An attractive and healthy smile is a key component in facial esthetics. A pleasing smile is far more than bright porcelain on the upper front teeth. Smile design becomes a combination of the art and science of positioning the teeth and lips properly within the frame of the face. A clear understanding of the form and function of teeth and soft tissues in a healthy smile acts as the foundation for the tools we have to enhance what is present.
Digital photography is a critical tool in identifying potential enhancements and limitations. Once a clear understanding of treatment goals is established, the appropriate sequencing of treatment may be developed.
Vital tooth bleaching has become one of the most common and inexpensive cosmetic dental procedures available. The safety and effectiveness of peroxide or Carbamide peroxide bleaching have been well documented for more than two decades. Dr. Van Haywood of the Medical College of Georgia School of Dentistry has published numerous University based studies for both professional journals and consumer magazines alike.
Dr. Van Haywood
There are several key concepts associated with “vital tooth bleaching”:
- Stronger bleach does not mean faster or better. The research that has established the safety of the bleaching agents was based on low concentrations (approx. 10% Carbamide Peroxide).
- Lights, lasers, and heat wands do not speed up the process. Most of these systems also include a home bleaching program. Drying out the teeth makes teeth look whiter until they re-hydrate
- Most systems are based on 2-3 weeks of treatment. The custom bleaching trays are worn from 1-4 hours.
- Sensitivity is the most common side effect. The sensitivity can be managed by alternating days of bleaching or by using desensitizing agents in the same tray following bleaching.
- Over the counter products may be effective. The shelf life of the bleach products is critical. The better professional products will have dated expirations and have good preservatives.
- Bleaching will not influence existing fillings, crowns, or veneers.
A professional examination and dental cleaning are advisable before bleaching to assure that there are no cavities and to become aware of areas that will be more subject to sensitivity.
TMJ and Facial Pain
Facial Muscle and Joint Pain (TMD or TMJ) is common among the general dental population. There is not a recognized dental specialty in TMJ/TMD; however Dr. DeArmond has extensive training in diagnosis and treatment of certain types of muscle and joint disorders. The muscles and joints that allow our lower jaw to move and chew must work in harmony with our teeth. An interference with this harmony or a trauma or series of traumas may result in a number of symptoms. The symptoms may be pain when opening, pain while chewing, discomfort in the morning, noises in the joints, headaches, or changing in hearing.
Each patient has a different pain tolerance and adaptive capacity to different types of interferences. Some symptoms may be directly related to the fit of the teeth. In other instances, the interferences may not cause pain, but instead result in excessive wear of the teeth, sensitivity to biting or temperature changes, excessive mobility of the teeth, or tooth fracture. These types of symptoms are often referred to as “Occlusal or Bite Disease”.
We provide diagnostic evaluations that help to separate facial pain with a dental origin or contributing element from other types of head and neck pain. Our evaluation is based on a thorough physical examination of the chewing system. The chewing system includes the teeth, the bone that holds the teeth, the gum tissues, the muscles that control the movement of the lower jaw, and the joints that allow the lower jaw to move. This system must work in harmony or there will be a breakdown. The breakdown may result in pain, worn or broken teeth, fatigue in jaw muscles, mobile teeth, or a combination of these symptoms.
A proper diagnosis is critical before beginning any treatment. Common diagnostic aids are a thorough patient history, accurately mounted models of the teeth on an articulator for occlusal (bite) analysis, a complete evaluation of the facial muscles associated with chewing and jaw movement, screening panoramic x-rays to eliminate the possibility of cysts or growths in the jaws. The use of bite splint therapy to stabilize a patient’s bite in a reversible manner is often recommended for the relief of symptoms and as a diagnostic tool.
Bite Splint Therapy is a valuable diagnostic and therapeutic treatment that allows observations of changes that occur when the bite is stable. No changes are made to the teeth in this process so Splint Therapy is a reversible procedure that allows your body time for repair.
Information gained from Splint Therapy helps to anticipate the need for additional treatment. Stress reduction and force management are two important goals in a stable bite. There are occasions that more extensive studies are necessary that may involve MRI’s and CT scans for a more definitive diagnosis. Medical assistance and physical therapy are also potential needs. A small fraction of patients with joint disorders require a surgical approach. A stable bite will always be a portion of the prescribed treatment.
Occlusal or bite adjustments may be indicated if minor changes to the shape of teeth will allow them to function more comfortably. These adjustments are often performed on diagnostically mounted models of the teeth to see how much adjustment may be necessary. If extensive changes are necessary, other methods of addressing the teeth may be needed. Common options may involve selective reshaping of a tooth or teeth, orthodontics, selective crowns, or combinations of all of the options. The key is planning and preparing the most appropriate treatment for the individual. A clear picture of the desired outcome should be developed prior to beginning treatment.
Extractions and Minor Surgery
“An extraction is only minor when someone else is the patient.” This is exactly why we will always discuss these types of procedures with you prior to treatment. Patient comfort and safety must always be a consideration when determining what is appropriate.
We do remove teeth and provide some minor gum surgeries, but we will always recommend what we feel is appropriate for each patient and their circumstances.
We do not remove impacted wisdom teeth. We work with several excellent Oral Surgeons in the area and will be happy to assist you in choosing someone. We do not offer extensive or complex periodontal surgery. The field of periodontics (treating gum disease) is so dynamic that our Periodontists are the appropriate choice when their additional skills and knowledge are indicated.
Root canal treatments have been the source comic humor for years. “I would rather have a root canal than…..” has been a standard for humorist for years.
The science of root canals, endodontics, has evolved dramatically over the past 35-40 years. The pain of an abscessed tooth is a combination of a very damaged nerve within the tooth coupled with some degree of infection. Our ability to mange infection has improved the comfort of treatment. If a damaged tooth can be treated reasonably early in the process, often the root canal can be completed and the pain eliminated in a single visit.
The inside of a tooth may be very simple or very complex. Normally the more roots a tooth has, the more difficult the canals are to locate and treat. Age is also a variable as the canals become smaller with age. Because of the variability of teeth, we ask our Endodontists colleagues to perform most of our patient’s root canals. The most basic treatments may be completed in our office, but if there is any question about the treatment, we will request that you allow one of our specialists perform the procedure for you.