Tooth whitening isn’t helping the white spots.

Dr. B I’ve been whitening my teeth and I’m just not happy, the white spots are still there. What options do I have at this point?

You know we talked about this earlier on, that the white spots might not blend in as well as you’d like. So probably the next step that we can investigate would be the Lumineers or real thin porcelain veneers. They would cover the fronts of your teeth and cover up the white spots. The other thing that we can do with Lumineers, if you’re not happy with anything with your smile, is we can do what we call a smile makeover. With a smile makeover and a real thin porcelain veneers, we can not only change the color of your teeth, but we can also change the size and shape of your teeth.

I’d think I’d be interested in doing a smile makeover.

That’s great, we’ll get some diagnostic records together and I’ll put together a case presentation for you and we’ll have you come back and do a short visit.

Is there anything I can do about white spots on my teeth?

Dr B. I’ve noticed I’ve got white spots that are coming up on my teeth and I’ve tried using different toothpastes and mouth rinses. Is there anything that I can do to help with that?

Let me take a look. Your white spots aren’t really prominent and a tooth whitening procedure may work well for you for that. One of the things we see with teeth whitening is the teeth get whiter all the way around. So at first when you start whitening your teeth, you may notice that those white spots get a little bit whiter first, because it’s going to take the rest of your teeth to catch up to them. And then generally after a couple of weeks of whitening your teeth, that all tends to blend in and you have a nie sparkling white smile. Now sometimes the white spots are a little bit deeper than they appear clinically and if that becomes a problem and tooth whitening doesn’t work for you, then there are some other alternatives that we can discuss.

Is there anything as far as whitening is concerned, that I should be concerned with?

Probably the most common thing that I hear from our patients is an increase in sensitivity to temperature changes, a little bit of hypersensitivity. That is completely reversible. If the sensitivity becomes so much that you can’t eat and drink, and it’s really bothering you, then a lot of times we’ll say instead of whitening your teeth every day, then just do it every other day. If you still have persistent sensitivity, then there are other mixtures that we can use, less strong whitening solution, but most people do just fine.

What is periodontal disease?

So Dr. B, my mom went to the dentist the other day because she’s complaining of her teeth hurting and feeling like they’re loose and when she went they told her that she had periodontal disease, what in the world is that.

Periodontal disease first of all is gum disease, that’s what most people call it.  Most people don’t understand or realize that gum disease is the number one cause of the loss of teeth in adults.  The bad thing about gum disease is that it doesn’t hurt.  If gum disease hurt, we would be seeing people all the time complaining.  About 75% of the adults in the United States have some form of gum disease in their mouth and it’s been my experience that about 90% of those people don’t even know about gum disease or the fact that it’s in their mouth.  So if you’d like you could have your mom come over and we could do a consultation with her.  We have several non-surgical approaches to treating gum disease.  I can tell her the whole story of gum disease.

Is that something that I should be concerned about since she has it?

That’s one of the myths in dentistry, my mom lost all of her teeth at 20 because of gum disease so I’m doomed to lose my teeth, when in fact gum disease is caused by bacteria that live in our mouths naturally.  There is a mild genetic component to it, but almost all gum disease is caused by poor oral hygiene or not going to the dentist and getting your teeth cleaned regularly.

Would you like to know more?  I have a visual I can show you.


So Amelia, these are photographs that explain gum disease.

Let’s start at the top. This first row is normal health gums and bone.  The gums are nice and pink, they are a coral pink.  We don’t see any puffiness or bleeding.  If you look at the x-ray over here, this gray stuff around here, this is the bone that actually holds your teeth in place. You can see the bones right up around the necks of the teeth. That’s all normal. So this is normal and healthy, when this patient brushes and flosses, they see no blood on their floss or tooth brush.

The first step of gum disease then is caused by bacteria building up on our teeth and that’s called plaque.  Those bugs make a sticky gooey substance that allows them to stick to our teeth and our gums.  So that’s the first stage of gum disease.  You can see the gums are bit swollen, they look a little red and the gums will readily bleed when you brush or floss.  So if your gums bleed when you brush or floss, you have gum disease.  More than likely it’s gingivitis.  That’s what we call gum disease when it’s just in the gums.  If we look at an x-ray of a person with gingivitis, you can see the bone is still normal, so the bone has not been infected.

Periodontal disease goes in stages.  It starts with gingivitis, that’s just in the gums and then left untreated will move to the bone that holds the teeth in. That’s what’s going on with your mom. If her teeth are getting loose, that means that she’s loosing bone around her teeth.  It’s just a matter of how much bone has she lost.

So that’s what these lower photographs are showing.  This is when the gum disease is starting to move from the gum tissue itself into the bone that holds the teeth in.  You can see here you start to see little pits in the bone.  You see the gums starting to recede a little bit, it’s kind of puffy looking. So that’s type 2 gum disease.  Left untreated it moves on.  The sad thing is, it never hurts until it’s too late.

So left untreated for a few years, you can see now on this ray the bone has really started to disappear around the teeth.  About half of the bone is gone and generally when you start to get a half or more the bone, that’s when the teeth start to get loose.  If you look right here on this picture, you’ll see a white chalky substance.  That’s what most people call tarter or calculus.  Tarter and calculus are actually colonies of bacteria.  Those bugs have been living on that tooth so long that they’ve picked up calcium from the saliva and now they’re calcified onto the tooth and they’re kind of like barnacles.  So once this stuff forms on your teeth, you could brush your teeth 100 times a day and floss your teeth 50 times a day, it’s not coming off.

So those bacteria are living there 24 hours a day, 7 days a week.  So every time that you eat, they take the food that you eat and they turn that food into acids and toxins.  It’s those acids and toxins that cause the bone to slowly disappear.  In fact if you look at this x-ray right here, you’ll see these little bumps on the root, those are actually colonies of bacteria, they picked up calcium, they calcified onto the root now, and they’re what’s causing all of this bone to be lost around this tooth.  And that’s the end result of gum disease, is the bone is all gone and now the tooth has to be removed.

People talk about the domino effect of gum disease and that’s what’s going on here, this root of this tooth has lost so much bone, now it’s caused bone loss on the tooth in front of it. So this tooth needs to be removed.

So gum disease is very treatable.  It can be controlled but not cured, because it’s the bacteria that live in our mouths naturally that cause gum disease, so the whole idea is keep the bacteria off of your teeth.  You do that with routine teeth cleaning.  So in order to treat gum disease, what we do is we want to get rid of the cause, and that’s these bugs that are living on the roots of the teeth, we want to get all of them off, nice an clean.  Then your body will have a chance to heal itself.

Porcelain Veneers Louisville, Kentucky

So Amelia we talked about a couple of options with porcelain veneers.

The first option is we have some pre-made porcelain veneers that we simply bond onto your teeth, we shape them and
customize them onto your teeth.  And then the other is where we actually send them to a porcelain studio in California and they custom make them and those are top of the line.

So if budget is a concern for you you might want to consider these pre-made thin porcelain veneers.  I can hold one up against your teeth and you can kinda look at it and see what you think.  These porcelain veneers are very very thin. They are about the thickness of a contact lens. When they are thin like this and not bonded to the tooth they are very fragile, but once they are bonded to the tooth, they are just like having your own tooth again.

So I’m just going to lay one against your tooth and we can kinda get a gist of what this is going to look like.

What is the lifetime of a dental implant?

So Dr. B if I decide to with an implant, what is the lifetime on that?

Implants have about a 95 – 98% success rate and generally last indefinitely.  It’s probably one of the safest most secure dental restorations there is.

If I chose to go the route of the implant, is there something we can do now while we’re waiting for the implant or can I come in next week to just have the implant put in?

When we do an implant we do what’s called a diagnostic workup.  We’ll make some models of your mouth, we’ll make some x-rays, and then I’ll diagnose and treatment plan that.  We have some 3-D

software that we use and I can actually do the surgery via the software before we ever go and put the implant in your mouth. So that takes me a week or so to get all of that together, and then I’ll have

you come in and we’ll do the final consultation and we’ll discuss the treatment in more detail then.

Is there any special upkeep as far as implants go?

The thing about dental implants is you can’t get a cavity around one or in one, but you can still get gum disease around them.  So meticulous home care just like you do regularly, brush and floss, get your teeth cleaned twice a year and it should last you the rest of your life.