnants of the pulp tissue inside a tooth’s pulp chamber and root canals. Certain cements used during the procedure to help seal in the filling material and leftover blood pigments can cause the tooth to darken over time.

To alleviate this discoloration, we use a bleaching agent, usually sodium perborate mixed with a diluted solution of hydrogen peroxide to achieve a safe, accelerated color change. After determining that the root canal filling is still intact and the bone is healthy, we create a small cavity in the back of the tooth to access the pulp chamber. The chamber is cleaned of any debris or stained material and then thoroughly irrigated. The original root canal filling is then sealed off to prevent leakage from the bleaching agent.

We then place the bleaching agent in the cleaned-out space with a cotton pellet and seal it in with a temporary adhesive. This step is repeated for several days until we achieve the desired shade of white. Once that occurs we then seal the dentin with a more permanent filling and then restore the cavity we created with a composite resin bonded to the enamel and dentin.

If we’re successful in achieving the desired color, intrinsic whitening could help you avoid more costly options like veneers or crowns for an otherwise healthy and attractive tooth. The end result would be the same — a beautiful smile without those unsightly stains.

If you would like more information on treating internal tooth stains, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Whitening Traumatized Teeth.”

By Aaron S. Berger, DMD
April 12, 2020
Category: Oral Health
Tags: oral health   vaping  
ConcerningYourOralHealthVapingIsntaSafeAlternativetoSmoking

The first week of April is National Public Health Week, putting the spotlight on health issues that impact us all. The popular practice of vaping is one of those top issues this year due to its connection with recent lung illnesses and deaths. But this isn't a new problem—dentists have been critics of vaping for some time now over the growing evidence of its effect on oral health.

Vaping is the popular term for inhaling aerosol vapors through an e-cigarette (or e-cig for short). The electronic device contains a small reservoir filled with flavored liquids that contain nicotine and other chemicals. The device heats the liquid, turning it into a vapor that's inhaled or “vaped” into the lungs.

Vaping has been touted by proponents as a safer alternative to cigarette smoking. But there's growing evidence that vaping isn't a kinder and gentler way to “smoke.” A good portion of that evidence comes from dentists who routinely treat oral problems caused or worsened by vaping.

In reality, the adverse effects of vaping on oral health aren't much different from smoking. Like smoking, vaping ingredients can irritate the inside of the mouth and cause dryness, an ideal environment for dental disease. And nicotine, the main chemical in both vaping and smoking, constricts blood vessels that deliver nutrients and disease-fighting antigens to the gums and teeth.

If these hazards weren't bad enough, recent clinical findings seem to indicate they're only the tip of the iceberg. Researchers from New York University's (NYU) College of Dentistry have found evidence from a combined study of cigarette smokers, e-cig users and non-smokers that vaping may significantly alter the mouth's microbiome to the ultimate detriment of oral health.

A “microbiome” is a term describing the intricate relationship between the millions of microorganisms inhabiting the human body and the body itself. While a few are malicious, many, namely in the gut and mouth, help the body obtain nutrients from food and fight against disease. Disrupting that delicate balance opens the door to diminished health.

The NYU researchers found that both smokers and e-cig users had higher levels of pathogenic bacteria in their saliva than non-smokers, suggesting both habits disrupted the mouth's microbiome balance enough to allow less benevolent bacteria to flourish. They also found that both smokers and e-cig users had significantly higher incidences of gum disease (72.5% and 42.5%, respectively) than non-smokers (28.2%).

If you're a smoker, a cessation program to quit the habit—not switching to vaping—is the way to a healthier life. If you would like more information about the effects of vaping on your oral health, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Vaping and Oral Health.”





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