Frequently Asked Questions

Bonding

What are the disadvantages of bonding?

Bonding is an alternative to porcelain veneers. The disadvantages of bonding are its limited strength and porous composition. Because the material is more porous than porcelain it tends to stain easily and requires regular maintenance and repair. Dr. Weisbard can discuss the advantages and disadvantages of the various materials and the best solutions to meet your particular needs.

Cosmetic Dentistry Question

What are some examples of cosmetic dental procedures?

Cosmetic dentistry covers a multitude of procedures from teeth whitening to repairing, straightening, replacing or enhancing the appearance of one’s teeth and smile. Most common is the use of porcelain veneers. These thin, but durable restorations are a much more conservative approach than traditional crowns, preserving more natural tooth structure, and have become a very popular way to enhance a smile. In certain procedures dental bonding can be a way to correct and shape teeth as well. Tooth colored natural fillings and natural porcelain crowns are also considered cosmetic dental procedures and make a huge difference in the way your mouth looks and feels.

Crowns

What materials are crowns made of?

A metal crown can be precious, non-precious or semi precious. The higher gold content the better. Gold, platinum and palladium are much more biocompatible (healthier) than semi-precious or non-precious metals, which can contain nickel, copper or other scrap metals. Dr. Weisbard uses a high content of gold, precious metals only for her metal crowns. These crowns provide excellent marginal integrity, strength and can last a very long time.

A porcelain crown is entirely porcelain. These crowns provide the best esthetics, translucency and natural appearance. They resemble the natural tooth structure best but lack strength. These crowns are best in the front of the mouth where esthetics are most important and chewing forces are lower.

A porcelain to gold crown is an excellent choice for the majority of back teeth as it provides the esthetics of porcelain with the support and strength of metal. These crown are made with a metal (precious metals) core with porcelain baked over it.

Zirconia crowns have a high strength non-metal core with porcelain baked over it. These are also an excellent choice for strength and esthetics.

Cerac - This is a fairly new system that can design and mill a custom crown in a single visit to your dentist. The dentist prepares the tooth in the normal way before fitting a crown. Instead of taking an impression, sending it to a laboratory to custom make the crown, the dentist takes a digital image of the prepared tooth. This information is converted into a three dimensional computerized model of your tooth, which is used as a guide for the computer to design the new crown. The information then goes to a milling machine that fabricates the new crown from a ceramic block.

The drawbacks are that since the crown is made from a ceramic block it lacks the translucency of natural teeth and variation of color. It tends to be very opaque and monotone. Some dentists will stain these crowns and reglaze them; however the surface staining can wear over time with normal brushing and chewing. There is also some question of the marginal adaptation (fit) to the tooth.

Dr. Weisbard feels that her laboratory can produce a more natural, translucent crown with better margins (fit to tooth) using traditional very exact impressions. These high quality crowns last longer, are more durable, fit better and look more natural than the Cerac crowns. Dr. Weisbard chooses not to offer Cerac restorations at this time.

What type of crown is best for back molars?

Porcelain may be the most esthetic but porcelain fused to gold or all gold provides the strength and durability needed for heavy chewing. These are better choices for patients who may grind their teeth as well.

Dental Implants

What are the advantages of dental implants?

There are many advantages to dental implants. A once loose-fitting denture can now be secured and stabilized with implants. Missing teeth allow surrounding teeth to drift and opposing teeth to move, changing the alignment of the teeth and allowing unnatural forces to shift teeth further.

Improved appearance. Dental implants look and feel like your own teeth. And because they are designed to fuse with bone, they become permanent.

Improved function: With a full set of teeth, function is improved and digestion is improved.

Improved speech. With poor-fitting dentures, the teeth can slip within the mouth causing you to mumble or slur your words. Dental implants allow you to speak without the worry that your teeth might slip.

How successful are dental implants?

Success rates vary, depending on where in the jaw the implants are placed but, in general, dental implants have a success rate of up to 98%. With proper care, implants can last a lifetime.

Can anyone get dental implants?

In most cases, anyone healthy enough to undergo a routine dental extraction or oral surgery can be considered for an implant procedure. Patients should have healthy gums and enough bone to hold the implant. They also must be committed to good oral hygiene and regular dental visits. Heavy smokers, people suffering from uncontrolled chronic disorders – such as diabetes or heart disease – or patients who have had radiation therapy to the head/neck area need to be evaluated on an individual basis.

What is the process involved with dental implants?

The first step in the process is the development of an individualized treatment plan. The plan addresses your specific needs and is prepared by Dr. Weisbard and the oral surgeon or periodontist.

Next, the implant, a small post made of titanium, is placed into the bone. As the jawbone heals, it grows around the implanted metal post, anchoring it securely in the jaw. The healing process can take anywhere from 3 to 10 months.

Once the implant has bonded to the jawbone, a small connector post – called an abutment – is attached to the implant to securely hold the new tooth. To make your new tooth or teeth, we take impressions of your teeth, and create a model. A replacement tooth, called a crown, is then attached to the abutment.

With patients missing all their teeth, implants are placed, impressions are taken and a new denture is made to snap on to the implant post.

We will match the color of your new teeth to your natural teeth. Because the implant is secured within the jawbone, the replacement teeth look, feel, and function just like your own natural teeth.

How painful are dental implants?

Most people who have received dental implants say that there is very little discomfort involved in the procedure. General and/or local anesthesia can be used during the procedure, and most patients report that implants involve less discomfort than a tooth extraction. IV sedation is also an option.

After the dental implant, mild soreness can be treated with over-the-counter pain medications, such as Tylenol or Ibuprofen.

How do I care for my implant?

Dental implants require the same care as real teeth, including brushing, flossing, and regular dental check-ups.

Dentures

What are my choices for teeth replacement once I have lost my teeth?

The choices range from a traditional denture which has minimal stability to an implant secured denture which improves stability and preserves bone. Dr. Weisbard can help you make the best decision for your particular circumstances. Please call for a complimentary consultation to see what would best suit your needs.

Fillings

What materials are used for fillings?

Composite is a tooth colored putty-like material that is set and hardened with a special light. First the decay is cleaned out of the tooth. The tooth is then prepared by using an etchant to chemically roughen the surface of the enamel allowing for a better bond to the tooth structure. A desensitizer material is applied over the surface and then a liquid bond is applied. The composite material is then placed and shaped into the cavity space. The material may be placed in small layers to allow for better setting and hardening of the material. The light is applied to each layer. Once the cavity is filled, the dentist shapes and contours the surface to restore the natural contours of the tooth. After checking the bite and the contacts between the teeth the new restoration is given a final polish. Dr. Weisbard is highly skilled in placement of these fillings, which become virtually undetectable. Ask to see additional examples of her artistic work!

How long do composite fillings last?

Composite restorations have improved dramatically over the past 10 years. Improved strength and durability, combined with superior esthetics and health has made composite fillings a first choice for small to medium fillings.

Can you get decay under a composite filling?

It is always possible to get decay under any restoration. However with good homecare and regular dental cleanings and exams, this can be minimized and detected early.

Full Mouth Rehabilitation

How do I know if I need full mouth rehabilitation?

If you have severely worn or broken down teeth you may be in need of full mouth rehabilitation. Since this is a lengthy and involved procedure, it is best to consult with Dr. Weisbard prior to making this decision.

Periodontitis and Cleaning

Why do I need to have my teeth cleaned and how often?

Your teeth are continually bathed in saliva, which contains bacteria, calcium and other minerals and substances that help strengthen and protect the teeth. While this is a good thing, it also means that we tend to get a build-up of calcium deposits on the teeth. During your hygiene visit we will remove tarter and calculus (hardened prolonged buildup) from around the teeth and under the gum where floss and a tooth brush do not reach. The hygienist will measure the depth of the "pocket," or space, between the tooth and gum. The smaller the pocket the better. Up to three millimeters without bleeding is considered healthy. When people don't floss as often as necessary, dental cleaning visits are even more important, as plaque will build quickly. A visit every six months is recommended for people in good oral health who floss and take good care of their teeth and gums. For some people, more frequent visits may be necessary as recommended by the hygienist and dentist. Regular monitoring of your hard tissues and soft tissues (gums) is essential in prevention of disease and maintenance of good oral health.

What is the difference between Gingivitis and Periodontitis?

In the early stages of gingivitis, bacteria in plaque build up, causing the gums to become inflamed (red and swollen) and bleed easily during tooth brushing. Although the gums may be irritated, the teeth are still firmly planted in their sockets. No irreversible bone loss or other tissue damage has occurred at this stage.

When gingivitis is left untreated, it can advance to periodontitis. In a person with periodontitis, the inner layer of the gum and bone pull away from the teeth and form pockets. These small spaces between teeth and gums collect debris and can become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line.

Toxins or poisons produced by the bacteria in plaque, start to break down the bone and connective tissue that hold the teeth in place. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. When this happens, teeth are no longer anchored in place, they become looser, and tooth loss occurs. Gum disease, or periodontitis in fact, is the leading cause of tooth loss in adults.

What causes periodontal disease?

Plaque is the primary cause of periodontal disease. However, other factors can contribute to gum disease.

These include:

• Smoking makes it harder for gum tissue to repair its self, and weakens the immune system.
• Poor oral hygiene habits such as not brushing and flossing on a daily basis make it easier for gingivitis to develop.
• Hormonal changes such as those occurring during pregnancy, puberty, menopause, and monthly menstruation make gums more sensitive and increase blood flow, which makes it easier for gingivitis to develop.
• Illnesses may affect the condition of your gums. This includes diseases such as cancer or HIV that interfere with the immune system. Because diabetes affects the body’s ability to heal patients with this disease are at a higher risk of developing infections, including periodontal disease.
• Medications can affect oral health because some lessen the flow of saliva, which has a protective effect on teeth and gums. Some drugs, such as the anticonvulsant medications Dilantin and the anti-angina drug Procardia and Adalat, can cause abnormal growth of gum tissue.

What are the symptoms of periodontal disease?

Periodontal disease may progress painlessly, producing few obvious signs, even in late stages of the disease. Although the symptoms of periodontal disease often are subtle, the condition is not entirely without warning signs. Certain symptoms may point to some form of the disease.

These include:

• Gums that bleed during and after tooth brushing
• Red, swollen, or tender gums
• Receding gums
• Formation of deep pockets between teeth and gums
• Loose or shifting teeth
• Changes in the way teeth fit together upon biting down or in the fit of partial dentures

Research has uncovered links between periodontal disease and other serious health conditions. Over the past few years, studies have shown a definitive link between your oral health and your general health.

Here are some of the many health problems that can be aggravated my poor oral hygiene:

Stroke: Those with adult periodontitis may have increased risk of stroke.

Respiratory Infections: Inhaling bacteria from the mouth such as plaque buildup creates a dangerous source of bacteria that can be inhaled into the lungs.

Heart Disease: Bacteria from the mouth in those with adult periodontitis may have an increased risk of fatal heart attack, are more likely to be diagnosed with cardiovascular disease and are at a higher risk for clotting problems in the cardiovascular system.

Severe Osteopenia: Reduction in bone mass (osteopenia) is associated with gum disease and related tooth loss. Severity has been connected to tooth loss in premenstrual women.

Uncontrolled Diabetes: Chronic periodontal disease can disrupt diabetic control. Diabetes can contribute to bacterial overgrowth in the mouth. Smokers with diabetes increase their risk of tooth loss. People with type II diabetes are three times more likely to develop periodontal disease than nondiabetics.

Preterm or low birth rate babies: Women with advanced gum disease may be more likely to give birth to an underweight or preterm baby. Microbes from the mouth can cross the placental barrier, exposing the baby to infection.

Root Canals

What is a root canal?

Root canal therapy refers to the process of cleaning out the inner aspects of a tooth, the nerve, pulp tissue and blood supply.

Root canal therapy is needed when the pulp has been damaged from decay or trauma. Once the pulp is damaged it breaks down and bacteria begin to multiply within the pulp space or chamber. An infection or abscess can develop if untreated.

Warning signs of pulp damage can include:

• Pain with chewing or pressure
• Pain with hot
• Discoloration of the tooth
• Swelling of the tissue around the tooth
• Pulsing or throbbing around the tooth

Root canal therapy will clean out the pulp chamber and seal the tooth off so that bacteria or saliva cannot move from the mouth into the bone or the bone into the mouth.

Dr. Weisbard can examine your tooth, take appropriate radiographs and discuss the best treatment for your needs. She may refer you to the appropriate board certified specialist depending on the degree of difficulty of the procedure needed in your particular tooth.

Veneers

What is a veneer?

A veneer is essentially a conservative crown. Rather than reducing the entire tooth 360 degrees, a cosmetic veneer is a thin shell of porcelain that covers the front/visible part of a tooth preserving a large amount of the natural tooth structure. It wraps slightly over the edge of the tooth to help with retention of the veneer and add strength. Veneers can straighten, lengthen, close gaps, repair chips and whiten teeth to provide the desired effect. Each veneered tooth must be individually shaped. This means that a thin outer layer of the natural tooth structure is removed to allow space for veneer placement. Generally, the amount of tooth structure that is reduced is very minimal - about .8 mm to 1mm. The veneer is bonded to the tooth, making it very strong.

How long do veneers last?

Veneers are strong and can last for many years, possibly a lifetime with good oral care. There are many different reasons someone would need to replace a veneer or cosmetic crown. Cosmetic dental techniques have advanced dramatically over the last decade. Some veneers/crowns made a long time ago are not as white and natural looking because we didn’t have the same porcelain materials we have today. In the past metal may have been used under cosmetic crowns for the front teeth, creating a gray, blue, or greenish color. The reason for replacement may be entirely for esthetic purposes. Another cause for replacement may be due to gum recession, which allows the edges of the veneer or crown to show (where the veneer ends and the natural tooth begins). Poor home care, lack of proper brushing and flossing or neglecting your regularly-scheduled dental hygiene cleanings can cause the teeth to decay around the margins of the veneer/crown, resulting in the need for replacement of the restoration. Dr. Weisbard provides 100% all-porcelain restorations on all front teeth.

Braces or veneers?

If you are happy with the shape and color of your teeth, then orthodontic teeth straightening may be a good option for you. Invisalign may be a great alternative to traditional braces. Invisalign is the latest generation of “invisible” braces. Though not always necessary, some people will choose to undergo some teeth straightening prior to being fitted with cosmetic veneers.

Will veneers eventually stain?

Porcelain veneers are non-porous and will not stain or discolor. What is bonding and how is it different from a veneer? Bonding is the use of a composite resin material to cover the tooth in order to change shape, fill chips or build up the tooth. The disadvantage is that it will discolor over time since it is a porous material and is more prone to breakage than a veneer. It may require more maintenance to resurface or repair over a number of years. It is not as “permanent” a restoration as a veneer.

Whitening

Brite Smile versus bleaching trays?

Brite smile is a fast and effective way to whiten your teeth. It is a combination of highly concentrated hydrogen peroxide gel applied to your teeth and a high-powered light system that is used to activate the bleaching process. It takes about 2 hours for the entire appointment. Some patients experience some sensitivity a few hours after the bleaching, which can be easily reduced with ibuprofen, and is usually gone the next day. Teeth whitening trays are a take home method of whitening. The trays are custom made to fit your teeth. You disperse a small amount of the bleach provided by our office into the trays and wear them for approximately one hour per day. Depending on each patient’s needs, there are different instructions as to how long you leave the solution in and how often you use the trays. You may choose to have custom bleach trays made after your Brite Smile to “touch up” and maintain the brightness of your teeth.

How long does teeth whitening last?

Brite Smile teeth whitening studies indicate that results can last two to three years. Longevity will obviously vary depending on each person and their lifestyle. Most people will choose to use one of the many simple methods our office provides to maintain their white teeth. Take home custom bleach trays, Brite Smile toothpaste and mouthwash can be purchased from our office.

Is teeth whitening harmful to my teeth?

No, not if used properly and under the supervision of a dental professional. Studies have shown that with normal or suggested use of teeth whitening products, there are no harmful effects on teeth. It is common for some people to have some sensitivity with whitening products at first, but these symptoms usually subside within 24 hours.

Who is a good candidate for teeth whitening?

There are two kinds of stain on teeth — superficial and inherent. Superficial stain comes from the things we drink, eat and expose to our teeth. This kind of stain is usually yellowish and yields the best results with teeth whitening systems. Inherent stain comes from things we absorb into our bodies such as minerals, fluoride and various antibiotics such as tetracycline. These substances, especially at key developmental phases in life can permanently discolor teeth. Many people will choose to change the color of their teeth by having porcelain veneers placed, which addresses the color as well as alignment of their teeth.

Wisdom Teeth

Why should I have my wisdom teeth removed?

While Dr. Weisbard does not extract wisdom teeth, she frequently offers evaluations and makes the appropriate referral to a board certified oral and maxillofacial surgeon.

Top 10 health reasons to remove your wisdom teeth!

10. Due to limited space and difficulty in keeping tissues clean, inflammation and infection are common even with out symptoms. Once this occurs it is almost impossible to eliminate and infection may spread to other teeth.

9. Research has suggested oral inflammation associated with wisdom teeth may contribute to preterm or low birth weight infants.

8. Even when wisdom teeth erupt they rarely provide any meaningful function and are difficult to keep clean.

7. In some cases, impacted wisdom teeth have been shown to develop cysts and tumors around them.

6. The chance for complications related to the removal of wisdom teeth increase with age.

5. Gum disease and inflammation associated with wisdom teeth may lead to receding gums, bone loss and eventual tooth loss.

4. Wisdom teeth may crowd other teeth, including front teeth.

3. Even wisdom teeth that seem problem free remain a breeding ground for bacteria. Bacteria may enter the bloodstream and contribute to a variety of diseases including cardiovascular disease and stroke.

2. Early removal of wisdom teeth is associated with faster and easier recovery.

1. Peace of Mind! While Dr. Weisbard does not extract wisdom teeth, she can evaluate your wisdom teeth and make the appropriate referral to a board certified oral and maxillofacial surgeon.