Level 3: Complete Dentistry and Elective/ Cosmetic Care

Where Do You Want to Go?

     Level 3 is where dentistry really shines. You've achieved a solid level of dental health, and you now have the freedom and ability to customize your smile to look exactly as you'd like it to. Modern dentistry can straighten, whiten, and revitalize your teeth to reverse years of aging or just give you an added level of confidence. 

     Entirely optional, this kind of dental work puts you in the driver's seat to allow your dentist to build the smile you've always wanted. Do you want to replace old dental work to make it look like natural teeth? Do you want to fill in gaps or spaces? Have years of wear left you with shorter teeth and less confidence in chewing? Maybe instead you've worn a removable denture for years and you'd like to have dental implants that your denture can clip into. You could even throw away the denture and have several implants placed to reconstruct a full set of choppers that look and feel like natural teeth. 

     Sound expensive? It can be. Depending on your budget, time frame and willingness to undergo multiple procedures your dental team has procedures and materials available to help you achieve almost whatever you like. Although pricing varies widely, you'll have several options at multiple price points to move closer to your ideal vision. At this level of care you'll likely be working with a team of dental specialists that are all on the same page, working in harmony to create your smile. This is perhaps the most important thing to be sure of before making a commitment to an extensive dental transformation: that all of the dentists involved in your care are communicating regularly and are beginning with the end in mind. Many dentists develop close working relationships with trusted specialists and the results they can achieve are truly impressive. It all starts with a commitment to long-term, regular care to maintain anything you decide to have done. Once your dental team comes up with a game plan that matches your vision, they can take you just about anywhere you'd like to go. The first step, as in levels 1 & 2, is to set up an initial consultation to get the process started.

Level 1, 2, or 3... Get Started Today!

Well, those are the three main levels of dentistry. The point I hope comes across is that no matter what level you're at there are options available to you. Whatever your situation, your dentist has either seen it before or has access to information that he or she can use to help you out. Find a dentist who will help you leave any guilt behind, will take you as you are, and will focus on helping you get better. 

Level 2- Routine/ Foundational care

What's So Great About Routine Care?

     If you have a regular dental checkup once or twice a year then you're probably safely in level 2, a state of routine and foundational care. If you're in level one, this is where you want to be. What's so great about level 2? Well, for starters, it proves that the old saying "an ounce of prevention is worth a pound of cure" is as true in dentistry as just about anywhere else. In level 2 you regain control over your dental health, making emergency visits a much rarer occurrence. Together, you and your dentist regularly review your current condition and your future goals. You dentist can alert you to developing problems at their earliest stages so they can be addressed as conservatively as possibly. Since decay and gum problems hardly ever produce any noticeable symptoms in their early stages, these regular visits allow your dentist can find them before they turn into major issues. As older dental work begins to wear out, your dentist will help you prioritize how to replace it before it breaks so your chance of dealing with a broken tooth while on vacation goes down dramatically. 
    This type of routine care builds a strong foundation for keeping your teeth for a lifetime. The economic benefits are twofold: not only does regular care keep your overall dental costs down, but because most of your work will be done preventatively (rather than as a reaction to some emergency), you can schedule it to work best with your finances and insurance limits. 

What Would I Be Signing Up For?

     Some people's mouths require more upkeep than others, but in addition to regular cleanings this stage commonly involves occasional fillings, crowns, or gum therapy. If a tooth is ever lost then implants, bridgework, and removable options exist. Those with extensive grinding issues can be fitted for mouthguards to slow down tooth wear and fluoride can be used to strengthen your teeth if you're prone to decay. Are you missing several teeth? Then for you this stage would involve making sure any full or partial dentures that you wear are functioning well. You'll also benefit from having a dentist monitor your situation so you can pursue dental implants before bone loss makes that option harder to obtain. The focus here is on achieving and keeping up a strong foundation so that if you ever want or need to go up to Level 3 (complete dentistry and elective/cosmetic care) you can. This is where the advances made in modern dentistry really shine. We'll discuss some of the exciting options available to you at level 3 in the next post!

Level 1- Urgent/ Emergency Care Only: Damage Control

A Downward Spiral?

    Much of the population falls into this category. The typical picture here involves a number of worsening dental problems throughout a person's mouth. This stage can be depressing, frightening, and emotionally draining. People in this situation can see that things are getting worse but often feel helpless and doomed to stay at this level until they lose all their teeth. Often fear, finances, or both keep a person out of the dental office except for painful emergencies. These happen less often at first but then they start to pick up speed as small problems become big ones in many different areas of a person's mouth at the same time. It's no surprise that when a person at level one makes it into a dental office with a painful problem that the dentist has to do something invasive to relieve the pain. Often this means an extraction or a root canal; while these procedures have become a lot more comfortable over the years, they still aren't entirely pleasant. It's no wonder that folks at level 1 associate going to the dentist with pain and expense, and they start to think "This is why I hate going to the dentist in the first place!". 

What's a person to do?

Frustration and doubt are normal feelings that result from getting pulled deeper and deeper into this vicious cycle. My advice for those stuck at level 1 is to make an appointment for a non-emergency visit and for about the cost of an extraction the dentist can help you by making a complete list of the problems you're facing (from most urgent to less urgent) so you can start to get some control over the situation. Fear of the known is always easier to handle than fear of the unknown. Maybe you can't afford to tackle all of your dental issues right now, but knowing which problems are likely to be the next emergencies can put you in a position to take care of some of them beforehand and break the cycle. Since planned dental work is easier on you than urgent, unplanned work and fillings often cost less than difficult extractions, this path can be less expensive, more comfortable for you, and can allow you to save teeth while they can still be saved. There is no shame in losing teeth or not being able to go through with all your dentist's recommendations right away. What we can do at this stage is keep you comfortable and help you avoid emergencies as your finances will permit while keeping your options open for the future. As your feelings about dentistry and your circumstances change, you'll be in a great position to move up to the next level (which we'll discuss in the next post): routine, foundational care.

Are there different levels of dental care?

There sure are. You can receive quality dental care from just about any licensed dentist, but there are different levels of dental health that our profession can help you can achieve depending on your goals, motivation, and finances. While it would be great if everyone could have a picture-perfect white smile the reality is that many people would be happy if they could just break the cycle of going from one toothache to another or could just chew solid foods again. There are a number of different steps on the ladder from a mouthful of lingering dental problems to a state of confidence-building, worry-free, long-lasting dental health. No matter your current place on the ladder, there is some way that regular dental visits can benefit you. When you're ready and able to move up on that ladder, there's a world of possibilities available to you!

We'll explore the levels of dental care in the next few posts. The main levels of care are:

  1. Urgent/ Emergency care only

  2. Basic, Foundational care

  3. Complete Dentistry and Elective/Cosmetic care

While it's a great goal to get and stay in the highest level of care, depending on what's going on in your life moving around from level to level is sometimes unavoidable; that's reality. Your dentist can serve and help you no matter what level you're starting at, so find a dentist you trust to be on your side today.

Why Put Up With Floppy Dentures?

 If I Would Have Known This is How Dentures Were Going to Be...

   For some people, traditional dentures work really well. As an alternative to no teeth, they can be great. Unfortunately, many people struggle with them. This is especially true of lower dentures. While others may see it as an minor annoyance, for some people a traditional denture (even with a sticky adhesive) can be a nightmare. First you might give up some of the foods that you love, then you stop smiling as often, and later you may even avoid some social situations altogether because of the fear that your dentures may cause some kind of embarrassment. 

Implants Might Be Your Solution

   It doesn't have to be this way. Today's dental implant techniques are highly successful and create options at multiple price points for improving a person's ability to eat and smile with confidence. Of course it's true that dentistry can get pretty expensive depending on just how natural-looking and comfortable you want your new teeth to be (not to mention how fast you need to have them that way). Most times though you and your doctor can come up with a solution to improve just part of your denture experience (like the fear of them falling out) while leaving the door open for upgrading to an even more comfortable situation (like enjoying crunchy foods again) gradually over time as your desire and finances permit.

Finding a Way to Benefit

     While many people may have given up hope that implants are not an option for them due to their age, health, or checkbook, the fact is that most denture wearers can benefit from some kind of implant therapy. Although it can be common for a person in their mid-60s to tell us that he/she doesn't feel there's a point to putting the time or money into implants for their denture, there are plenty of 90 year old people out there thriving with them, even getting them for the first time! The importance of being able to chew and digest nutritious foods doesn't decrease with age--it only becomes more important. A person's ability to eat and smile comfortably is truly a quality-of-life issue. For many dentists, myself included, upgrading a patient's denture experience is one of the most fun and rewarding services we can offer to our patients. Whether you're unhappy with your current set of dentures or you're getting ready to have your first set made and are concerned about how your life will change as a result, an honest talk with a dentist will help you to define what can be done to improve your situation in a way that works for you. There are certainly more important things in life to spend your time dealing with than your teeth--implants can help free you from your denture worries so you can get on to more fulfilling things. It's a decision you won't regret--you just might wish you'd done it sooner. 

     The first step to improving your denture experience is to set up an initial consultation, like the complimentary consultations we offer at Northstone Dental Group. If you're interested in receiving one, you can contact us anytime.

What's the Story on Consultations and Second Opinions?

10 different dentists, 10 different approaches

     Whether you’ve been away from the dentist for a while and have several issues or a new problem has sprung up with one or two teeth, often the best place to start is with a consultation to get a grip on what is going on and what can be done to address it. This is one place that patients can get frustrated because they might find that their new dentist does things completely different from their old one, or that their visit sounds completely different from the experience that their neighbor described going through when he or she (fill in the blank--broke a tooth, needed a root canal, etc) last year. One dentist may have given a short, free consultation, while another may have charged hundreds of dollars for a longer visit that included several x-rays, pictures, and impressions.

     The truth is that like in medicine the vast majority of dentists out there genuinely care about your best interests and use them to guide their decisions. Dentists love helping people to improve their health, comfort, and confidence. But dentistry is much different than medicine in that it is not controlled nearly as much by insurance companies so individual offices are freer to practice as they wish. As a result we all tend to do things a little differently from each other, more so than family physicians that may be required by your insurance to run certain tests based on your symptoms.

      When going to a new dentist communication is key so that you aren’t left feeling like you were forced into something you didn’t sign up for. Often patients can feel confused after leaving an appointment. Even though they’d like to get a second opinion they may have already invested time and money getting the first one and they fear that a second might take even more time and money so they’re not sure what to do! There are a couple schools of thought on how dentists approach new patient visits, and as a patient it can be good to know what you might encounter when you walk into a new office for the first time so you can select dental care that meets your expectations.

Consultation or Comprehensive Exam?

     Most approaches boil down to either a short consultation or a longer, more thorough comprehensive exam. Some offices offer both while others require you to do one or the other. In our office for example we always offer free consultations. At a visit like this you can expect about 30 minutes of a doctor’s time to discuss what is going on and some possible options to address it. Occasionally a single x-ray may be needed to make sure certain options are possible. It’s no secret that the question on everyone’s mind is “how much is this all going to cost?” That’s a very fair question because in dentistry there are usually several ways to create a beautiful smile. As the comfort, chewing ability and natural looking quality of the options goes up so does the price and often your budget is going to determine what option you choose. At this visit you can expect to talk about some very ballpark figures that can help you focus on one or two options. You’ll also want to discuss how long you can expect to be in treatment and whether or not any specialist visits would be involved. At this point you can go home, think things over, and decide if you would like to get more opinions or start with treatment. The next step would then be a fee-based comprehensive exam. The fee covers all the detailed record gathering, x-rays, photos, and impressions that are needed to plan out the specifics of your treatment. It’s only after a doctor has had a chance to plan your exact treatment that an exact estimate can be given but you can expect it to be close to the ballpark figure you’ve already discussed. Some offices choose to start with the comprehensive exam. It’s a matter of choice, but if you feel this is what is going on you’ll want to make sure the fees for this have been discussed with you prior to going through with it. On a positive note, if you came into an office looking for an opinion but left with a full exam, you should have most of the records that any dentist would need to give you a second opinion. There may be a fee to have them copied and transferred to another office but any dentist will make them available to you.

Where Do I Start?

     Knowing you need to see a dentist to address several problems or just one can cause a lot of anxiety about what’s going to be recommended, how long it will take and how much it will cost, just to name a few common concerns. In general with dentistry if you’re having a problem or have just been away for a while the sooner we can see you the more options you’ll have.  A short, relaxed consultation with a dentist can be a great first step towards developing a relationship with a dentist that will result in giving you back a healthy, comfortable, beautiful smile. If you need to see a dentist, set up a consultation with an office today!

2010 ODA Humanitarian Award Winner: Dr. James E. Nicholls!

It's Official!

    Northstone Dental Group is celebrating the recent news that co-owner and founder Dr. James Nicholls has been announced as the 2010 recipient of the Ohio Dental Association's Marvin Fisk Humanitarian Award. This award is given to dentists who have provided oral health care to those in need by donating their time, skill and personal resources. The Columbus Dental Society nominated "Dr. Jim" for his accomplishments over his thirty years in practice, particularly for his participation in Doctors With A Heart Day at his office starting in the late 1980s. 


A Career of Caring

     Dr. Nicholls graduated from The Ohio State University with a degree in pharmacy, then worked as a pharmacist in the Northland community while attending dental school at OSU. He began his practice on Schrock Rd in 1979 and a few short years later moved across the street to the larger building where the practice(now Northstone Dental Group) is located today. He first participated in Doctors With a Heart Day, a day of donating free  health care to the community, in 1988. The concept, started by Iowa dentist Duane Schmidt, is simple: any health professional can pick one day a year to open up the office doors and donate free care to those in his or her community that can't afford basic services. The idea is that anyone can do this at their own office. If every health care provider would pick a day to give back then access to care for at-risk individuals in a community could be improved and the burden on the usual safety net clinics might be reduced. The offering has grown over the years to include several other area general dentists and specialists volunteering with Dr. Nicholls and Dr. Halderman. Recently other dentists in Central Ohio have even formed similar events at their own offices.


    "It's great to be picked for this award," says Dr. Jim, "back when I started this I never imagined I'd be recognized for it some day". He will be presented with the award at the 144th Ohio Dental Association Annual Session in September in Columbus.

What's the Story on Tooth Grinding/TMJ?

Do You Grind Your Teeth?     

You may notice some gradual shortening or flattening of your teeth over time. It's possible that your dentist noticed some wear on your teeth at your last cleaning but you weren't aware of it. Maybe you had an idea that you were grinding at night because you wake up with a stiff jaw in the morning. Or, it might be that you've had some broken teeth or broken fillings lately even though this hasn't ever been an issue for you before. Whether your jaw clicks, pops, hurts or doesn't seem to do anything at all, it's possible that you grind your teeth. Tooth grinding(also known as bruxism) is incredibly common in the United States. While it's commonly linked to stress there can be a number of different causes, most of which are out of a patient's control since it commonly occurs while sleeping. The causes, however, are vastly outnumbered by the different ways in which grinding can affect a person's teeth and jaw joints/muscles. The effects can be as mild as some minimal wear or flattening of a person's teeth (which may not even be noticed by the person doing the grinding) to a debilitating and painful complex condition that severely affects a person's quality of life.Fortunately most people's experience with grinding, if any, falls short of this type of situation. Once a person's grinding habit is identified problems can often be avoided or managed with dentist supervision and treatment, if needed.

     Why does grinding cause problems? For one, although our tooth enamel is the hardest substance in our body it was not designed to come into contact with other teeth covered with enamel for more than a split second each time you chew. Add it all up and your teeth should only come together for about 9 seconds over the average day. Someone who grinds, however, often does so for three hours or more every night. Add to this the fact that some people also grind some more during the day (maybe while driving or at work) and you can see why it's a recipe for wearing away that protective enamel. Once you get through to the dentin layer underneath it, the tooth wears away about seven times faster.

So What Do I Need to Do?

     For some people, only the teeth are affected. When that's the situation the goal for most dentists and their patients is to restore those teeth that have been chipped or broken back to health with fillings and/or crowns while setting up a game plan for protecting and reducing any further damage to the teeth. In other people, problems arise in the muscles (often sort of like a Charley horse). This can occur either just occasionally for some people or more regularly for others. Often a soft diet and over-the counter pain medication can get a person through the occasional episode. For others who have pain more often some type of mouthguard is usually used. Most dentists make one or several styles of occlusal (bite) guards; fortunately, most of them work well when they are designed and fitted by a licensed dentist. Although mouthguards can be obtained for less outside of a dentist's office, there can be a big advantage to having your dentist supervise your care and provide the ongoing repairs and maintenance that are usually needed. 

 

     In rarer cases the problem is within the jaw joint (TMJ) itself. Sometimes this is clear right from the start, but other times it is only discovered by the process of elimination when other attempts to treat the pain are unsuccessful. In these cases, a referral to a doctor with extensive training in TMJ disorders and treatment is usually a person's best bet. While there is no specialty limited specifically to bite problems, there are many qualified oral surgeons, prosthodontists, orthodontists, periodontists and general dentists that have a strong interest in helping those with more severe problems and who have received additional training in this area. Surgery is reserved as a last resort, and there are several options available for those suffering in these situations.

     While both the problems related to tooth grinding and the options available to treat them range from simple to complex, fortunately most people can benefit from a discussion with their doctor. I often recommend keeping a journal about when and how the problems or discomfort you're having affect you. It's always tough to sum up an ongoing ailment while you're in your doctor's office--we all forget some detail until later that might be the key to selecting the right treatment. The more details you doctor has available the better he or she can serve you.

What are My Options to Replace a Single Missing Tooth?

A Common Situation

     One of the most common treatments in dentistry is the replacement of a single missing tooth. It's something we do so often because recent studies estimate that more than 70% of Americans are missing at least one tooth (not including wisdom teeth) whether that tooth was lost to disease, a traumatic accident, or even because it never formed in the first place. 

While there are several treatment options to solve this common problem, they can vary widely in terms of durability, initial and long-term maintenance costs, number of appointments needed and total length of treatment time. Ultimately the choice is yours but your dentist can help you to understand the pros and cons of each option in your specific case. It's also important to keep in mind that in some cases if your situation seems stable and not likely to worsen with time, simply doing nothing and leaving the space can be an appropriate option. In most cases, though, some kind of treatment would improve the situation.

Removable

     Removable appliances are usually the most economical way to replace a single tooth, but they often have more disadvantages. The most obvious is that the device comes in and out of the mouth and often moves around while chewing and speaking. To prevent it from being a choking hazard it must often be bulky. Where a removable device usually becomes a more attractive option is for the replacement of several missing teeth. In this kind of situation the price difference between a removable partial denture and teeth that stay in all the time and look and function naturally can be much larger, so the disadvantages become less of an issue. There's definitely something to be said though for the psychological advantage of teeth that look and feel like a part of your own body. A removable device can speed up bone loss in the missing space though, making the upgrade to a fixed or cemented-in solution more costly or time-consuming to achieve in the future.

Fixed Option #1: Bridging the Gap

     Once the decision is made to go with a 'fixed' or cemented-in option, the most common choice is between a bridge or an implant. A bridge is essentially a chain of crowns made of metal and porcelain (or just porcelain) that uses the teeth on either side of the space for support while placing a natural looking tooth in the space itself. This option almost always requires removing some of the top and sides of the support teeth to produce a bridge that will stay cemented in place predictably. Some advantages include the time of treatment (usually just 2-4 weeks), the number of appointments needed (2-3) and the fact that most dental insurances provide coverage for the procedure. Disadvantages include that they are harder to keep clean (they require special brushing and flossing methods), higher replacement costs if something breaks or fails down the road, and the fact that you have to involve the teeth on either side (which increases the small chance that  they may need additional treatment, like a root canal, in the long-term). That final consideration (the teeth on either side) can often make the choice between a bridge or an implant easier. If the teeth on either side of the space have large fillings or some other condition that would have require putting a crown on them sometime in the future anyways, then a bridge may ''kill two birds with one stone'' by filling the space and improving the teeth next door at the same time. If those teeth wouldn't have needed crowns or have never had any work done to them, then the option that really shines is the dental implant.

Fixed Option #2: Implants Can Mimic Nature

 

     With over forty years of solid research behind them, dental implants have really changed the way dentists treat missing teeth. They represent a way to replace what has been lost  

by adding back rather than taking away from the surrounding teeth. A titanium implant is placed in the bone in the area of the missing tooth. After a healing period a post called an abutment can be added and a crown is made over this piece. The advantages include little to no drilling on the teeth next door and the fact that implants do not decay and never need root canals. If they fail to heal in the bone in the short term, the procedure can often be repeated. If the replacement tooth breaks in the long term, replacing the crown and/or abutment could be all that is needed (at a cost of about a third of replacing a failed bridge). The disadvantages are mostly related to the additional time that is involved to allow the implant to heal in the jawbone. These times vary depending on the area of the mouth involved and the quality of the bone there. Current guidelines suggest waiting no less than 3 months but possibly up to 6 months for the most predictable results (although in some cases a temporary crown can be inserted on the same day as the placement of the implant). Additionally, to achieve the best results it is often necessary to improve the site of the missing tooth by grafting bone or soft (gum) tissue before a properly-sized implant can be placed there. These additional procedures, while adding time and expense to an overall treatment plan, can make the difference between a ''just O.K.'' result and a solid, long-term result that really mimics nature. The pictures shown here represent an almost ideal situation where we planned from the start to place the implant just a few months after the loss of the tooth. We were able to put a bone graft into the area at the same time the tooth was removed. Afterward, healing went well (a little bit of gum recession resulted in the exposure of a some of the metal collar under the crown but this wasn't a concern for this patient). Many times, however, the tooth has been missing for awhile and more gum and bone has been lost; in this case a choice has to be made between undergoing additional procedures or settling for a less than optimal result.

    
      Another factor to be aware of is that not all dental insurances cover dental implants, but this is improving. While it's understandable to want to choose the option that takes less time or has a lower cost up front, it's important to remember that treatment doesn't end the day the space is filled--we hope to provide you a solution that will serve you for a long time. However, nothing we do in dentistry lasts forever- a dental implant can result in lower costs and less time in the chair in the long run. 

     As always, your dentist can help to guide you through the pros and cons in your particular situation. Fortunately, there is rarely a 'wrong' option--your dentist's goal is to empower you to choose the option that makes you feel the most comfortable while improving your chewing and self confidence by replacing your missing tooth.

 

So What's the Story on Tooth Whitening?

Too Many Choices?

When you decide that you're interested in whitening your teeth, you soon find out that there are a ton of different options to choose from, many of which make the same promises but carry widely different fees or treatment times. By the time you're done digesting all the options, you probably aren't sure whether to bleach at home, at a kiosk, in a doctor's office, overnight, or during the day. Do you use a pen, strip, tray, or maybe a liquid? Do you need to be supervised by a dentist? Do you need a laser or a light? It can be confusing even for your dentist, as some companies may market one product to doctors while recommending another directly to consumers for use at home. There are many ways to bleach your teeth. The truth is that the before and after pictures you see may not tell the whole story. Think about when you see an ad for a product claiming to give you six pack abs or that promises quick weight loss. The examples they show are almost always the very best results. You can be sure that many other people  improved somewhat but fell short of what the pictures show. In fact, attaining a six pack or losing weight can be a great analogy for tooth whitening: everyone responds a little differently, so attaining the goal (in our case, white teeth) involves tailoring a regimen that works for your individual situation. In this post we'll sift though some of the more common options available to you and your doctor. Keep in mind that just like that friend who seems to be able to lose weight by barely exercising, there are people that can get great results with a minimum of bleaching. Then there are others that may need to bleach for 4-6 months or more to achieve the results they're looking for. When you go in prepared for a long treatment time, you won't be disappointed if bleaching takes awhile. Getting quicker results will be a welcome surprise.

Over the Counter

Over the counter options include strips, gels, pens, and liquids, and represent the lowest concentration of peroxide (the two main types used for whitening are hydrogen peroxide and carbamide peroxide, both of which are safe but whose active ingredients are used up over different periods of time). The benefit is that these are easy-to-use and you generally don't need to be supervised while using the product because the concentrations are low enough that side effects like sensitivity are less common. That same benefit can be a drawback, however, because unless you fall into that group that bleaches very easily, you may be disappointed by the results of one package of whatever product you're using. I'll often tell my patients to try no more than one or two packages and if they're disappointed with the results we'll discount our bleaching fee by that amount so they're not losing out by trying an OTC product first. If you've never bleached before, trying an OTC product may be worth a short trial run. The number of people I've met that can get the results they're looking for with this option is small but it is possible. For the majority of us, the best results are usually obtained by the next step up: dentist-supervised tray bleaching.


Custom Tray Bleaching

There are many advantages of custom-fitted take-home trays made by your dentist. First, a higher concentration of peroxide can be used because the active material is held in place by your tray. Also, since you can expect a professional strength product to have a higher chance of side effects the dentist supervision you receive will help minimize you chance of problems. Your dentist's exam before bleaching will allow him/her to identify conditions that make bleaching more difficult (like particular types of internal stains) and areas like recession that might cause sensitivity issues. Your dentist can adjust your treatment accordingly to make your experience more comfortable and help you achieve your goals. While you'll usually start to see results in two to four weeks, most people will get the best results with eight to twelve weeks of daily tray use. In extreme cases it can take up to six months to whiten. Just like dieting and exercise, you get out of it what you put into it. I recommend bleaching just one arch (either the top or the bottom) first so you can really see it working. After that it is easier to 'catch up' with the rest of the teeth. You can expect to invest more than with a single package of OTC whitener (probably about the same as five to six packages) but in many cases this is the best way to get the maximum results. It is also less of an investment than the final option: in office whitening.


Same Day In-Office Whitening

This is what you began to see a few years ago on makeover shows, and with claims of fast, easy whitening it generated a lot of interest as an alternative to wearing trays. You might compare this option to liposuction: it can be the easeist way to get results fast but you'll pay more, you'll still need to do some work on your own afterward, and not everyone is a candidate. The idea is that in a supervised way your teeth are exposed to a very high concentration of peroxide for about an hour. Some brands use a light to activate the bleach and others are designed to work just fine without it.  Your dentist has to place some protective coverings over your gums and lips to prevent injury to them. The good news: when it works it can be a great way to have instantly whiter teeth. The reason this hasn't fully replaced everything else: we know that only about 25% of people get an outstanding result with in-office treatment alone. Some of the whiteness that you see after the in-office treatment is due to the teeth dehydrating over the hour of being deprived of saliva and exposed to the air. Within a couple of hours they rehydrate and lose some of this initial brightness. Most people get a nice 'jump-start' but need to continue bleaching with trays at home for several weeks to reach their brightest levels.  Some dentists will include trays and take-home bleach in their fee for the in-office treatment, and starting with the in-office session may be a great way to shorten your overall treatment time. While sensitivity tends to be more of an issue, it will usually last only a day or two and can often be controlled with over-the-counter pain medication. 

Whether you plan to try OTC products or are interested in a treatment offered by your dentist, it can be very helpful to bring this up to your dentist so he/she can steer you in the right direction. Bleaching your teeth can improve your confidence and give you a radiant smile, and your dentist should be happy to help you achieve your goals in a safe and effective way. Feel free to ask any of your bleaching questions here and I'll be happy to answer them for you.