White Spots on Your Teeth

There are a number of reasons that there are white spots on your teeth.  It can range from an issue called fluorosis, which means that a person has had too much fluoride and it has affected the tooth structure.  What people forget is that many mouth washes have fluoride, major metropolitan areas have fluoride in the water,toothpastes, bottled water and on top of that some dentists do fluoride treatments after a cleaning.  These things make it easy to get white spots on the teeth when you are a kid and the teeth are growing.  There are other types of white spots- after wearing braces with wires, around the brackets, which were glued to the teeth  people will get white spots. These spots are due to poor oral hygiene around the brackets. Poor oral hygiene will also cause white lines at the gum line of the teeth.
    These are the common causes of white spots that can be reversed easily and with minimal invasiveness.  What it requires is scrubbing the teeth, cleaning them with a gel and then using a calcium paste to force calcium back into the tooth, repeat if needed. It's Simple and  effective.  If this method doesn't work then you can move onto more invasive techniques like composite(bonding), veneers(porcelain facings) or decide that the spots aren't so bad after all.
    There is one last type of white spot that hasn't been covered. Sometimes when a person gets a cavity the tooth can turn a dull white.  This gives the patient and dentist no option but to treat the decay.

News Flash-Your nose ....it's on your face!!

Alrighty, I am going to start this blog up...again.  Let me tell you doing this blogging thing is not as easy as it looks. Today's topic is the New York Times article "Rethinking the Twice-Yearly Dentist Visit".
    I am amazed at the confusion caused by the routine things in dentistry.  The article (paraphrased) says that a cookie cutter approach to treating patients might not be the best way to care for a patient. The reaction to this article ranges from "wow, I knew the dentist was ripping me off" to "Isn't science great and what will they discover next".
    First off, the origin of the twice a year cleaning is murky.  It either come from  "Amos and Andy in the middle of the last century" or a toothpaste jingle ,where you need to use this toothpaste and see your dentist twice a year.  It doesn't really matter where it comes from. What matters is that a one size fits all is a terrible way to treat a patient. I don't know when it happened, the patient devolved from being an individual  with needs, quirks,and desires to being a  widget that is plugged into a one size fits all regimen. Then out comes amazing new information! The patient is a person!
   The time between cleanings should be based on the patients needs and desires.  I have some patients that I see once every three years.  Why should I see them more often?  They don't need to have a cleaning and are not prone to getting cavities.  I am sure they have better things to do than going to the dentist.  I have other patients I see every three months.  Why? Because they need to.
    So, is the dentist ripping you off?  No,  how often you get a cleaning should be decided between you and you're dentist.  Wow, mind blowing. What will they think of next?

Implants Vs. Bridge

The topic today everyone is implants vs. bridge.  When you lose a tooth or teeth and are going to have it/them replaced how does a dentist pick the best treatment? Well, first are the teeth on either side virgin (untouched)  then implant is a good way to go, simply because cutting the teeth on either side of the space to place a bridge is like destroying the village to save the village. A good rule of thumb is- what a dentist can do is not better than what you were born with. Cutting down untouched tooth to support a missing fake tooth usually does not make a whole lot of sense.  If the teeth adjacent to the space have boneloss then implant again. Alright what if the teeth next to the space have large fillings and lots of bone support?  Well then you have to think, will they need crowns in the future?  Then a bridge is not such a bad option. You can cover the teeth with crowns and use those crowns to support the fake tooth(pontic)  The bridge doesn't require surgery, or waiting for integration- an implant has a waiting period of 3-6 months to allow the bone to attach to the implant called integration, so it takes a while to finish up the case. The work around for getting implant teeth faster is- immediate load implants which mean that the implants are placed and a provisional (temporary) crown is placed on the same day but not placed in the bite. Nice, walk in with a gap and walk out with a tooth then wait for the bone to heal and get the permanent crown cemented.  In this situation it is important to pick your cases carefully or else the the bone won't grow properly and the whole implant will come out. A permanent bridge goes from start to finish in weeks not months. As in everything else there are downsides to a bridge.  I think the biggest problem is the spot where a tooth was taken out.  When a tooth is pulled there is no tension on the bone so the bone starts to resorb(shrink) unfortunately the bridge tooth stays the same creating a gap  between the fake tooth (pontic) and gum.This is where food will get caught which brings me to the possibility of cavities because the fates of the teeth are now intertwined lose one supporting tooth(retainer) and the whole bridge might be lost.

Bleaching

Alright let's start this off with the question that I get asked the most- Will bleaching hurt my teeth? The answer is NO. Bleaching is basically an optical illusion. A persons teeth are a lot like Swiss cheese,stay with me here, the tooth has lots of microscopic pores these pores are filled with a jelly.  The tooth(Cheese) is pretty much impervious to stain, the jelly is what gets stained so the whole tooth looks darker.  Things with vibrant colors tend to stain more coffee, tea,red wine, etc. When you bleach you place a gel (carbamide peroxide)on the tooth.  This gel breaks down into air and water.  The microscopic bubbles of air cause the jelly in the tooth to break apart and voila' more light passes through and your teeth are magically whiter. So is it safe- yep it actually doesn't do anything to the teeth.  The process has been around for a long time (it was used by dentists to stop bleeding after gum surgery) and O.K.ed by the FDA in 1989.  Here are the down sides:  it is not permanent so you have to keep doing it, it can cause cold sensitivity using sensitivity toothpaste can really help, and lastly there is no easy way out whitening toothpastes and rinses don't work. Period. So whether you do it at home, in a dental office, or with something like crest strips they all function the same.  The other thing is dental work is not affected by bleaching so if you have white fillings or crowns in the front teeth the dental work won't get lighter.  So if you bleach you will need them replaced.  On the flip side if you need something done on your front teeth bleach first then have the color matched to the bleached teeth.