If you have discolored teeth, the cause is often staining on the enamel surfaces from foods, beverages, or smoking. But tooth discoloration may also originate deep within the root of a tooth. Sometimes this happens to a tooth that had to have earlier root canal treatment because of injury or decay.

In such cases the living pulp tissue and its blood vessels and nerves had to be removed from the root canals, resulting in the death of the dentin layer, which makes up most of the tooth's body. Over time this caused the dentin to darken. The color may come from remains of blood that was left in the tissue, or from filling materials left in the root canal that are showing through.

Since these stains are caused internally (intrinsic) and not on the outside of the tooth (extrinsic) they must be whitened from the inside. This is usually done by putting a bleaching agent into the empty chamber from which the pulp was removed. Usually the bleaching agent is a substance called sodium perborate.

When it is mixed with a solution of hydrogen peroxide, sodium perborate slowly bleaches the color from the tooth's internal material. It is considered to be safe and reliable for this use.

The work begins by taking x-ray images to make sure that the root canal is correctly sealed and the bone is healthy. After this, we will make a small hole in the back of the tooth through which the root canal space will be cleaned. The root canal space will be sealed and the bleach will be applied in a putty-like form and sealed off from the rest of your mouth. Every few days this procedure will be repeated until the bleaching reaches the desired level.

At this point a tooth-colored composite resin will be used to seal the small hole that was made in the dentin to insert the bleach. After the tooth has reached the level of whiteness that matches it to your other teeth, veneers or crowns must sometimes be used to repair the surface if it is chipped or misshapen, for example.

Contact us today to schedule an appointment to discuss your questions about whitening internally discolored teeth. You can also learn more by reading the Dear Doctor magazine article “Whitening Traumatized Teeth.”

If you are unhappy with your smile or the way some of your teeth appear, porcelain veneers may be the solution to your concerns. They are a fast, effective, and well-proven method for cosmetically enhancing your smile — and a secret that Hollywood and other celebrities have been taking advantage of for years. To help you determine if they are right for you, here are some questions we typically receive.

What is a veneer?

A veneer is a custom made thin “shell” or thin layer of a dental ceramic material (usually porcelain) used to replace the front, visible surface of the tooth. They are artistically and hand-crafted using a precise model of your mouth and teeth to achieve a natural look.

What can they do for me?

Veneers are the optimal choice for correcting small to medium gaps between teeth; slight rotations of teeth causing them to be misaligned; oddly shaped, chipped, or “short” teeth; as well as teeth that are discolored or unevenly colored. However, veneers have their limitations, too. They cannot correct bite issues, poor tooth position, or profile issues. It is also important to note that if you have this procedure, we will typically need to remove a small amount of enamel from your teeth to accommodate the veneer and produce dramatic improvements to your smile.

How long will they last?

While they can vary widely from person to person, porcelain veneers usually last from 7 to 20 years. Factors that impact this timeline include your oral hygiene habits, diet, lifestyle, as well as how well you protect your veneers during sleep and while playing sports.

Have more questions?

Contact us today to discuss your questions or to schedule an appointment. You can also learn more about veneers by reading the Dear Doctor article, “Smile Design Enhanced With Porcelain Veneers.”

If you have a tooth that just doesn't look good because of decay or injury, a porcelain laminate veneer is probably a good way to make it look as good as it ever did — and maybe even better! Dental veneers are composed of thin layers of dental ceramic material. They essentially replace the original tooth enamel and require preparation of the tooth by removing a small amount of enamel to allow room for the placement of the veneer.

Recently, more and more dentists have been using minimal prep or prepless techniques that do not require this preparation. In such cases, the porcelain is bonded directly to the outer layer of the tooth's enamel. Highly skilled dental technicians can design a custom-fit veneer that feathers into the tooth just short of the gum line.

Prepless techniques cannot be used in all situations, but when they are used appropriately the results are beautiful and very stable. Should you get prepless veneers? The following is a list of advantages and disadvantages of prepless veneers.

Advantages of prepless veneers include:

• Tooth preparation or reduction is not needed, leaving the original tooth whole.
• They are not placed under the gum tissue, eliminating the possibility that the restorations negatively impact the gum tissue.
• They can be used to change the appearance of teeth that are too small or misshapen making the teeth look larger and eliminate unwanted spacing.
• They can be used to “lengthen” teeth that have been worn down by grinding.
• Since the underlying tooth has not been reduced, prepless veneers are reversible and practically risk-free.

Disadvantages include:

• There are many cosmetic situations in which they cannot be used, and traditional veneers (requiring preparation) must be used instead.
• Prepless veneers cannot be used in cases in which orthodontic treatment is recommended to move the teeth, such as improper tooth position, poor bite, or a poor facial profile.
• Since they are added on to existing tooth structure, they do not work for teeth that are relatively large or in a forward position in a smile.
• They do not usually work for lower teeth because of space restrictions.
• They cannot replace lost or damaged enamel.

Working with prepless veneers requires special skills and training. Please discuss our credentials and experience with us when you inquire about this technique. We can assess your specific situation and let you know whether restoration without the drill is appropriate for you.

Contact us today to schedule an appointment to discuss your questions about prepless veneers. You can also learn more by reading the Dear Doctor magazine article “Porcelain Veneers Without the Drill.”

What is composite resin bonding?
This term refers to a kind of tooth-colored material that is a mixture of a plastic resin and a glass filler. The glass gives the mixture, or composite, strength and translucency that is similar to a natural tooth. The composite is bonded to the tooth by slightly abrading or roughening the tooth so that the resin fills in small cuts in the tooth surface and bonds with it. The end result functions and looks like part of the original tooth.

What is bonding used for?
This technique is a good way to restore chipped or stained teeth or to change a tooth's shape or color. It can also be used to restore parts of a tooth near the gum line where the gums have receded and left the root partially exposed.

What are the advantages of bonding?
Composite resin tooth restorations have several advantages.

• They take only a single dental visit because they are done right in the dental chair rather than having to be sent to a dental lab for preparation.
• They are less expensive than many other dental restorations.
• They leave most of the original tooth intact since little tooth preparation or drilling has to be done in order to make the composite material bond to the tooth.
• They can be made in a wide range of colors and can be matched well with the teeth around them.
• Because little of the original tooth has to be removed, they are a good choice for teens, whose dental arches (upper and lower jaws) are still developing.

What are the disadvantages of bonding?
The composite resin material is not as strong as the original tooth material, so the bonded restorations may not last over a long time. If it does last, the material may also stain as it ages.

When should you choose bonding?
Composite resin bonding is a good choice for a quick and attractive tooth restoration that may be replaced later by something more permanent, such as porcelain veneers.

Contact us today to schedule an appointment to discuss your questions about bonding. You can also learn more by reading the Dear Doctor magazine article “Repairing Chipped Teeth.”

Before determining if a bridge or an implant will work best for you, here is some useful background information. There are two main parts to a tooth; the crown or part that you see above the gum line and the root portion that is below the gum line and encased in bone — the part that is replaced by a dental implant.

A dental implant is inserted into the jawbone during a surgical procedure. The implant is actually a titanium screw-like device that is placed in contact with the bone. During a 3 to 6 month healing period, it subsequently fuses to the bone. A crown made from dental porcelain, gold or a combination of both is then attached to the implant to mimic a healthy, normal tooth.

There are two critical reasons why implants are the preferred method for permanently replacing an adult tooth. The first is that they are less susceptible to gum disease and they are not subject to tooth decay. The second is that because they attach to the jawbone and not to the adjacent teeth. And while an implant may cost a little more initially, when compared to the longevity and replacement cost of bridgework over a lifetime, they may cost less.

By contrast, a fixed bridge is also a non-removable restoration or prosthesis (replacement part) that is held in place by attaching it to your natural adjacent teeth. The treatment gets its name from the French word for bridge, “pont,” as the tooth being replaced is called a pontic. Before placing a bridge, the teeth on either side of the missing tooth must be prepared by removing layers of tooth enamel. Three new teeth are then crafted as a single unit from dental porcelain and/or precious metals with crowns on either side of the pontic. The pontic is held in place when the crowns are placed. Bridgework is at risk for gum disease and tooth decay and requires careful maintenance.

As with most dental procedures you have options and choices. Luckily, when it comes to determining whether a bridge or an implant will work best for you, you can rely upon our expertise. However, by having a clear understanding of these two options you are now better prepared for working with us should you require this treatment option. To learn more read the article, “Implants Vs. Bridgework.” Or, contact us to discuss your questions or to schedule an appointment.