Ask Dr Andrews

ask your dentistDental Health 101

Is in-office tooth bleaching better then the at-home method which involves wearing trays and using a gel?

Recent clinical research has conclusively demonstrated that the “at-home” method is every bit as effective as the “in-office” method.  The “at-home” method also costs much less, decreases the likelihood of tooth sensitivity, and is more convenient for the patient.  Alot of the apparent “benefits” of in-office bleaching is due to the teeth drying out during the procedure.  This dehydration immediately makes the teeth appear lighter by a few shades.  The next day, the teeth darken significantly because they will have rehydrated.

I recently saw a dentist who is a “graduate” of an aesthetic instiitute.  Does this mean he is an expert?

I place a strong emphasis on continuing education and have been fortunate to learn from some of the world’s finest clinicians.  These “institutes” you mention often produce “graduates” after only a three day course.  I believe this designation is deceiving to the public and such advertisement should be prohibited.  There is not a three day or one week program that can make anyone an “expert”.  The best clinical dentistry is achieved by knowledgeable, experienced and caring individuals who place an emphasis on attention to detail and use of the best materials and dental ceramists available.

My old dentist wanted to crown all of my teeth because she practices neuromuscular dentistry.  Do you think this is a good treatment?

Obviously, I can only make a judgment on such complex treatment for a particular patient after a comprehensive clinical examination is done.  In addition, a review of radiographs and photographs is needed, as well as placing a model of the patient’s teeth on an instrument which replicates all of the ways in which their teeth function.   However, the indications for such radical dentistry are rare.  Unfortunately, they are being heavily promoted and over utilized by certain dentists.  My advice would be to talk to other patients this dentist has treated and see if they are satisfied.

How long should porcelain veneers last?

Dr. David Garber was one of the pioneers of porcelain veneers and began accomplishing these restorations about twenty years ago.  He says that many of these veneers are still serving well.  Obviously, our materials are far superior to those he first worked with.  My oldest porcelain veneers are over thirteen years old and still serving the patient well.  I have yet to have a porcelain veneer fail in my dental career.

checking childs teethMy insurance company said that my last dentist charged too much and that his fees were above “usual, customary, and reasonable.”  Can you explain what this term means?

This is a frequently asked question.  Insurance companies do not have the best interest of the patients they cover, in mind.  Their chief objective is to make the largest profits possible for their share holders and chief executives.  I read recently that some top officers of these insurance companies make bonuses exceeding fifteen million dollars per year!  “Usual, customary, and reasonable” is a term created by insurance companies in an attempt to intimidate dentists to keep their fees lower than they might otherwise.  This term is meaningless because fees are chosen by the different insurance companies vary widely within each geographic area.  Rather than relying on the insurance company to dictate our fees, we use a better method.  We base our fees on the approximate time a certain procedure will take us, the materials needed, and the necessary laboratory support, which will provide the absolute best service we are capable of providing.

I just moved from New York where I had been seeing my dentist every six months for the past ten years.  He said my teeth were fine.  Recently, I saw a dentist in Raleigh who told me I have periodontal disease and old fillings that need to be replaced.  What does this mean?

All dentists have different philosophies about when to address problems.  Dentistry is not a science.  It is an art which is based on science.  The clinical judgment of each dentist is a result of their training, experience, and perceived level of skill.  My personal philosophy is to address problems at their earliest sign in order to prevent the need for a more complicated treatment later.  We spend a lot of time educating our patients, which involves showing them detailed photographs of their teeth.  This better enables them to see the condition of their mouths.  My patients and I, then work together to make a treatment plan which best meets their needs.

I had sealants placed for my son about a year ago and three of the four have popped off his teeth.  Are sealants not reliable?

Placement of sealants is very technique sensitive.  In many practices, a dental assistant or hygienist places sealants by themselves.  It is difficult for them to keep the areas receiving sealants from becoming contaminated with saliva which causes the failure you describe.  I believe sealants, accomplished properly, are the most important service a dentist can provide.  I personally place every single sealant in my practice.  Whenever possible, I use a rubber dam in order to keep the tooth completely isolated from saliva when I work on it.  If a rubber dam is not possible, and my assistant is not able to maintain a clean and dry field for me, I will not place a sealant.  I’ve found that an improperly accomplished sealant can lead to extensive decay which is often worse then if no sealant had been placed in the first place.

I have dark stains in some of my back teeth that my last dentist has been watching for some time.  One of them recently became a big cavity.  Should we have done something sooner?

Posterior teeth, especially molars with dark stains in their grooves, have decay present in them more often then not.  Some dentists prefer to watch these.  If a patient desires, I will “watch” these areas as well.  I believe a better alternative is to offer to remove the stains.  If the stain is restricted to enamel, a sealant can be placed.  If decay is discovered, the decay can be removed and the tooth will usually be restored with a very conservative tooth colored restoration.  I have had all of the stained areas removed from the grooves in my own teeth in order to prevent large cavities such as you describe.

a beautiful smileI’m planning to have all porcelain crowns done on 6 of my teeth.  I’m currently seeing a dentist who placed temporary porcelain crowns and their charge was $1500/tooth.  I’d like to find out if that’s an average charge for all porcelain crowns in this area.  If not, I’d like to get a second opinion because every time I go see my dentist, our plan changes and I feel like I keep paying more than what I should.  How much do you charge for all porcelain front tooth crowns?

There are a lot of things you can purchase, for example a box of cereal.  At one store it may be less than another.  The product is the same, so it makes sense to buy the cheaper product.  Dentistry is different.  Porcelain crowns, or any other kind of dental restorations, are services and not commodities.  In your case, I assume the teeth in question are your upper front teeth.  A dentist who merely places crowns on these teeth in an arbitrary manner without much regard for your esthetic’s, speech, gingival health, or how your teeth function, will probably charge less than a doctor who can skillfully negotiate each of these factors.  Fees also depend upon the quality of the ceramist who produces your restorations.  Excellent labs sometimes have technicians who charge double or triple what their colleagues’ charge—at the same lab.  In short, our fees in cases such as this, are based upon the amount of time I anticipate spending and the laboratory costs associated.  This provides patients with the absolute best experience and technical result, which I am capable of achieving.  I would be happy to discuss your situation further if you choose to come see me.

I had porcelain veneers put on less than a year ago.  4 of the top front have all popped off and I replaced some more than once.  My dentist blamed it on not wearing a night guard.  They popped off while eating every time.  What can I do to fix this problem? A new dentist?

Success with porcelain veneers depends on a variety of factors.  Some of these include, case selection (are the patient’s teeth good candidates for porcelain veneers?), the attention to detail the doctor gives during the tooth preparation and bonding process, and finally, the patients occlusion (is the patient a bruxer?).  Without seeing you, I can only speculate, but it appears that problems occurred during the bonding process.  Almost without exception, bruxism which causes veneers to fail, results in chipped veneers.  In these cases, because a properly bonded veneer has a very strong bond to the enamel of the tooth, the veneer chips rather than popping off.  I would welcome an opportunity to take a look at your situation and discuss your options.

Dental Health 101 References

Oral Hygiene 101

Every Day Health

Dental Health Glossary