If you have discolored teeth, the cause is often staining on the enamel surfaces from foods, beverages, or smoking. But tooth discoloration may also originate deep within the root of a tooth. Sometimes this happens to a tooth that had to have earlier root canal treatment because of injury or decay.

In such cases the living pulp tissue and its blood vessels and nerves had to be removed from the root canals, resulting in the death of the dentin layer, which makes up most of the tooth's body. Over time this caused the dentin to darken. The color may come from remains of blood that was left in the tissue, or from filling materials left in the root canal that are showing through.

Since these stains are caused internally (intrinsic) and not on the outside of the tooth (extrinsic) they must be whitened from the inside. This is usually done by putting a bleaching agent into the empty chamber from which the pulp was removed. Usually the bleaching agent is a substance called sodium perborate.

When it is mixed with a solution of hydrogen peroxide, sodium perborate slowly bleaches the color from the tooth's internal material. It is considered to be safe and reliable for this use.

The work begins by taking x-ray images to make sure that the root canal is correctly sealed and the bone is healthy. After this, we will make a small hole in the back of the tooth through which the root canal space will be cleaned. The root canal space will be sealed and the bleach will be applied in a putty-like form and sealed off from the rest of your mouth. Every few days this procedure will be repeated until the bleaching reaches the desired level.

At this point a tooth-colored composite resin will be used to seal the small hole that was made in the dentin to insert the bleach. After the tooth has reached the level of whiteness that matches it to your other teeth, veneers or crowns must sometimes be used to repair the surface if it is chipped or misshapen, for example.

Contact us today to schedule an appointment to discuss your questions about whitening internally discolored teeth. You can also learn more by reading the Dear Doctor magazine article “Whitening Traumatized Teeth.”

Humans naturally react with pleasure to a beautiful smile. Starting with our mother's joy at seeing our first smile, we have learned throughout our lives that a smile is an invitation to a positive interaction. But are some smiles more beautiful than others? What is it that makes a smile beautiful?

As with art and music, people's perceptions of beauty differ with their backgrounds and culture. Most people respond well to an appearance of healthy teeth and gums. Some feel that teeth must be very white and bright, while others look for even alignment and proportionally sized teeth. With today's dentistry, all of these factors can be changed and enhanced.

Let's look at the components of a smile, starting with the teeth. Evenly sized, white teeth are generally considered to be the basis of an attractive smile. Chipped or discolored front teeth can be repaired by bonding tooth-colored composite resin restorations. Thin porcelain veneers can be applied to teeth that are too small, misshapen or discolored. Tooth colored fillings can be used to repair damaged or decayed back teeth, or porcelain crowns may be used to replace the top part of a tooth that has been seriously damaged. If teeth are missing because of trauma or loss due to decay, today they can be replaced by dental implants, topped with crowns that are colored and shaped exactly like the natural teeth.

Of course, if your teeth emerge from inflamed, infected gums, your smile needs improvement. Healthy teeth and gums result from good dental hygiene habits and regular professional dental cleanings and checkups. Teeth can be whitened and brightened both through home methods and in the dental office. Ask us about the options available for tooth whitening.

Another factor that goes into a smile is the relation of the upper to the lower jaw, or the bite. A poor bite is called a malocclusion. Orthodontic treatment, with the use of traditional braces or clear aligners, can move the teeth into a better bite position so that they look and function better.

Repairing parts of your smile that make you feel self conscious will help your smile in more ways than one. If you feel good about yourself, you look better. We get the process started, and you do the rest.

Contact us today to schedule an appointment to discuss your questions about cosmetic dentistry. You can also learn more by reading the Dear Doctor magazine article “Cosmetic Dentistry: A time for change.”

For a bride, there is so much to remember when planning the wedding — invitations, a dress, flowers, the site, the caterers, the cake, the photographer — the list goes on and on. In the midst of all these things, don't let a very important piece of the plan be forgotten — your smile!

Your wedding will be celebrated every year on your anniversary and commemorated in beautiful photos at any time. It is a special occasion you, your family, and your friends will always remember. But how will you and your family look in those photos? You have an opportunity to get makeovers that will make your smiles shine radiantly, and not only in your album. Your makeover will improve your appearance, your self-confidence, and your oral health far into the future.

Start with a visit to your dentist to assess your current situation and discuss your goals and dreams. Each person's situation will be different. At a minimum you may need a professional cleaning to make sure that your teeth and gums are healthy. Get started on treating any cavities or gingivitis (gum inflammation). If you haven't already, now is a great time to establish healthy dental hygiene habits including proper daily brushing and flossing.

You may feel that your teeth are discolored and need to be whiter and brighter. Your upper and lower jaws may not meet properly for the most effective biting and chewing. Your teeth may be crowded or misshapen. All these things and more can be modified and repaired with today's dentistry.

Teeth can be whitened by bleaching in the dentist's office or with products that can be used at home under a dentist's supervision.

Orthodontia may be needed to repair your bite. Today orthodontia may be done either with traditional braces, or with clear aligners. Remember that this process works slowly, so start well in advance of your wedding day.

After your teeth are properly aligned, your dental team can work on subtle contouring, overall shape and color changes for individual teeth, using techniques such as porcelain laminate veneers. Temporary veneers can be made so that you can try out your new look before the final installation.

Wedding planning works best when started early. To make sure you, your new spouse, and your family look and feel their best, remember to include smile makeovers in your plan.

Contact us today to schedule an appointment to discuss your questions about wedding smile makeovers. You can also learn more by reading the Dear Doctor magazine article “Wedding Day Smiles.”

Dental implants are replacements for missing teeth. They are very stable and can be made to look as good as or better than the teeth they replace. How do we do it? Here are seven frequently asked questions.

What are the parts of a dental implant?
The implant consists of a root, usually made of a titanium alloy, which extends below the gum tissue into the bone; and a crown, which emerges from the gum and resembles the crown of the original tooth.

Why is a dental implant so stable?
Titanium has a property of fusing with the bone of the jaw, so that it actually becomes part of the bony structure. The new implant's stability depends on having the needed volume of bone and gum tissue in the right position to anchor the implant.

How can you make sure I have enough bone?
When a tooth is lost, the bone in which it was anchored will resorb or melt away if care is not taken. It is important to minimize trauma during tooth removal to preserve bone tissue. If tissue has been lost it can be built up by bone grafting techniques.

What factors make a crown on an implant look real?
How real the crown looks depends on its shape, particularly as it emerges through the gum tissues, its color and its position relative to the teeth around it.

What is the emergence profile?
This term refers to the way the crown emerges through the gum tissue. It involves both the shape of the implant and how far it is placed into the gum and bone tissues.

How do you match the color of the crown?
We analyze your tooth color using shade guides and/or photography to provide the dental lab with as much information as possible to create the best color match. This is part of the artistry of reconstructive dentistry.

How will my gums look with my dental implant in place?
When people use the word “gums” they are often referring to the small pink triangles of tissue that fill in the spaces between teeth, called “papillae.” An implant must be placed at the correct distance from adjacent teeth and at the correct depth below the gum tissue for natural looking papillae to form.

You can see that success in matching of color, shape, and location of an implant is not simple and depends on the skill, artistry, and experience of your dental team.

Contact us today to schedule an appointment to discuss your questions about dental implants. You can also learn more by reading the Dear Doctor magazine article “Matching Teeth & Dental Implants.”

Guidelines regarding the concentration of fluoride in water have recently been changed by the US Government's Department of Health and Human Services (HHS) and the Environmental Protection Agency (EPA). These agencies recommended a reduction of fluoride in water supplies to 0.7mg/L, modifying the original recommendations provided in 1962 by the US Public Health Service.

What is fluoride, and why add it to water supplies?
Fluoride is a chemical form of fluorine, a naturally occurring element. For decades, scientists have carried out studies on the effects of fluoride in water, and they have proved that fluoride strengthens tooth surfaces and makes them resistant to decay. A fluoride concentration of about one milligram per liter (1 mg/L), or 1 part per million (1ppm), in the water supply is associated with substantially fewer cavities. This concentration of fluoride (equivalent to a grain of salt in a gallon of water) has been found to have no negative health effects.

The Center for Disease Control (CDC) says that fluoridated water is one of the ten most effective public health measures of the 20th Century. The optimal amount of fluoride necessary to make teeth resistant to decay turns out to be between 0.7 and 1.20 milligrams per liter (mg/L). A certain amount of fluoride occurs naturally in water supplies, and communities have added fluoride to bring the amount up to the optimal recommendations.

How does fluoride you drink get into your teeth?
The fluoride you drink in your water is deposited in your bones. Bone is an active living substance that is constantly broken down and rebuilt as a normal body process. As this happens the fluoride is released into the blood, from which it can enter the saliva and act on the tooth surface.

What about fluoride from other sources?
Americans now have access to many sources of fluoride in addition to the water they drink. These include foods, beverages and toothpaste. As a result, dentists have begun to notice an increased prevalence of a condition known as Dental Fluorosis.

What is Dental Fluorosis?
Dental Fluorosis can occur when teeth, particularly in children, receive too much fluoride. This condition is a mottling or uneven staining of the tooth surface enamel. There may be small white spots or extensive brownish discolorations. The mottled enamel is still resistant to decay, but it may be unattractive in appearance.

What is the idea behind the new guidelines?
With the new guidelines, fluoride is kept at the lower end of the scale of the optimal concentration for strengthening teeth against decay. At this end, there is room to add consumption of fluoride from other sources such as foods or toothpaste. In short, it is the best of both worlds.

Contact us today to schedule an appointment to discuss your questions about fluoride. You can learn more by reading the Dear Doctor magazine articles “Fluoride & Fluoridation in Dentistry” and “New Fluoride Recommendations.”