Ways to whiten your teeth

A common desire of patients is to have their teeth a brighter shade.  Typically this can be achieved in several ways.

1. First is by a professional in office whitening.  This is a great way to get a quick couple of shades by getting the surface of the tooth whitened.  In our office we spend about 1 hour with this procedure and get about 2-3 shades brighter for most patients.  Since the whitening agent is so strong it needs to be done in office to avoid burning the rest of the mouth.
2. Second is by making custom trays to wear at home.  Some of the benefits to this method is that the longer slower whitening can get deeper into the tooth and give some additional results you can not get from in office whitening.  You can also use the trays for other things such as fluoride gel.
3. Third stock trays are a popular trend now.   This includes whitening strips.  Other companies make similar whitening products we use opalescence which are the same makers of our in office and take home tray whitening products.
4. Fourth is by touch up products.  I will group most other products in this section since there is a plethora of options including: tooth pastes, on the go pins, gum, mouth rinses and the list can continue on.  These may not get a lot done for you unless you have already whitened your teeth and you want to help maintain your smiles new brightness.

There are also some ways which you should not whiten your teeth:

Chemical burn of the gums from hydrogen peroxide

1. Bleaching your teeth with bleach.  A common term for tooth whitening is bleaching your teeth. When you whiten your teeth there is not any bleach involved.  In fact using bleach is very toxic, will burn your gums (if not worse) and will not result in a brighter smile.
2. Using hydrogen peroxide to whiten your teeth.  The concentrations on hydrogen peroxide sold at the store will also burn your gums and create very sensitive teeth.  Whitening agents use a peroxide to whiten your teeth so hydrogen peroxide will get your teeth whiter but the cons of damaging your gums and creating very sensitive teeth can be avoided by other whitening agents.
3. Baking soda is a common one I hear of patients using to clean their teeth to make them brighter.  Baking soda is very abrasive and will not only remove stain from your tooth but it will move some of the actual tooth.

A few random facts about whitening your teeth:

1. Most modern whitening products contain a tooth desensitizer.  This is because whitening products naturally create tooth sensitivity. So something needs to counter that sensitivity.
2. Tooth brightening is probably a better term.  If your teeth looked more white they would also look odd and dull.  This is because the tooth is partly clear and some colors, such as reds and blues, appear in small amounts naturally to help the teeth to look brighter.  Think of a toilet bowl, a very solid white, and it would look horrible as the shade of your teeth.
3. There are some stains that will not whiten by these traditional methods.  They include fluoride stains, tetracycline staining and demineralized teeth. There are other ways to deal with these stains but that is a topic for another day.

The power of a photo: Seeing through the eyes of a Dentist.

I work in a very small world.  The problems that develop on teeth can be microscopic.  In order to help me in this small world I use 2.5X and 4.5X magnification along with a very bright head lamp and mirrors to look into all of the odd angles of the mouth.  Needless to say I see peoples mouths in a completely different way than they do.

It's no wonder that I am able to find many things in my patients mouth that they are unaware of.  This is one of the reasons we take a lot of photos in our office.  We consistently take 9 photos of all our new patients.  We also frequently take photos of things we find during dental surgery and photos of our finished work.

I hope the photos below help to show the difference that a patient might see compared to what I might see with my Dental loops (magnification)

A fairly normal size to look at a tooth
At this size nothing may look troubling

Now try to lean in  a little and you may notice some suspicious dark areas

Zoom in with some low power loops say 2.5X and you may notice a crack

Now lets look at it through some higher power loops say 4.5x the crack at the top of the tooth is now very apparent

Now add a little more light and this a tooth the crack at the top seems obvious.  

This is how I see the tooth as a dentist.  I look at the ridge of the tooth splitting.  I can almost see the bacteria crawling into this crack causing it to stain as the they slowly produce acid causing the tooth to decay as the crack and the bacteria continue on their way to find the nerve.  These problems usually wait to break or cause pain until you are on some cruse ship off the coast of another country.  You final bite into an almond extending the crack into the nerve and will not be able to to eat sleep or even have a cold drink the rest of the trip.  Well at I see similar situations happen fairly regularly. 

New Dentistry: Meeting the demands of a longer life.

REVIEW
In the last post I reviewed some of the Dental challenges of a longer life.  These were addressing the 10-20 year life span of dental work before a problem arises.  Then how it may not seem like a problem to most people until it is an obvious problem and often if more difficult and expensive to address.   This may have been okay when the average life span meant that the dental disasters happened with few years left but now it means things fall apart with a decade or more still to live.  Lastly, to help avoid tooth loss it is helpful to treat the mouth when initial problems develop instead of waiting until the problem is obvious.

CHALLENGES
It is not uncommon to hear about dental fears.  I have heard many people call themselves "Big babies", "Cowards", or even "Bad patients" because of how fearful they are of going to the Dentist. So a big challenge we face as Dentists is make a comfortable experience out of something which is not a fun as say Disneyland.

Getting fillings to look like teeth and last a long time is difficulty were huge developments have been made.  This challenge is actually filled with multiple other challenges including making it so there is little discomfort the day after fillings are placed, getting material to work in a wet environment and having the numb feeling for hours after appointments.

Affordability is the last challenge faced by most patients.  This one is a little complicated.  Nationally people spend much less on dentistry than many other things they would consider less important.  So why do most people consider it so expensive? Probably because most people usually face the expenses all at once.  A second reason is a continuing change with dental insurance most people have been unaware of.

SOLUTIONS
Lucky for us, we live in a time of great progression and this holds true for the world on dentistry.  I don't have enough time write out all of the advancements that have been made but I will try to at least review some solutions for the challenges we commonly face.

-Improved Dental appointments

Very few people think about one of the first advances that has been made.  There have been advances in the management of an office.  There are actually companies that focus all there time and efforts into what to do to for offices to make their patient experiences positive.   We work hard to stay up to date with ways to make sure our office is comfortable to be in from the sights to the sounds, and the smells.  We also spend time learning how to arrange our schedule to keep our patients wait time to a minimum.
 
Minimizing the pain from dental work is a constant area of research.  Even with new developments nitrous oxide (laughing gas) is still commonly used to help relax patients.  It also has it's a numbing effect on the body, in fact many years ago they pulled teeth with only the use of laughing gas.  Today still I am able to avoid injections while treating many small cavities by using nitrous oxide.

Better needles have been made, yes  better needles which are sharper, beveled and smoother which make injections less of a pain.

Different anesthetics work faster and can last longer.  Novocaine is no longer in use but many of its cousins are. Articaine, prilocaine, buffered lidocaine and marcaine are all different local anesthetics that have been developed to either last longer, penetrate the bone better and or sting less as they are administered.  Needless to say it is easier to give a "painless" injection today than it was years ago.

-Better crowns and fillings

I work with a metal drill in a small space only millimeters away from a nerve confined in a hard case (the tooth) which offers no relief to any swelling from the trauma of both a bacterial infection (cavity) and physical removal the hardest substance in the body often at the same time as removing an old metal filling.  I am amazed that complications don't happen much more often.   I am even more amazed that we have been able to almost completely eliminate them.

There are several improvements that have made it possible to reduce post operative sensitivity as low as we have achieved. Water has been used with drills now for years to reduce the heat generated during a procedure.  They have recently developed something we can apply to the teeth that is antibacterial in addition to sensitivity reducing.  After I started to use this almost all my patients have little to no tooth sensitivity the day after dental surgery.  Amazing! That's all I can say.

Dental fillings don't set well when exposed to water, and the mouth is normally filled with saliva.  Years ago to keep the working area dry a rubber dam was used.  The mouth was covered in latex and a metal clamp was used to keep it in place.  They were time consuming and patients did care for them so they were rarely used.

Now there is a much more comfortable simple to use plastic piece the removed the water used during the procedure and well as keeping the tongue and check out of the way to prevent tissue damage.  Using this has provided a convenient way speed up dental procedures (less time in the chair) and provide a longer lasting filling.

I know very few people who are excited about the appearance of silver fillings or gold crowns.  Esthitic dental work was had to develop and was not very strong at first.  In the last few decades huge strides have been taken to improve the strength, appearance and fit of dental fillings and crowns.  Bonding agents no longer require a separate acid etch which would often leave teeth sensitive.  Fillings strengths have increased to were they have favorable out comes for the hard chewing back teeth.  New porcelains have been developed that are strong enough with out the old metal cores previously required.  Stronger fillings and crowns also mean I can keep more of the tooth when do fillings and crowns were as years ago more needed to be removed to make space for the material to be strong enough.

-Expenses

Unfortunately I have some bad news first.  Dental insurances plans have had a history of changing to cover less and have a lower yearly pay out.  Originally they pain about $1,000 per year, which is still about what they pay only adjusted for inflation that amount should be around $6,000 per year.  Need less to say patients have needed to reach into their pocket books more to cover beneficial dental procedures.

I should also add in here that most people are lucky to have dental insurance because most plans pay benefits to you regardless of were you go.  Also those benefits tend to be higher than what is pain into the insurance because only 50% people go to the dentist often even when they have insurance.  This means if your one of the people who uses there insurance that is paid by their work, you are basically getting free money for your dental care even if it's not as much as it use to be.  So come in to see me and use it.

The good news is that relative to other medical cost dentistry is actually fairly reasonable.  The difficulty is people often come in to the dentist once problems have come to a point of requiring an investment all at once.  Luckily there are financial options available to be able to pay for treatment that could greatly improve peoples lives.

Other advances

I will just briefly mention a few other advances that have been made in dentistry.
Quicker root canals with less files, with new rotary file systems
Less bleeding in some gum surgeries with lasers
Numb reversal agents, oraverse
Digital impressions
Online patient portals for better access to patient account balances and other patient information


Summary 
The mouth is a very personal and sensitive part of the body.  It is easy to have a bad experience in the dental chair.  The challenge to make the experience a better one has been met by the hard work of many before me.  There is now better understanding of how to create a comforting office.  Improving techniques and materials have made for better looking, working and feeling dentistry.  Even if a longer life means more dental work to keep you teeth, the options available have greatly improved.


Next post I will finish with the new and improved solution to replace teeth.

#comfortable#dentistry
#dental#advances
#dentalcrowns

What makes you love your Dentist?

This morning I was at the grocery store buying gift cars for patients who have sent others to our office. The lady at the registrar asked why I was getting so many gift cards.  I let her know I was a Dentist and I used the gift cards to send to some of my patients.  Her smile dropped as she suddenly became solemn saying "I hate the Dentist."

I looked at her and brightly responded, "But we've just met."

She laughed and started to explain how she had once had a bad experience, so now she avoids seeing dentist but then when she needs to go it's for a root canal. I listened to her continue about how the sound of the drill and having her mouth open for a long time also made her dislike the dental visits.  I gave her my card and told her I would like to try to give her a better experience.

This is a fairly common occurrence for me.  I meet someone, they find out about my profession and they then let me know their felling for my profession. Sometimes it is very negative, and many times it is very positive.  The stories they tell me have helped me find what usually make one person love their dentist and the other person to dislike them.  The  following are some of the things I have learned that make people love or hate the dentist:

1. The Dentist's Personality
The Dentist was a very nice guy, or he was very impersonal.  Dentists are people and just like everyone else.  There are a lot of great Dentists and there are a few bad ones.  If you have had to deal with a bad one it is especially difficult because of the personal space they are working in.
The better personal relationship people have with their Dentist and his or her team the better their experiences tend to be.

2. That Numbing Feeling
Many people have expressed to me how much the dislike being numb for so long.  Well I have some good news we have a numb reversal agent called Oraverse. We can use this to greatly shorten the time you are numb after a procedure.  I've used this for patients who need to give presentations or are going to a social event so they can have normal function sooner.

3. Discomfort After Dental Procedures
Some people never notice any discomfort after dental work and others have had their teeth become sensitive or even hurt after dental procedures.

This can be difficult because dental surgery is just that, surgery.  If you just had surgery on your foot it would be unlikely that you would be walking on it the next day.  However this is what we do with our teeth.

Luckily there are some different agents that can be used to help relive this very common post operative sensitivity.  We use Microprime with all of our crowns and fillings.  Not only has this greatly reduced the percentage of our patients who experience after dental work but it also helps to decontaminate the tooth.

4. Cost
 I have heard people in all walks of life say that their dental care was worth every penny and others who say that it is just too expensive. On average people spend more on their cell phone or clothing. Beyond this the longer you wait to correct a dental problem the more expensive it will become.  A root canal which will then require a crown is 10 times the cost of a filling and a filling costs about the same as an extraction.

The difference with the cost of dentistry when compared to cell phone coverage, or clothing is that it tends to come all at once.  To help with this we offer several financial options to help make the dental care you need more affordable.

In Summary
The dental office can seem like a scary place for many reasons.  We understand this and work hard to create comforting memories for those we serve.  We encourage you to take care of your smile and would love to take your oral health to the next level.

Our New Web Site

We have recently launched a new web site leathamdental.com We are hoping this will help us to improve new patient experience for all of our new and existing patients.  We are still putting a few things together.  We don't have everyone's photos up yet, but we will soon.

Some of the exciting new features will a patient login.  This will offer some new services for our patients once they create a login.  If you are interested you can ask any of our team about starting an account in January 2015.

If you go to Meet Dr Paul Leatham on the web site there is now more information about me as a dentist.  Including the continuation education courses I have been attending. As well as some of my involvement in the community.

A cool feature is at the bottom of each page is a link to the organizations I participate in.  If you click on the logos at the bottom for each page it will take you to the webs sites for the American Dental Association (ADA), the Academy of General Dentistry (AGD) and Spear Education (SPEAR), This will also work for the Facebook, Twitter and Google plus logos, they will link you to our our social media sites.

We are all excited about the web site and look forward to continuing to provide better access to our office.

Dr. Paul Leatham DMD