Over the past few weeks I have had six or seven patients come in complaining of unsettling pain in various teeth—now this would not be unusual, after all I am a dentist—what makes it unusual is that in every case, these people who are complaining of pain strong enough for them to take time off from work, request an emergency appointment, and actually look happy to see me have had nothing wrong with their teeth!
What the heck is going on here?
The common thread in each of these cases is that the patient has switched to a whitening toothpaste within the previous three to four weeks. Eureka! A problem with an easy solution.
Using whitening toothpaste doesn’t actual make your teeth whiter. These popular toothpastes actually can make your teeth dull and less white in the long run, not to mention the kind of sensitivity that you can feel in your armpits! Here’s why: the reason whitening toothpaste whitens is because it has a mild abrasive in it which takes of a film of enamel as you brush. For a moment of two seconds your teeth look a little whiter, but over time it actual dulls your teeth and makes them harder to get white. Worse than that, since the toothpaste is an equal opportunity abrasive, it roughs up your gums and oral mucosa like sandpaper on a car paint job. This causes the sensitivity that is a pain in the root tips and an emergency visit to me.
Fear not, there are other solutions to getting white teeth.
But before I explain these methods, let me just say this: Teeth are not naturally WHITE. They are shades of white, and even the lightest, there can be a subtle yellowing near the roots. So, if your goal is to have super-white teeth with no subtle variations of color, the teeth may look unnatural. Also, not everyone has the same shade of teeth. The shade guide below shows the range of color in natural human teeth.
As you can see, there’s quite a lot of color! So it’s important to note that bleaching will not take you to A1 (on the left) if you started at C4 (on the right). Most bleaching will only lighten a few shades.
Home Bleaching:There are two basic forms of home bleaching: Bleaching trays with gel, available from your dentist in several strengths (10%, 20%, and 35% hydrogen peroxide) and whitening strips (Crest, etc.) available from the drug store. Both work well but require diligence—you must use it everyday for several days or weeks to achieve the maximum benefits. I do occasionally recommend this method to patients since it is the cheapest (about $35/box), and the results are OK. There is some sensitivity, along with a little bit of clumsiness—the strips don’t fold over your teeth quite as easily as that girl in the commercial makes it look—so I suggest using a custom bleaching tray (available from your dentist) for better results. If you experience sensitivity with the strips, try using them every other day and use a dot of Sensodyne toothpaste in the trays for about 15 minutes on the off-bleaching days.
In-Office Bleaching: there are several kinds of in-office bleaching available today. One method that is well advertised is Zoom. This technique takes several visits and can get pricey ($500+). Immediate results are reportedly good (I don’t use this in my office, so I am sharing what I have heard); however, there can be some increased sensitivity. In fact, some patients who have had this technique have reported it to be painful.
Another in-office technique is called Sinsational Smile . This is what I use in my office. I chose this system because I liked the overall premise that it is gentle, takes one visit, can be done several times a year, and is relatively inexpensive (under $150/treatment). A flexible tray pre-filled with bleaching material is placed in the mouth for 20 minutes and exposed to a strong, warming LED light. So far, every patient who has had this done LOVES it! And they results are terrific. No sensitivity, even in patients who tend to be sensitive. Noticeable results. Teeth are brighter, even in between, and the touch-up pen that comes with each treatment keeps teeth refreshed and bright for weeks at a time.
Veneers:A veneer is like a false fingernail that is applied to your tooth with minimal preparation of the tooth surface. It is a fantastic treatment for people who can’t achieve the desired shade in their teeth through bleaching. This would include people who have tetracycline stains, a tooth discolored because of a root canal or injury to the nerve of the tooth. It is a two-visit procedure, but the results last for years. Since the restoration is custom made in a dental lab, the color is matched to your predominant tooth color so it blends in with your other teeth. Some cosmetic defects—chips, irregularities in shape, etc can be corrected; however, it cannot usually resolve large gaps or twisted teeth. It is also more expensive at ($1100+) per tooth than other strictly whitening techniques.
Crowns: A crown or “cap” as many people call it, is another way to correct the color, shape, and look of a tooth, although this approach is used when there are structural issues or damage and shouldn’t be use strictly for whitening. The dentist (that would be me) drills the tooth down until it resembles a peg, then a false cover or crown is hand-made by the dental lab. In the lab, porcelain can be fused to a metal or, especially for front teeth, there are crowns made of all porcelain. The porcelain shade is customized as with veneers. This procedure is also upwards of $1100; however, the results are excellent, and in some cases where permanent discoloration or decay is present, a crown is the perfect solution.
That’s a lot of talk on a blog-post about bleach and toothpaste.
Smiling to myself,
Directly from the American Dental Association website
ADA, CDC, OSAP Provide Resources to Dental Professionals
The ADA remains in contact with the Centers for Disease Control and Prevention (CDC) and the Organization for Safety, Asepsis and Prevention (OSAP) regarding Ebola and is dedicated to providing the most up to date information for dental professionals on this evolving issue.
As of October 17, 2014, dental professionals are advised of the following:
A person infected with Ebola is not considered contagious until symptoms appear. Due to the virulent nature of the disease, it is highly unlikely that someone with Ebola symptoms will seek dental care when they are severely ill. However, according to the Centers for Disease Control and Prevention and the ADA Division of Science, dental professionals are advised to take a medical history, including a travel history from their patients with symptoms in which a viral infection is suspected.
As recommended by the ADA Division of Science, any person within 21 days of returning from the West African countries Liberia, Sierra Leone and Guinea may be at risk of having contacted persons infected with Ebola and may not exhibit symptoms. If this is the case, dental professionals are advised to delay routine dental care of the patient until 21 days have elapsed from their trip. Palliative care for serious oral health conditions, dental infections and pain can be provided if necessary after consulting with the patient’s physician and conforming to standard precautions and physical barriers.
An elevated temperature (fever) is often a consequence of infection, but Ebola is not the only infection that may have similar signs and symptoms. The most common signs and symptoms of Ebola infection are:
You are advised not to treat dental patients if they have these signs and symptoms for Ebola. If a patient is feeling feverish and their travel history indicates they may be at risk of Ebola, dental professionals and staff in contact with the patient should:
The Ebola virus is spread through direct contact (through broken skin or mucous membranes) with blood and body fluids (urine, feces, saliva, vomit and semen) of a person who is sick with Ebola, or with objects (like needles) that have been contaminated with the virus. Ebola is not spread through the air or by water or, in general, by food. Again , there is no reported risk of transmission of Ebola from asymptomatic infected patients.
A patient came into the office today and as he sat down in the chair he told me that he had read something about Gandhi teeth. Gandhi was a fragile man, so very thin, had very few teeth, and sufered from bad breath. He often went barefoot so his feet were heavily calloused.
"So, " says my patient, " I guess you could call him a Super calloused, fragile mystic hexed with halitosis!"
We're here all week people, and the jokes are free!
Hello, smiling faces! I know you are smiling because you are reading a dentist's blog and that is kind of funny. Now I will give you a great reason to smile....my patient's recipe for Christmas Cheer. WARNING: This stuff is addictive! Proceed with caution. And brush. And floss!
Here it is, in her own handwriting:
Last week, a patient brought in treats for the office. (Note to readers and patients: this is a great idea!). My lovely receptionist (and wife) put the ziploc container in the break room and when she came back at lunch, I was chowing down on these little turtle treats.
They are amazing!
Here is the RECIPE:
But wait.... there's more...
Just this morning, Sabrina received an email from her art teacher, Sandy Jones, here is an excerpt.....
Also, I wanted to let you know that the pretzel/Rolo/pecan jobbies were a HUGE hit this weekend at my neighbor's BBQ!!! Her son (My quasi-nephew) was home from the Marines and he flipped. How-EVER, he had an excellent suggestion to substitute mini Reese's PB cups, which I did, and I honestly can't decide which is better!! You should try it. I sent him back to base with about 50 of those puppies and he couldn't be happier.
PLUS, I passed the "recipe" to 3 other women at the BBQ, so this thing is going viral - HA! Curses on your patient....thankfully I only had about 20 over the course of the 3-day weekend JEEEEZ.
So Reeses...a BRILLIANT substitution. Go forth and go viral, y'all..
Happy Smiling and Snacking and Brushing and Flossing!
Happy New Year! I hope all of you have had a lovely holiday season and that you maintained a consistent brushing and flossing schedule in spite of excesses in Rum Toddies, Peanut Brittle, and Cheese Balls. I have nothing pithy to offer at this time, but I wanted to start the year with a blog, so here are two humorous and completely unrealated bits of fun:
Derek THompson did an unemployment study in the Atlantic Monthy, which you can read in full below the graph. The graph shows lowest unemployment rates by profession--just the top thirteen. Take a look at the third from the left...and thank you very much from me.
and in unrelated humor: