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.  

Doctors With a Heart Day 2009 Video

Just wanted to share a recent video from Doctors With a Heart Day 2009 at our office. Keep an eye out for announcements for next year's event, which will likely include volunteer physical therapists as well!

What are implant dentures?

'Dentures aren't a replacement for teeth. They're a replacement for no teeth'. This is a common phrase in the dental world to describe the limitations of traditional dentures. At their best traditional dentures can be a beautiful replica of a full set of pearly whites, fooling even close friends and loved ones with their natural look. Even a great looking set of dentures, however, usually leaves something to be desired when eating a meal with foods like steak, salad, and crunchy vegetables. Most denture wearers experience the shifting, sliding, and falling out that can be a very frustrating part of the denture experience. Besides making eating difficult, it can give a person a lot of anxiety about their denture coming out during social or romantic situations. Many people can get by with an upper denture because there is usually a lot more bone for the denture to rest on and more suction provided by the roof of the mouth. Unless advanced bone loss is present, a little adhesive can generally make an upper denture tolerable. But a lower denture is a completely different story. Making a traditional lower denture that satisfies all of a person's expectations for fit, comfort, and chewing ability is without a doubt one of the hardest things to do consistently as a dentist. Try as we might, the lack of bone combined with the strong action of the chin muscles and the floor of the mouth pulling upwards and outwards often makes trying to keep a lower denture in place during chewing like trying to keep a tight squeeze on a bar of soap with wet hands. This is where dental implants can make a huge difference in a person's quality of life, by giving support to a lower denture to keep it in place while eating and speaking. Just two titanium implants can reduce a lower denture's movement and improve all of its features. Depending on how much movement a denture wearer is willing to put up with, more implants can be added (often with a bar connecting them) to reduce the movement even further. If enough implants are used(often 5-6 in the lower jaw) a prosthesis with no movement at all can be made, with the additional benefit that the teeth can stay in all the time. This can be done gradually, adding a couple implants every few years until enough are in place to go with this option. Because bone loss starts the moment teeth are removed, it's best to make implants a part of the plan with lower dentures right from the start. As bone loss takes place, the window of opportunity for having implants slowly closes, so that by the time a person is really having problems with denture movement, extensive bone grafting may be needed, adding time and expense to one's treatment. With dental implants, dentures CAN be a great substitute for teeth, and can be very rewarding for both patients and their dentists, who get to hear about their improved chewing, self-esteem, and confidence compared to what they experienced with traditional dentures. Feel free to ask any questions you have about implant dentures, and I'll be happy to try to answer them for you.

Sedation Options in Dentistry

Sedation dentistry most often involves the use of anti-anxiety medication to do just that--reduce your anxiety surrounding dental treatment. Depending on your level of fear and the procedure that you need to have done (taking into account things like how long it will take), your dentist can discuss different options to improve your dental experience. It's important to remember that something like having a dental implant placed or undergoing root canal treatment causes different levels of anxiety in different people, and the goal is to match the level of sedation with your particular needs. In order of the lightest to the heaviest levels of sedation, here are the options you'll usually have:

In a general dental setting (and often in the movies) the most common option (due to its high level of safety) is nitrous oxide, known affectionately as 'laughing gas'. When mixed with oxygen and inhaled through a small rubber mask that fits over your nose, nitrous oxide produces a feeling that most people find very pleasant. The phrase I like to use (because it seems to be accurate) is that once the gas kicks in, being at the dentist sounds like a much better idea than it did on the way to the office. By reducing your anxiety, the gas also elevates your pain threshold (which is great because even though you'll still receive numbing medication, for some people things like opening wide and having your lips and tongue tugged on can be bothersome too). It also can make the appointment seem shorter. If for any reason you don't like how the gas makes you feel, it can be turned off and its effects wear off very quickly. Perhaps the best benefit of this option is that after a few minutes of breathing regular oxygen as the procedure is finishing up, you're back to feeling like your old self and can drive yourself home with no after-effects (though to be completely honest, you sometimes feel a little drained--this is thought to come more from the adrenaline surge you get building up anxiety before the procedure than from the gas itself). If I haven't convinced you yet, it's also wonderful for all procedures performed on children, allowing us to build positive experiences for them from the start. In many offices there is no charge for the gas so you may want to consider it even for minor work like fillings and other small procedures.

The next step up would be oral sedation, usually given as a single dose in pill-form before your appointment. For a small fee (the cost of the pill at the pharmacy) you'll reach a slightly more sedated level than with nitrous oxide, but will still be awake and breathing on your own. If you appear to be strongly affected your doctor will likely attach a monitor to you to keep a constant watch on your blood pressure and breathing habits to keep you safe. You'll probably talk during the procedure but will have little recollection of it. This type of sedation means that you need to arrive at the office with an escort who will stay there until your appointment is over, can go over post-operative instructions with us, and will drive you home afterward. This is a common option if you'd prefer not to remember too much about the visit, but requires a little more planning because you'll probably be drowsy for several hours after your appointment so you'll have to make arrangements for work, etc. Another great use for this type of sedation is take a small dose to help you get a restful night's sleep before the appointment. Because medications affect everyone differently, you might be a little more or less sedated than you planned on but over a couple of visits your dentist can figure out a dosage that works best for you.

The safe way to reach a deeper level of sedation (though still called 'conscious sedation' because you're still breathing on your own) involves the use of intravenous (IV) medication. When you take a pill your level of sedation cannot be adjusted because taking more pills while in the chair is not a safe option. With IV sedation, however, your doctor can predictably raise your level of sedation if you are uncomfortable or lower it if you appear to be approaching levels deeper than conscious sedation. You'll be in a state where you can be woken up if needed, but you'll probably spend much of the appointment with your eyes closed and will have less memory of the procedure than you would with oral sedation. Like oral sedation you're required to bring an escort. There's an additional requirement of not having anything to eat after midnight the night before your appointment. Due to the additional training, equipment, and medications needed to offer this option, IV sedation almost always carries a moderate fee.

Less common, the deepest levels of sedation are often reserved for treatment in an oral surgeon's office or in the most serious cases of dental anxiety. As you'd expect for a surgery like having your appendix removed, you are unconscious and breathing is controlled for you via machine until the procedure is over. Though this option has a long track record of safety, it can sometimes result in more drowsiness and nausea. Since it requires the most equipment and training it often carries the highest cost but in some instances it is the only option.

Hopefully this gives you some idea of what options are out there. Your dentist can discuss whether you are a candidate for one of these types of sedation. For some people these techniques can mean the difference between being able to receive dental care or not, while others may choose to use them only from time-to-time for a particularly involved or anxiety-producing procedure. As always, the choice is up to you, but know that you can probably benefit from at least one of the many types of sedation in dentistry. If you have any questions, please feel free to contact us here or at www.northstonedental.com!

Discussing Fear and Anxiety with Your Dentist

It's no secret that going to the dentist is consistently ranked as one of the things most feared by people, sometimes listed higher than public speaking or even death. I've heard many different stories from our patients over the years about dental experiences that caused them a great deal of pain or left them feeling traumatized for life. Often these were procedures they had done as children, and the memories still conjure up anxiety, in many cases so much so that certain parts of the dental experience trigger an overwhelming sense of terror or a 'fight or flight' type of response. This could include arriving at the office, getting in the chair, or seeing the instruments on the table. It often results in a vicious cycle of avoiding the dentist until something is seriously wrong and extensive work is needed, leading to even more anxiety and causing the person to think 'This is why I hate going to the dentist in the first place!'

Regardless of your level of anxiety about receiving dental care, you can be sure that a caring dentist will be happy to discuss the things that are unpleasant for you, and would prefer to know about them so they can do their best to minimize their impact on you. Many people feel embarrassed or guilty and feel the need to apologize for what are often uncontrollable responses that come from their fear and anxiety. The first thing to realize is that your fears, whatever they may be, are completely normal and are probably shared by many others just like you. Your dentist has almost certainly heard a story similar to yours at least once and is there to help you have better experiences moving forward. We really do want to make you as comfortable as possible, and our profession as a whole has more tools than ever before at our disposal to do this. We know that these triggers are different for everyone, and something that really frightens one person may just annoy someone else but isn't even noticed by another. Some people are more comfortable being able to ask many questions about a procedure (this is always allowed and highly recommended if you are interested) while others would prefer to know as little as possible about the details. Knowing as much about your past experiences allows us as dentists to try to tailor your dental experience to your individual triggers and emotions. This type of open discussion can do wonders for improving how you feel about the dentist! But beyond discussion dentistry has many other tools we can offer to make your experience a better one; these are often grouped together into what is called 'sedation dentistry'... (more on this in the next post)

Doctors With a Heart Day 10.22.2009

This Thursday our office will participate in its 4th annual Doctors With a Heart Day. This special event was first conceived by an Iowa dentist named Duane Schmidt in the early 1980s. Dr Schmidt's intention was to inspire physicians, dentists, podiatrists, optometrists, physical therapists, and psychologists to pick one day a year to open their doors and provide free care to their community. Although originally the event centered on Valentine's Day, offices can pick whatever time of year works for them. We've found that as the holidays draw near and the prospect of all the other demands on people's spending increases (making dental care that much harder to obtain), we've enjoyed offering this service in late October each year. As a thank you not only to the North Columbus community that has nurtured and sustained our practice for over 30 years, but also to all those in need in Central Ohio, we're proud to open our doors from 8AM-5PM this Thursday to offer free dental care to anyone who thinks they would benefit. We'll have seven volunteer dentists from around Columbus to extract and fill teeth, adjust dentures, provide cleanings and more on a first-come, first-served basis. We saw 180 patients last year and hope to be able to help even more in 2009. For directions, further information, and to download and print registration forms, please visit us here . Please pass this along to anyone you think may benefit, and we'll look forward to seeing you on the 22nd! Northstone Dental Group 1730 Schrock Rd Columbus, OH 43214

What's the deal with all the X-rays? (Part 1)

As you come in for your new visit or twice-yearly checkups, it becomes obvious that in the modern practice of dentistry you can expect to have X-rays (or radiographs, as we like to call them) recommended to you pretty often. What's the deal with all these films? They carry a monetary cost (often, but not always covered by insurance plans) in addition to raising concerns about radiation exposure. As with many things in life, you have to weigh the pros and cons. The truth is that a regularly-taken series of radiographs is one of the most important parts of a successful preventive dental plan. Whether your dentist takes a full series, routine bitewings, or an orthopantomograph (the one where you stand up and the tubehead rotates around you), these films allow a dentist to keep your overall time in the chair and costs down in a number of different ways. First off, although we like to think that we're pretty good at catching dental caries (decay) and periodontal (gum) disease in its early stages, we are limited when all we use is the naked eye (even with the nerdy-looking microscope glasses that we wear). In certain areas, like in between teeth and under existing fillings, decay is often detectable several months earlier on well-taken radiographs than under direct vision. It's amazing how silently decay can grow and when it finally becomes visible in these spots, you can be sure it's going to be deep, opening the door for more involved dental work (like a root canal and/or a crown) . If we can find a spot of decay while it's still small, now we're only talking about a small filling or even better, a chance to stop the decay in its tracks with a high-fluoride toothpaste or rinse. The cost savings for a filling vs. a root canal and crown can be over a thousand dollars, making the films (at less than fifty bucks a year) a pretty attractive option. Lately, a lot of people are analyzing their spending and trying to eliminate unneccessary purchases. This can be a great thing in many aspects but it can work against you in dentistry where, like the old saying, an ounce of prevention is worth a pound of cure. In our office we recommend keeping up with a regular schedule of X-rays, but if yearly films aren't an option for you right now then getting them every two years can still make a tremendous difference in your ability to avoid future unplanned dental work. As far as radation exposure is concerned, over the long term the exposure from the number of films that must be taken for a procedure such as a root canal can outnumber the exposure for routine preventive X-rays. Also, digital films (which are becoming increasingly more common) reduce your exposure even further. As always, it's important to be as informed as possible about the dental treatments that are recommended for you, and your dentist should be happy to discuss any concerns you may have about the pros and cons of dental X-rays.