New tooth-colored fillings sensitive? They should not be!

When most people think of “bonding,” they are thinking of tooth-colored dental fillings, or composite fillings.  To be completely technical for a moment (I try to avoid that as much as possible to not bore you 😉 ), “bonding” is actually the series of steps and the products we dentists use to make the tooth-colored fillings actually STICK to the teeth.  OK – technical moment is over.  Whew, aren’t you glad of that?

An issue that many patients have experienced in the past, is that their new tooth-colored fillings seem to be mildly or even extremely sensitive to cold, and sometimes hot, foods and drinks, even just to tapping your teeth together.  Naturally, it’s not a fun experience, and one that all conscientious dentists try to avoid for their patients, but even in 2009, when one would imagine there is a solution, many patients still run into this problem.  Here’s the thing, though……..THERE IS A SOLUTION!

OK, you’re probably asking, if there’s a solution, why is it still a problem?  Well, it’s simply a matter of technique, really, and getting the technique for bonding is actually more difficult than it might seem to be.  In addition, just as in the rest of the world, there are MANY bonding products that dentists can use when doing tooth-colored fillings, but just because the companies that produce them supposedly have research behind these products, they’re not all they’re always promised to be.  Some work better than others in strength, sensitivity, durability…..and it can honestly be rather tough to sort through all the stuff that companies throw at us, just like for physicians with all the stuff pharmaceutical companies throw at them.  So it is CRITICAL that dentists really stay up on the latest research, but here’s the thing…..just because something has the “latest and greatest, newest and most improved,” labels all over it, that doesn’t mean it actually works as well as the old stuff all the time.

There’s one other REALLY CRITICAL FACTOR for long-term success of composite fillings, and that is keeping the teeth DRY while the bonding is placed and activated, then the filling material is layered into the tooth. Saliva contamination is one of the most common reasons for bonded fillings to be sensitive, and it’s also one of the most common reasons bonded composite fillings fail earlier than they should.  There are a couple techniques dentists can and SHOULD use to do this – a Rubber Dam or something like the Isolite2 Dryfield Illuminator system.  Both are pretty inexpensive for the dentist to have (we have both and use them as appropriate), both are pretty easy to use, and to tell the honest truth, they actually make it EASIER for us to complete your dental work faster and with better results.  I really don’t know why not all dentists use 1 or the other; I can’t imagine practicing without them, ’cause it’s a lot harder to get good fillings!

So there you go: 2 of the most common reasons why bonded, tooth-colored, composite fillings are often sensitive to hot and cold foods/liquids or even just tapping your teeth together.

The good news in our office?  I’m fortunate to actually know the man who basically INVENTED bonding, and I not only use the techniques he teaches, but I even use the most current materials that he himself has developed and/or recommends, and I can honestly say that ALMOST NOONE who gets tooth-colored fillings in my office ever has hot/cold sensitivity afterwards.  There are rare exceptions, ’cause I’m not going to claim perfection, but they’re quite rare indeed.

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Not all dental crowns are metal-free, even for cosmetic dentists doing Smile Makeovers

While many cosmetic dentists claim to be “metal-free” dentists, too, I do not make any such claim.  Why not?  For a few simple reasons…..

1. Gold onlays and gold crowns are still the strongest and longest-lasting ways to fix broken teeth or teeth with cavities currently available, and if that’s what you want, then you want gold.
2. Teeth stained by the antibiotic tetracycline can be so dark that is extremely difficult to  bleach (whiten) them, except with Deep Bleaching (TM), and even porcelain veneers may have difficulty covering such dark tooth stains,  so Porcelain-to-Metal (also known as Porcelain-to-Gold) crowns are sometimes the best choice.
3. Bonding (tooth-colored fillings) usually does not hold up very well if you grind or clench your teeth intensely, as they aren’t hard enough to take that much force, so silver (amalgam) fillings are often a better choice.

Here’s a case from a few years ago where the patient was really unhappy with his old, yellowed, kind of ugly old Porcelain-to-Metal crowns, partially because of the dark grey line at the end of the crowns where the black metal underneath the porcelain was showing as his gums receded.  He only had crowns on the top 6 front teeth (a bad idea), and he wanted all of his teeth bright white, and he’d gotten the crowns initially because of severe Tetracycline staining of his teeth.  They were the darkest teeth I’ve EVER had to treat.  I’ll post something soon about how to create a beautiful smile despite tetracycline-stained teeth, but for this I simply want to show that dental crowns that are used to create a Smile Makeover can be just as beautiful and natural-looking as all-porcelain crowns.

Replacing ugly old porcelain-and-metal crowns with a dark grey line at the gums with porcelain-to-gold crowns that look beautiful, natural, and white - to cover tetracycline-stained teeth.

Lead in Crowns from China? Not in our office!

It’s been reported by the media recently that some dental crowns, made in China, have been found to have excessively high lead content.  Generally, these crowns come from very low-priced laboratories, but the full extent of the problem is not yet known.

However, I want ALL of my patients (and potential patients) to know that we do not use any labs in China, and in fact, we rarely use crowns that have metal in them.  That’s not to say that we are a “metal-free” dental office; by no means!  There are a number of very good reasons to use gold, silver, and mixed metals for different situations, but none of those require that we use cheap crowns from cheap labs that might put you at risk.

In fact, my patients can be reassured that they aren’t getting any metal the huge majority of the time because of our CEREC 3D CAD/CAM system that allows us to make incredibly strong, very natural-looking, beautiful crowns in just 1 appointment.  You can literally watch your crown being made!

In those instances that we do have to use a dental laboratory, we can still avoid metal most of the time, but even then……all the labs that we use are proud to say, “Our dental lab work is made in the USA!”

Just so you know it’s perfectly safe to make an appointment for a crown with us, knowing there’s no chance of lead in your crowns or bridges.

Gum (periodontal) disease, gum recession, gingivitis, and all that jazz

Given how important gum health is to overall mouth health, it is kind of bad that I haven’t addressed it yet on my blog, so it’s time to get to this very important subject!  The first thing to note: as much as I love to use photos to illustrate different situations, I’m not going to use any pictures of gum disease, and please trust me on this….you don’t want me to do so!  LOL  Gum disease can look pretty nasty (and it is!), and if you’re reading this around lunch or dinner, I don’t want you to lose your appetite.  🙂

First question then: What is the difference between Gum (Periodontal) Disease and Gingivitis?

In simplest terms: Gingivitis is inflammation of your gums, but Gum Disease is infection of your gums. Both are caused by bacteria, but gum disease is a lot more severe and has worse implications for your overall health, not just your gums and teeth.

If you listen to the TV commercials by certain mouthrinse manufacturers, you’d get the idea that gingivitis is pretty darn bad stuff.  True, you should not ignore it, but no, it does not mean your teeth are on the verge of falling out.

Whether or not gingivitis ever progresses to gum (periodontal) disease is affected by a number of factors, including

1. The kinds and amounts of bacteria that you have in your mouth
2. Your immune system
3. Your oral hygiene habits (brushing, flossing, mouthrinses, etc)

We actually categorize gum disease into 4 stages, called Type I, II, III, and IV  (there are some oddbal scenarios, but as they’re rare I”m not going to bother you with them). Type I is the mildest form and is when gingivitis crosses the line into gum disease, with Types II and III getting progressively worse with the gum separating from the teeth, bone being lost around the teeth, the gums getting redder and bleeding more easily, more and more tartar and plaque building up around the teeth, and EVENTUALLY (if it’s not treated and controlled) it reaches Type IV, and if your gum disease has progressed that far, it is quite possible that you will be losing your teeth pretty darn soon.

Did you know that gum disease is the cause of more extractions that cavities even?

So what can you do about it?  Stay tuned…….more information coming soon!  It’s important, too, BECAUSE GUM DISEASE HAS BEEN LINKED TO A NUMBER OF OTHER VERY SERIOUS MEDICAL CONDITIONS YOU DON’T WANT!

Single-visit, all-ceramic crowns with CEREC CAD/CAM

Another exciting technology that we offer is the CEREC CAD/CAM system.  Very simply put, with CEREC we are able to design, mill, glaze, custom-stain, and bond an all-ceramic crown or onlay IN JUST ONE VISIT.  That’s right – no temporary crown or onlay, no second appointment to get numb, no worries about the temporary falling out.  When you come in, you need the crown done, and when you leave — it’s DONE.  Finito.  Finished.  Complete……….you get the idea.  😉

Sylvia’s case this morning, an old silver filling that had cracks in the tooth around it, new decay forming at the edges, and discomfort when biting, meaning the tooth was truly starting to crack and might have broken apart.