Steven Goodman, D.D.S.

Whitening or bleaching procedures can effectively restore the smile of people with stained, dull, or discolored teeth. Teeth can change shade for a variety of reasons. External factors such as some foods & drinks, smoking or chewing tobacco can stain teeth. Brushing and flossing can usually help with these types of stains. Furthermore, when you have your teeth cleaned here, we will polish off more of these stains. Whitening agents will further lighten the color of your teeth by penetrating through the shell of enamel and oxidizing the color out of the darker tooth structure underneath.

Another type of stain can be caused by traumatic injuries, medications and Fluorosis, and they actually begin inside the tooth; so brushing and flossing don’t help. This is also where tooth-whitening procedures are effective.

Some stains can be more difficult to lighten, and bleaching will not work on restorations such as crowns, bridges, bonding and tooth-colored fillings (porcelain veneers or dental bonding may be more appropriate in this case).

Some commercially available "whitening toothpastes" can be somewhat effective at removing stains and making teeth a few shades brighter. However, many of these products have abrasive substances that can actually wear away your tooth's enamel.

Professional whitening performed by our office is considered to be the most effective and safest method; and done properly, tooth whitening can last many years. Ask Dr. Goodman if you are a good candidate for whitening your teeth. He can show you where you are now and how light we could anticipate getting your shade to by bleaching.

When teeth have small chips or are slightly decayed, bonded composite resins may be the material of choice. Bonding can last for many years depending on several issues -a patient's home hygiene and diet, the area where the bonding is placed, and if the patient is a grinder or not. The bonding procedure also requires a very clean and dry environment when it is placed. For these reasons, several factors should be weighed to determine if composite is the correct material for a given application.

Bonding can be more susceptible to staining or chipping than some other forms of restorations such as porcelain crowns or veneers, but it is less expensive. When fractures are large, decay is significant, or the area to be repaired can't be kept clean and dry, composites are not a good choice.

Teeth that are badly stained, shaped or crooked may be improved by a veneer placed on the surface of the affected teeth.

Veneers are thin pieces of porcelain or plastic cemented over the front of your teeth to change their color or shape. Veneers are used on teeth with uneven surfaces or are chipped, discolored, oddly shaped, unevenly spaced or crooked. Veneers have a longer life expectancy and color stability than bonding, and highly resist permanent staining from coffee, tea, or even cigarette smoking.

Veneers are usually made by a dental lab technician working from a model provided by your dentist. Veneers are usually irreversible because it`s necessary to remove a small amount of enamel from your teeth to accommodate the shell.

Porcelain veneers can mask undesirable defects, such as teeth stained by tetracycline, by an injury, or as a result of a root-canal procedure, and are ideal for masking discolored fillings in front teeth. Patients with gaps between their front teeth or teeth that are chipped or worn may consider porcelain veneers.

Typically, veneers entail at least three appointments: diagnosis and treatment planning, preparation, and bonding.

During the tooth preparation visit, usually lasting one to two hours, the teeth are lightly buffed to allow for the small added thickness of the veneer. Usually, about a half to one millimeter of the tooth is removed, which may require a local anesthetic. During the same visit, a mold is taken of the prepared teeth and temporary veneers are placed. The impression is then sent to the laboratory for the fabrication of the veneers.

During the final "bonding" visit, also about one or two hours, the veneers are placed on the tooth surface to check their fit and to get a sense of the shade or color. While the veneers are resting on your teeth, they can be adjusted with various shades of cement to match the color of your teeth. To apply the veneer, the tooth is cleansed with specific chemicals to achieve a suitable bonding surface. A special cement is placed in the veneer which is then placed on the tooth. A visible light is used to cure the cement and bond the veneer to the tooth. Excess cement is then cleaned off, and a final check of the bite and polish is done.

Porcelain veneers are reasonable facsimiles of natural teeth, not perfect replacements. It's not uncommon to see slight variations in the color of porcelain veneers upon close inspection, as this occurs even in natural teeth.

For a very small number of patients, no preparation of the teeth may be necessary, but this is rare.

Dentures and partial dentures are removable appliances that replace missing teeth and adjacent tissues. They are made of acrylic resin, sometimes in combination with a metal framework.

Complete dentures replace all the teeth, while a partial denture fills in the spaces created by missing teeth and prevents the remaining teeth from changing position.

Types of Dentures

Candidates for complete dentures have lost most or all of their teeth. You can have a full denture on your upper or lower jaw, or both. A denture can improve appearance, chewing ability, speech, and will provide support for facial muscles. The retentive capabilities (how tight a denture fits) is dictated by the size and shape of the ridge of bone that remains after teeth are extracted.

Complete dentures are called "conventional" or "immediate", according to when they are made and when they are inserted into the mouth. Immediate dentures are inserted immediately after the removal of any remaining teeth. To make this possible, the dentist must go through several steps to prepare for this during preliminary visits. A conventional denture is done after all healing has occurred or when a new denture is being made to replace an existing one.

The primary advantage of an immediate denture is that the wearer does not have to be without teeth during the period of healing. However, bones and gums will shrink over time, especially during the first three months after the removal of teeth. When gums shrink, immediate dentures get loose and will require a reline to fit properly. A reline or a new conventional denture is then made once the tissues have completely healed. Healing usually takes 12 weeks. An overdenture is a removable denture that fits over a small number of remaining natural teeth or implants. The natural teeth must be prepared to provide stability and support for the denture.

Partial Dentures

Partial dentures are often a solution when several, but not all teeth are missing. Several factors influence how stable a partial denture will be- the number of natural teeth remaining, the position they are in, and the size and shape of the ridge of bone is where the missing teeth are located. All affect how tight a partial denture will be.

Removable partial dentures usually consist of replacement teeth attached to pink or gum-colored plastic bases, which are connected to a metal framework. Removable partial dentures are held in your mouth by metal clasps which attach to your natural teeth. Crowns on your natural teeth may improve the retention of a removable partial denture.

How are dentures made?

The denture process takes 4 -5 appointments over about a one month time period. The initial diagnosis, treatment plan options and costs are discussed prior to beginning. Next an initial impression is taken and sent to a dental laboratory. Following this, a wax bite is done to determine the proper vertical dimension and jaw position(how the upper and lower jaws relate to each other), and a tooth shade is agreed upon. Next a "try-in" visit is done to verify color, shape, bite and fit of the appliance. Changes are made at this time if they are needed. If everything looks good, the dentures are finished and delivered to the patient at the next appointment. Instructions on cleaning and caring for the dentures are discussed.

It is normal to have adjustments following the placement of any new appliance. Sore spots, rough edges or the bite not feeling perfect are all very common occurrences. Call our office as soon as you discover a problem.

Getting used to your denture

For the first few weeks, a new denture may feel awkward or bulky. Speaking clearly and eating with it will require practice. However, you will eventually adapt and become accustomed to wearing it. Inserting and removing the denture will also require some practice. Your denture should easily fit into place. Never force a partial denture into position by biting down. This could bend or break the clasps, break your teeth.

For the first day or two, you may be asked to wear your denture all the time. Although this may be temporarily uncomfortable, it will allow for the quickest healing to occur after extractions, and will be the best way to identify any denture areas that need adjustment. If the denture puts too much pressure on a particular area, that spot will become sore, and your denture will need to be adjusted for it to fit more comfortably.

After the first couple of days, it is always recommended to take out any removable appliance at night and replace it in the morning. This allows saliva to freely circulate in the mouth as a natural cleaner. It lets the teeth and gums that support the appliance relax, not being "loaded" 24 hours a day. This will help prevent potential bone loss and allow you to have a tighter fitting appliance and require fewer, less frequent relines.

Start out by eating soft foods that are cut into small pieces. Chew on both sides of the mouth to keep even pressure on the denture. Avoid sticky or hard foods, including gum. You may want to avoid chewing gum while you adjust to the denture.

Care of your denture

It's best to stand over a folded towel or a sink filled with water when handling your denture, just in case you accidentally drop it. Brush the denture (preferably with a denture brush) daily to remove food deposits and plaque, and keep it from becoming permanently stained. Avoid using a brush with hard bristles, which can damage the denture. Look for denture cleansers with the American Dental Association (ADA) Seal of Acceptance.

Pay special attention to cleaning the teeth in your mouth that fit under a partial denture`s metal clasps. Plaque that becomes trapped under the clasps will increase the risk of decay on these teeth.

Hand soap or mild dishwashing liquid to clean dentures is also acceptable, but I don't think they taste very good. Other types of household cleaners should not be used for cleaning dentures as they are too abrasive. Do not use bleach on a denture. A denture can lose its proper shape if it is not kept moist or is heated up. At night, place the denture in a soaking solution or water. If the appliance has metal attachments, use a soaking solution that is suitable for partials or just use plain water.

Even with full dentures, you still need to take good care of your mouth. Every morning, brush your gums, tongue and palate with a soft-bristled brush before you put in your dentures. This removes plaque and stimulates circulation in the mouth. Selecting a balanced diet for proper nutrition is also important for maintaining a healthy mouth.

Adjustments

Over time, adjusting the denture may be necessary. As you age, your mouth naturally changes, which can affect the fit of the denture. Your bone and gum ridges can recede or shrink, resulting in a loose-fitting denture. Loose dentures can cause various problems, including sores or infections. Dentures that do not fit properly can be adjusted or relined. Avoid using a do-it-yourself kit to adjust your dentures, as this can damage the appliance beyond repair. Glues sold over-the-counter often contain harmful chemicals and should not be used on a denture.

If your denture no longer fits properly, if it breaks, cracks or chips, or if one of the teeth becomes loose, see your dentist immediately. In many cases, dentists can make necessary adjustments or repairs, often on the same day. Complicated repairs may require that the denture be sent to a special dental laboratory.

Over time, dentures will need to be relined, re-based, or re-made due to normal wear. To reline or re-base a denture, the dentist uses the existing denture teeth and refits the denture base or makes a new denture base. Dentures may need to be replaced if they become very loose or the teeth show signs of significant wear.

Common concerns

Eating will take a little practice. Start with soft foods cut into small pieces. Chew slowly using both sides of your mouth at the same time to prevent the dentures from rocking. As you become accustomed to chewing, add other foods until you return to your normal diet.

Continue to chew food using both sides of the mouth at the same time. Be cautious with very hot or hard foods and sharp-edged bones or shells.

Some people worry about how dentures will affect their speech. Consider how your speech is affected when you have a number of your natural teeth missing. Pronouncing certain words may require practice. Reading out loud and repeating troublesome words will help. If your dentures "click" while you`re talking, speak more slowly. You may find that your dentures occasionally slip when you laugh, cough or smile. Reposition the dentures by gently biting down and swallowing. If a speaking problem persists, consult your dentist.

Denture adhesives

Denture adhesives can provide additional retention for well-fitting dentures. Denture adhesives are not a solution for old, ill-fitting dentures. A poorly fitting denture, which constantly slips will cause irritation and will lead to sore spots. These dentures need either a reline or may need to be replaced. If your dentures begin to feel loose, or cause pronounced discomfort, consult with your dentist immediately.

Before the development of dental implants, fixed bridges or removable dentures (full or partial) were the only two alternatives to replace a missing tooth or teeth. However each of these options had significant disadvantages to them. That is why so much research went into developing implants for teeth.

Implants are synthetic structures that are placed in the area of the tooth normally occupied by the root. Implants are usually made of titanium covered with a synthetic, yet biocompatible material that allows your bone to fuse with them.

Not everyone is a good candidate for dental implants though, so it is best to take a 3-dimensional scan of the bone to determine chances of success prior to beginning the process. For a successful implant to take hold, a candidate must have proper bone density and have a strong immune system. In all cases, dental implants require strict oral hygiene.

Surgery is necessary to prepare the area for an implant and place the implant in the jawbone. Following the procedure, a period of healing time is required for the implant to integrate into the bone and anchor the device. Usually 4-6 months in the top jaw, 3-4 months in the lower jaw is preferred prior to restoring the implant(s).

Bridges are natural-looking dental appliances that can replace a section of missing teeth. Because they are custom-made, bridges are barely noticeable and can restore the natural contour of teeth as well as the proper bite relationship between upper and lower teeth.

Bridges are sometimes referred to as fixed partial dentures, because they meant to be permanent and are bonded to existing teeth or implants. There are several types of fixed dental bridges (cannot be removed), including conventional fixed bridges, cantilever bridges and resin-bonded bridges. Unlike a removable bridge, which you can take out and clean, your dentist can only remove a fixed bridge.

Toothaches can be caused by a variety of reasons including trauma, decay, a crack in the tooth, exposed live tooth structure or your bite being off. Sometimes, a toothache can be caused by a piece of debris lodged between the teeth under the gums. A dentist needs to be seen to properly diagnose and treat a toothache.

Never place an aspirin between your tooth and gum to relieve pain. The dissolving aspirin will burn your gum tissue.

A Broken, Fractured, or Displaced Tooth
A broken, fractured or displaced tooth can be concerning, and depending on the situation, decisive, quick action should be taken.

If a tooth has been knocked out intact and whole, carefully rinse the mouth of any blood or other debris. Then holding the tooth by the crown, not the root, gently clean the tooth off, being careful not to scrub it. Then try to place the tooth back in its socket. Call your dentist immediately.

If you cannot place the tooth back in its socket, hold the dislocated tooth by the crown - not the root. Next, place it in a container of warm milk, saline or the victim's own saliva and keep it in the solution until you arrive at the emergency room or dentist's office.

Place a cold cloth or compress on the lip or cheek near the injury to keep the swelling down.

For a fractured tooth, it is best to rinse with warm water and apply a cold pack or compress. Ibuprofen may be used for pain relief and to help keep down swelling. If the tooth fracture is minor, the tooth can be smoothed or if necessary, restored by the dentist with a filling or crown. If the fracture is more severe, a root canal may be required to save the tooth. In a worst case scenario, the tooth may not be restorable and need to be extracted.

A Tooth With Intense Pain or Swelling

A tooth that causes intense pain and/or swelling is usually the sign of a significant problem. Antibiotics and pain medication are a distant second choice to seeking dental care. A dentist should be seen immediately and appropriate treatment options should be discussed and initiated.

When a Crown or Bridge is loose or comes out

When a crown or bridge is loose or comes out, a dentist should be seen on the soon side. There may or may not be pain or sensitivity, but we don't want you to swallow or lose it before we can hopefully recement it.