David A. Schwartz, D.D.S, P.C.

TMD/Sleep Dentistry

Although they can be two separate issues, recent studies find that there is a nearly 85% co-morbidity between TMJ pain syndromes and sleep breathing disorders. In other words, if you have one, there is an 85% chance that you have both. Thankfully, there are ways to find the source and to determine how to treat it.

TMD

Temporomandibular Joint Disorder, or TMD, refers to a condition that involves the temporomandibular joint (TMJ) and the tendons, ligaments, muscles, and bones relating to it. In many cases, this condition causes a lot of pain and discomfort for people. It is, however, very treatable.

Causes and Symptoms of TMD

Not all causes of TMD are known, but some contributing factors that may trigger symptoms of this condition can include injuries to the jaw, dental procedures, worn or missing teeth, chronic nasal congestion, and neck and back problems.

 

With so many possible causes, it is not difficult to understand why it is often misdiagnosed or simply not treated. However, untreated TMD can affect your ability to perform normal, basic tasks such as:

 

  • Speaking

  • Hearing

  • Eating

  • Chewing

  • Swallowing

  • Breathing

  • Making facial expression

 

TMD can also cause many symptoms and conditions that are misdiagnosed by medical professionals. Most often a person suffering from TMD will only be correctly diagnosed and treated by a properly trained dentist. Some misdiagnoses, symptoms, or conditions associated with TMD include:

 

  • Migraine and other headaches

  • Tinnitus

  • Allergies

  • Fibromyalgia

  • Cardiac arrhythmias

  • Sleep disorders

  • Irritable bowel syndrome

  • Physiological Dentistry

 

This is where Life Changing Dentistry comes in – helping a person who had daily debilitating headaches for 30 years and was about to go under the knife to have part of his brain removed but who now, after proper dental treatment, only occasionally gets headaches and was able to go on vacation with his family for the first time in 20+ years (and actually had a good time!). Or another who had to give up his passion for playing the piano because the aches and pains were tiring him out but who now can play again and has bought himself a new grand piano to celebrate. I could go on with similar stories. This has become my passion and is what gets me out of bed and going in the morning – knowing that I have the opportunity to touch another’s life in the same way.

 

If you have been diagnosed with TMD or feel it is possible that you have TMD, as a physiological dentist, I should be able to help you. Only 5 % of the dentists in North America have reached the level of physiological training that I have. I use state-of-the-art technology to determine the cause of your malocclusion and take steps to realign your bite and alleviate your TMD symptoms. Determining your optimal jaw position is the key – the movements of your jaw and the function of its muscles are measured to evaluate the treatment needed in order to balance your Temporomandibular Joint.

Physiological Symptoms

Symptoms of physiological problems vary widely from one person to another. Since 2004, I have focused much of my skills and talents on working with people who suffer with this debilitating condition. I sought training in physiological dentistry because I suffered for years with the negative effects of malocclusion. I tried numerous methods to relieve my pain with no real or long-term positive outcomes. That is until I tried physiological dentistry. Being without pain since 2007, it is sometimes hard to remember. My pains were subtle compared to many, but it is still a relief that they are now just a part of my past.

 

Some of the most common symptoms that people with physiological dental problems suffer from may include one, some or all of the following:

 

  • TMD (Temporomandibular Joint Disorder)

  • Migraine and other headaches

  • Facial pain

  • Neck pain

  • Shoulder pain

  • Tinnitus (ringing in the ears) and earaches

  • Congested ears

  • Pain behind the eyes

  • Sensitive teeth

  • Sore teeth

  • Loose teeth with no apparent explanation for them

  • Jaw pain

  • Limited jaw movement and jaw locking

  • Clicking and popping in the jaw joints

  • Difficulty swallowing

  • Depression

  • Numbness in arms and fingers

  • Dizziness

  • Insomnia/difficulty sleeping

 

As you can see, there are so many different symptoms that can be the result of a physiological dental problem that it is easy to understand how the problem can be misdiagnosed. Or you may be treated for one or more of the symptoms, but the root cause common to all of them is never addressed.

Why These Symptoms Occur

When one part of the body is not functioning correctly and is not correctly diagnosed and treated, it creates a sort of domino effect that slowly complicates itself and creates more and more problems in other areas of the body.

 

When there is constant strain on the muscles and joints of the jaw, tension builds in the head and neck. The contraction of muscles reduces blood flow and can pinch nerves that can trigger headaches and numbness in the limbs.

 

When the jaw is misaligned, it can cause unintentional clenching of the jaw and grinding of the teeth due to discomfort. The jaw muscles reach from ear to ear so any time there is discomfort in the jaw, the whole face may be negatively affected and suffer painful side effects, as well.

 

The unfortunate truth is that, more often than not, the common signs of physiological dental problems are misdiagnosed by medical doctors and even dentists who are not familiar with recognizing and treating these issues. It is imperative that, if you or someone you love is suffering from any of these symptoms, you are properly evaluated by a trained professional who is familiar with the symptoms and treatments of physiological dental issues.

 

If you believe you may be suffering from any of these symptoms, please do not hesitate to contact me today.

Sleep Dentistry

Causes of Snoring and Sleep Apnea

Your snoring and sleep apnea problems may stem from the position your jaw rests in when you are asleep. The majority of your throat is soft tissue, which when you are awake, can maintain its position but, during sleep, relaxes and may even collapse. The position your mandible (lower jaw) is in directly affects your airway by either holding it open for air to move freely or allowing it to collapse, leading to snoring and breathing difficulties during your sleeping hours. Snoring is vibration caused by the passage of air through a constricted airway and may be associated with a partial or complete collapse of the airway.

 

Obstructive sleep apnea is when your airway moves beyond being constricted and actually collapses, leading to what are called apneic episodes, or moments of halted breathing. In order to regain breath, the body must come to a state of partial wakefulness. In persons with clinical sleep apnea, this occurs at least five times an hour, leading to a dramatic reduction in sleep. The main effect is not so much the amount of total sleep lost, but the effect of these waking episodes on the amount of time spent in deeper levels of sleep, such as REM sleep.

 

The most common first line treatment for sleep apnea is constant positive airway pressure (CPAP), but more than 60% of the people find that CPAP is not a good fit for them. The noise of the machine, the discomfort of the mask, the maintenance necessary, all lead people to not use their CPAP machines.

 

Fortunately, oral devices have been developed that a sleep apnea sufferers can place in the mouth and wear comfortably throughout the night in order to prevent snoring and sleep apnea from occurring. These devices are said to be effective in approximately 87 out of 100 cases.

 

Those are some great odds when you think about the fact that you are not the only one who loses sleep due to this condition. The development of dental devices that allow you to prevent snoring and sleep apnea from occurring make choosing between allowing your partner to get a decent night’s sleep or being banished to the spare bedroom for the night a much easier and livable decision for all involved.

How to Obtain a Snoring and Sleep Apnea Treatment Appliance

As with all treatments, it starts with a thorough exam. During this exam, I will determine whether or not you are a good candidate for the device. Most situations are completely treatable and should not exclude you from being able to benefit from the snoring and sleep apnea device. Being highly skilled and experienced in treating physiological dental issues like TMD, I can perform the restorative dentistry procedures needed to correct any correctable underlying conditions.

 

If you haven’t done so already, you will undergo a sleep study to determine whether you are a sleep apnea sufferer. The most extensive study is done at a local sleep clinic where you will be monitored with a polysomnogram. The degree of your sleep apnea will be determined, which will influence the type of appliance you receive. For some, sleeping at a strange place can yield some false information. We offer a simple home sleep monitor called the MediByte Jr. While is does not monitor nearly as much as a full polysomnogram, it can certainly give enough information to determine if someone is just a snorer or if they have sleep apnea.

A Medibyte Jr. kit.

For snorers or mild to moderate sleep apneics, you will then be introduced to the bite procedure that is needed to fit the device properly. During the next visit, your device is custom fitted and molded to your mouth. Finally, if necessary, the device may be adjusted to ensure exact fit and comfort. It is designed to last for a few years and you and your loved ones can enjoy an end to your snoring and sleep apnea problems.

To learn more about these devices or any other dental treatments available to you, please contact our office today to schedule an exam.

Tooth Replacements

People need to replace their natural teeth for numerous reasons. The more common ones are that the tooth was too broken and/or decayed to fix, lost due to gum infection, or lost due to an accident. Another scenario is that the adult tooth just never developed – the worst days for me are when I have to tell a parent that one or more of their child’s adult teeth will never grow in.

 

Thankfully, there are options for replacing a missing adult tooth. You may have read about implants and bridges in the Cosmetic Dentistry section. These are wonderful ways to replace teeth and will give you the feeling that you have your own natural teeth again.

 

Some people need a quicker replacement or an alternative that better fits their budget. Dentures might be the answer. Dentures can replace a single tooth, multiple teeth, or all of them. They come in many styles – too many to list and describe here – but I would be happy to help narrow down the many choices based upon your needs when you are in for your next exam.

Root Canals (Endodontics)

The term “root canal” actually refers to the natural cavity in the center of the tooth. Root canals are not as scary or as painful as they used to be. The practice of treating the nerve of a tooth is actually called endodontics, and this practice has advanced technologically along with the other areas of dentistry. Remember, your comfort and care are our prime concerns.

 

An endodontic procedure is performed when a tooth is infected or badly decayed. During the procedure, the nerve inside the tooth is removed and the inner tooth is cleaned and then sealed. This is the only method available to save a tooth that is in this condition. Pulling the tooth is an option, but in most cases, the dentist’s primary goal is to save as many natural teeth as possible. This is the optimal solution when treating infections and tooth decay. Otherwise, the surrounding tissues may become infected, causing abscesses.

Knowing When a Root Canal is Needed

Sometimes it is possible to have no symptoms at all when there is a problem with one of your teeth. Other times there will be definite signs, such as:

 

  • Severe pain in the tooth when pressure is applied or while chewing

  • Sensitivity to hot and cold continuing after the source has been removed

  • Swelling and tenderness of the surrounding gums

  • A pimple on the nearby gums that keeps coming back

  • Discoloration or darkening of the tooth compared to others around it

 

If you or someone you love is suffering from any of the symptoms listed above, please do not hesitate to contact my office to schedule an appointment. There is no need to continue suffering from this or any other dental issue.

Pediatric Dentistry

Pediatric dentistry is the area of dentistry that focuses on the dental needs of infants, children, and adolescents. It includes all preventive, therapeutic, and primary care of the child’s oral health. The American Pediatric Dental Association recommends that parents start bringing their children with them for dental visits at age 1 or sooner if the child gets their first tooth. There are several reasons for this:

 

  • To begin teaching the child that the dentist’s office can be a positive experience

  • To begin tracking the development and growth of the child’s teeth

  • For early detection of developmental problems that may interfere with speech and hearing

  • To identify possible problems leading to issues with posture

  • To identify possible problems that may lead to concerns with the development of the child’s facial structure

Tooth Development

Primary teeth usually begin coming in during the first year of life. The lower central incisors are generally the first to emerge, followed by the upper ones. Usually at one year of age, all of the incisors are present. Keep in mind that this timeline can vary from one child to the next by as much as six month window.

Bacterial Concerns

Once the infant’s teeth have begun to emerge, the risk of bacterial development becomes a factor. If members of the immediate family have bad teeth, chances are it is due to the existence of bacteria in their mouths, which can easily be passed on to the child’s mouth, as well. Good oral hygiene should be practiced in both the parents and the child in order for it to be optimally effective.

The First Pediatric Examination

During your child’s first pediatric dental examination, we will begin recording a thorough medical and dental history. You should be prepared to review all developmental records concerning prenatal and postnatal stages.

 

Your child will be given an oral examination with you present in the office. With children under 2 years old, this will only be a visual exam. The possibility of developing oral and dental disease will be discussed at length so that you are fully aware of how important proper dental hygiene is even at this young age. Tooth decay can advance very rapidly in children.

 

Your child’s oral and dental development will also be evaluated and you will learn about how many teeth are appropriate at what age and have the opportunity to ask any questions and discuss any concerns that you may have. If therapy or fluoride treatments are necessary, they will be discussed, as well. We will also discuss other factors that may affect tooth development such as:

 

  • Sucking on a pacifier

  • Sucking on fingers

  • Oral hygiene

  • Diet

  • Injury prevention

 

To learn more about pediatric dentistry or any other dental questions you may have, please contact us today.

Health Risk Assessment

Even though this is listed last, it is always where my exams begin, and it carries through the exam to the end. It starts with a thorough review of your health history including diagnosed medical ailments, medications, supplements, and operations. It is part of the other assessments, as well – looking for clues of undiagnosed ailments or the risk factors for developing them. Some of the many health ailments that show up in the mouth are:

 

  • Cardiovascular disease

  • Nutritional deficiencies

  • Sleep breathing disorders

  • Diabetes

  • Postural issues

  • Sinus disorders

 

Many medications and herbal supplements can have a negative effect on the saliva content and flow rate. Since saliva is the body’s defense against cavities and gum infections, even small changes can have a profound effect.

 

In my 30+ years of being a dentist, I have helped to save countless lives by learning beyond my dental school education. I have learned what to look for, to take the time to properly assess all aspects of a person, and then to be able to either treat things here at my office or to point the person in the proper direction for further help.

Occlusal Assessment

The occlusal assessment deals with how your teeth function as a unit. Just like a good auto mechanic can tell how your car is working by listening to the engine and looking at the wear on the tires, a good dentist can obtain a wealth of information about the body through the many clues the mouth holds. I look not only at the wear patterns of the teeth, but the motion and function of the jaw joint.

 

It is not hard to imagine that two things hitting or rubbing against each other will wear over time. The enamel on the teeth is the hardest substance in the human body, and it should take a long time to wear away. Years ago, some people were told that they just had “soft teeth” as a reason their teeth showed excessive wear. We now know that is not true. Other than the rare genetic disorder, amelogenesis imperfecta, everyone’s enamel is the same. What differs is our saliva, diet, ability to properly breathe through the nose, trauma, and environmental issues.

 

When the teeth wear, it can lead to sensitivities to temperatures or sweets and can even lead to cavities. It can also result in the destruction of the bone around the tooth, which can lead to tooth pain and, eventually, loss. As the teeth wear down, there is a change in pressures at the jaw joints that can cause a multitude of issues such as headaches and fatigue.

 

As with all wear and tear problems, early detection and intervention can prevent other more serious problems down the road. Like they say, “An ounce of prevention is worth a pound of cure.”

Oral Cancer Assessment

Cancer of the head and neck is number six on the list of the most common cancers in the US. Unfortunately, it has the lowest five-year survival rate of those six. As with all cancers, early detection is the key to better long-term outcomes. The oral cancer assessment only takes a few minutes. To minimize your oral cancer risk, it is best to avoid the behaviors that lead to cancer’s formation in the first place. Tobacco use, especially chewing tobacco, is the number one risk factor for developing oral and other cancers. Chewing tobacco’s long contact time with the tissues of the mouth is what makes it the greatest risk for oral cancer. Excessive alcohol use is another risk factor. If you are routinely consuming more than one serving of alcohol per day, you are increasing your risk.

Periodontal Assessment

Cavities are caused by a particular type of bacteria. But there is another group of bacteria that live your mouth that do not cause cavities – their favorite food is your jaw bone. They will first start to grow in the film of food that collects at the gum line during a meal. If the food is not cleaned away, they will work to get under the gums and separate them from your teeth, eventually working through them to get to your jaw bone. As they work under the gums, they help to promote the formation of tartar. Tartar, technically called “calculus”, is a hard substance that forms first at and then below the gum line. It acts as a seal so the bacteria can work without being disturbed. It takes a couple of months to form and harden, but once it does, a professional is needed to remove it.

 

Infections such as this are totally painless, that is until it is too late. As they eat the bone, the tooth loses its foundation and starts to become loose. It eventually becomes so loose that it hurts to bite on it, and the only thing that can be done at that point is to remove the tooth. Throughout this process, the body has been desperately trying to keep the infection contained to just the area around the tooth. Research has shown that this kind of infection also increases a person’s risk for developing blood clots that can lead to heart attacks and strokes. There are many other health problems that can arise from these infections, too, such as diabetes, intestinal disorders, and low-weight, pre-term births. I am sure this list will grow over time.

 

By the way, the use of tobacco speeds up the process of the bacteria separating the gums from the teeth and the hardening of the tartar. That is why smokers rarely go to the grave with all their teeth, unless they die young.

Prevention

I have always maintained that, when it comes to prevention, the patient has the bigger hand in it than I could ever have. Bacteria multiply quickly. Unlike humans, where it takes years for a new generation to be born, bacteria generations are measured in hours. That means in one day’s time, they can more than double their numbers! The good news is that the bacteria that cause cavities or gum infection are easily killed. The even better news is that there are some things that kill both groups of bacteria – physically removing the bacteria from your teeth on a daily basis.

 

Yes, that means brushing and flossing. Both groups need a warm and moist environment in which to live. Getting them out of your mouth causes them to die. The minimum is brushing twice a day, after eating, for at least 2 minutes, and flossing once a day after your last meal. When brushing, feel the brush touch the gum line so that you know you covered the whole tooth. The same with the floss, it needs to go under the gums. Yes it may be sore and bleed, but that is due to the infection you are trying to clear. It will get better.

 

Some products, like certain mouthwashes, claim that if you use them, they will kill most of the bacteria that live in your mouth. While that claim is true, there are two other groups of bacteria that live in your mouth that you need to know about. The next is a group that causes you no real harm (other than maybe causing some odor), and they actually are helpful – since only so many bacteria can live in a specific area at any given time, by them just being there, they help to keep all the other bacteria’s populations down. The last group of bacteria is even nastier than the ones that cause cavities and gum infections. When you use a product that kills, it kills most of the bacteria, but the ones left behind will repopulate – hopefully it is not the nasty ones that get the upper hand.

 

Thankfully there are some other simple things that can be done. At your appointment, I will assess what is happening in your mouth, review your habits, and then offer suggestions specific to your needs.

Prevention in Children

Good dental hygiene should begin with the arrival of your child’s first tooth. The sooner you start teaching your child good dental hygiene practices and begin helping them adjust to having regular dental cleanings performed, the better you will be able to instill good dental habits in them that will last throughout their life. This will also help to avoid difficult dental problems down the road.

 

Preventive measures begin with wiping your baby’s gums and new teeth gently with a damp soft cloth after every feeding. This prevents the buildup of bacteria and gets your baby used to having the teeth and gums cleaned. Once teeth begin coming in, you should begin using a soft children’s toothbrush twice a day on them.

 

Once your child reaches preschool age, start using a fluoride toothpaste for brushing. Be sure to only use a small smear. Small children tend to swallow the toothpaste when they are first learning to brush and this can cause permanent staining of the teeth and belly aches. As children start to get their adult teeth, they will need a bit more toothpaste – about the size of a pea.

 

It is important to monitor your child’s dental hygiene from baby to teenager. The sooner you instill good oral cleaning habits in them, the more likely those good habits will be to carry over into adulthood. In the short amount of time that it takes to brush and floss twice a day, you can save your child from future dental and other health problems.

Hard Tissue Assessment

Cavities are holes in the teeth caused by a group of bacteria that initially feed on the sugars and starches in the foods that we eat and drink. They convert those foods to acid which eats away at the tooth’s enamel – the hard outer layer of the tooth. Once past the enamel and into the next layer, the dentin, it is a quicker journey to the center of the tooth where the nerve and blood vessels are. From there, they can get anywhere in the body.

 

Pain is a strange thing when it comes to teeth. I have had people who claimed they had pain in the tooth when there was only a small hole that was still just in the enamel. While others have had the nerve sticking out of the tooth and claimed that they never had any pain. For most, pain comes somewhere in between. People who choose to wait until there is pain before calling a dentist usually end up needing to have significantly more work done to fix the problem. It usually ends up costing quite a bit more, too.

 

In recent years, there has been an increase in the number of cavities due to the constant sipping of drinks. Almost every drink is acidic, even bottled water. While the drink is in the mouth, it is maintaining the mouth’s environment in an acidic state. Once it is swallowed, it takes the average person’s mouth 15 minutes to neutralize the acid. It starts all over again if another sip is taken. With some people’s habits, the mouth never gets the chance to recover. If a starchy food is eaten at the same time, it is an even harder battle for the mouth.

Laser Treatments

Perhaps your embarrassment over your smile does not stem from a problem with your teeth. Instead, you dread the need for flashing your pearly whites because you feel like your smile consists of all gums. There is help available for this dental imperfection, as well. We offer laser gum treatments to correct a gummy smile and help you find that beautiful grin underneath.

 

The line of a person’s smile, or the teeth that show when you smile, is formed by different factors. These include:

 

  • Facial muscles

  • Amount of gum tissue

  • Size and shape of your teeth

  • Size and shape of your lips

 

The optimal smile line reveals the least amount of gum tissue. The contours of your gums should balance well and be in harmony with your upper lip.

Bring up the Teeth

For some people, gummy smiles are the result of small or worn-down teeth. For them, the best solution may be to build up the teeth using porcelain veneers. Then laser gum recontouring can give your smile a very attractive balance of tooth and gum tissue.

The Big Gums

Some people just have very full and big gums due to heredity or disruptions in their facial growth. Others who have had periodontal issues with their teeth may suffer from infected and swollen gums. Some signs of gum disease include:

 

  • Bleeding

  • Dark red tissue

  • Swollen mouth

  • Pain

  • Pus

  • Persistent bad breath

  • Change in bite

  • Sore teeth

  • Receding gums

 

It is really very difficult to repair the effects of gum disease on the mouth and gums. But with the use of laser gum treatment, we can provide a way to reduce and reshape your gums and make them more attractive and shapely.

 

Many of the signs listed above can also have other causes. So it is best to let us evaluate your individual case and identify the cause.

Laser Gum Treatments

Laser gum treatments are performed to bring contour and shape to your gum line. They are used to straighten the line of your smile and bring symmetry to your overall facial features and expressions.

Before
After

There was 2 to 3 mm of gums covering her beautiful teeth.

 

In some cases, porcelain veneers may be combined with laser gum treatments in order to restore or repair a person’s smile, making it one that they can be proud of. First, the gums are contoured with the laser to make them more attractive and shapely. Then veneers are placed over the fronts of the teeth to provide you with a straight, well-contoured, bright, and enviable smile.

Cold Sores and Mouth Ulcer Treatments

Another fantastic use of our laser is to heal cold sores (herpes labialis) and mouth ulcers. Using the laser in a non-cutting mode, we can relieve the pain and burning sensation from these lesions, usually in less than one minute. When it comes to cold sores, if we can apply this treatment at the earliest stage when there is only a tingle, we can prevent the sore from breaking out at all. For most people, it will never come back at that spot again!

 

To learn more about fixing a gummy smile or any of our other cosmetic dentistry procedures, please contact us today.

Orthodontics (Braces)

Orthodontics is the treatment of malocclusion (improper bite) in children, teens, and adults. Treatment usually begins when a person is in their preteen or early teen years, as early intervention has been shown to give better results and require less total treatment time. If a problem is discovered before it causes further issues, it can be fixed while the teeth and jaw are growing into their permanent positions. I am able to treat anyone who suffers from malocclusion issues by employing the most efficient orthodontic procedures available to meet each individual’s needs.

Aesthetic and Restorative Orthodontics

Orthodontics, depending upon the specific case, can be considered aesthetic or restorative. Malocclusion can prevent proper development of an aligned smile and facial jaw lines. This makes orthodontics a form of cosmetic dentistry. Malocclusion can also interfere with eating, speech, and hearing, which makes orthodontics restorative dentistry. Because of this, your dental insurance may cover a portion of your orthodontic treatment.

 

No matter how old you are, orthodontic treatments can help to protect your bite, provide maximum effectiveness in the function of your jaws and teeth, and help give you a beautiful smile. It can also help reduce a risk factor for developing sleep breathing disorders, such as obstructive sleep apnea.

 

There are many styles and types of orthodontic therapies available depending on your particular needs. Some are more effective than others, so it is important that we discuss everything first so I can give you the best recommendations to meet your needs.

Physiological Orthodontics

Physiological Orthodontics treats the source of the problem, not just the secondary problems that result. For example, if your bite is off and your teeth are wearing abnormally, it won’t help to just fix the wear and tear on your teeth if you do not repair the bite issue that caused the problem in the first place. The problems with the muscles and joints in your jaw that caused your malocclusion must be repaired, as well.

 

I place emphasis on Physiological Orthodontics when treating everyone – children through adults. Malocclusion and TMD can cause many problems that are often improperly treated. Through physiological orthodontics, the root problem is addressed, and other problems may disappear once the source is alleviated. I understand the pain and discomfort due to physiological issues, for I had suffered with facial strain, neck pain, and bite problems due to malocclusion for years. It was a great day when I heard of and began to study the principles of physiological dentistry. Ultimately, I treated myself so I, too, would be free from pain. I would love the opportunity to discuss your situation with you to see if I can help.

 

Click here to read more about physiological dentistry, or check out some of our cases in our Smile Gallery.

Cosmetic Bonding and Veneers

You see celebrities flash their bright smiles all the time. Do you find yourself wondering how they got them to look that way? You probably suspect they have had some form of cosmetic dental work performed, and they have. What you don’t realize is that many of them have had porcelain veneers placed and that you could do the same. I offer multiple types of veneers that will best suit the needs of each person. Some of the issues that veneers can help with are:

  • Alignment

  • Color

  • Gaps

  • Shape

  • Size

 

Bonding

Dental bonding is the process of using a composite resin to repair, restore, or change the shape of the teeth. Reshaping and filling are done in order to sculpt the tooth so that it matches your surrounding teeth. Bonding can be employed to help change many problems with one or more teeth, but its use and durability is limited. The cost is typically less than other option, which makes its limitations acceptable to some.

Before
After

Ceramic Veneers

Ceramic veneers offer a way for me to help make your smile look fabulous. The newest type of veneers are called E-Max, a Lucite-reinforced, pressed ceramic material that offers greater durability than earlier porcelain veneers. E-Max veneers are also very translucent. This means that they allow the light to pass through them much in the same way our own natural teeth do. In cases where an even higher level of natural beauty is wanted or required, the E-Max veneer can be layered with traditional porcelain to make it virtually indiscernible from the surrounding natural teeth.

Before
After

The Veneers Process

My process for veneers is very different from what is taught in most dental schools. With the advanced cosmetic training that I received at the Las Vegas Institute for Advanced Dental Studies (LVI), I now use a more predictable method to create the smile a person has always wanted. It begins with a discussion of your expectations and how we both expect the final results to look. Unlike most offices whose next step would be to make irreversible changes to your teeth, I take a model of your teeth and have a skilled lab create a mock-up of your new smile in wax on this model. You then can see what the result will look like, and any changes can be made at that step.

 

Once approved, your teeth will be prepared to receive the new veneers. A model of your own teeth will be made and this model will be used to create the precisely-fitted set of dental veneers for your teeth. To protect your teeth while the veneers are being created, a plastic trial smile made from the approved wax model is put on your teeth. This way, you leave with your teeth looking like the model and any necessary subtle changes can still be made before the real ones are completed. Once your veneers are created, their fit and quality will be assessed, and then they will be bonded to the fronts of your teeth.

Instant Orthodontics (Instant Braces)

Because bonding and veneers can correct some gaps and tooth alignment issues, they have been given the nickname of instant orthodontics or instant braces. Traditional braces are still needed in some cases to get the foundations in order. That process can take months or even years. If the foundations are pretty close to where they need to be, the rest can be handled by the veneers and a person can have their completed smile in a few weeks.

Personalized Cosmetic Dentures

Dentures are rarely a person’s first choice when it comes to replacing missing teeth or improving their cosmetics, but for some, it is their only choice or the best choice for their situation. My goal is to make every set of dentures look as natural as possible while considering input from the person who will be receiving them. A typical set of dentures, made the way dentists are taught to make then in dental school, will have the teeth set over the already receded jaw bones, making a person look as old or even older than they really are. This worsens over time as the jaw bones continue to recede. I set the teeth where they would have been if the person never lost their teeth. This can take 10-15 years off their appearance, especially if the person has had dentures before.

Before Dentures
After Dentures

When it comes to the details of how the front teeth are positioned, I will make it whatever way you would like. I have had people, for example, who always had a space between their two from teeth and hated it and want it closed with the denture. While others have stated that the gap has always been there and it is a part of what makes them who they are and want it retained. I am perfectly comfortable with any cosmetic choice a person wants. This is also why I take the time to have teeth set in wax for a trial so a person can see what they will look like before we are finished.

Crowns and Bridges

A dental crown is a type of restoration that is created to cover your whole tooth. It is a tooth cap that is used to cover the tooth and restore strength, shape and size. Older crowns required a large portion of metal in them in order to maintain their strength. Thankfully, this no longer has to be the case. The type of crown that I use depends on the needs of the particular area is it to be used. Sometimes we can even conserve portions of sound healthy tooth structure with ceramic inlays or onlays. That is why I prefer the term custom ceramic restorations when I discuss dental crowns.

 

People choose to have, or need to have, custom ceramic restorations placed for many reasons. Some of these reasons may include:

 

  • Restoration of a broken or worn tooth

  • Protection of a weak, broken or cracked tooth

  • Covering and supporting a tooth that is mostly filling

  • Holding a dental bridge in place

  • Covering a dental implant

  • Covering badly discolored and misshapen teeth

Before
After

E-Max Crowns

E-Max restorations are a Lucite reinforced pressed ceramic material. They eliminate the need for the support of a metal understructure. The metal prevents the light from passing through the porcelain material in the same manner as it does through real tooth enamel. With E-Max restorations, you can have natural looking teeth that are made entirely out of durable porcelain. 

Zirconium Crowns

These are CNC milled from a block of Zirconium. They are very strong and hold up well to biting forces, but they lack the opalescence of a ceramic and are typically used just for back teeth. People mistake Zirconium as being a metal-free option. Zirconium is a metal that when processed one way it can be clear and as used as Cubit Zirconia, or fake diamonds, or processed another way and it becomes tooth colored.

Porcelain-Fused-to-Gold Crowns

Porcelain-fused-to-gold crowns have an almost completely natural appearance other than the gold framework. They are generally used when the crown is being placed on teeth other than the front ones. Ideal for teeth that primarily bite and chew, the strength added from the metal they contain allows them to stand up to much more wear and tear than all-porcelain crowns.

 

Although traditionally described as porcelain-fused-to-metal, the ones that I use only contain high noble metal and no mercury. Essentially a 20-carat gold, the high noble metal crowns contain the highest possible high noble metal content. Crowns cannot be 100% noble metal because, in order for porcelain to fuse properly to metal, oxidation must take place. Since many people can have undiscovered allergies to metals, I try to provide the safest and best treatment in order to avoid an allergic reaction from the patient.

 

With the current historically high price for gold, I now use it sparingly.

Bridges

A dental bridge is used to replace a missing tooth that has fallen out or has been removed due to extensive damage or even a tooth that the body never grew. The gap between the remaining teeth can cause problems for both the surrounding teeth and the gums because each tooth offers stability to the area it occupies.

 

In some cases, the surrounding teeth will begin shifting out of place. In others, the gum line in the area of the missing tooth will begin to fall, changing the shape of your gum line and even the appearance of your facial features in that area. These factors can change your overall bite and possibly begin to cause physiological pain issues.

 

A bridge is basically multiple crowns that are hooked together using the teeth on each side of the space to hold the false ones. They do not come out daily like a denture. In fact, they usually stay in place for many years. Only a dental implant will feel more like your natural teeth when chewing food.

Implants

I work together with your oral surgeon to ensure that you get the best possible results from your dental implant. I let the surgeon perform the surgical phase of the implant process, and then I take over to place the visible portion of the restoration – crowns, bridges, or dentures.

Implant Before
Implant After
Implant After

How do Dental Implants Work?

Dental implants are replacements for lost teeth. They are an alternative to dental bridges and dentures, although they are sometimes used in conjunction with dentures to help hold them in place better. They are titanium fixtures that are implanted directly into the bone of the jaw where they play the same role as roots for natural teeth. In order to be completed, they must be topped with a restoration, but once complete, they function as well as or better than your natural teeth.

Implant Before
Implant After

What Is the Dental Implant Process?

First, remnants of your lost tooth may have to be removed, and the jaw and gum may need time to heal. Then an operation is performed to place the implant into the jaw bone. The method by which this is performed varies from surgeon to surgeon, and it may involve a CAT scan, a computerized surgical die, or a screw-type implant. Depending on the quality of the bone, a restoration will be placed on the implant within a couple of days to a few months.

 

All dental crowns and bridges have their advantages and disadvantages. We will focus on using materials that will best suit the needs of each individual situation and educate you on all the available options so we can choose what is best for you together.

Tooth-colored Fillings

Some of the most basic dental needs that cosmetic dentistry guests often have are the restoration of problem teeth that have been damaged or the replacement of old, silver-mercury metal fillings with new, tooth-colored ones. This is where dental bonding and white fillings combined with the advanced skills of an experienced cosmetic dentist come into play. It is much quicker and easier to slap in a silver-mercury filling than a tooth colored one, especially in the back teeth. I have not placed a silver-mercury filling since 1990 and continue to refine my skills with advanced, hands-on courses to make sure my skills stay on the cutting edge. I am a member of the International Association of Mercury-Safe Dentists, and I am very aware of the possibility of metal allergies among my patients. That is why I use metal only when necessary, and even then I use only high noble metals.

Before
After
Before
After

White or Tooth-Colored Fillings

White fillings (tooth-colored fillings) are used to replace old, mercury fillings. They are also used when a tooth has decayed and needs restoration. A white filling is made of composite resin, which is an acrylic polymer (plastic). All of my materials that I use are certified BPA free.

 

The white filling is designed to be natural looking and can be colored to match the true coloration of the person’s own teeth. The filling is also extremely durable and can be placed anywhere in the mouth that needs dental work. The material is placed in layers and provides support and structure to the remaining parts of the tooth.

Teeth Whitening

There are probably just as many reasons for wanting to undergo some form of teeth whitening as there are ways to accomplish it. The methods available to you change and improve as dental technology continues to advance. We strive to offer treatments that will, above all, provide you with optimal results while protecting your teeth from harm.

 

For teeth whitening, we get the best results using the Kör Whitening System – a strong whitening solution approved only for use under a dentist’s supervision with a unique chemical activator that also contains ingredients that can reduce your sensitivity. There are basically three types of treatments: in-office, where we do the work for you in about an hour; take home kits, where you wear custom-made trays at home and get the same results in about one month; or a combination of the in-office and home treatments, used for cases of severe stains.

Before
After

Kör Whitening Take-Home Kits

There are several advantages to the take-home whitening kits that we can provide. You can enjoy long-term results because it will be convenient for you to give your teeth a periodic touch-up when you feel it is necessary. The cost is lower than our in-office treatments, so your investment is manageable. The product is portable and can be used anywhere you go, if necessary.

Teeth Whitening Risks

Teeth whitening treatments are very safe when they are recommended and monitored by a qualified dentist. There are potentially some minor risks, however, including teeth sensitivity and gum irritation. If you experience either of these problems, be sure to let us know immediately.

 

Another problem with teeth whitening procedures is that they have no effect on dental restorations. If you need dental work done, you may wish to whiten your teeth first. Then have your bonding, crowning, or filling material colored to match the new color of your teeth.

 

Once you have obtained that smile you want to show the world, it is important to continue practicing good oral hygiene which includes brushing after eating, drinking, or using any type of staining agents. To learn more about teeth whitening and which methods are the best and safest for you, please contact us today.