DeterminingtheRightWhiteningApproachisKeytoBrighteningaDullSmile

Bright, naturally white teeth are a key component in a beautiful smile. But the opposite is also true: nothing diminishes an otherwise attractive smile more than stained or discolored teeth.

There is good news, however, about tooth staining: it can be greatly reduced with the right whitening technique. But before taking action we need to first uncover the cause for the staining — whether from the outside or inside of the tooth, or a combination of both.

If it’s an external cause — known as extrinsic staining — our diet is usually the source. Foods and beverages that contain tannins, like red wine, coffee or tea fall in this category, as do foods with pigments called carotenes as found in carrots and oranges. Besides limiting consumption of stain-causing foods and maintaining daily oral hygiene, you can also diminish extrinsic staining with a bleaching application.

There are two basic ways to approach this: with either a professional application at our office or with a home kit purchased at a pharmacy or retail store. Although both types use similar chemicals, the professional application is usually stronger and the whitening effect is obtained quicker and may last longer.

Discoloration can also occur within a tooth, known as intrinsic staining, and for various reasons. It can occur during tooth development, as with childhood overexposure to fluoride or from the antibiotic tetracycline. Poor development of enamel or dentin (the main sources of natural tooth color), tooth decay, root canal treatments or trauma are also common causes of intrinsic discoloration.

There are techniques to reduce the effects of intrinsic staining, such as placing a bleaching agent inside the tooth following a root canal treatment. In some cases, the best approach may be to restore the tooth with a crown or porcelain veneer. The latter choice is a thin layer of dental material that is permanently bonded to the outer, visible portion of the tooth: it’s life-like color and appearance covers the discoloration, effectively renewing the person’s smile.

If you’ve been embarrassed by stained teeth, visit us for a complete examination. We’ll recommend the right course of action to turn your dull smile into a bright, attractive one.

If you would like more information on treatments for teeth staining, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Teeth Whitening.”

WhyemBigBangTheoryemActressMayimBialikCouldntHaveBraces

Mayim Bialik has spent a good part of her life in front of TV cameras: first as the child star of the hit comedy series Blossom, and more recently as Sheldon Cooper’s love interest — a nerdy neuroscientist — on The Big Bang Theory. (In between, she actually earned a PhD in neuroscience from UCLA…but that’s another story.) As a child, Bialik had a serious overbite — but with all her time on camera, braces were just not an option.

“I never had braces,” she recently told Dear Doctor – Dentistry & Oral Health magazine. “I was on TV at the time, and there weren’t a lot of creative solutions for kids who were on TV.” Instead, her orthodontist managed to straighten her teeth using retainers and headgear worn only at night.

Today, there are several virtually invisible options available to fix orthodontic issues — and you don’t have to be a child star to take advantage of them. In fact, both children and adults can benefit from these unobtrusive appliances.

Tooth colored braces are just like traditional metal braces, with one big difference: The brackets attached to teeth are made from a ceramic material that blends in with the natural color of teeth. All that’s visible is the thin archwire that runs horizontally across the teeth — and from a distance it’s hard to notice. Celebs like Tom Cruise and Faith Hill opted for this type of appliance.

Clear aligners are custom-made plastic trays that fit over the teeth. Each one, worn for about two weeks, moves the teeth just a bit; after several months, you’ll see a big change for the better in your smile. Best of all, clear aligners are virtually impossible to notice while you’re wearing them — which you’ll need to do for 22 hours each day. But you can remove them to eat, or for special occasions. Zac Efron and Katherine Heigl, among others, chose to wear clear aligners.

Lingual braces really are invisible. That’s because they go behind your teeth (on the tongue side), where they can’t be seen; otherwise they are similar to traditional metal braces. Lingual braces are placed on teeth differently, and wearing them often takes some getting used to at first. But those trade-offs are worth it for plenty of people. Which celebs wore lingual braces? Rumor has it that the list includes some top models, a well-known pop singer, and at least one British royal.

So what’s the best way to straighten your teeth and keep the orthodontic appliances unnoticeable? Just ask us! We’d be happy to help you choose the option that’s just right for you. You’ll get an individualized evaluation, a solution that fits your lifestyle — and a great-looking smile!

For more information about hard-to-see (or truly invisible) orthodontics, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Orthodontics for the Older Adult” and “Clear Aligners for Teenagers.”

ProfessionalCleaningsHelpyouMaintainHealthyTeethandGums

Every good oral hygiene regimen has two parts — the part you do (brushing and flossing) and the part we do (professional cleanings and checkups).

But what’s involved with “professional cleanings” — and why do we perform it? The “why” is pretty straightforward — we’re removing plaque and calculus. Plaque is a thin film of bacteria and food remnant that adheres to tooth surfaces and is the main culprit in dental disease. Calculus (tartar) is calcified plaque that occurs over time as the minerals in saliva are deposited in bacterial plaque. It isn’t possible for you to remove calculus regardless of your efforts or hygiene efficiency. Ample research has shown that calculus forms even in germ-free animals during research studies, so regular cleanings are a must to keep you healthy.

The “what” depends on your mouth’s state of health and your particular needs. The following are some techniques we may use to clean your teeth and help you achieve and maintain healthy teeth and gums.

Scaling. This is a general term for techniques to manually remove plaque and calculus from tooth surfaces. Scaling typically encompasses two approaches: instruments specially designed to remove plaque and calculus by hand; or ultrasonic equipment that uses vibration to loosen and remove plaque and calculus, followed by flushing with water and/or medicaments. Scaling can be used for coronal maintenance (the visible surfaces above the gum line) or periodontal (below the gum line).

Root planing. Similar to scaling, this is a more in-depth technique for patients with periodontal disease to remove plaque and calculus far below the gum line. It literally means to “plane” away built up layers of plaque and calculus from the root surfaces. This technique may employ hand instruments, or an ultrasonic application and flushing followed by hand instruments to remove any remaining plaque and calculus.

Polishing. This is an additional procedure performed on the teeth of patients who exhibit good oral health, and what you most associate with that “squeaky clean” feeling afterward. It’s often performed after scaling to help smooth the surface of the teeth, using a rubber polishing cup that holds a polishing paste and is applied with a motorized device. Polishing, though, isn’t merely a cosmetic technique, but also a preventative measure to remove plaque and staining from teeth — a part of an overall approach known as “prophylaxis,” originating from the Greek “to guard or prevent beforehand.”

If you would like more information on teeth cleaning and plaque removal, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Teeth Polishing.”

WhySmokingandDentalImplantsDontMix

With a 95-plus percent survival rate after ten years, dental implants are one of the most durable replacement restorations available. Implants can potentially last much longer than less expensive options, which could make them a less costly choice in the long run.

But although a rare occurrence, implants can and do fail—often in the first few months. And tobacco smokers in particular make up a sizeable portion of these failures.

The reasons stem from smoking’s effect on oral health. Inhaled smoke can actually burn the outer skin layers in the mouth and eventually damage the salivary glands, which can decrease saliva production. Among its functions, saliva provides enzymes to fight disease; it also protects tooth enamel from damaging acid attacks. A chronic “dry mouth,” on the other hand, increases the risk of disease.

The chemical nicotine in tobacco also causes problems because it constricts blood vessels in the mouth and skin. The resulting reduced blood flow inhibits the delivery of antibodies to diseased or wounded areas, and so dramatically slows the healing process. As a result, smokers can take longer than non-smokers to recover from diseases like tooth decay or periodontal (gum) disease, or heal after surgery.

Both the higher disease risk and slower healing can impact an implant’s ultimate success. Implant durability depends on the gradual integration between bone and the implant’s titanium metal post that naturally occurs after placement. But this crucial process can be stymied if an infection resistant to healing arises—a primary reason why smokers experience twice the number of implant failures as non-smokers.

So, what should you do if you’re a smoker and wish to consider implants?

First, for both your general and oral health, try to quit smoking before you undergo implant surgery. At the very least, stop smoking a week before implant surgery and for two weeks after to lower your infection risk. And you can further reduce your chances for failure by practicing diligent daily brushing and flossing and seeing your dentist regularly for cleanings and checkups.

It’s possible to have a successful experience with implants even if you do smoke. But kicking the habit will definitely improve your odds.

If you would like more information on dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Implants & Smoking.”

CouldADentalCheckupSaveYourLife

Most everyone knows that going to see your dentist for regular checkups and cleanings can help save your smile — but did you ever stop to think that it just might save your life?

That's what recently happened to 11-year-old Journee Woodard of Edmond, Oklahoma. The young girl was having a routine teeth cleaning when hygienist Rachel Stroble noticed something unusual: The whites of her eyes (her sclera) had a distinctly yellow tint. Dr. Michael Chandler, Journee’s dentist, confirmed the hygienist’s suspicions, and advised her mom to take her for further testing. The tests revealed that Journee had a tumor covering parts of her pancreas, gallbladder and liver; it could have ruptured at any moment, with devastating consequences.

The tumor was removed three days later in a 9-hour operation, and Journee is now recovering. As for her dentist, Dr. Chandler told reporters that he and his staff were just doing their jobs thoroughly. “It's hard to feel like I’m a hero,” he said (though others might disagree).

Is this a one-in-a-million case? Maybe — yet for many people, a family dentist may be the health care professional who is seen more often than any other. That can put dentists in the unique position of being able to closely monitor not only a person’s oral health, but also their overall health.

There are several reasons why that’s so. One is that most systemic diseases (such as diabetes, leukemia, and heart disease, for example) can have oral manifestations — that is, symptoms that show up in the mouth. If your dentist notices something unusual, further testing may be recommended. Dentists also regularly screen for diseases specific to the mouth — such as oral cancer, which has a much better chance of being cured when it is caught at an early stage.

But beyond checking for particular diseases, dentists often notice other things that may indicate a health issue. For example, if you complain of dry mouth or snoring, and appear fatigued in the dental chair, your dentist may suspect undiagnosed sleep apnea: a potentially serious condition. Many other signs — such as yellowed eyes, a pounding heart rate, or shortness of breath — can indicate potential problems.

Of course, we’re not even mentioning the main reason for regular dental checkups — keeping your smile healthy and bright; for many people that’s reason enough. How does Journee’s mom feel about keeping dental appointments? “I will never miss another dentist appointment,” she told reporters. “I will never reschedule.”

If you would like more information about routine dental checkups, please contact us or schedule an appointment. You can learn more by reading the Dear Doctor magazine articles “The Dental Hygiene Visit” and “Good Oral Health Leads to Better Health Overall.”





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Dr. George Salem and Associates, P.C.

Braintree, MA Dentist
Dr. George Salem and Associates, PC
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Braintree, MA 02184
(781) 843-0660
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