If you’re considering cosmetic dentistry, you may have heard the terms bonding and veneers. The basic intent of both cosmetic dentistry procedures is the same, but the materials used are quite different.

Bonding uses a tooth-colored composite resin – a putty-like material that we apply over a chip in a tooth or to cover over some other type of deformity. Once the material has “set,” we then contour it to either mimic the original shape or the desired shape. Bonding is not an option in some cases – the extent of the damage to a tooth can be such that neither a composite filling nor bonding is appropriate. In that case, a crown may be needed to restore your tooth and provide good oral health. The same is true for veneers, although there are cases where a veneer will work when bonding is not a viable option.

Veneers are made of porcelain, and can provide a more natural tooth appearance – especially when larger areas of the tooth are being treated.  The natural enamel on your teeth is actually translucent, and the porcelain veneer is also translucent.  That means that light tends to react the same way to both surfaces, and that is why veneers can look more natural than the solid composite resin materials that are used in the bonding process. By now, you may be wondering how veneers can help with severely discolored teeth if they are translucent. That’s where the skill of your dentist really comes into play.

Well-fitted veneers are generally more durable than bonding, although both procedures require that you practice good oral health practices (brushing, flossing) and avoid bad habits like chewing ice or other excessively hard materials.  (That’s not good for your natural teeth, either!) Not sure what you need?  We’re here to provide all your Raleigh cosmetic dentistry needs, in addition to our general dentistry services. We’ll advise you on what treatment is most appropriate for you and answer all the questions you have about the personalized treatment plan we will develop to help you restore or create the smile of your dreams.

Today, we know exponentially more about a whole spectrum of sedation techniques and forms of localized anesthesia. Dentists certified for providing sedation dental care today  have many more options – and an exponentially greater wealth of knowledge of dosages and risk management – than Wells and Morton did in the 1800’s. We know what types of sedation and anesthesia work best in combination for various types of dental procedures. And we know that we’re not only managing pain, but also anxiety. In terms of what the patient experiences, it’s still not well understood just how tightly intertwined the two (pain and anxiety) really are.

Many people assume that anxiety is a purely psychological experience, while pain is the purely physiological experience. Not so! For example, anti-anxiety pharmaceuticals as well as psychological procedures for treating anxiety are often useful in the treatment of pain complaints. And it’s also been scientifically proven that patients who experience high levels of anxiety before undergoing surgical procedures actually have slower healing times. It’s not just about sparing people mental distress, it’s about helping them have a better outcome, too.

That’s another reason that taking advantage of sedation dental care is just good common sense. You don’t NEED to try to figure out whether it’s anxiety or pain management that you need. We know how to manage both effectively and safely. And we’re happy to answer any questions you might have about sedation dental care in Raleigh.

I think a lot of people who are interested in sedation dental care are being held back because that question lingers at the back of their minds. The relative scarcity of Raleigh sedation dental care (or for matter, across the state of North Carolina) may be part of the reason that people don’t know that much about it. The odd thing, though, is that people are routinely sedated by physicians for procedures that are far less invasive than procedures often done in dentistry without using sedation. And yet, patients don’t usually question being sedated in those lesser circumstances.

Fortunately for residents of North Carolina, the State Board of Dental Examiners recently enacted new guidelines to help patients be assured that sedation dentistry is a safe option for them to use. The Board has put in place a rigorous certification process (July 2009), so that you can be assured that your dentist has the appropriate training. The new guidelines cover various levels of sedation, and ensure that your dentist also has the right type of equipment to monitor you while you’re undergoing sedation dental care. To put your mind fully at ease, you can always ask your dentist to show you his or her formal accreditation to provide sedation dental care, especially since the guidelines are relatively new in our state.

For the type of sedation dental care that lets you have more invasive or lengthy procedures performed comfortably, the level of accreditation is referred to as limited moderate conscious sedation dentistry, or oral conscious sedation dentistry. Some patients also need this level of sedation to be comfortable with lesser procedures, such as teeth cleanings or fillings.

If you still have questions or concerns, you may want to read our more detailed description of the new qualifications put in place by the Dental Board. Of course, Raleigh Comprehensive and Cosmetic Dentistry is happy to personally answer any questions you might have, too, whether you’re an existing patient or not. Learn more about how sedation dental care can free you from the anxiety or pain that might be standing in the way of your own or a family member’s good dental health.

That’s a question that some of my patients ask, and it’s often based on what they learned about braces one or two decades ago. Some of these people never had braces when they were younger because family finances wouldn’t permit it. Others had braces, but their teeth drifted somewhat out of place after the braces were removed. Some people who have had their teeth whitened feel that the new brightness of their smile draws more attention to misalignments that were not so noticeable before.

The answer is that you’re not too old for braces. A couple of decades ago, adults probably accounted for about 5 percent of the patients wearing braces.  Today, probably a third of the patients getting braces are adults, and the trend could drive that number higher. There are several reasons for that. First, there are new technologies. But more importantly, there are options for braces that are far less noticeable than ever before. You may have friends or colleagues who are wearing them without your even being aware of it. Adults have always been “sensitive” about appearing in public with braces on – maybe because “braces are for children” or maybe because they feel braces could interfere with how they are perceived in the workplace.

One of the most exciting options to be considered for adults is the Invisalign system, which is actually a form of “removable braces.” Not every occurrence of teeth misalignment can be corrected with Invisalign, but people whose misalignment is less severe are usually good candidates. We (Raleigh Comprehensive and Cosmetic Dentistry) are excited to have been named a Preferred Provider of Invisalign in Raleigh, based on our extensive experience with using this system. Even if you’re not a good candidate for Invisalign, we can talk to you about less visible options than the metal braces that were the only option years ago.  See our FAQs About Invisalign to learn more about the system.

If you’ve been thinking about braces or have been wondering if there’s a provider of Invisalign in Raleigh, come talk to us about the options that make sense for your situation. In addition to performing the important dental assessment, our staff can help you understand and plan for the financing, including the possibility of using your healthcare flexible spending account to cover some of the cost.

Did you know that North Carolina ranks very near the bottom (# 47) in the nation for availability of dental care access? The news is better, however, for those looking for dental care in Raleigh. Wake County is one of eight North Carolina counties with dentist-to-patient ratios that exceed the national average. (Durham and Orange counties are also among the eight.) If you combine June 2009 figures from the North Carolina Dental Board with 2008 census figures for Raleigh, you can extrapolate that for every 1,350 residents, there is one general dentist providing dental care in Raleigh.

The low ranking for the state is a bit surprising, especially since 80% of the students admitted to the UNC School of Dentistry come from North Carolina. The dentistry school is recognized as one of the top in the nation for both education and research. (Unlike medical and law schools, schools of dentistry in the U.S. have no “official” national rankings. But UNC is one the most highly acclaimed schools in the informal rankings that appear from time to time.) It seems like a lot of graduates who were originally residents of NC must be relocating to other states in order for our statewide ranking to be that low.

By the same token, dentists also need to be especially careful with their specialized and more powerful teeth-whitening treatments. One of the best examples is the use of ultraviolet (UV) light in teeth whitening. UV light is sometimes used to activate, accelerate, or enhance bleaching solutions. And it can be used safely. That means directing the UV light only onto the tooth surface – and not onto surrounding gum tissue. Would you even consider going to the beach and holding your lip down to expose your gums to the sun for a couple of hours (aside from the fact that it might look dumb)? I thought not! You’re already aware of the short-term and long-term damage that UV light exacts on your skin – especially when you’re not protected by sunscreen. That’s why it’s very important for your dentist to protect your gums and other mouth tissue from UV light exposure when using it as a component of your teeth-whitening program.

Her criteria?

While she lived in her hometown, she went to the dentist her parents had chosen. That dentist happened to be a UNC School of Dentistry graduate, and also served as a part-time lecturer there. When she moved elsewhere, that dentist referred her to a dentist who practiced in her new location, but also lectured at UNC. He retired early, but sent her to a  young dentist who was a recent UNC School of Dentistry graduate and lecturer. So her dental provider selection criteria was finding a dentist who UNC had summoned back to teach and mentor future dentists.

How did you choose?

I met this person in a business operations context, and never realized I was being sized up as a “qualified” dental provider. I did think her question about whether I ever lectured at UNC was a little odd, but thought nothing of it at the time. Months later, she was knocking at my door to become her new Raleigh dentist. I never cease to be amazed at the criteria people use in choosing their dentists, other than just word of mouth. But I’m always interested in learning why new patients decide to come to RCCD, and how they heard about us.

Reduction, Reshaping, and Stabilization

Crowns are used when a tooth has been damaged in a way that makes other forms of repair, such as a filling, impossible or unreliable. Broken teeth, severely cracked teeth, or teeth with underlying inflammation may warrant treatment with a crown. We begin by reducing, reshaping, and otherwise preparing what remains of the tooth to accept the crown (cap).  One guide in determining how to reshape or reduce the tooth is the removal of the damaged or diseased portions of the tooth, so that further damage doesn’t continue to occur underneath the crown once it has been placed.  Teeth with underlying inflammation get a root canal before they have a crown placed over them. A root canal involves removing the tooth’s pulp (the core of the tooth that contains the nerves and runs down through canals into the roots) and replacing it with a rubbery filler.

A second guide in reduction and reshaping is removing enough of the tooth to allow the crown to be thick enough to be strong and durable as well as cosmetically pleasing. Usually, a crown needs to be about a sixteenth of an inch thick, although our measurements in preparing and designing crowns are far more precise than that. A third guide is to create a certain tapered shape that permits the crown to easily but snugly slip over the top of the remaining tooth.  The more of your tooth we can leave, the more stable the finished product will be. Sometimes, we apply special materials to “build-up” what remains of a severely damaged tooth in order to increase the strength and durability of the end result. This overall reduction and health restoration results in the tooth being properly stabilized to receive a crown.

Off to the Lab

Once we have created a stable base to work on, it’s time to begin the “design” of the crown (cap).  We place a putty-like substance into your mouth and create an impression of the prepared base, the surrounding tissue and adjacent teeth. This impression is sent off to the lab where a stone-like mold is created that allows the lab to precisely model a crown to fit into your mouth as naturally as possible.

The lab will return the custom-designed crown to us within one or two weeks. Meanwhile, we select and place a temporary crown over the prepared tooth to protect it and allow you to chew with relative ease until the precisely fitted crown is ready.

Perfecting the Fit

While the lab delivers a precisely crafted crown back to us, we will always perform our own quality checks and minor, but exceedingly precise and important adjustments to the crown. To give you a great fit and appearance, we will:

•    Verify that the overall shape and coloration of the tooth is as close to natural as possible
•    Confirm that there is a precise marginal seal between the prepared tooth base and the inner surface of the crown (This preserves the health of the live tooth base.)
•    Verify and adjust as needed the contacts between the crown and adjacent teeth
•    Check the way your bite fits with the opposing teeth, adjusting as needed to ensure a good balance

Just as with your natural teeth, you need to exercise care to keep the crown intact. Avoid chewing ice and other hard substances like popcorn kernels that could cause the crown to develop cracks. Even with good care, your crown may not last a lifetime. For this reason, many dental insurance companies will permit replacement of crowns – usually after five to eight years, depending on the policy. Our staff can help you verify your benefits should you ever need a replacement.

Believe it or not, it’s not because we like to hear ourselves talk! It’s about trying to make you feel relaxed and comfortable. Every member of our staff wants to make you more comfortable during your visit. In fact, our offices – from the reception area to the exam rooms – were also specially designed to help you feel relaxed during your visit.

And yes, we’ll probably start a conversation while you’re in the chair. The main reason is that talking is a distraction.  (That’s why using a cell phone while driving can be hazardous!)  It is our hope that our talking to you will help the time you spend in our office pass quickly. We know it can help because we receive specialized training in dental school that helps us be very sensitive to the patient’s experience and point of view while we’re working.

Part of a dentist’s training is to learn and practice different techniques that can help you relax during routine exams and specific procedures. We’ve been trained well in the science of dentistry, as well as in the art of combining both psychological and pharmacological approaches (sedation dentistry) to keep each unique individual comfortable.

Learning to make you feel comfortable and at ease during your visits is a whole art unto itself, and one that must be learned along with a tremendous body of medicine and science that supports your safe and effective treatment. We sometimes jokingly refer to surgeons and some types of physicians as “lucky” in this regard – because they often put patients completely “out” before performing any procedure on them. That means they don’t have to worry about learning and practicing this special art like dentists do.

There’s also one more strategy behind our striking up a conversation. If you’re relaxed, we also find it may be easier for you to share with us any dental concerns and needs that may have come up since your last visit. Remember, we’re not here to practice our oratory skills. We’re here to help you maintain good oral health and give you a smile you can be proud of. Our goal is to make your experience with us as pleasant as possible. The more we can help you relax while you’re here, the more likely you’ll feel good about coming back and being proactive about maintaining your oral health.

•    Food – Spicy foods, such as those containing onion and garlic, can’t really be covered up with tooth brushing, flossing, and rinsing with mouthwash after the meal. Those measures only help to a degree. That’s because many foods stay in the body for 72 hours or more, are absorbed by other body tissues, and continue to make their presence known on the breath. Believe it or not, garlic rubbed on the soles of your feet can eventually show up on your breath!  Even coffee can often be smelled on the breath days after you drink it.

Even if you avoid the types of food that leave lingering breath odor, foods with little or no odor can also be a major cause of bad breath. Aside from causing tooth decay, any food particles left behind by poor oral hygiene begin decaying and can produce bacteria that cause bad breath odors.  To help ensure that this isn’t your problem, your oral hygiene regimen may need to include brushing not only the teeth, but also the tongue, gums, and roof of your mouth – any place that food and beverage residue can become trapped. Saliva is nature’s way of trying to wash away food particles in the mouth. So, if your mouth tends to be dry for some reason, you may need to be even more attentive to your oral hygiene and food particle removal than most other people.

•    Common oral diseases – I’ve mentioned dry mouth (xerostomia) as one condition that can lead to halitosis. Certain medications, radiation treatments, or even skipping meals can all be causes of a dry mouth condition.

Periodontal (gum) disease is another cause of bad breath. In periodontal disease, plaque – a sticky film of bacteria that forms on your teeth – can build up and cause gum irritation that results in inflammation, receding gums, and even damage to underlying bone tissue. Good oral hygiene, rinsing with anti-bacterial mouthwashes, and regular dental exams and cleanings are the best defenses against periodontal disease.

There are some special dental products, such as CloSYS, that are especially effective at combating the sulfonamides that develop from bacterial growth in the mouth. A reputable comprehensive dentistry provider can help you bring these dental conditions and diseases under control, and also help you decide what dental hygiene products and procedures you can use at home to manage or avoid the disease.

•    ENT infections – Ear, nose, throat, and sinus (ENT) infections, because of their close proximity to the mouth, can be another cause of bad breath. These should generally create only a short-term problem, clearing up when the infection does. However, some conditions, such as sinusitis and bronchitis, can be chronic and result in a persistent problem with bad breath until the condition is alleviated. Talk with your dentist about any problem with bad breath that you are experiencing. By discussing the problem during your regular check-up, you and your dentist may be able to more quickly pinpoint the most likely cause, and you can see a medical professional if an ENT infection seems to be the culprit.

•    Problems with major organs – There’s a natural tendency for all of us to assume that bad breath is caused by something in or in close proximity to the mouth. When we’ve eliminated some of the other causes discussed above, it’s important to consider other causes, such as problems with other body organs. Issues with lungs, liver, stomach, and kidneys can all result in an outgassing of bacteria or other abnormal by-products that are vented from the body on your breath.

A comprehensive dentistry provider is your first line of defense in both identifying and treating oral health issues, and can point you to other medical professionals who may need to be involved. Don’t be afraid to ask if you have a concern – tens of millions of people share this problem. If the source of the problem isn’t obvious to your dentist during a regular check-up, he may ask you to return for a follow-up to further discuss and evaluate the problem. It is only logical to start by assessing the oral health possibilities because dentists receive special training on the potential causes of halitosis.

For more information on comprehensive dentistry or halitosis, contact Dr. Robert Williamson today!

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