July 17, 2018

Joyce gets straight beautiful teeth without braces

Joyce got straight beautiful teeth without braces with dental veneers by Laguna Niguel cosmetic dentist Dr. Huefner.

Joyce came to our Laguna Niguel cosmetic dental practice referred by a mutual colleague, Dr. Juris Bunkis, a very prominent plastic surgeon in Rancho Santa Margarita.  Her children were grown and out on their own and so it was finally time that she could start doing some things she had always wanted to improve her appearance and make herself look a little younger.

When she came to our office for her consultation the first thing she said was “I don’t like the way my teeth look and I understand you can give me straight beautiful teeth without braces.”  She went on to explain that when she told her family dentist that she wanted better looking teeth he immediately sent her over to an orthodontist.  Hesitantly, she went and when the orthodontist told her she would have to be in braces for 18 months and then wear a retainer for decades after, Joyce declined his treatment.  Then she went to a “cosmetic dentist”, who said that he could make her dental veneers to fix the color and chipping, but again, she should have her teeth straightened with Invisalign first.  After the dental veneers were made for her the “cosmetic dentist” also recommended decades of wearing retainers so that her teeth and dental veneers wouldn’t go crooked again.  Defiant that under no circumstances would she consider any orthodontics, and a bit confused, she came to our office for “one more opinion.”

Joyce didn't like her crooked, chipped, discolored teeth. She was adamant that she would not go through orthodontic treatment. She came to Dr. Huefner after being referred by plastic surgeon Dr. Juris Bunkis, who told her that Dr. Huefner could make her straight beautiful teeth without braces.

Before jumping to any conclusions about the best treatment for Joyce, Dr. Huefner asked her a number of questions.  “What do you dislike most about your teeth?”  She answered that her teeth were crooked.  “What else bothers you?”  Her front teeth were chipped along the edges and the side teeth were too pointy was her response.  “Anything else?”  She said that she really wanted whiter teeth, but had already tried bleaching.  Her teeth were too sensitive afterwards and they didn’t get as white as she wanted them.  “So, essentially you want straight, white, pretty teeth and you aren’t willing to have braces, is that right?” asked Dr. Huefner asked Joyce.  She confirmed that was precisely what she wanted.

Then Dr. Huefner carefully examined her teeth, which he found to be healthy with only a few fillings.  And they were yellow, crooked, chipped and pointy, as she had said in the beginning.  Then he told her exactly what she wanted to hear, that he could give her beautiful, straight, white teeth and her entire treatment would be completed in less than three weeks and that she would not have to have braces or any retainer.  Joyce was ecstatic…..straight beautiful teeth without braces!  Dr. Huefner went on to explain that the “cosmetic dentist” she had seen wasn’t off base at all, that orthodontics would make the dental veneering process a little easier.  However her teeth weren’t that crooked and that Dr. Huefner had successfully treated numerous patients with teeth more crooked than hers without needing to do any orthodontics at all.  He felt very confidant that he could create a beautiful smile with straight, white teeth for Joyce without any braces.

Joyce the asked how many teeth Dr. Huefner thought should get dental veneers.  In looking at Joyce’s smile, she clearly showed 10-12 teeth, thus he recommended dental veneers for her ten upper front teeth.  “What about my lower teeth?” asked Joyce.  Dr. Huefner answered that her lower teeth were pretty straight and that he thought she could use a milder bleaching treatment that wouldn’t make her teeth so sensitive.  Although they might not get as white as her upper dental veneers, he thought that they would get white enough to satisfy her.  Joyce was getting very excited about the techniques that Dr. Huefner would be using and very anxious to get started with her cosmetic dental treatment with dental veneers and teeth bleaching as soon as possible.

Lower photo: Joyce had crooked, chipped, discolored teeth. Upper photo: After dental veneers by Dr. Huefner her upper teeth were beautiful, white and straight. Her lower teeth were whiter after mild bleaching treatments.

After doing a dental exam with x-rays and taking models of Joyce’s teeth to plan her treatment, Dr. Huefner scheduled her appointments.  Joyce’s treatment went smoothly and just as Dr. Huefner had promised, she got her straight beautiful teeth without braces a couple weeks later.

As can be seen in the photos, Joyce got a great result.  The interesting thing is that she is not unlike many if not most of our cosmetic dental patients.   Almost any adult has some slightly crooked teeth, but even if orthodontics are done it doesn’t solve problems related to the color and shape of the teeth, or take the place of unnatural fillings or crowns.  So depending on the condition of the patient’s teeth and some other factors, most cosmetic dentists today can achieve the desired results with porcelain veneers and/or porcelain crowns.  And the great news about both of these treatments is that nowadays the color of porcelain veneers and crowns is very stable…THEY WON’T DISCOLOR OR DARKEN over the years like natural teeth do.  The extremely smooth surface is very resistant to stain insuring a beautiful smile with white teeth for years and years!

Dr. Norman Huefner, Laguna Niguel dentist, dental veneers Orange County cosmetic dentist

“Yikes! My Front Tooth Broke Off, What Can I Do?” How an Orange County cosmetic dentist saved his patient from major embarrassment.

broken front tooth

Amy was devastated and in tears when her front tooth broke off near her gum line. When this happens sometimes the tooth can be saved with a post and core and new porcelain crown. Other times the treatment of choice is either a dental implant or non-removable porcelain bridge.

Amy is an attractive lady, a Realtor by profession.  Back in her 20s she had chipped her front tooth badly and ended up needing to get a root canal and crown on it.  She was content until one day she was eating and bit down hard on something in her food.  Wham…..her tooth broke off near her gum line.

Amy was devastated, actually in tears!

She came into our Orange County dental office in Laguna Niguel as an “emergency” patient and in tears.  “What can I do?,” she asked.  “I can’t go out in public or to work missing my front tooth.  There must be some treatment you can do to give me back a front tooth.”

What happened to Amy is unfortunate, but not all that uncommon.  If a tooth has a large cavity or substantial amount of tooth broke off, then root canal and crown treatment are often the two treatments to save the front tooth.  The only problem was that Amy’s tooth was already very weak, and then she suffered additional trauma when she bit down on the hard object.  That was way more than her weak tooth could handle.  Thus, breaking off the crown.

How much tooth is left is a major consideration when treating a broken tooth

When trying to salvage the tooth for Amy our first consideration was how much tooth was left ABOVE THE GUM LINE?  If there is 2-4mm or tooth ABOVE the gum line, then with some heroic dentistry a new crown can oftentimes be made.  But the patient must understand that there is absolutely no guarantee that the tooth won’t break again.

If the tooth breaks at or below the gum line, then it is unlikely that the tooth can be saved.  In that case, the tooth would be extracted and either a dental implant, fixed porcelain bridge or some cases a removable partial denture made to give the patient back their front tooth.

laguna niguel porcelain crown

Amy was fortunate that she had already had a root canal on her tooth and there was a minimal amount of tooth left above her gum line. A post and core and new porcelain crown were fabricated, saving her from the humiliation and embarrassment of not having a front tooth.

In Amy’s case, as one can see in the photo, there was some tooth left above the gum line.  So she was in luck!  Since her tooth had already had a root canal we explained to Amy that we could try to save her tooth by placing a post and core into her root canal filling and by doing that we could create enough tooth above her gums to place a new porcelain crown on.

Amy tears began to stop.

“When can you do that for me?” she asked.  “I have to go to work today and I can’t see clients looking like this?”

To Amy’s delight we said we could build up her tooth with the post and core and make her a temporary crown right then and there.  We would do what we needed to do, make her a new tooth and she would be done in just over an hour’s time and be able to go to work as normal.  In two weeks time her porcelain crown would be completed by our ceramist and we would then remove her temporary crown and cement on her final porcelain crown.

We were able to do everything exactly as planned and Amy got her new crown on her broken front tooth two weeks later. However, that being said, it must be stressed that this kind of heroic dental treatment to save a broken tooth cannot always be done and oftentimes it is not the best long term solution.  Again, alternative treatments options like a dental implant, fixed porcelain bridge or sometimes (but rarely) a removable partial denture are better ways to treat a patient with a broken off or missing front tooth.

Please feel free to comment or ask questions about Amy’s treatment.

Dr. Norman Huefner, Orange County Cosmetic Dentistry and Porcelain Veneers. Serving the surrounding cities of Laguna Niguel, Irvine, Newport Beach, Mission Viejo, Coto de Caza and Rancho Santa Margarita

Why Should I Replace My Old Silver Fillings?

mercury amalgam filling

This patient had a relatively small mercury amalgam filling placed a number of years ago. There was leakage around the filling, causing internal decay. Because of the high content of mercury in the filling the restoration exhibited much expansion and contraction over the years and there are at least five visible fractures in the tooth. If this tooth would have been restored before the fractures developed a simple composite filling could have been utilized. In this case the tooth is so damaged by the fracture and decay that a full crown is necessary to save the tooth.

Question: I had a lot of cavities when I was a kid and my dentist back then filled them with silver amalgam fillings.  My dentist tells me that my fillings are leaking and that teeth are getting cracks in them.  I’ve never had a problem before except a few years ago one tooth broke and I had to get a crown.  The teeth he’s talking about don’t hurt and never bother me.  Why should I do what he recommends and put in new fillings or crowns?  Shouldn’t I just wait until they break or start bothering me?  John, from Orange County

Answer:  A hundred years ago the horse and buggy was one of the best modes of transportation.  But today we have much better ways of getting around.  The automobile and airplanes certainly have many advantages over horseback, right?  The “silver” amalgam fillings were developed around the time of the Civil War and certainly have served their purpose in dentistry for over a hundred years, but today they are not the best way to restore teeth and unquestionably have their own share of problems.  Many dentists like myself haven’t even used them in our dental practice for over fifteen years.

First, you should know that “silver” is actually a misnomer.  They really aren’t “silver”.  When first placed in the tooth the amalgam fillings are “silver colored” because the amalgam filling’s main component is mercury, up to 50%, which is silver colored.  It is the mercury that imparts that color to the amalgam.  Later that silver color often corrodes and discolors and the filling becomes black.  The other 50% of the amalgam ingredients are lead, tin, copper, zinc and a small amount of silver.  From a health standpoint alone, many researchers and physicians would argue that having mercury and lead in the mouth is not healthy.  When we remove the mercury filling material it is legally categorized as “bio-hazard” and dentists are not allowed to throw it into the trash or down the drain.  By law we are required to have a bio-hazard removal service come to our office to take away our “bio-hazard”materials and dispose of them in a way that does not contaminate the environment. It is amazing that the government considers mercury amalgam filling waste bio-hazard and still have not completely outlawed the usage of the material as they have done in many other countries.

When you were younger John do you remember what was in the thermometers used to take your temperature?  It was mercury, right?  But, it’s not longer used today, is it?  There are health reasons for that.  Mercury is toxic.  The reason it was used in thermometers was that mercury is actually a metal that is a liquid.  And the reason it worked as a thermometer is that mercury expands or contracts based on the temperature.  Now imagine a filling in the middle of your tooth that expands and contracts each time you eat or drink something hot or cold.  When it contracts it allows bacteria to go into the tooth in between the interface of the tooth and filling.  When it expands, it places internal pressure on the remaining tooth.  This is what commonly produces the cracks in the enamel of the teeth around the filling.

Now, most dentists are all in agreement that when a tooth has a cavity and the decay is removed that if it was a small cavity the tooth will be 10-25% weaker, if a medium cavity 25-40% weaker, if a large cavity 40-60% or more weaker.  So imagine a tooth that is weaker to begin with, and then having a filling that expands and contracts thousands upon thousands of times over a period of years.  At some point something has to give, and the tooth often develops cracks, and these cracks often lead to fractured teeth.

You might say, doesn’t the mercury amalgam filling strengthen the tooth?  The answer is a resounding no!  It just fills the void of the cavity and actually relies on the strength of the remaining tooth structure.

Today when dentists see teeth with leakage, which leads to decay, or visible fractures in the tooth around the filling most dentists will recommend being proactive.  This means removing the old mercury amalgam filling and replacing it with a restoration that will strengthen the tooth and help keep it from breaking.  The choices the dentist will typically recommend are a bonded composite filling, an onlay (usually porcelain, but many dentists still use gold on back teeth) or a crown (again, usually porcelain but sometimes gold).  Obviously the choice of which of these types of restoration will depend on the size of the original filling, the amount of decay or tooth that is cracked or fractured.  Your dentist should be able to explain to you why he/she makes a particular recommendation.

What will happen if you don’t follow your dentist’s recommendations.  If it’s a small filling and you have a light bite and don’t grind or clench, and if you’re lucky, maybe nothing will happen.  Or on the other hand, maybe nothing will happen for a while.

If your mercury amalgam filling is medium or large in size or if you have a heavy bite and grind or clench your teeth, then at some point your tooth will undoubtedly break.  Broken teeth are the most common emergency I have in my practice.  Sometimes when that happens there is a lot of pain involved.  Sometimes even a root canal might be necessary if the fracture goes into the tooth nerve.  Probably the worst case scenario is that so much of the tooth breaks off that the tooth cannot be restored and has to be removed (extracted).  That would then necessitate needing to replace the missing tooth with a much more involved treatment like a 3 unit porcelain bridge or implant.

John, I can’t tell you much more about your particular situation without seeing you as a patient.  But in general you will be best served by proactive dentistry geared to prevent larger dental problems from occurring.  Certainly replacing old mercury amalgam fillings that are leaking or exhibit cracks in the surrounding tooth structure with state-of-the-art dental restorations (whether composite fillings, porcelain onlays or crowns) is usually the best way to preserve teeth and prevent pain and more expensive dental treatment down the line.

Dr. Norman Huefner, Orange County Cosmetic Dentistry and Porcelain Veneers. Serving the surrounding cities of Laguna Niguel, Irvine, Newport Beach, Mission Viejo and Rancho Santa Margarita
Question: I had a lot of cavities when I was a kid and my dentist back then filled them

with silver amalgam fillings.  My dentist tells me that my fillings are leaking and that teeth

are getting cracks in them.  I’ve never had a problem before except a few years ago one

tooth broke and I had to get a crown.  The teeth he’s talking about don’t hurt and never

bother me.  Why should I do what he recommends and put in new fillings or crowns?

Shouldn’t I just wait until they break or start bothering me?

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