My Blog

Posts for: July, 2018

By Dr. Edward Portnoy and Dr. Grace D'oria
July 22, 2018
Category: Dental Procedures
Tags: teeth whitening  
AnsweringYourQuestionsaboutYourUpcomingTeethWhitening

Whitening can transform the dullest teeth into a dazzling smile fit for a Hollywood star. But before you undergo a whitening procedure, you might have a few questions about it. Here are the answers to a few of the most common.

How white can I go? In an office application we can adjust the solution and application time to control the level of shade (dark or light) from subtle to dazzlingly bright. The real question, though, is how much color change will look best for you? A good rule of thumb is to match the shade in the whites of your eyes.

Whitening will improve poor dental conditions…right? Not necessarily. Besides foods, beverages or poor hygiene, decay, abscesses or problems from root canal treatments can also cause discoloration. In some dental situations, whitening could make your smile less attractive. If, for example, you have exposed roots due to gum recession, those areas won't bleach like the enamel and could make their exposure stand out more. Better to try and repair these problems before whitening.

What effect will teeth whitening have on my dental work? None รข??composite or ceramic materials won't lighten. The real concern is with creating a situation where whitened natural teeth don't match the color of dental work. Depending on the location of your veneers, crowns or other bridgework you could have a color mismatch that will look unattractive. We would therefore need to take your dental work into consideration and adjust the shading accordingly.

Will teeth whitening work on any stained teeth? That depends on the cause of the staining. If it's on the enamel, then external bleaching techniques should work. If, however, the discoloration comes from inside the tooth, then only a dental procedure that applies a bleaching agent inside the tooth can alleviate that kind of discoloration.

So after whitening, I'm good to go? Well, not permanently. Eventually the brightness will diminish or fade, usually in six months to two years. You can, of course, prolong the fade rate by not using tobacco, cutting back on staining beverages like red wine, tea and coffee, practicing daily oral hygiene and visiting us for regular office cleanings and other dental work. We can also touch up your existing whitening during your visits.

If you would like more information on teeth whitening, 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 “Important Teeth Whitening Questions…Answered!


By Dr. Edward Portnoy and Dr. Grace D'oria
July 12, 2018
Category: Oral Health
LifeIsSometimesaGrindforBrookeShields

Ever since childhood, when her career as a model and actress took off, Brooke Shields has enjoyed worldwide recognition — through advertisements for designer jeans, appearances on The Muppet Show, and starring roles in big-screen films. But not long ago, that familiar face was spotted in an unusual place: wearing a nasal anesthesia mask at the dentist's office. In fact, Shields posted the photo to her own Instagram account, with the caption “More dental surgery! I grind my teeth!” And judging by the number of comments the post received, she's far from alone.

In fact, researchers estimate that around one in ten adults have dental issues that stem from teeth grinding, which is also called bruxism. (Many children also grind their teeth, but it rarely causes serious problems, and is often outgrown.) About half of the people who are teeth grinders report problems like persistent headaches, jaw tenderness and sore teeth. Bruxism may also result in excessive tooth wear, and may damage dental work like crowns and bridges; in severe cases, loosened or fractured teeth have been reported.

Researchers have been studying teeth grinding for many years; their findings seem to indicate that it has no single cause. However, there are a number of factors that play a significant role in this condition. One is the anatomy of the jaw itself, and the effect of worn or misaligned teeth on the bite. Another factor relates to changes in brain activity that occur during the sleep cycle. In fact, nocturnal (nighttime) bruxism is now classified as a sleep-related movement disorder. Still other factors, such as the use of tobacco, alcohol and drugs, and a high level of stress or anxiety, can make an individual more likely to experience bruxism.

What can be done for people whose teeth grinding is causing problems? Since this condition may have many causes, a number of different treatments are available. Successful management of bruxism often begins by striving to eliminate the factors that may cause problems — for example, making lifestyle changes to improve your health, creating a soothing nighttime environment, and trying stress-reduction techniques; these may include anything from warm baths and soft music at bedtime, to meditation and mindfulness exercises.

Several dental treatments are also available, including a custom-made occlusal guard (night guard) that can keep your teeth from being damaged by grinding. In some cases, a bite adjustment may also be recommended: In this procedure, a small amount of enamel is removed from a tooth to change the way it contacts the opposite tooth, thereby lessening the biting force on it. More invasive techniques (such as surgery) are rarely needed.

A little tooth grinding once in a while can be a normal response to stress; in fact, becoming aware of the condition is often the first step to controlling it. But if you begin to notice issues that could stem from bruxism — or if the loud grinding sounds cause problems for your sleeping partner — it may be time to contact us or schedule an appointment. You can read more about bruxism in the Dear Doctor magazine article “Stress and Tooth Habits.”


By Dr. Edward Portnoy and Dr. Grace D'oria
July 01, 2018
Category: Oral Health
Tags: loose teeth  
LoosePermanentTeethisaProblem-takeActionNow

If you've noticed one of your teeth feeling loose, you're right to believe it's not a good thing. Loose permanent teeth are a sign of an underlying problem.

Periodontal (gum) disease is usually the culprit. Caused by bacterial plaque, a thin film of food particles, gum disease causes the tissues that support teeth to weaken and detach. While a tooth can become loose from too much biting force (primary occlusal trauma), it's more likely bone loss from gum disease has caused so much damage that even the forces from normal biting can trigger looseness.

A loose tooth must be treated or you may lose it altogether. If it's from gum disease, your treatment will have two phases.

In the first phase we need to stop the gum infection by removing plaque and calculus (hardened plaque deposits). Hand instruments known as scalers or ultrasonic equipment are usually sufficient for removing plaque and calculus around or just below the gum line. If the plaque extends deeper near or around the roots, we may need to consider surgical techniques to access these deeper deposits.

Once the infection is under control and the tissues have healed, we can then undertake the second phase: reducing biting forces by breaking clenching and grinding habits, doing a bite adjustment for advanced problems and securing loose teeth with splinting.

Although there are different types of splinting — both temporary and permanent — they all link loose teeth to adjacent secure teeth much like pickets in a fence. One way is to bond dental material to the outer enamel of all the teeth involved; a more permanent technique is to cut a small channel extending across all the teeth and bond a rigid metal splint within it.

To reduce biting forces on loose teeth, we might recommend wearing a bite guard to keep the teeth from generating excessive biting forces with each other. We may also recommend orthodontics to create a better bite or reshape the teeth's biting surfaces by grinding away small selected portions of tooth material so they generate less force.

Using the right combination of methods we can repair loose teeth and make them more secure. But time is of the essence: the sooner we begin treatment for a loose tooth, the better the outcome.

If you would like more information on treating loose teeth, 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 “Treatment for Loose Teeth.”