Hope Restorative & Cosmetic Dentistry

Touching up Your Teeth Whitening Before Dental Work

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I need to get a dental crown and wanted to touch up the whitening on my teeth first. My dentist provided me with Opalescence PF 20%. What I need to know is how long I need to use it and for how often before I schedule the crown. Can you give me any guidelines?

Yvonne

Dear Yvonne,

Teeth Whitening Trays

One thing which I want to bring up immediately is my concern that your dentist isn’t guiding you on this himelf. Is he unaware of how this works? It is a possibility. If that is the case, it would mean taking a big step back and deciding whether or not you want this dentist to be the one to do your crown. This is especially true if, as I suspect, it is a visible tooth.

If your dentist is mainly engineering-minded, you may end up with a functioning crown, that fits well, but you will be disappointed in the look of it.

As for the teeth whitening, there are a variety of factors involved. How white do you want them? There isn’t really a whiteness cap. The bottom line is the longer you wear the whitening trays, the whiter they get. How much you wear them each day, depends completely up to you. As long as you aren’t experiencing sensitivity you can wear them for as many hours a day as you can tolerate. You really need a minimum of 20 to 30 minutes for the gel to adequately seep into your teeth.

If it’s possible for you to wear them overnight, you will get faster results. Our saliva production slows down at night. That enables the whitening gel to stay on your teeth even longer. During the day, you can wear it as much as you’d like as well, but your saliva will slowly seep into your teeth whitening trays and wash away the gel, requiring you to reapply the gel several times a day.

One definitive is the waiting period between the whitening and the crown development. I suggest waiting two weeks between the time you get the whitening to the color you want and the dentist making your crown.

Who Should Do Your Crown

As I mentioned earlier, it doesn’t appear that our dentist has a lot of cosmetic skills. A dental crown, especially one on a front tooth requires a lot of technical knowledge as well as artistry. This is something I would want you to get an expert to work on. Because cosmetic dentistry isn’t an actual recognized specialty, it is up to the dentist how much they invest in the training.

I’d start by looking for a dentist who is AACD accredited. While they are the top 1% of cosmetic dentists in the country, there aren’t very many of them. If you can’t find one in a reasonable distance to you, there is another list you can check. The mynewsmile.com website also lists expert cosmetic dentists by area. They’re not all AACD accredited, but they do all have expertise and artistry. Any of them can give you a beautiful crown which blends in perfectly with the rest of your teeth.

This blog is brought to you by Tulsa Dentist Dr. Jerome Cha.

Dentist Refuses to Give Son Porcelain Veneers

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I’m looking for options for my 10-year-old son. A neighborhood child chased my son with a dog. He was so terrified he ran too fast and tripped, chipping his front tooth. He’s really embarrassed to smile. I want to get a solid fix for him, like a porcelain veneer. Our dentist refuses. I suggested a crown. He refused that too. I need options. What CAN I do for my son?

Olivia N.

Dear Olivia,

I’m sorry your son had such a horrifying experience. Hopefully, the neighbor boy’s parents are taking some initiative in helping with this expense. I hope this experience hasn’t soured him on dogs.

There is a good reason for not giving your son either a porcelain veneer or crown, though I do understand you want a solid treatment.

Your son’s bite is still developing. If you did one of those other treatments, though fantastic for adults, you’d have to replace them every few years. That’s an unnecessary expense. Plus, with a crown, you’d be forced to ground down perfectly healthy tooth structure. Fortunately, there is a great solution.

A Conservative Repair for a Chipped Tooth

A smile with a chipped front tooth

Before Dental Bonding

A smile after a chipped tooth is repaired

After Dental Bonding

Traditionally, a chipped tooth is restored using dental bonding. This uses composite resin to fill in the chip and blend it naturally with his natural tooth structure. If it makes you feel better, this solution is the go-to for adults in this situation as well.

One word of caution. This is done free-hand. If your pediatric dentist isn’t a skilled cosmetic dentist, you’d be better served having a general dentist who is willing to treat children do the procedure who’s an experienced cosmetic dentist to ensure his restoration will look natural.

This blog is brought to you by Dr. Jerome Cha.

My Porcelain Veneer Is Turning Dark at the Top

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I need some advice. I had a large chip that my dentist repaired with a porcelain veneer. It always looked okay, but for some reason it’s turning dark at the top near the gumline. I don’t know why. I’ve only had it for two years. The dark line is really visible and is making me feel awkward about smiling. Do you know if this is normal? My dentist never mentioned this as a possibility.

Serena A.

Dear Serena,

I can think of a couple of possibilities for what is happening. If you truly have a porcelain veneer (and I’ll explain why I’m not positive that’s what you have in a moment), then it means it’s not bonded on properly. A porcelain veneer should sit flush against your gums so that nothing can become trapped there. If it’s not properly placed there can be a ledge. This will attract food and bacteria. If it’s not dealt with it will lead to decay. Poor bonding can also leave a space between the veneer and your tooth which will allow things to seep between them. Not only will this also lead to decay, but your veneer will turn dark from the things gathering beneath it.

However, if you had a very large chip it’s possible you were given a dental crown instead. Porcelain veneers are used for smile makeovers and only cover the front of your teeth. Dental crowns are used to cover the whole tooth when there are large chips or decay over a majority of the tooth.

If you were given a porcelain-fused-to-metal crown, it would explain the dark line as well. These will begin to show the metal at the top of your gums eventually. However, it generally takes more than two years for that to happen. There are a couple exceptions to that time rule. One is if you have gum disease. Another is if you brush hard. That can cause your gums to recede.

Either way, the only way to fix this is to have either the crown or the veneer re-done. If it is a crown, be sure to have them give you an all-porcelain crown this time, so you don’t have to worry about a dark line eventually showing up. However, if there is gum disease you’ll want to address that as well. If it’s a veneer, the problem resulted in an error on the dentist’s part. They should repair it for free.

I hope this helps.
This blog is brought to you by Dr. Jerome Cha.

Is It Safe to Get My Teeth Whitened While Pregnant?

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I’ve been looking forward to getting my teeth whitened. I have an appointment next week. This morning, I just found out I’m pregnant. Is it still safe for me to get them whitened or do I need to wait until after I have the baby?

Chrissy P.

Dear Chrissy,

Congratulations! It’s so exciting to have a newborn in the house. I don’t know if this is your first child, but it’s the most challenging and rewarding thing you’ll ever do.

As far as teeth whitening and pregnancy goes, the truth is we don’t know. It’s been put on the “not recommended” list. That’s not because we know anything bad will happen. In order for it to be declared safe, it has to go through controlled studies where expectant moms have teeth whitening done while pregnant and then we wait and see if it has any adverse effects on the baby. As you can imagine, there aren’t too many moms queuing up to have their unborn child be the guinea pig.

That doesn’t mean it will cause harm, just that we don’t know. That probably has given you no definitive direction to go, but it’s all the data we currently have. I will say there haven’t been any reports of babies having any negative effects from mothers that have gone ahead with their work.

Most obstetricians will recommend you put off any unnecessary treatments. That’s not the same as if you have decay or a tooth infection. Those need to be dealt with, because leaving an untreated infection has been linked to premature delivery and low birth weight. You also don’t want to risk passing an infection onto your child. There are antibiotics which are safe to use while preganant. Never put off a dental emergency.

Again, congratulations!

This blog is brought to you by Dr. Jerome Cha.

Are Dentures “Really” the Worst Thing I Can Do?

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I have teeth which have been a constant problem my whole life. It seems like every couple of months I’m back with a new problem even though I brush and floss as instructed. I told the dentist on this last visit that I’m just tired of it and want to just get dentures. He pretty much shouted that’s the worst thing I can do, and suggested I take better care of my teeth. I don’t know what else to do besides brushing and flossing two times a day.  Are dentures truly my worst decision?

Steve O. – Pennsylvania

Steve,

Admittedly, that wasn’t the best way for your dentist to handle the situation.  Like in every other profession, sometimes dentists lack in people skills.

You can be doing everything you’re supposed to with your dental care and still struggle with your teeth. Your dentist should know this, too. Sometimes our genetics work against us and our teeth will be a problem no matter what. There are some extra steps your dentist can take, such as fluoride treatments.

As to whether dentures are your worst possible decision, it depends. If you’re losing your teeth and cannot afford a better option, then dentures are better than nothing.  In your situation, here are the steps I’d recommend.

First, I’d try to save any teeth you can. Natural teeth are truly your best option. Even the top of the line tooth replacement, dental implants, which are like having natural teeth, have risks that you won’t have with your natural teeth.

Second, get crowns or implants on the teeth which can’t be saved. If you get to keep part of the tooth, get a porcelain crown. If the tooth is extracted, get an implant.

I realize that not everyone can afford a dental implant. In that case, I would say a removable partial denture would be okay. However, there is a downside to dentures.

When your teeth are removed, your body recognizes the roots of your teeth are gone and automatically begins reabsorbing the minerals in your jawbone. Eventually, you won’t have enough bone structure there to retain dentures. This is most common when you have a full set of dentures. You’ve likely seen patients in this situation. Their face has a sunken, aged appearance.

Implants solve this problem because it places a prosthetic root into your jawbone, so your body recognizes those minerals are still necessary.

The key here is to save what you can. Then, when you can’t, go down the list for the best replacement you can afford. I’d also talk to your dentist about getting some extra fluoride.

Another trick for fluoride is to make sure you’re drinking tap water and not bottled water. Bottled water is defluorinated. Your tap water should contain fluoride.

Also, don’t beat yourself up about your teeth. Sometimes, you can do everything right and still have problems with your teeth. You can’t change your genetics.

This blog is brought to you by Dr. Jerome Cha.

Snap on smile for a 7 year old

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My seven year old son has quite a large chip on his tooth. We had it fixed with composite, but it broke off. Would snap on smile work to hide the problem until he was old enough to get it capped?

Bridgette, Las Vegas

Bridgette,

I’m going to advice against Snap-on Smile in this case. Your son is only 7 years old and snap-on smile is removable. This means he is going to lose it. Then even when you buy another one, he’ll probably lose that as well. Also, the snap-on smile is a little bulky which will probably bother him. Children are often sensitive to different textures and feelings. But the strongest argument against it is the fact that your sons teeth are changing. He would need a new appliance every couple of months.

I think you can still fix it with composite. It probably broke off because it was interfering  with his bite. You need to go to an expert cosmetic dentist to have this fixed. He or she will be able to fix it where it doesn’t interfere with his bite.

You may also be interested in reading about CEREC crowns for when he is older.

This blog is brought to you by Tulsa Cosmetic Dentist Dr. Jerome Cha.

Whitening teeth with a porcelain crown

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I have to get a porcelain crown and thought I’d get my teeth whitened at the same time. My dentist has this thing where you can get your teeth all the way whitened in one appointment. I wondered if it matters which one I do first. Will the crown whiten?

Billye Gaye- Maumelle, AR

Billye Gaye,

Yes, it does matter which one you do first. Porcelain crowns will not whiten. At our office we do CEREC crowns, which are also one appointment. Whatever level of whiteness your dentist makes it is as white as it will ever get. So, I’d do your teeth whitening first, getting them to the level of whiteness you want, and then get the crown made to match that tone, especially if it is a front tooth that is very visible. However, if your crown is a back tooth, like a molar, it may not make a difference what color it is so the timing will not be as relevant.

This blog is brought to you by Oklahoma City Cosmetic Dentist Dr. Jerome Cha.

 

 

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