Dr. Ross Nash

I haven't found that to be a problem at all. I don't think there's any study showing there's really any harm. I'm sure if someone used the solution on their teeth every days for years it might cause the teeth to be dehydrated and it might cause some problems. But clinically speaking we have found no detrimental effects to the tooth whitening procedures.

The over-the-counter products can vary in their efficacy because of the way they're delivered and the amount of teeth whitening solution and the strength of it that actually can be offered over the counter. Crest White Strips and those types of things can be effective and some patients get a decent result out of them, however the whitening procedures provided from dental offices normally have a stronger solution and the bleaching trays fit very precisely compared to the ones over the counter, which are an average fit. The kits patients take home from a dental office are usually more effective than the OTC ones because the solutions have a higher percentage of whitening material. But the most effective whitening that I have experienced have been the office power bleaching whitening. With those we can help activate the material with a laser or a high intensity light and the materials can be substantially stronger than what you can buy over the counter. The tissue has to be protected and that kind of thing but it's done by a professional.

You can lighten individual teeth with the power bleaching technique or with home bleaching, you just have to put the material on that particular tooth. Canines, or cuspids, the ones in the corner, normally are a little darker than the front teeth and that's just the way nature makes them. However, I must tell you that most of the patients I'm providing veneers for, they really want that tooth the same color. We don't make those teeth a darker color than the rest of the teeth as often as we may have in the past because people want whiter teeth all over but in nature normally the canine is a little bit darker.

They can yield similar aesthetic results. The difference is that composite bonding, placed directly by the doctor, or in some states dental assistants can actually place them, is built directly on the tooth, just like a filling would be done. Most dentists can apply the material but the end result really comes down to the artistic ability of the provider who's doing it. Some dentists are more artistic than others and to get good looking restoration or veneers requires layering several different colors of material, carving in exact anatomy of the teeth, making them shaped exactly like the teeth. Some have more artistic ability than others. That's the real difference in composite bonding, and when I say that, composite resin is the material that's used, it's made of glass and plastic, mostly glass, but it has a plastic matrix that holds the glass particles together and bonds it to the tooth. It's the plastic material over time that tends to deteriorate, absorb fluids which may have pigment in them, like wine and coffee and tea and soda so we find that the composite bonding, even done well, over time, will wear a little bit and discolor more. Porcelain, on the other hand, is a sold material, it's baked in an oven and usually about twice the cost because of the two appointments necessary and the laboratory procedure involved to make these. And when it comes to veneers, porcelain is certainly the Cadillac or the Mercedes. Direct bonding is a good substitute though.

Yes. There's not one answer to the source of the problem though. If somebody has bite problems that are causing them to have headaches and pain, sometimes they need orthodontic movement of the teeth to get them in the right spot so that the muscles are more comfortable. Sometimes they can do it through an occlusal adjustment where you just change the shape of the teeth a little bit and improve the way they hit. Sometimes you have to do it with crowns or veneers or restorative procedures. So it depends on the patient as to the cause of the bite problems but it certainly can cause some significant discomfort. You can wear a night guard to help position the teeth better or keep you from grinding your teeth and that type of thing, so there are some palliative things we can do to help the patient. But we can also do some restorative work, like putting a crown or a filling or veneer on the tooth, to realign the teeth and get the bite in the right position and that can help reduce or eliminate the headaches and the pain.

There are some practices in the country that can give some patients teeth in a day. Especially in my experience, teeth in a day are for people who are going to get dentures that are stabilized with implants. If you don't have any teeth they can put some implants into the bone to stabilize dentures and then you can walk away with them in a day but it's not a common thing at all.

No, you can get cavities around the margins of the crown where it touches the tooth and the remaining tooth structure that's not covered. But the porcelain itself is an inert material.

That's one problem, the porcelain is not going to change much at all, if any, and the surrounding teeth probably will with time. So if you've got a crown that matches the rest of your teeth when you're young, when you're older it's probably not going to match anymore and you may have to try to whiten your teeth to get them back to what they were before and then maybe they'll match again. But the one difficulty we have aesthetically is that the porcelain doesn't really change and that the structure does.

Generally speaking it does. I would say that over a period of 20 years or so you may find a little change in the porcelain but it is really really color stable. So if you want color stability, porcelain really is the choice.

There's a number of ways that can be done. It can be done by a surgical procedure where they actually move the entire bone upwards, it can be done by removing some of the gums and bones from the tooth and making them longer. The only problem with that is you can lose bone support of the tooth because it takes the bone away from the roots. Those two procedures are about it. Sometimes orthodontics can help because they put the tooth in a different position and the bone will follow it and so will the gums. But usually the gummy smile is going to need to be corrected with a surgical procedure, a gum lift.

No. As a matter of fact, you usually can't even tell you have the liner on because it's a clear plastic. It comes in and out as does the Inman aligner, which looks just like a retainer.