This will be the last cosmetic dentistry/Smile Makeover video that I will post for a little while, as I next want to devote some time to showing how destructive “Grinding” of the teeth can be and why it is NOT something that you should take lightly. Bruxism/Parafunction (the general term for both grinding and clenching, which are 2 separate things) can cause major problems for patients, and often in ways not easily visible because it takes time to develop or they’re under the surface. I believe this is an area of dentistry that is often neglected, and it only makes things worse for patients.
With that said, I do hope you enjoy the way we combined different kinds of treatments to achieve a dramatic Smile Makeover for Daniel, as visible in this video.
Don’t forget – if you want to see all of the videos for our practice, check out our YouTube channel: SmilesbyPayet.
Combination Porcelain Veneers and Short-Term Braces
Smiles by Payet Cosmetic Dentistry: Porcelain Veneers
Here’s another video to enjoy of patients for whom we’ve done Porcelain Veneers to achieve some remarkable smile transformations.
We just finished up this case today — doesn’t need much explanation, just that it took about 6 months and the patient was thrilled. 🙂
As I’ve mentioned, there are 2 basic “philosophies” of dental care, although I didn’t really spell them out. They are (approximately, please understand!):
1) Watch and wait until it it actually hurts or breaks,
2) Diagnose and recommend treatment BEFORE it actually hurts or breaks.
As a general rule, at Smiles by Payet Dentistry, we follow the second philosophy. The key to remember, though, is that it is ALWAYS up to YOU to decide when to actually proceed with treatment. I’ll show you what I see by digital photography and x-rays, give you my recommendations, and then it’s up to you to decide what to do about them. We understand that the treatment has to fit into your life – your budget, your schedule, your priorities. I give you my word — I will NEVER pressure you into doing any treatment. I MAY make some very strong recommendations and urge you to proceed with treatment so that you avoid pain, loss of teeth, or other complication, but it’s still your decision, and we promise to respect that.
One of the tricky parts of dentistry is this: we can’t see through old fillings and crowns and bridges, not even with digital x-rays, digital photography, not even with the Zeiss PICO dental microscope that I use. We can only see things AROUND them. And quite honestly, as much as I believe silver amalgam fillings are a perfectly acceptable treatment, I also believe that they hide a multitude of evils. I already showed you the cracks that are often associated with big, old silver fillings, especially in patients who grind their teeth. What I didn’t show you, though, is how much decay (cavity) can be hidden from us by old silver fillings. They may not hurt, but it is not uncommon for there to be so much decay under them that a root canal becomes necessary when it’s all removed — and often times it can not be seen on x-rays! This makes it frustrating for patients, can’t understand why we recommend replacing a filling with a new filling or a crown.
So along with examples of the beautiful dentistry that we provide, I’ll also regularly show you the problems we often encounter when treating teeth, which should help you, the patient, better understand the WHYs of our recommendations.
A perfect example: This lady had these fillings for many years, probably over 20. The molar had just recently started bothering her a little with sensitivity to cold and sweets, but nothing serious. The main reason she wanted them replaced was for appearance, though — the greyish color really showed through on the front of the teeth. You’ll see that they don’t actually look all that bad to an untrained eye. After seeing thousands and thousands of them, though, I had some idea of what to expect……..but even I didn’t expect the problem to be so extensive.
Oh YUCK! See all that black crud? That’s decay — mushy, soft, and definitely NOT healthy. And this is fairly normal to find under 20+ year old fillings, to tell the truth.
Just some food for thought: maybe your dentist has recommended some treatment, perhaps to replace those silver fillings that have been there for 20-30 years, and maybe they’re not even bothering you, so you think, “Nah, I’ll just wait, doc. Thanks but no thanks right now.” Consider this: another 6 months, and this lady probably would have needed at least 1 root canal, maybe even 2. Not only would that have required more time, possible a lot of discomfort, but probably would have added another $1500-2000 in treatment costs.
Do you really want to wait?
Porcelain veneers are one of the most requested cosmetic dental procedures in dentistry, and they can make a dramatic difference. Here’s another case that we did a number of years ago. Craig wasn’t happy with either the color or the shape of his teeth, he’d tried whitening before with little success (this was back before we offered Deep Bleaching), and he also just didn’t have the patience to do touch-up whitening on any kind of regular basis. So veneers became the logical choice. In 1 fell swoop we gave him a dazzling white smile and changed the shape of his teeth to a less angled, less square, more flowing line of a smile from the sharply angled, very square with fang-like eye-teeth smile that he never liked.
For more examples of what cosmetic dentistry can do, don’t forget to visit our website: Smiles by Payet Dentistry
In today’s world, when dental patients are increasingly savvy about dental care, but also increasingly worried that they’re being taken advantage of, developing the critical trust between a patient and our team is occasionally difficult. This is where the power of digital photography is so evident, and why I recently wrote about it on my photography blog (http://cdpayetphotography.wordpress.com), because communication is so much easier, and trust is so much easier to establish when you – the patient – see everything that we see. That’s one of the reasons that we document our work so extensively with Canon Digital Rebel XTi’s. Of course, the other reason we do is because we are proud of our work and love to show off what we can do to serve you and help you keep your teeth for your life. 🙂
Yesterday was a perfect example (although this patient has been with us for some time and we’ve already established that trust, plus she was having some pain). This old silver filling had provided many years of use for Mrs. X, but she was having off-and-on soreness and throbbing and wanted it looked at. When we took the picture and showed her the tooth, it was easy for her to understand why it was bothering her, as well as why we recommended a crown to save it; a root canal may well be needed, too, but we’re keeping our fingers crossed for her that she won’t.
Remember my last post about cracked teeth? Take a look at this tooth — SEVEN CRACKS! No wonder it was hurting. It’s almost a miracle that the tooth had not split in 1/2, to be honest.
And this is how the tooth looked after we’d shaped it for a crown (which we’ll make with our CEREC CAD/CAM system); the crack extends well below the gum line and very deep into the tooth from both sides.
If you ever have questions about the treatment that’s being recommended — ask to see pictures. X-rays are often very inadequate in diagnosing these problems. The cracks that are so evident here do NOT show up on x-rays; they’re too small.
Digital dental photography — the PATIENT’S friend.
One of the most common reasons that patients come to us for dental emergencies is cracked and broken teeth. For some reason, this always seems to happen on weekends, when you’re out at dinner, or right after we’ve closed for a long weekend – go figure. This is avoidable, though, if you act preventively. Here’s the key, though, and this is one of the reasons we use digital photography so extensively to communicate with our patients — very often these teeth won’t hurt at all until they break. Don’t ask me why – noone really knows. But so often, what we’ll here is, “Doctor Payet, it never bothered me at all, and then last night I was chewing on a banana and a big chunk of the tooth just broke off!”
Many doctors still go by the philosophy of, “If it ain’t broke and it don’t hurt, leave it alone.” The problem with that philosophy (in my humble opinion) is that when it finally does break, it will take more time, cost more money, and until it’s fixed is often pretty painful than if it had been treated before it broke. If it’s a small crack, treat it with a nightguard and a filling. If it’s a big crack, treat it with a nightguard and a crown. But if it breaks, you might well need a nightguard, root canal, build-up filling, and a crown. And all because the small crack wasn’t treated with a filling.
Research tells us that teeth with tooth-colored (composite resin) fillings crack just as often as those with silver fillings. My experience over 10 years, however, tells me that teeth with LARGE silver fillings crack much more frequently than with composite fillings. But even the bonding process can’t stop a crack from forming if the stress isn’t relieved. I’d like to show you some examples of what we often see:
It does seem that these cracks form around old fillings most of the time……..but they can even happen in teeth that have never had any work done. All it takes is a lot of force (usually grinding and/or clenching your teeth) and enough time. Here’s an example from a young man in his late 30’s who clenches his teeth so hard that he split this back molar completely in 1/2. It had NEVER had any dental work, and in fact, it didn’t even have a cavity. But he split it so far that it had to be extracted. Obviously I recommended a nightguard to help him not do this to any other teeth!
So what’s my point? Simply this: if you have been told that your tooth is cracked, at the VERY least, please make sure that you have a nightguard, because clenching and grinding of your teeth is the most common cause. But also — get it treated BEFORE it breaks. It’s less expensive and a lot less uncomfortable that way. And you won’t have to worry about it breaking over that long weekend or holiday when we’re out of the office.