Word Of Mouth – A Dental Blog

by: Trish Rubin
That’s me now that I am on TRAY two, brace 2. I have graduated and, boy
am I ever full of myself! I’m getting a bit scatterbrained too, but, I think
it’s because this process is so easy…much easier than I imagined. So when
I take my braces out briefly, I sometimes wind up scouring the apt for
them…don’t tell my dentist they weren’t in the handy case I use at
fancy restaurants, ok! And the funny thing is I have to put on my contacts to
find my braces. Thank God my kids are grown and they aren’t using them for
costume shows in the backyard! Although my 20 year old son has threatened to hide
them. ( No worries now..I’m on tray 2, that means if I lose that tray, I
still have tray in a pinch!)

I like them, really. OK I like that they are not permanent, too…and that I
feel progress real or imagined, I do.

And I’m in a club. I’ve had two social incidents this week alone where
I compared Invisalign notes as I networked. And I’m confident enough to BIG
SMILE it now, sort of proud that I am wearing them! When I saw an Invisalign
commercial last night I almost applauded…that’s me! That’s where I am
going!

It’s funny though, some people have tried to convince me I don’t need
them??!! yes…I can see myself in the mirror and in photos and on video and I
KNOW I do! But for some people it seems silly that a middle aged woman would
wear braces….DON’T LISTEN TO PEOPLE LIKE THIS! Make yourself as healthy and
comfortable and as beautiful as you want to be…and with the excellent
resources of Dr. Sorin’s practice, you can. I even wore my braces proudly
into another dentist’s office when I picked up a friend for a meeting…and
guess what…I smiled and they didn’t even see them!!! Invisable!!
Now the trick will be wearing them to speak in front of 100 people on cable TV
next week! I CAN DO IT! My support team at Health Comfort and Beauty will be
standing by me when I do… literally!

Tooth whitening or “bleaching” one’s teeth has become very common today and we have some wonderful techniques in dentistry for getting great results with our patients’ smiles. However, we still get a lot of questions regarding “the truth” about all of those products you see at the grocery and drugstores, along with questions and doubts about their effectiveness compared to in office options. We would like to take this opportunity to dispel some common myths that we hear, answer some questions, and hopefully address some of the most common problems we see in our office with regard to tooth whitening.

First of all, let’s discuss how tooth whitening works. Basically, no matter which product you choose, the bleaching chemicals penetrate into the tooth enamel and set off a chemical reaction known as oxidation. To do this, most tooth whiteners use one of two chemical agents: carbamide peroxide or hydrogen peroxide. When used in the mouth, carbamide peroxide breaks down into hydrogen peroxide and urea, with hydrogen peroxide being the active whitening ingredient. The key to how effective any product is depends on two factors: how strong the solution is, and how long the agent remains against the teeth in order to allow the oxidation process to take place. Typically, the longer you can hold it on the tooth, the closer you can keep it to the tooth and the stronger the agent, the better the results.

For the most part, the products that you can purchase at your local supermarket do exactly what they claim. The strips cover 6 to 8 teeth, and the effects will last anywhere from 6 to 12 months, with monthly touch-ups, depending upon your own personal habits. They seem very affordable, given that your short-term investment is anywhere from $20 to $50, but the concentration is not always listed on the container. So if cost is an issue, try to compare apples to apples. The problem with these systems is not so much in the products themselves.  The problem we see in our office, is that patients’ expectations can be unrealistic. Whether you’re using strips or have decided to pay a little extra for the trays, the product is not custom designed for your mouth. What does that mean? It means that unless your teeth are perfectly straight, you’re going to get spotty results. Some of the strips can be especially problematic in that they cover only 6-8 teeth, leaving you with a two-tone mouth!  When we smile, most of us show 10 to 14 teeth. This is especially true when you laugh. Most patients want that younger-looking, beautifully-white, natural-looking smile, with no stain or discoloration showing at all. The more crowded your teeth are, the more you need the custom trays that only a dentist can provide.

Also, you are probably already aware that most over-the-counter medications are weaker, by law, than prescription medications. The same is true for whitening agents. What they are allowed to sell in the grocery store is not the same strength that your dentist can provide. Why does that matter? A stronger agent will give you longer-lasting results. The whitening systems used by dentists today can get very satisfying results that last for a long time.

Another problem we see occurs when a patient decides to use an over-the-counter method before they come in for a cleaning. If you have tartar buildup on your teeth when you whiten, the agent cannot get through to the enamel, so when the tartar comes off those portions of your teeth are the same color as before you whitened. Very disappointing!  So if you are going to use an over-the-counter product, at least get your teeth cleaned immediately before-hand so that you get the best results possible. Even though the over-the-counter whitening solution is weaker than our professional brands, if you have cavities, you will increase the risk of some uncomfortable sensitivity if you don’t get them evaluated and cared for prior to bleaching. Likewise, if you have any issues with your gums, you’ll want to get that evaluated prior to whitening as well.

More and more patients these days are asking about “the light.” Some whitening systems have been developed that utilize a high-intensity light to expedite the oxidation process. In our office, we utilize the BriteSmile Whitening System , the most advanced in-office whitening system.  BriteSmile whitening gel is carefully applied to your teeth. The gel is then activated by BriteSmile’s patented gentle blue light for 20 minutes while you relax and watch TV or listen to music. This process is repeated twice more before you go home with a naturally brilliant new smile. Take-home whitening systems can be just as effective, but usually require wearing your custom trays with the bleaching solution for about 30-60 minutes per day, for 14 days. If you are looking for the most expediant method, the BriteSmile process is for you.

Finally, we offer another whitening choice for those teeth that are badly discolored or are very gray; Power Bleaching consists of an in-office application of whitening agent, use of the tray system at home for 14 days, and a final in-office whitening application. We have found this combination to work very effectively on teeth that are very dark and have tetracycline staining.

With regard to safety, most studies show that tooth whitening is both safe and effective. If tooth sensitivity or gum irritation occur, it is best to stop using the whitening product for a few days, and then start again, but less frequently — say, every other day instead of every day — and reduce the amount of time spent with the whitening agent against your teeth.

These are the most common questions and concerns raised by our patients, but we’d love to hear from you! If you have a question or comment about specific whitening options for your teeth, please call us at 212.355.3533, or e-mail us at info@nycdmd.com.

As dentists concerned about and focused on facial appearance, we realize that a pleasing smile does not exist in a vacuum, unaffected by other facial structures. At times we need to consider overall facial symmetry, harmony, proportion and balance and to address parts of the face apart from the teeth.

In April of 2008, The Harvard Women’s Health Watch reported on the increasing popularity of dermal fillers in women seeking a younger look as an alternative to more conventional facial plastic surgery. BOTOX® Cosmetic was the top non-surgical cosmetic procedure of 2007 according to statistics compiled by the American Society for Aesthetic Plastic Surgery. In this post, Dr. Bryan G. Forley shares with us some of his thoughts on this topic.

BOTOX® Cosmetic and Dermal Fillers

BOTOX® Cosmetic injections provide a non-surgical way of reversing some of the visible signs of aging. Crow’s feet, laugh lines, and frown lines are caused by the contractions of underlying facial muscles. Dynamic lines occur with every smile, laugh, or frown. These can lead to wrinkles that are present when you are not expressing emotion. Botox works by blocking the nerve impulses to the wrinkle producing muscles so they do not contract. The overlying skin will be smooth and unwrinkled. The untreated muscles will allow for normal facial expression to remain unaffected. The treatment is simple with minimal discomfort, requires only a few minutes, and you can immediately resume normal activities. Very precise injections are made into the areas selected for treatment. The results will be apparent in a range of a few days up to two weeks. The duration of effect is between 4-6 months.

BOTOX® Cosmetic is an excellent choice in areas of the face where muscle contraction can be modified to achieve the desired effect of smoothing of the overlying wrinkled skin with maintenance of normal facial expression. In contrast, dermal fillers composed of hyaluronic acid, such as Juvederm™, Restylane®, and Perlane® , are indicated in areas of folds, wrinkles, or hollowing that result from volume shifts or deficiencies in the face. Recent trends in facial rejuvenation have focused on restoring the “facial deflation” that occurs with aging. Hyaluronic acid is found naturally in the body and provides volume and fullness to the skin. Injectable hyaluronic acid has been modified to allow for a greater longevity than that found in the skin. In addition, these products contain no animal proteins so no skin testing prior to treatment is required and the body degrades them gradually over time. The duration of effect is from 6-12 months.

The selective use of BOTOX® Cosmetic in conjunction with a dermal filler maximizes the potential benefits of each modality to the patient. In many cases, they produce an anti-aging benefit that can postpone the need for surgery while maintaining a natural appearance.

BRYAN G. FORLEY, M.D., F.A.C.S.
Dr. Bryan G. Forley is a plastic surgeon certified by the American Board of Plastic Surgery. After graduating from Brown University in 1979, Dr. Forley received his medical degree from the Mount Sinai School of Medicine and trained in general surgery at New York University Medical Center and the Mount Sinai Medical Center. His residency in plastic surgery was completed at the Saint Francis Memorial Hospital in San Francisco and was followed by an aesthetic surgery fellowship with Dr. Bruce F. Connell and a craniofacial surgery fellowship in London, England.

Dr. Forley is an active member of the American Society of Plastic Surgeons, the American Society for Aesthetic Plastic Surgery, and a fellow of the American College of Surgeons and the Royal Society of Medicine.

Dr. Forley is in private practice in Manhattan with an office on the Upper East Side. He specializes in cosmetic surgery of the face, eyes, nose, breast, and body. Please visit www.drforley.com for additional information.

In a society increasingly focused on youth and a certain standard of beauty, more and more Americans are turning to reconstructive and dental cosmetic surgery to change the way they look. A new wave of reality television shows is fueling this trend. Recently Dr. Anthony LaBruna and I spoke at the Health and Wellness Seminar at Weill Cornell Medical College about the problems this trend causes by distorting the expectations of our patients. While television has informed the public about the possibilities of aesthetic-enhancing procedures, more often than not, however, “reality” shows are anything but reality.

An article about our presentation continues here >>>

Recently a popular New York weekly magazine featured several articles on the popularity of cosmetic procedures, including cosmetic dentistry. One of the authors interviewed several “cosmetic” dentists to discover what treatment would be most appropriate for him. I found the article surprising and disappointing.

The author consulted five Manhattan dentists, reporting on their “styles of care”, their bedside manner and their treatment proposals. What I found most surprising and disappointing was that in none of the offices being evaluated, did the author (patient) receive a comprehensive evaluation of his dental health. No mention of an oral cancer exam, no mention of a check for gum problems, no mention of an examination to determine if the muscles and the tempromandibular joint were working harmoniously -only an emphasis on what to do to improve the “the look”.

Now I must apologize if I am missing the boat, but as one who provides cosmetic services I have always thought, and still believe that patients can and should have it all. Good dental care should be based on health, function and beauty. A desire to achieve improved dental aesthetics does not have to neglect either oral health or masticatory function! After all, an outstanding cosmetic result can only be created on a well functioning and healthy foundation.

While it is certainly true that more and more patients are seeking cosmetic dental care to help them look and feel better about themselves, aesthetic care must also consider the health of the underlying structures and how these structures work as an integrated unit. Anything less and the patient is simply not getting the best.