Frequently Asked Questions

Porcelain Veneers

What exactly is a porcelain veneer?
A porcelain veneer is a laminate of porcelain that covers the outside of the tooth. It is done to create a lighter appearing tooth. By placing a light layer of porcelain over a darker tooth you can create a very natural appearing tooth that is very esthetic.

Why can't I just bleach my teeth?
Oftentimes bleaching is all that is necessary to create a very appealing smile, however sometimes the anterior teeth are so discolored and there might be too many pre-existing fillings to get a good result with bleaching.

Are porcelain veneers done just for cosmetic reasons?
Yes probably 50 to 60% of the time, however teeth can show signs of wear and chipping. A porcelain veneer is a very conservative treatment in this case because of the minimal amount of tooth structure that you remove from the tooth. All you need to do is remove about 0.7 mm from the face of the tooth and slightly more than 1 mm from the edge of the tooth so you can rebuild it in a very esthetic porcelain.

Can you do a veneer without drilling any tooth structure away?
There are some companies out there that are marketing a non prep veneer. Unfortunately, if you don't remove any tooth structure you are forced to make a bigger tooth. I have seen numerous cases that were previously done this way elsewhere and I have never seen a case that I thought looked natural. When a tooth is not prepared for a veneer then the veneer always looks bulky particularly at the gum line because the tooth does not emerge out of the gum naturally. It always looks artificial. It is essential to remove 0.7 mm from the face of the tooth. This is a minimally invasive reduction of tooth structure necessary to achieve the desired esthetic result.

What is the difference between a crown and a veneer?
When a tooth is prepared for a crown tooth structure is removed from the entire circumference of the tooth as well as the chewing surface of the tooth. A crown is necessary if the tooth has so many large fillings that there would not be enough natural enamel from the original tooth to bond a veneer to it.

If a veneer can be done it is the esthetic restoration of choice but often times due to preexisting conditions a crown might be the necessary.

How long do veneers last?
On average a veneer is going to last 10 to 15 years. For people who are heavy bruxers that grind their teeth at night it is advisable to wear a night guard to protect their dentistry. Good oral hygiene and avoiding excessive sweets is probably the biggest contributing factor to longevity of veneers. A tooth with a veneer or crown on it is just as susceptible to decay as a natural tooth. The better you take care of it the longer it will last.

Dentures and Implants

A substantial portion of the population have complete upper and lower dentures. Many patients think that once they have their teeth removed they no longer need to go to the dentist. Some maintenance should exist. More often patients with a complete upper denture still have a number of lower natural teeth that need to be maintained on a regular basis

I have a complete upper denture and a lower partial denture that is supported by four teeth. Why should I go to the dentist just to get four teeth cleaned?
Patients with some natural teeth should go to the dentist every 6 months to get their teeth cleaned regardless of how many teeth they have. No matter how good their oral hygiene they will build up tartar on their teeth that cannot be removed with a tooth brush or floss. When you wear a lower partial denture it contributes to the accumulation of plague around you remaining teeth. It is essential that those teeth get cleaned on a regular basis.

If that is the case why don't I get all of lower teeth removed like I did with my upper teeth?
A lower denture never fits as well as an upper denture. With an upper denture you can get complete coverage of the palate which is the roof of your mouth. By doing so you can create some suction that keeps the denture in place. With the lower denture the presence of the tongue prevents you from developing that suction. It is very important to try to keep as many teeth as possible in the lower arch. Simply keeping the two eye teeth is extremely beneficial to providing retention and stability to a lower partial denture.

What happens if I lose all my teeth due to decay and or gum disease.
Up until the advent of Implants the only choice that existed was to have a complete lower denture made. It is very important to get as good an impression as you possible could. But due to that lack of suction the fit of the lower denture is going to be compromised.

If that is the case then why don't I just live with it and not go to the dentist anymore?

We call the bone that was around your teeth dentoalveolar bone. It is present to support your teeth.

When the teeth are no longer there then that bone no longer serves a purpose. Over time the dentoalveolar bone will resorb underneath the denture. When this happens the denture will start to settle into the jaw and the patient's bite starts to collapse. It looks as if they don't have teeth and they develop substantial wrinkles at the corners of their mouth. Also because the ridge is shrinking, the dentures do not fit as well.

What can I do to prevent that?

Without the placement of implants you cannot stop the resorption of the ridge but if you reline the denture every 5 to 7 years then you can maintain the fit of the dentures and the bite. Unfortunately if you have gone 20 years without going to the dentist then you cannot restore the bite back to the way it was 20 years ago because it would be too drastic of a change for the patient. Also the lower ridge has resorbed so much that it makes it difficult to get an adequate lower fitting denture.

What can I do to make the lower denture fit better?

Placing implants in the ridge offer a wonderful opportunity to acquire a good stable denture with an appropriate bite. As an example I have had numerous patients come into the office with complete dentures that were 20 to 30 years old. We were able to make a new good fitting upper denture, but the lower ridge had shrunk so much that we would never be able to get a good fitting lower denture.

By placing two implants where the eye teeth were, we were able to restore her bite close to the way it had been 20 years ago. After placing the denture the patient looked 15 years younger because we were able to open her bite up. These patients were delighted.

Do you only need 2 implants to support a lower denture?

If placing implants 2 is the bare minimum. Four an be placed to provide more stability to the removable denture or 4 or more can be designed to created a fixed denture that does not come out. The more sophisticated the prothesis the better the quality of chewing and the more costly.

Patients who have elected to support their complete denture with implants have experienced a huge improvement in the quality of their life. They look better, they eat better and their speech is improved.

Root Canals

What exactly is a root canal?
The best way to explain a root canal is to first discuss the anatomy of a tooth.

The outer layer of a tooth is comprised of enamel. It is a very hard inorganic material that is designed to remain hard throughout years of chewing. The layer under the enamel is called dentin. Good healthy dentin is necessary to support the enamel. Underneath the dentin is the pulp. The pulp is comprised of nerves, blood vessels, and connective tissue. The main purpose of the pulp is to provide nutrients to the tooth. The blood vessels in the pulp provide fluid to the dentin so that the tooth remains vital.

Why can't I just get a tooth filled if I have a cavity?
In most cases that is all that is necessary. Decay is a colony of bacteria that has eaten away at the dentin in the tooth. Once the decay is removed, if we are still in dentin, then the tooth can be restored without doing a root canal.

When do I need a root canal?
If the decay extends through the dentin and into the pulp then the bacteria will create an infection in the pulp chamber. The pulp will eventually become necrotic which means it will get infected with puss.

If it is an infection why can't I just take an antibiotic?
When the pulp chamber becomes necrotic, the infection constantly leaks out the end of the root. The apex of the root is where the nerves and blood vessels enter the tooth from the jawbone. When a tooth is abscessed the infection is leaking through the apex into the jaw. There are no more intact nerves and blood vessels inside the tooth to transport antibiotics into the pulp chamber. The antibiotics would clear the infection up around the end of the tooth temporarily but eventually the abscess would come back. It would be like leaving a splinter in your finger and never taking it out.

What exactly is a root canal?
A root canal comprises cleaning out the entire pulp chamber in the tooth. The dentist has special files and instruments that allow us to gain access to the apex of the root. After removing the infected pulp, the tooth is disinfected with a chlorox solution. Sodium hypochlorite is still considered to be the most effective disinfectant. Once the pulp chamber has been adequately cleaned then it is filled a pliable rubbery material that seals the chamber all the way to the apex.

Once the pulp is removed isn't the tooth dead?
The inside of the tooth is no longer alive and vital. Fortunately, the tooth is held into the bone with a periodontal ligament. This ligament is completely separate from the pulp chamber and and functions normally. Once the pulp chamber is removed the dentin in the tooth will tend to dry out, thus making the tooth more brittle. Posterior teeth, which are the back chewing teeth will usually need a crown on them to prevent them from fracturing.

How long will a root canal last?
I have numerous patients that have had root canal treated teeth 20 plus years. The biggest contributing factor to success is that the root canal was cleaned and sealed properly to begin with. The biggest benefit of saving your teeth is to keep the entire dental arch intact so the migration and shifting do not occur thus compromising your bite.

Conscious Sedation

Recently I had a new patient come into the office with a severe toothache that needed a root canal. Unfortunately she had developed a dental phobia that literally brought her to tears when she arrived at the office. We chose to get her on pain medication and antibiotics and reschedule an appointment for conscious sedation prior to starting dental treatment.

What is conscious sedation?
Conscious sedation is a means of reducing patient's fears and anxiety to a level that allows them to have a and pleasant experience in the dental office.

What is done to achieve conscious sedation?
In our practice we use a combination of a sleeping pill called Halcyon and nitrous oxide. We have the patient come to the office one hour prior to the dental appointment so that we can administer the sleeping pill. We have a reversing agent on hand in the event that the patient has an adverse reaction to the medication. Depending on the size of the patient will will administer 0.25 or 0.375 mg of halcyon. After one hour we will bring to patient back and start to administer nitrous oxide.

Are you unconscious?

No, this is considered a mild conscious sedation. The patient is still capable of responding to questions and commands. The level of nitrous oxide can be raised or lowered to adjust the level of sedation. Numerous patients sleep through the treatment and numerous don't fall asleep but experience a substantial reduction in anxiety.

Is it safe?

Yes it is. We do have a reversing agent available in case there is an adverse reaction. In the 100+ cases we have done we have never needed to use it. We monitor the patient's oxygen levels with a pulse oximeter that is attached to the patient's finger.

Is this done in place of getting an injection to numb up the mouth?

It is not. We still have to anesthetize the treated area with xylocaine. One of the biggest phobias that patients have is of getting a shot. We always wait until the conscious sedation as in effect prior to giving the injection. It makes the entire visit much more pleasurable.

Can I drive home after conscious sedation?
Absolutely not! It is imperative that the patient has someone take them home and also be present and administer to their needs for the next 4 hours. Usually they will go home and go to sleep, but we will not administer conscious sedation unless someone is with the patient for 4 hours following dental treatment.