People ask me all the time whether they should have laser bleaching to whiten their smile. “It all depends on whether you are in a hurry to get your teeth whitened, and whether or not you are a candidate for tooth whitening in the first place” – my typical response! The benefits of laser bleaching over an over-the-counter home solution include instant results, a painless experience and a completely guided procedure. If your teeth can benefit from teeth whitening, at-home tray bleaching techniques will work for most people unless their teeth are sensitive, eroding, severely worn or if they have gum recession. If you do have severely discolored teeth, a combination of laser bleaching and home bleaching and whitening toothpaste would be the best approach to obtaining and maintaining a bright and dazzling smile.
Laser bleaching utilizes laser light energy to accelerate the chemical reaction of a bleaching agent, typically a hydrogen peroxide base product. Hydrogen peroxide is very unstable in response to light and heat (which is why over-the-counter 3% hydrogen peroxide solution is stored in opaque dark brown bottles). Because of this, light energy can excite peroxide molecules, breaking the covalent bonds of the bleaching agent. The agent then reacts to and breaks the long, discolored molecule chains into shorter-chained molecules, lightening the tooth color. The bleaching agent used with laser bleaching is a high-strength solution when compared to home bleaching agents or over-the-counter kits. Your mouth will be protected with an isolator to protect the oral tissues , and placement of the bleaching agent is done in a very controlled manner by a highly trained dental professional. Once a 10-to-15 minute bleaching cycle is complete, the teeth will be cleaned and evaluated to discern whether additional applications of bleaching agent will follow. Normal bleaching procedures involve three applications of the bleaching gel, with an “instant average” of six shades of whiteness typically resulting. Laser bleaching is instantly gratifying. In my office, you can watch a movie through virtual i-glasses while the procedure takes place, and before your movie is finished your teeth will have been transformed into a younger, prettier and whiter smile!
Many different types of lasers (or light) are used for eliciting fast chemical reactions in teeth whitening. Some people will experience more sensitivity when infrared energy (heat) is utilized, which appears in most dental offices, but a few alternatives like Argon or KTP lasers (which emit blue and green light) exist. These lasers have the correct level of energy required to excite the bleaching gel, but they leave the teeth cool and comfortable. Most sensitivity is transient, and should subside within a day (Ibuprofen will be helpful if there is any available). After a smile has been bleached with a laser, one must be very careful to maintain his or her newly brightened smile lest the brilliant white color fade and dull over time. Alcohol, soft drinks and smoking are all bad habits which can stain teeth and regress any laser bleaching process. A healthy diet will also be beneficial for your physical and oral health. If you take care of your mouth, your reward will be apparent with a happy and healthy smile.
Antibiotics help us fight infections, however certain antibiotic medication could dim your smile! When taking antibiotic medications, it is important to realize that these types of medications not only eliminate harmful bacteria, but also affect the body by disturbing the balance of our gastrointestinal system. Sometimes the chemical components of antibiotic meds can leave deposits in the hard tissues of the oral cavity, like in the tooth and bone, affecting the color of the teeth.
Tetracycline staining: notice the yellow and brown bands.
It has been well established that commonly prescribed antibiotics like tetracyline, if taken during the second half of the pregnancy can affect the future teeth of the fetus. Children younger than eight years old with prescription tetracycline (for treating ear infections) can have seriously discolored teeth as well from chemical deposits on the inner layer of the tooth structure (dentin), causing grayish brown bands that are not so easy to correct. Discoloration is usually a consequence of the chemicals affecting the developing stage of the teeth. If any discoloration is noticed in a child with primary teeth, promptly speak with your doctor or dental professional! Review the child’s history to determine whether the discoloration could possibly be associated with any medications, diet or even drinking water. Discoloration of erupted permanent teeth has also been proven to result from antibiotic use, as discussed in an earlier edition of the Journal of the American Dental Association. Although this is fairly rare, discoloration can happen to nearly anyone taking tetracycline, erythromycin, minocycline, or rinses containing chlorhexidineantiseptic solution. Keep your dental professional informed as to your antibiotic regiment.
In Kentucky, a 25-year-old woman whose teeth were gray-streaked from use of antibiotics was highlighted in a study completed by Frederick M. Parkins, D.D.S., of the University of Louisville School of Dentistry. The patient took two years of tetracycline therapy for teenage acne. She had been taking minocycline (brand name Minocin), a synthetic form of tetracycline and now has very discolored teeth (see above picture). Thankfully, only about 3-6% of adult antibiotic users will experience tooth-staining. Discoloration can develop as early as one month after the antibiotic regiment begins, but the staining could take years to appear!
Prevention is always the best solution – avoid teeth staining medications. If staining does occur, speak with your dental professional about options to whiten affected teeth. Procedures such as in-office or take-home whitening and bleaching will be the first conservative treatment option available to you before porcelain veneers or bonding procedures, which work well at masking over discolored areas of teeth.
It is wonderful to have a dazzling white smile, and there are dozens of DIY or OTC teeth whitening products available – the demand is high! They promise to whiten your teeth in as little as 4-6 weeks, at a fraction of the cost of professional whitening done by your dental professional. Sounds like a great idea, but beaware, these fly-by-night whitening systems can potentially damage your teeth by wearing away at the enamel of your smile, weakening the teeth and leaving your oral health to suffer.
A study recently completed by the Ohio State University College of Dentistry evaluated the hardness of human enamel with the use of five name-brand tooth whiteners, comparing their values to non-treated enamel. Decreased hardness and elastic modulus of enamel were found in the study, and the conclusion read: “Nanohardness of human enamel was significantly decreased after usage of home-bleaching systems. The elastic modulus of enamel was also affecte by some bleaching systems”
Once tooth enamel hardness and elastic modulus has been reduced, a number of problems can start occurring. Teeth with weakened enamel are primarily more brittle and porous than healthy teeth, and are more likely to chip and break with little pressure. The savings in purchasing an OTC whitening kit over visiting your dentist could be reversed, many times over, if you were to chip or otherwise damage your teeth!
Before starting the teeth whitening process, it is best have your teeth evaluated by a dental professional – there may be a hidden cavity or weakened enamel already existing. Existing restorations, gum recession, tooth erosion and root exposure might be affected by the bleaching process. If you do decide to go through the bleaching process, keep your mouth clean, brush right after meals and beverages and brush after usage of any whitening products. This will help to maintain the health of your tooth structure. Stay away from foods or beverages that are acidic, or have a staining effect. Lastly, check into whether an added fluoride treatment could be beneficial in strengthening and/or remineralizing your enamel. It feels great to have a set of healthy whites – just be wise about your whitening decision! Speak with your dental professional for more information and go for that smile you’ve always wanted.
When you smile, the corners of the mouth upturn, eyes begin twinkling and positive emotion radiates. A person’s smile is a pleasant, agreeable part of their appearance and facial characteristics; a person’s smile is the window to their heart!
Dental components like teeth and gum do play an important role in a smile. In today’s society, if a person’s dental components are not healthy or if they do not look right, most will feel far less confident to smile. As cosmetic dentistry has come into a heavier demand in recent years, smile design has become a term used for various clinical treatment plans and for aesthetic improvement. This means smile design: projecting an enhanced smile through alteration of dental components as a practice of cosmetic dentistry. This is a type of comprehensive oral care that combines art and science to greatly improve the aesthetic appearance of the smile, as well as its health and function.
Proper smile design starts with a facial analysis, when the line between the pupils and the horizontal line from the connecting edges of your upper teeth (smile line) are [hopefully] in parallel harmony; the smile line should also harmonize with the upper curvature of the lower lip. Then we evaluate the color, size and alignment of the dental compound, whether it is somewhat in the right places and proportional in relation with the face.
Some of the most common cosmetic procedures include tooth bleaching (or whitening) which enhances the color appearance of your teeth, bonding and veneers or porcelain crowns(which can enhance the outward appearance of a tooth’s color or shape), and gum work (like a gingival plasty, gum contouring or crown lengthening) to harmonize with teeth. Straightening of teeth through adult orthodontics are also a part of cosmetic smile design – not only for improvement of the smile, but to set up a healthier foundation for other cosmetic procedures (or simply to make the mouth easier to clean and maintain).
Laser dentistry is very complimentary to cosmetic dentistry. Laser smile design not only makes common procedures like teeth whitening and gum contouring quick and painless, but because of the laser’s highly focused energy path, very little tissue around the site is disturbed. Procedures are very non-invasive.
Ultimately, cosmetic dentistry and laser smile design could be a great investment if you are not comfortable with your smile or the condition of your teeth (especially if they are worn or broken down, requiring rehablitation or reconstruction). Once you present a confident and happy smile, people will smile back at you and many windows and opportunity will open! Give thought to whether it’s time to have a smile analysis and smile design performed by your dental professional. If you need to find out more about cosmetic dentistry, www.aacd.com can be a referral source.
“Does it hurt? How long will it last? How long will it take? How much does it cost?”
These are common questions from patients looking for cosmetic dentistry.
If you’re interested in cosmetic dentistry to get yourself a winning smile, whether the problem is mis-alignment, cracked or chipping teeth, unsightly spacing, uneven or dark colored dentition, uneven or too much (or not enough) smile showing, or even gum erosion, the eternal question always arises: What would be the best solution?
In the past, crowns were the primary choice for masking tooth problems, but since the late 1980s, cosmetic dentistry has offered both bonding and veneers to improve your smile. This leads to the eternal question: “Bonding or veneers?”
Dental bonding involves the application of a durable composite material directly to the surface of the tooth, by your dentist, which is then sculpted and artistically shaped to the exact look the patient desires, to blend naturally and seamlessly with the patient’s existing teeth. A laser (or high intensity light) is then used to cure the composite material, hardening and reinforcing it to the surface of the tooth. This bonding technique has many applications, not only for aesthetic uses but also for prosthodontics and pediatric dentistry. The advantages to dental bonding are a quick treatment time (can be completed in one office visit after a consultation), and a relatively low cost per tooth when compared with porcelain veneers. Durability of bonding will be affected by the oral environment. Since composite bonding is a mixture of quartz particle (70% – 80% filled) and resin, discoloration and breakage is inevitable if your mouth has a high acidic pH value (if you are a soda drinker, lemon lover or candy sucker), if the bonding was not supported by a solid tooth structure, or if you are a night grinder.
Porcelain veneers are fabricated in the laboratory. They are 100% filled with hard mineral particles, and are fired at a high temperature with a vacuum (to procure the best physical properties to sustain the veneer’s strength in the harsh oral environment). Compared to bonding, there is more procedural work involved with porcelain veneers. There are different techniques to fabricate the veneer pieces (which call for different methods of preparation for the tooth); the pressing technique produces a stronger veneer, but requires 0.8mm thickness of the veneer. The porcelain powder build-up technique can produce super thin veneers (0.3mm), which produces a very conservative look on your tooth structure, while at the same time keeping a natural silhouette. The veneer piece lays on top of the tooth structure and is similar to a press-on nail. They chemically adhere to the tooth with bonding composite cement; since porcelain is acid resistant and stronger in physical properties than composite material, this restoration provides long-term service. When getting the veneers, the first visit consists of preparation and imprints f the teeth (which might involve anesthetic). After this, you will leave the office with temporary veneers which look like natural teeth. A wafer-thin veneer is then crafted out of porcelain which is seamlessly cemented to the front side of the tooth on the second visit. In addition to straightening teeth, porcelain veneers can close gaps between teeth, whiten teeth that do not respond well to bleaching, and can also be used to protect damaged tooth surfaces. The advantages to porcelain veneers over bonding is that veneers are much longer lasting (and stronger) than composite bonding material.
Whether you decide to invest in dental bonding or porcelain veneers, make sure you have all work done at a reputable dentist, preferably at a practice which has its own in-house ceramic lab. When ceramic work is done by an in-house lab with an in-house ceramist, any changes that need to be made to the length or color of the veneers can be done without requiring an additional office visit. Remember, the result of the cosmetic procedures are truly varied depending on the ability of the dentist, ceramist, your clinical situation and the communication between all parties involved. Do your research!
Both bonding and veneers are additive procedures, depending on the position, alignment and shape of your teeth, which is the foundation for any new restorations. This foundation will need to be in the right fundamental situation to receive restorations to result in a fabulous smile. In other words, sometimes, you do not need to do much to your own teeth before applying cosmetic restorations. It might be necessary to reduce or modify the tooth structure before anything can be added onto it to make it look perfect.
There is some risk involved with cosmetic bonding or veneers, so be cautious with any cosmetic procedure. A comprehensive evaluation of your present dental condition is absolutely necessary as a first step; blue prints of your teeth and of your prospective dental project are needed to establish clear verbal communication between all parties involved (including you), including possible mock-up or wax-up models to preview possible changes, which could avoid costly mistakes.
Do your homework: finding the right dental professional, discussing every aspect of your dental needs, understanding the pros and cons of each procedure, and making an educated decision will ensure you get the smile you’ve always wanted.
If your eyes are the gateway to your soul, your smile is the gateway to your heart. There are many factors that contribute to a beautiful smile in my line of work, but teeth whitening is one of the simplest ways to give your smile a brighter, whiter lease on life.
When we are children, our deciduous teeth (baby teeth) are bright, white and full of life – that is, until they fall out and are replaced by permanent teeth. From this point onward, our teeth are exposed to a multitude of conditions which endanger the white enamel surface of the tooth. Foods, dark liquids such as tea, coffee, red wine and caffeinated beverages, smoke and even some prescribed medication can all cause your teeth to loose their whiteness. A history of dental trauma can also cause tooth discoloration, which would require a different approach to reach the desired whiteness. Generally speaking, the teeth bleaching only applies to oxidizing normal tooth enamel. Whitening will not change the color of any dental restorations, and should not be used on darker root structures of the tooth or with tetracycline staining. Sometimes, cosmetic procedures such as porcelain veneers or bonding would be a better solution, in which case a consultation with your dentist would be necessary.
There are two ways to whiten your teeth: with whitening kits, and laser whitening (power bleaching). Over-the-counter kits to whiten teeth are sold both at your local pharmacy and from your dentist’s office. Custom fitted kits sold from your dentist’s office include retainer-like trays which are made from custom impressions of your teeth, whereas over-the-counter varieties are not as effective. The active ingredient breaks down into hydrogen peroxide, which oxidizes the stain deposits in the enamel of your teeth. Application is done for a few hours per day, for one to two weeks. The advantage to whitening kits is that you can keep your impression trays for future use, and only have to buy the whitening gel again. Regular dental check ups are necessary to make sure your teeth are healthily receiving the bleaching process.
Laser whitening is the method to whiten teeth I use in my office. Employing the use of an argon laser enables fast, painless and safe whitening of the teeth without potentially harmful UV damage, or heat which can irritate the pulpal tissues of the teeth. Arc lamps, a more common light-based whitening treatment, use energy that comes in a wide range of electro-magnetic waves, which could cover from the UV range into the infrared (heat) range, which could pose a health risk. Also, arc lamps can cause pulpal inflammation, leading to heightened gum sensitivity. The laser whitening process takes about 1 hour, providing instant gratification of the whitening results and the convenience of minimum work at home.
For the best teeth whitening results, I usually recommend my patients use a combination of in-office laser whitening, and usage of our take home kit, allowing for touch-up treatment by the patient at the convenience of one’s own time and own place. Once the desired bleaching result is reached, with proper care, it can last up to 3 years. If touch-up bleaching is needed, the time investment is extremely low (almost instant).
Remember, your smile is the gateway to your heart! Let it shine!
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to whiten their smile. “It all depends on whether you are in a hurry to get your teeth whitened, and whether or not you are a candidate for tooth whitening in the first place” – my typical response! The benefits of laser bleaching over an over-the-counter home solution include instant results, a painless experience and a completely guided procedure. If your teeth can benefit from teeth whitening, at-home tray bleaching techniques will work for most people unless their teeth are sensitive, eroding, severely worn or if they have gum recession 
