Whitening vs Bleaching..

 

Today's post is about a popular procedure,that is one of the main reasons that people go to the dentist;to have their teeth bleached..

This is the first of a series of two posts that cover the bleaching process.Today I am going to cover Over-the-counter whitening products and explain why they are different than the bleaching procedure performed in the dentistry.

 

 In the era of white-and-bright smiles everyone wants their teeth sparkling white;I like bleached teeth that look naturally white and more important healthy,and that is what I try to have as an outcome of any bleaching procedure.Some of my patients go for the bathroom-tile-white extra bleach color.Even though I don't recommend it,if the patient wants it I will give it to him.

 

Due to the fact that the economy is not exactly booming,there are some patients that consider using products that are advertised on tv or web ads that promise the spectacular results of the professionally applied bleaching products in half or a quarter of the price.

 

When-and sadly not if-they don't deliver the promised result the patients think:
 

Why didn't it work;it said it would whiten my teeth and my teeth are still dark.



It didn't work because the product was a whitening agent and not a bleaching agent.

Well excuse me doctor,I am not interested in linguistics;I just want a sparkling smile

Sadly dear readers of the blog,the terminology is of great essence.Because the devil lies in the details

 

There are  whitening agents and  bleaching agents.

Whitening agents are marketed as cosmetics,thus able to be sold in a variety of places from the local drug-store to supermarkets.These agents do not have to be applied by a dentist or a doctor.That is why some of these agents are referred to as over-the-counter medicines.On the other hand there is little credible proof that these agents work.

 

These agents can be found in the shape of a pen,strip,gloss etc

 

                                                     pen-formed whitening agent



Bleaching agents on the other hand can only be sold to health professionals(dentists-doctors);it is dangerous and highly illegal to be used by non-doctors.Unlike their whitening counterparts,bleaching agents have a well documented mode of action.in other words they work!

In a nutshell,if a product doesn't have acid(hydrogen peroxide or carbamide peroxide),or it has an extra low concentration of the aforementioned substances,it is a whitening agent.It works but it doesn't bleach the teeth.It gives them a sparkle and nothing else.If a product has the aforementioned substances,it is illegal to be sold to non-doctors but it is a bleaching agent and it gives you the white smile you always wanted.
 

I am telling you these facts because it is nice for the consumer-that is you-to be informed about what and why you pay. There are some patients that come to the dentistry wanting a bleaching done and when they hear that the price is greater than the one they had decided-or thought that they would pay,they mentioned these whitening agents.And when I try to explain the difference between whitening and bleaching they look at me sceptically.

 

Wanting the best possible treatment in the best possible price is not wrong;wanting to have your own in the expense of someone else is.

I hope I gave you some food for thought.Remember knowledge is the key to many things!

I want to have my wisdom tooth extracted

Today's post is about the problems ascossiated with the thrird molar a.k.a. wisdom tooth.
Lets begin with the backround story of the defendant.
Third molar a.k.a. wisdom tooth
                          
                               
 It erupts in the mouth between 17-21 years of age.It is the last tooth of the mouth and a residue of evolusion of the huan species.Meaning that because it used to be useful for our past human ancestors,it has outgrown its usefulness therefore future generations might not have third molars in the mouth. ,
It is positioned quite back in the jaw,so not only does it not contribute to the chewing of the food but it can very well cause problems ie caries due to the innability to properly clean the back teeth with the toothbrush.Also when it erupts, some people tend to believe that it causes their teeth to become crooked.This is partially true;when the third molar erupts it exercises pressure in the area.If there is a problem with the alignment of the teeth,then it becomes more evident.
 

     "So what do we do doctor?Do we extract the tooth,even though it is healthy?Isn't it wrong to do so?"

                          

 I stringly believe that when the wisdom tooth is healthy,we dont extract it.In the picture below (picture 1) you can see a panoramic x-ray of a mouth in which three out of fourr wisdom teeth have normally erupted in the mouth,without causing any problems,and the fourth is on his way out.The only discomfort that the patient might feel is pressure due to eruption and perhaps a little painful sensation.Occassionally some patients state that they have problems opening their mouth widely or are a bit feverish,but that is all.

                           
                                                        Picture 1
On the contrary in the xray below(picture 2) the wisdom teeth appear not to have the sapce required in the mouth;therefore a surgical extraction is needed because they will undoubtably cause problems when the start to erupt.


                        
                                                          Εικόνα 2

  Some doctors believe that if we extract a wisdom tooth then we must extract the opposing wisdom tooth,because it will cause a problem.It is my opinion that I don't extract healthy teeth.I notify the patient that there is a possibility that it will happen,but not now. If he wants to get it over with so as not to go through with this again,I extract both of his wisdom teeth.Or else we wait until the other wisdom teeth causes trouble,and then we procceed with the extraction.
 Another case scenario is what happens when the wisdom tooth has caries.If the caries can be dealt with by means of a dental filling,I do a dental filling In the picture below you can see a wisdom tooth where the dental caries has been removed and the cavity is shallow.I see no reason not to do a filling but rather to extract the tooth just because it is a wisdom tooth.

 

If the cavity is deep however,and we reach the dental pulp then we perform the extraction
.
 

A root canal treatment in wisdom teeth is not recomended because the inner morphology is atypical,and overall they are not worth fighting for.It is only recomended when the others molars have benn extracted and the wisdom tooth is the last tooth which can hold a fixed dental prosthesis(bridgework).

This is all I have to say about wisdom teeth.Don't forget;always brush! 


                                     

My two-year old fell and hurt his/her tooth;What now?

Today's post is about a real case scenario based on a true story

                                          

  Every child,from the moment he/she starts to walk, stands the chance and danger that he/she might fall and hurt somewhere.So a patient comes to the dental office and tells me that he and his daughter where in the amusement park,and his daughter bumped and hurt her tooth.Similar case scenario would include the house and an open door or a kitchen table or a sudden fall and a blow to the jaw.

When I examined the child I noticed that her tooth had become a little dark;not like the one shown in the next picture

                                         
but rather than the one seen in the picture below,with a grey hue although not all over the tooth.



It was more localized.Unfortunately I couldn't get a photo,because the child was petrified,so the pictures are from the web.
  I told the father, who had regretted his decision to go to the amusement park,that it was not something "to die for".Most likely the tooth,not his daughter, had suffered a concussion, and a small vain had bursted somewhere around or inside the tooth,causing this change in color.

His actions should be :

• To take a picture of the tooth,and to review it in a few months(2-3 months).There is a great propability that the color of the tooth will be less dark or near the natural tooth color.
• To be careful not to hurt the tooth again because repeated blows might cause more permanent and serious damage like necrosis of the pulp. Now the tooth is healing and is vulnerable.
• To check the gum surrounding the tooth,by lifting the lip,every week,in case there is a rash or a pimple-like buble.In the case that the lip was also hurt during the incident that action should be done when the healing of the lip nad gums is done.If the pimple-like buble appears,then things don't look good for the tooth and it might requier endodontic treatment or tooth extraction.And if the tooth belongs to the natal teeth,it might require the use of an orthodontic appliance,in order to keep the space for the permanent tooth. This is the dentist's decision,and it might not be necessary since the canine holds the position of the ather front teeth.
• Last but not least,he shouldn't worry about what other people will say about his daughter's black tooth. Children play,they fall and get hurt in the process.Everyone with a child or a nephew/niece knows that.

It should be noted that if the blow and the resulting trauma happens to a child older than six years,when the permanent teeth have erupted in the mouth,then things are more complexed and the possibility that an endodontic treatment will be required is greater,without being definite.

In any case a dentist's consultation is necessary everytime there is a trauma to the head that includes the mouth

Happy playing always with safety.Cheers


                        

Doctor why are my teeth black?

Today's post is about a frequent question from my patients

Why are my teeth black?Why are they not pearly white like the teeth of actors that I see on TV?

                                         

  Dental discoloration is a condition in which teeth are not so bright (color-wise,lol.)

NOTE : I am not talking about the unnatural brightness of some actors' teeth,when the color is described as bathroom-tile-like-white. This is atributed to other dental procedures.I am talking about the case in which the teeth,your teeth, don;t have a natural white color. The current color might be a wide range, from yellonwish to black.  

Tooth discoloration might be limited to a single tooth,or they might include several teeth. They might also be intrinsic( from the inside of the tooth) or extrinsic.
 
                                            

                Whoa doctor.Hold your horses.I am confused. Could you be more clear?

Ofcourse dear blog reader. Let me walk you through dental discoloration

First case scenario : Dental discoloration atributed to a single tooth 
 


1 There might have been an incident, such as an accident in which a tooth might be hurt. This is very common in children(which is going to be a topic in a future post),or bigger and older children(adults.).

                     
 
The management of sigle tooth discoloration in adults is different than in the case of children.Usually a root canal treatmant(RCT) must be carried.
There is also the case in which the tooth that has changed its' color is already treated with root canal. If this is the case,an internal bleaching must be performed.

2.Tooth change color in the presence of caries.Caries might also hide under a filling

                         
 (Amalgam filling with secondary caries(or caries ascossiated with the restoration).You can see the hallo of the amalgam being more black than usual.)

In this case the tooth will hurt during mastication or when we drink something cold.
How do we deal with that?We do a filling,or in the case of secondary caries we replace the filling with a new one.


3.A tooth might be black due to the black filling itself.This is a condition that is reffered as an amalgam tatto,due to the absorption of amalgam contents from the tooth.If that doesn't upset the patient,we leave it as it is. If it is upsetting the patient, for aesthetic reasons, then we can decide to replace it.

Fact: Amalgam tattoo might occur in the gums as well.But any discoloration of the gums must be checked by the dentist,to rule out malignancy(cancer)

                                          (Amalgam tattoo under fixed prosthesis,where there used to be a tooth ith an amalgam filling)


  The next case scenario is generalised discoloration of teeth. When this is the case,it means that something has happened that affected all of the teeth;so it is either genetic or it happened during pregnancy.

• It might be atributed to anaemia ie thalassemias.
• It might be atributed to prescribed drugs and antibiotics,that the mother used durnig pregnancy ie tetracyclins
• It might be due to fluorosis, which is the indigestion of fluoride more than it as needed,for a period of time.
• Iy might be due to dietery habits such as drinking  tea,coffee,red whine,cherries,berries soya sauce,vinegar etc.I am not saying to exclude these from your diet,but to eat them in normal quantity.
• Another factor might be age.Teeth become more dark while we age.
• ΓGenetics plays a huge role.The color of our teeth is controlled by genes.It's all about genes.
• Last but not least tooth discoloration might be linked to tobacco use,oral mouthwashes that contain chlorexidin,dietary supplements and some of the bacteria of dental plaque.

.                                                                                                                   

                          'Nough said doctor.Now what?

  
  First of all don't panic.For any tooth discoloration talk about it with your dentist.

If it is extrinsic,a good profecional cleaning of the teeth combined with a tooth bleaching procedure might give you the desired result. And if you are still not happy there are other options such as veneers or dental bonding procedures.

                Where the is will there is a way

                                           

How to take a dental impression

I am going to start today's post with an apology.I am sorry that my posts were not updated for a long time.I was a bit busy,and it is a bit difficult to run two professional blogs,the dentristry and to study for a post-graduate programme.
But I am back.

Today's post is about taking a dental impression,and making a good impression while doing it!

The process of taking a dental impression is a procedure,that many dentists believe it doesn;t need many explanations.Picture the following conversation

Dr. : "And then we are going to take a dental impression"
Patient : .....
Dr : "And afterards we are going to send it to the lab and .."

As you can understand the patient has no idea what the doctor is talking about. Tis is a common mistake made by dentists. It is not your fault that you don't know;it is the doctor's fault for not explaining.

Back to our post then.

A dental impression is the procedure in which a negative copy of your mouth is made(it is like a copy but imagine looking at it from a mirror) like the one shown in the picture below.

             

This impresion is going to be used to cast an exact copy of your mouth so as to use it for diagnosing and planning your treatment.

The impression depicted above,was used as a final dental impression for a fixed dental prosthesis,that is why it has two materials of different color.It was taken with a silicone-based material for extra detailed depiction of the teeth.
 In case we only want a study model we use a cheaper material such as alginate.

                                        

What is the process like ?

We put the material in a dental tray




                         


                         



 We put the dental tray inside the patient's mouth and wait for the material to set.


                         


When the material sets it is roughly like so

                   

It may have abother color;that depends on the material's brand

With this impression we cast the patient's teeth using dental die stone (aka gypsum)
Thus we have the following image


                    

which is an exact duplicate of the patients' mouth for us to study.

Thank you for reading.And dont forget to smile!