Monday, February 22, 2010

Why can't you just place a filling doc?

I get this question all the time. Why can't I place a filling and recommend a crown or onlay? Great question. Fillings are great. That is whenever appropriate. In fact recent studies show that composite (tooth colored fillings) actually can strengthen integrity of your crown if you have decay, broken silver filling, etc. I am not saying however, if you have fine intact tooth structure, that removal of that sound tooth structure and placing a filling would strengthen your tooth. That is false' your healthy intact tooth structure is the strongest thing.

In any case, the reason for progression of a filling to a crown or onlay involves typically the size of the cavity (or need for replacement of a filling) and extension of the issue requiring work. Your teeth have points called cusps and deeper parts called grooves. Think of a mountain: the peak is the cusp and the valley is the groove. If whatever work you require involves extension into the cusps, the typically a crown or onlay is recommended. This is the most typical reason for recommendation of a crown/onlay vs filling. Why can't I just place a filling to replace these cusps? Because placement of those is very unpredictable and likely lead to premature failure and cracking of your tooth (which may possibly involve the nerve and require additional procedures like a root canal). Those cusps are what your teeth uses to chew and break apart food. They receive a lot of pressure and force. A filling material has insufficient strength to act as a cusp, hence the need for something stronger and more durable like a crown or onlay.

Tuesday, February 16, 2010

Straight teeth + Adult Braces!

So everyone wants straight teeth. Who doesn't?? But most people - and I don't blame them - don't want to spend 2-3 years in full metal braces as an adult! So what options are there to straighten your teeth? Let's go over them:

1. Veneers. If you absolutely want the fastest way to straight teeth, then veneers are your answer. Major downsides include 1. you are shaving down possibly perfectly healthy teeth which can increase risk of root canals and also nothing is stronger than perfectly healthy teeth and 2. any dental work doesn't last forever so your veneers will need to be replaced down the line.

2. Comprehensive Orthodontics. You would typically visit an orthodontist where you spend 2-3 years in metal braces to move your teeth as close to the ideal position. In orthodontics, there is a position of how teeth fit together that is considered "ideal." If you are considering braces for your kids, this is the way to go. In adults, this is also a great option if your goal is to get your teeth straight and as "perfect" as possible. Obvious negative is length of treatment.

3. 6 Month Smiles Braces. With adults, often times they want straight teeth and see value in braces versus veneers, but don't want to spend 2-3 years as metal-mouth. Here steps in limited orthodontics. My philosophy with adults is to treat adults realistically and kids idealistically. Kids that want braces, go to the orthodontist to have comprehensive braces done. Adults, we can straighten your teeth in typically 6 months! How is that possible? In comprehensive orthodontics, teeth are moved into "ideal" positions; this means moving large multi-rooted molars through the jaw. With 6 Month Smiles braces, if your bite is alright, you don't have jaw pain, problems chewing etc, we do not focus on movement of your back teeth. All we focus on are the movement of your front teeth into a straighter position. It gives you the look you want in a MUCH shorter time!

For more information on it, check out our special website:

Thursday, February 4, 2010

How can I get a crown the same day? What is CEREC?

Traditionally the method for getting a crown -- now another question I get often is why don't you just place a filling doc? I'll answer that another day -- involves a messy impression (mold of your mouth). Then you have to wear a temporary for about 3-4 weeks while you wait for your permanent crown to be made by a lab. Doesn't sound fun does it? Well it isn't because during the 3 weeks, you run the risk of it falling off, breaking off, it being sensitive, etc. It's called a temporary for a reason!

The latest technology is getting a crown the same visit. How is that possible? Using a computer, I can now take a picture of your tooth before and during working on it. The brand name of the machine is typically called CEREC. So if you hear that someone got a CEREC crown, they got a crown on the same visit without a temporary!

CEREC technology is very sweet. It is all digital. An image of your tooth is captured and the computer creates your tooth digitally on the screen. From there I can edit and manipulate the tooth as I like. Think of it as 3D photoshop. Then a machine (CAD-CAM technology) will mill your tooth out of a solid piece of porcelain in about 15 minutes. When it is done, the new crown is polished, verified to fit and bonded into your mouth! Major advantages to CEREC technology include obviously no waiting, more conservative crown (b/c it is beautiful porcelain so more tooth structure can be saved to make it pretty), decreased sensitivity (because your tooth is sealed immediately with a crown) and no metal in your mouth (if you have the rare chance of allergy to metals).

So next time you need a crown, ask for CEREC crowns!

Wednesday, February 3, 2010

What about my Wisdom Teeth?

I always get the question why wisdom teeth should be removed. Let's talk about why. Wisdom teeth if they are visible (erupted in your mouth) are the most difficult teeth to clean. As such, they hold the most bacteria that contribute to gum disease and cavities. Sometimes they are not fully visible and covered by a flap of gum tissue; in this situation, the risk for infection is high and can lead to a very painful condition called pericoronitis which is inflamation and infection of the gum tissue around it. Typically for an adult, the most likely recommendation for removal of wisdom teeth would be due to active cavities on them, pericoronitis or contribution of bacteria to progressive and irreversible bone loss called periodontitis.

Now what about wisdom teeth that you can't see and are hidden below the gumline? Well for those teeth, they maybe hidden now, but may erupt down the line. They also often times will lean against your last visible molar in the mouth -- in those situations, there is risk of eventual root decay on that molar one day and risk of loosing it also. Also hidden wisdom teeth do run a slight risk of cyst formation and of those cysts, there is a small chance of malignant transformation (cancer).

When should I remove my wisdom teeth? Ideally, a good time to remove wisdom teeth would be somewhere in late high school years or college simply b/c you are younger, recover and heal faster, have less dense bone and have plenty of time off and don't have to worry about missing out on work!

Remember we have sedation from nitrous (gas) to pills to IV sedation for your comfort!

Any questions, please visit our website at