Dr. Irene Grafman

Yes, usually on people who grind, where some of dentin is exposed or where there is recession by the gum line. If you get bleach on those areas, you get sensitive. We place a desensitizer on before we use in-office whitening and block out those areas that are exposed.

I consider my specialty bonding. I prefer to do bonding in a lot of cases. I hate to shave down healthy teeth if there is nothing wrong with the teeth. With bonding, I don’t have to touch the teeth but add to them. If it’s done right, it can look just as good as your own natural tooth and you can’t tell the difference between where the tooth ends and the bonding begins. The disadvantage is bonding stains a little over time, but natural teeth stain overtime as well, so it actually blends in better. Bonding is less expensive because we don’t have to send anything to the lab. The other disadvantage is once you’ve had bonding you can’t whiten your teeth.

They are used when there is a very large restoration—where at least 50 percent of the tooth is old filling or has decay—when there is really nothing left of the tooth. If you have something wrong with the tooth, if there’s trauma or discoloration, a veneer would not mask the darkness. In that case, you would need a crown to cover it. Also, if one tooth is uneven, pushed in or out or rotated, we would use a crown. To put in a crown, we have to build up a foundation to support it, and then we put the crown on. If the tooth is gone, or has broken off, we may insert a post and core.

Everyone loves crowns, but onlays are so much better. An onlay looks like a filling but does the job of a crown. We clean out the old restoration, or remove the decay, and instead of putting in a filling, we take an impression and then the lab creates a custom restoration made out of porcelain to fill the tooth. It restores the strength of the tooth from the inside, instead of covering it from the outside. So, we are actually leaving the healthy tooth intact.

With crowns, we have to fill the middle and drill away the entire outside of the tooth, removing almost the entire tooth from the outside. Then the crown goes on the filling material in the middle. Crowns have to be replaced every 10 to 15 years, and each time it is replaced we have to put it further under the gum line because of inflammation caused by bacteria that gets trapped at the junction where the crown meets the gum line With an onlay, the outside of the tooth stays intact—we are just replacing what was decayed. This eliminates all the gum problems. Nothing is better than your own tooth.

I love implants. They are used any time you can’t save your tooth and it gets taken out. It’s our best restoration to replace the tooth. If done right, once they are in they are in, they will last for the rest of your life. They literally feel and function the same way natural teeth do. Implants created an option for people that they never had before. They no longer have to have bridges and they don’t have to involve other teeth. We put a crown on an implant and they are as good as new.  The only risk factor is if the patient smokes. We have to be careful, because in smokers they tend to fail a little more often.

I think it is great for people who want to test-drive a smile. If someone is thinking of having veneers or crowns or any other major restorative work done, which is a big expense; they can try out their smile to see if they will like it and to make sure there are no issues, such as with the bite. It can also be used for someone who can’t afford such a huge case; for someone who wants a nicer smile for social occasions; or as a temporary for someone waiting for implant restoration. It’s not meant for everyday use all the time. If you are going to wear it for any extended period of time, we have to make sure the teeth and gums are fairly healthy. A Snap-On Smile can trap food and make unhealthy teeth worse.

It’s what is used in-between stages while someone is waiting for custom veneers or implant restoration. The technology today is amazing for temporaries. The temporary material used for the back teeth is acrylic. It almost looks like bonding, so it looks like your own tooth, but it is not as strong as bonding; it’s not meant to last long-term. The temporary is not actually bonded to the tooth, it is held in mechanically in areas between the teeth. It’s done the same day the tooth is shaved down, so no one has to leave the office with missing or shaved teeth.

They are clear so nobody knows you have them. Metal braces make it more difficult to clean the teeth, so you end up with gum problems, and after metal braces teeth can get white spots. Not an issue, so difficult to clean with braces on and wind up with gum problems. People actually brush more with Invisalign so their hygiene improves greatly.

It does in so many ways. By shaping the teeth or adding to them with bonding or veneers, we can bring them out one to two millimeters which puffs up the lip. People don’t realize that if the teeth are inclined toward the tongue, the lip falls in and curls under. Orthodontic treatments also bring the teeth out and the lip up so it looks fuller.

They do to maintain whiteness after another whitening treatment, but not to actually whiten because the concentration of bleach is not that high, just 7 percent. If you use them for three weeks, you will see a slight change. It works for those who already have white teeth to keep stain from coming back.

People don’t realize the problem is sometimes the gum and not the teeth. All we have to do is take away a little gum to even the teeth out. Most people don’t know that’s even an option. If you have uneven gums on certain teeth, we can use the laser to remove some of the gum. We have soft tissue lasers that are totally painless with no recovery time.  It’s an in-and-out office procedure. It’s not for everyone, though, you can’t use it if you have a severe case. Also, for a gummy smile, some people have a little frenulum—the piece of skin that connects the lip to the gum between the front teeth. Some people have low one, so we can reattach the lip to the gum a little bit. This could eliminate a gummy smile in a person who has a severe case because it keeps the lip for coming up as much which can hide some of that. It’s a great procedure.

Yes. You want to avoid all dark liquids (including red wine, cranberry juice, sodas, soy sauce, and coffee) avoid for 48 hours after you whiten. Also, avoid anything acidy, like citrus, because they promote sensitivity.

Everybody. I love Invisalign because you can have anything you want perfected, whether its one tooth that is out of alignment or the whole mouth. But, the patient has to wear them and follow instructions. I prefer Invisalign over crowns and veneers if there is nothing wrong their teeth. All it takes is a few months to move teeth to the right position. With veneers, they always have to be replaced. Invisalign can also be used for TMJ and bite-work. It’s a great tool for catching bite issues at an early stage so damage doesn’t get worse as they age. It also functions like a night guard which prevents them from grinding. I use Invisalign before I do anything else.  If you put teeth in the proper position it makes restorations look that much better.

Veneers made out of porcelain, so the color is stable and they won’t stain. They are stronger and last quite a long time. They look a little more natural, almost like glass, and can mimic the tooth. A lot of perfect smiles you see on TV are usually veneers. A veneer is sort of like a fake fingernail. We take away a little portion of the outside of the tooth and that portion gets replaced with the veneer. We have to shave down the tooth, so it’s not reversible. Another disadvantage is if the tooth edges are chipped or broken and you want to get veneers to fix it, it will probably break again. We must check the patients bite because chips and cracks are caused because the teeth are not aligned properly. You have to correct their bite or veneer will break. If you are going to invest that kind of money, you want it to last.

A beautiful smile is not only about teeth—your gums, lips and face shape play an important role as well and need to be balanced in order to create a perfect smile. A smile transformation can sometimes take place in just two appointments, while others may need extra time to achieve their desired result. So while we don’t believe that there is a formula for the perfect smile, we do believe there is a perfect formula for YOUR smile.