Patient Education – Calgary Dental Clinic
Patient Education Information is provided by Dr. Lawrence Lai.
Please note that the information provided here is only for educational purpose. It is not meant to be used for diagnosis of any dental problems you may have. Please consult a dental professional for diagnosis and treatments.
The opinions expressed here are of Dr. Lawrence Lai. They may not be agreed upon with other dentists.
- Amalgam Filling & Dental Amalgam
- Bad Breath
- Children’s Dentistry
- Cosmetic & Aesthetic Dentistry
- Dental Check-Ups
- Dental Composite Resins
- Dental Emergencies
- Dental Filling
- Dental Implant
- Endodontic Therapy (a.k.a. Root Canal Therapy)
- Full Mouth Rehabilitation
- Gum Disease & Alveolar Bone Problem (Periodontal Diseases)
- Inlays & Onlays
- Invisalign® Treatment
- Periodontal Disease
- Pit and Fissure Sealants
- Post and Core
- Removable Partial Denture (RPD)
- Removable Complete Denture
- Scaling and Root Planing
- Sedation Dentistry
- Temporomandibular Joint Disorder
- Tooth Whitening
- Tooth Extraction
- Topical Fluoride Treatment
- Wisdom Tooth Removal
- Zoom Whitening
Amalgam filling or dental amalgam was the most commonly used dental restorative material used for dental fillings. it contains a mixture of mercury with at least one other metal. Amalgam has been the restorative method of choice for many years due to its low cost, ease of application, strength, durability, and bacteriostatic effects. Factors that have led to recent decline in use are a lingering concern about detrimental health effects, aesthetics, and environmental pollution.
Amalgam fillings or silver fillings: are they harmful to my health?
Dentists have used dental amalgam for more than 150 years. However, over the past decade, more and more people are concerned about the safety of this longest-lived and most affordable filling material. Amalgam is an alloy of many metals, including silver, copper, zinc and mercury. The main concern of this material is about its 45% mercury content. According to many people’s understanding, mercury is very toxic. However, there is detailed information about this that people oversee. Mercury in its elemental form, such as in old-fashioned mercury thermometers, is toxic. But when it is mixed with other metals, and turned into an alloy as the one in the silver fillings, it becomes inactive and safe. Nonetheless, the media and other anti-amalgam groups including some consumer groups, environmentalists, lawyers, and holistic dentists have been successful to lead many people to believe the contrary. Their argument is based on some studies claiming that the mercury in amalgam fillings is hazardous and directly related to Alzheimer’s disease, autism and multiple sclerosis. On the other hand, some important scientific and public health organizations argued that these studies was based on faulty science and they insist that 150 years of scientific research and real-world application of amalgam fillings have proven its safety. These organizations include the Food and Drug Administration (FDA), World Health Organization (WHO), U.S. Public Health Service (UDPHS), Centers for Disease Control and Prevention (CDC), American Dental Association, Canadian Dental Association, and Academy of General Dentistry. Are you confused about this issue as well? What can you do as a dental consumer? First, you have to understand the pros and cons of amalgam fillings as compared to its alternative, i.e. composite or white fillings.
Amalgam is a very good filling material based on the followings:
- Cheapest and most affordable as compared to the white filling. The dental fee for white filling is about 30-40% higher than amalgam fillings.
- It is more forgiving to be worked in a wet field as compared to composite fillings. In the case of a very deep fillings and difficult to keep the area dry because of too much saliva or too much bleeding or patient cannot tolerate the use of rubber damp to isolate a dry field, composite filling placed in this situation will not last long because it has to be bonded onto the tooth structure and this bonding will not take place when the field was wet. In contrast, amalgam filling does not depend on this bonding mechanism. It stays in place in the tooth by “mechanical inter-locking.”
- Amalgam, being a metal alloy, is very strong and long lasting material, as compared to the plastic-like synthetic composite material used in white fillings. In addition, it does not shrink in size after setting. In contrast, composite filling will shrink after setting. This may create some sensitivity to biting. However, recent advancement in dental material science has produced some composite materials with very strong and very high wear-resistance as well minimal shrinkage. Personally I do not encounter a significant difference in post-operative sensitivity complaints between white fillings and amalgam fillings.
White or composite fillings may be your choice over amalgam based on the followings:
- It is more esthetics, since it is tooth-colored while amalgam is silver colored.
- It is more conservative in the preparation of the tooth to receive the filling. Because amalgam stays onto a tooth by mechanical retention, the dentist has to create some specific form in order to create an interlocking effect to hold the amalgam physically. This requires removing some good tooth structure in addition to removal of the decayed tooth structure. In contrast, because white filling stays onto a tooth by chemical bonding, only removing the decayed tooth structure is all needed most of the time prior to placing the filling. This is especially significant when the cavity is very small and the dentist wants to conserve the good tooth structure as much as he can.
- When a tooth has lost the majority of its structure, ideally a crown will be the choice of restoration. But if you cannot afford having a crown placed, then a huge filling is your next option. In this case, I have found composite filling is often better than amalgam filling because of its bonding mechanism to stay onto the tooth (just like being “glued” to the tooth surfaces). If amalgam is used in this case, dental pins are normally necessary in order for it to stay onto the tooth because there is not enough tooth structure to physically “lock” the amalgam in place. Research has shown dental pins create micro-cracks which increase the chance of tooth fracture or the need of root canal therapy.
- If the “amalgam controversy” has given you sleeplessness.
Now let me share with you my personal stance. Because of its superior esthetics and its lack of controversy, composite restorations have become my primary filling material. I rarely insert amalgam fillings nowadays unless patient specifically asks for it. On the other hand, I will not suggest to patients to have their existing amalgam fillings replaced for the reason that they are hazardous to their health. If the patients want to change the amalgam fillings to white fillings because of cosmetic reasons, I will be pleased to have them done. However, I always make sure the patients understand that it is an elective procedure and there is a possibility that the tooth can turn into inflammation and eventually requires root canal therapy because of this elective procedure.
Bad breath can be a problem that involves oral health, as well as overall physical and mental health. First of all, gum diseases, and/or tooth cavities can cause bad breath. If these two factors are eliminated, you may look for other factors. People taking a myriad of medications that cause decreased salivary flow will often experience bad breath. These medications include some antidepressants, psychiatric drugs, blood pressure pills, antihistamines etc. It is estimated that at least 400 prescription medications are linked to dry mouth. Dry mouth can also be related to a variety of diseases and medical disorders. People with stomach upset or ulcers or acid reflux problem also suffer bad breath. Sometimes, bad breath can be a mere psychological belief in some patients.
A bridge, also known as a fixed partial denture, is a dental restoration used to replace a missing tooth by joining permanently to adjacent teeth or dental implants.
Dental bonding is a procedure in which a tooth-colored resin material is applied and hardened with a special light, which ultimately bonds the material to the tooth to restore or improve a person’s smile. It can be used to repair chipped or cracked tooth, to mask a discolored tooth, to close spaces between teeth, to change the shape or length of the tooth, or to cover a portion of a tooth’s root that has been exposed due to gum recession. However, it is much easier to get stained, and not as long lasting as porcelaine veneers.
Cavity is demineralization of the tooth structure, involving enamel first, then the dentin layer. It is an infectious disease because scientific research has found the bacteria that are involved in this mechanism: Streptococus mutans (or Actinomyces Viscosus if we talk about cavity on root surface, this problem happens more in the older population group). In brief, in order to have cavity to happen, you need three things: the bacteria, the nutrients for the bacteria (let’s say sugar in the candy), the host (yourself, or the tooth that get infected). How does it happen? To say it simple, the bacteria metabolize the nutrient into some acidic substance, which in turn will dissolve the mineral in the enamel or in the dentin, making your tooth become soft, hence cavity.
How do dentists treat cavity? They treat the cavity by drilling it with a bur, with microabrasion, or with laser technology as far as the soft decayed part of the tooth can be removed. Then they have to fill the empty space now left behind. They can choose a material called Amalgam (or commonly known as silver filling), or some synthetic materials such as composite resins (or commonly known as white filling), or even ceramic/porcelain (as in the case of inlays). One of the more recent approaches to treat cavities is by assessing the risk of patients. Patients with a high risk of contracting cavities are prescribed with some fluoride rinses, regular chewing of gum which has the ingredient called xylitol. I believe that this is more of a preventive and progressive approach dentists should be heading for in the future.
Children’s dentistry (a.k.a. Pediatric dentistry) has become a specialty in dentistry. Young children can have a lot of dental problems and because of their young age, special treatment or treatment approach is sometimes quite different from treating adults. Some common oral diseases seen in children includes baby bottle syndrome, early loss of baby teeth causing loss of arch space for future adult teeth to erupt, unwanted habits such as thumb sucking result in malformation of the facial jaw complexe. Early detection of these problems is important so that long term damages can be avoided. Bring your children at early age to your dentists is a good start for them to build up confidence and trust in a dental setting. This will affect their future attitude towards their oral health for a life time. If your dentists find out that your children needs the help of a children dentist specialist (pedodontist), they will be happy to refer one whom they can put their trust in.
Nowadays, people seeking dental care is not only limited to treating basic oral diseases. They want a perfect smile like Hollywood movie stars. Here comes the term cosmetic or aesthetic dentistry. Dentists can enhance your confidence by improving your smile, straightening your teeth, whitening your teeth or a combination of all these with veneers, tooth bleaching, traditional braces, invisible braces such as Invisalign® clear aligners (see Orthodontics).
A crown is a type of dental restoration which completely caps or encircles a tooth or dental implant and is typically bonded to the tooth using dental cement. It can be a precious metal (gold) crown, a metal ceramic crown (inside metal to give strength and outside ceramic to mimic tooth color), or non-metal ceramic crown (such as Empress ceramic crown which is weaker but more translucent and life-like or Zirconia crown which is not as translucent but stronger).
More on crowns: What types of crown are available nowadays?
Dental crowns are more commonly known as caps. They really look like caps that put on teeth. Here is an important question: “When are the situations that just putting a filling (or dentists call a direct restoration) is not enough and then you should consider having a crown on that tooth?” Let me list some guidelines for you:
- When the tooth has extensive cavity that after removing the cavity, not much tooth structure is left for the filling to add on.
- When the fillings are discolored or the tooth has discolored or the patient does not like the look of the tooth (I am talking about the front teeth), then for cosmetic reasons.
- When the tooth has extensive filling that has the risk of fracturing the tooth because tooth with big filling may not be able to withstand heavy biting force in your mouth.
- When the tooth has had root canal therapy. Why? First, you have to ask why the tooth requires root canal therapy. Most of the time it is because the tooth has had deep or extensive cavity that it involves the pulp of the tooth. When dentist removes the cavity on that tooth, you can imagine that not much tooth structure will be left. How does dentist perform root canal therapy? He/she will drill a hole on the top surface of the tooth into the inside core of the tooth where the pulp or nerve or blood vessels are located. You can imagine that after this procedure, more tooth structure will be gone. So a crown is needed exactly for the same reason as in point 2 above: the tooth becomes too weak to stand for your heavy biting force because not much tooth structure is left on the tooth.
Controversy scenario: Then you may ask how about a tooth that has had root canal therapy but still has quite a lot of tooth structure left? Many dentists believe that once a tooth has root canal therapy, the tooth will become more brittle than teeth without root canal therapy, hence has a higher risk to fracture if not protected by crowns. In fact, research studies did not show such a case, at least not to the extent that every tooth has had root canal therapy must have a crown on it. In some situation, tooth requires root canal therapy may not have extensive decay. Maybe the tooth has had trauma, maybe the decay is quite small but very deep so that it involves the pulp, hence requires root canal therapy. In this case, root canal therapy can be performed with just drilling away the top surface away to get into the pulp. All the side-walls of the tooth is still intact, what we call only an occlusal surface is involved, then the tooth will not require a crown. There is research showing that if only the top surface is involved on a root canal treated tooth, the strength of that tooth only reduce by 5% while if the tooth is missing at least two surfaces, let’s say the top surface and one of the side surface are with filling and the tooth has had root canal treated, the tooth will have reduced strength by 45 to 50%. But how often we hear dentists tell their patients that every tooth that has root canal therapy must have a crown on it or it will break or fracture eventually. Why? Because crown procedure is expensive and lucrative!
How much a crown is worth?
I hope you are not mistaken that any dentist tells you that you need a crown for a tooth is trying to ripe you off. Crown treatment is the premium dental service you can get. It is expensive because it is very techniques sensitive and the materials that are involved in the procedure are very expensive. However, it is very cost effective and gives you a long lasting result. Researches show that a direct filling normally last for 5-7 years while crowns last for 12-15 years in average. Most of the crowns which fail are due to recurrent decay around the crown margins. This can be caused by your poor oral hygiene or the quality of the crowns made (more of this later). And so often I see crowns in many patients’mouths are still in good shape after 30 or 40 years of service in your mouth, 24 hours a day! Think about how long your car will last if you use it 24 hours a day! Don’t tell me you are not using your teeth while you’re sleeping. Every movement you do such as swallowing, breathing etc you do involve your mouth and your teeth! A crown also make your oral hygiene maintenance much easier to implement because either the gold alloy or the porcelain material is very smooth and does not attract plaques in your mouth compared to decayed surfaces or surfaces of direct filling materials. As mentioned earlier, crown protects your tooth from fracturing. Also one important advantage of crowns is that it can change the shape and color of the tooth and gives it a completely new look that is so esthetic that you will love it. Think about the beautiful white teeth in the models of the cover pages of many magazines. Many of them actually have crowns or veneers in their front teeth so that they can have such beautiful attractive smiles!
What kind of crowns are available?
Now let’s talk about the types of crown available nowadays. In the old times, full gold crowns (they are not 100% gold, the alloy used to make gold crown can range from quite low the gold content to as high as 80% gold content) are the standard crowns of choice. In poor countries, you can see stainless steel crown or some cheap alloy crowns as well. My discussion here does not include those stainless steel crowns or alike because they are not up to the North American standard requirements for crowns. – The main advantage of full gold crowns is its unparalleled strength. A well-made full gold crown is rarely fractured or broken into pieces. In addition, dentist needs to reduce the size of the tooth before placing a crown on it. Because gold alloy is stronger, crown from this material can be made thinner and still provide enough strength to withstand the biting forces of your mouth. In other words, when a dentist is delivering a full gold crown to a tooth, he will reduce the least tooth structure. In comparison, if the dentist is giving you a all-porcelain crown, because the porcelain is easier to break and more brittle, the crown made of this material has to be thicker in order to give enough strength to withstand the biting forces. In other words, the dentist has to reduce more tooth structure in order to fit the crown. If they don’t reduce the tooth small enough, but the crown has to have certain thickness, what will happen? The crown will become very bulky! Think about a very big cap fitting onto a small head!
This can create gum or periodontal problems because food and bacteria trapped underneath these overhangs cannot be easily removed.
Gold crown: Another advantage of full gold crown is that gold alloy is moldable and not brittle (as in the case of porcelain). Full gold crowns can be easily made to fit well at the margins where the crowns sit onto the teeth. Fortunately, with nowadays technology, all porcelain crowns can be fabricated to fit the margins precisely as well.
This is a very important factor to consider. If the margins do not fit well when a crown is placed onto the tooth, creating what dentists call “open margins,” this tooth will become very susceptible to decay again at the margins as food and bacteria will trap at these open margins. So when you are told that your existing crown which was made only 3 years ago needs to be replaced because of some recurrent decay at the crown margins, you may as well suspect that the crown delivered at that time may have an open margin already (even though your dentist will likely blame your poor oral hygiene for it, especially if he/she is the one who delivered that crown). So you may blame the dentist who delivered that crown to you!
Of course, nothing is perfect. The main disadvantage of full gold crown is its poor esthetics, at least according to nowadays North American Beauty standard. However, Beauty is always in the eye of the beholder. I have had at least two patients requested for full gold crowns in the front teeth! For most people, if the tooth that needs a crown is located deep inside the mouth where the teeth are rarely visible to other people, they may not mind having a full gold crown to benefit from all its advantages.
Porcelain fused to metal crowns:
Can you benefit all the advantages of full gold crowns and still have an esthetic tooth-colored crown? The answer is yes! Here comes what dentists call the porcelain-fused-to-metal crowns (PFM crowns or CMC crowns as they are also known as ceramo-metal crowns). They are crowns with gold alloy underneath but with porcelain wrapping around most, if not all, the metal so that the crown is tooth-colored when seated on a tooth. Wow, what an innovation! What is the catch, you may wonder? The main disadvantages of PFM are that dentists have to reduce more tooth structure than full gold crown (but still less than all-porcelain crowns) and because the crown has metal underneath the porcelain, it is not as transparent and life-like compared to all porcelain crowns and to the natural teeth. Have you ever noticed some friends of yours when they smile you can see some of their front teeth have a grayish margins close to the gum or the teeth somehow look a bit grayish or dark or not natural. Those teeth probably have PFM crowns. Therefore the demand from the public for a more esthetic solution has driven the dental business to develop a better product: all ceramic or all porcelain crown.
In other words, if you expect paramount esthetics, a Hollywood smile, all-porcelain crowns is your choice of crowns. Because there is no metal underneath the porcelain, light can shine through it, giving it very life-like appearance. The disadvantage of porcelain is that it is quite brittle and weaker than metal, so crown fractures can happen quite frequently if your dentist just do all porcelain crowns on every patient indiscriminately. As a general rule, I do all porcelain crowns mainly in the front teeth only. Why? The front teeth are the visible teeth when you smile, so esthetics is very important. Front teeth normally do not have much biting force on them as compared to the posterior teeth. How about if patients insist to have only all porcelain crowns even in their posterior teeth, will I do it? I will explain to patients about the likelihood of fracturing or chipping of all porcelain crowns and if they still want to go ahead, by all mean! I will respect patients’ choice as far as they are well informed of what they are going for. I find it quite irresponsible for dentist who talks patients into all porcelain crowns without letting them know the fact that all porcelain crowns do fracture, and at a much higher rate than PFM crowns! I know most dentist will redo the crown for free if that happen within 1 or 2 years. But how about if the crown cracks in 5 years do you think your dentist will redo it for free? What they will then tell you? “Mr/Mrs so and so, because your bite is so strong (or because you grind your teeth so often), now we have to make a new crown for you. But fortunately, your insurance will cover some of it because the crown is over 5 years old!” Of course they will blame your bite rather than blaming himself/herself! But I believe as a health care giver, your dentist should deliver something suitable for you. If he/she cannot diagnoses in the first place that you have a heavy bite and prescribed an all-ceramic crown for you, sooner or later, you will crack that crown! Do you want to worry about cracking your crown when one day you bite on some hard stuff? I heard of at least two persons who have had the crown redone for 2 times and still cracked it the third time! Fortunately, by the time I am writing this paragraph, the dental market already has some all-porcelain crowns available which are very strong to withstand your heavy bite. Some examples of these strong crowns are Zirconia crowns However, most dentists find them not transparent enough to give that life-like appearance and prefer what is very transparent but quite weak (e.g. Empress crowns) over them. I myself do quite a few Empress crowns because they are really very esthetics. But I will never do them in the posterior teeth! So next time when your dentist suggests to you to have all-porcelain crowns in the posterior tooth, make sure you ask which one he/she chooses for you.
Teeth from opposing arches grind on each other all the time. If they are of same material, as in the case of two natural teeth touching together, they wear in the similar rate. But let’s say the bottom tooth has a crown and the top surface of that crown is of porcelain, which touches the top opposing tooth surface, which is enamel, the enamel surface from the top tooth will wear faster than the bottom tooth porcelain surface because porcelain is very abrasive. In other words, if you have a very heavy bite, porcelain crowns will grind away your natural teeth surfaces in the opposing arch very aggressively, whereas gold alloy is found to have a closer abrasiveness to our natural enamel than porcelain does. This is one more plus to have full gold crowns rather than porcelain crowns.
Regular dental check ups are the best way to make sure your gums and teeth stay healthy. The check up allows your dentist to diagnose any problems, and to take preventive action to stop problems before they develop.
Your dentist is trained to look for anything unusual in your mouth, throat and neck, including the oral manifestations of diseases, oral cancer, infections, the early signs of gum disease, eroded fillings and dental decay.
Your dentist understands the treatment alternatives available to you, and can help you make informed decisions about your dental care. But you have a role to play too in preventing many of the common dental problems associated with growing older. That is to see your dentist regularly!
Dental composite resins (a.k.a. tooth-colored fillings or white fillings) are types of synthetic resins which are used in dentistry as restorative material or adhesives. Synthetic resins evolved as restorative materials since they were insoluble, aesthetic, and insensitive to dehydration and were inexpensive.
Patients are often presented to dentists with toothache, oral-facial pain with unknown reason, broken tooth, broken fillings, broken restorations such as crowns, dentures, bridges, abscessed tooth, swelling in the face, accidental fall causing front teeth chipped or broken. Often these incidences can happen unexpectedly, suddenly and causing people severe grief or embarrassment. Treating dental emergencies promptly is a dentist’s daily routine responsibility.
Dental filling or dental restoration is a dental restorative material used to restore the function, integrity and morphology of missing tooth structure. The structural loss typically results from caries or external trauma. Fillings are the first line of treatment for oral cavities.
Endodontic therapy(a.k.a. Root Canal Therapy) is a sequence of treatment for the pulp of a tooth whose end result is the elimination of infection and protection of the decontaminated tooth from future microbial invasion.
Pulpal problems (Root Canal Problems)
What happen if you leave a tooth with cavity untreated? The cavity will get bigger and bigger, spreading from the surface enamel layer to deeper dentin layer, then eventually into the pulp space. Does it hurt as the cavity spread, you may wonder? It may or it may not! Many patients with cavity that affects the dentin layer will experience sensitivity when they eat sweet stuffs or when they drink cold liquids. However, equally many patients presented to me with huge cavity, which has affected the pulp, did not have any pain or any symptoms at all! Why different people response differently? I don抰 know. It may be related to the strength of the immune system the individual has or it may depend on how an individual responses to pain. Many people have the idea that if nothing bothers me now, why should I go to see the dentist? This is one of the reasons why you need a regular checkup, as cavity may not give you any symptoms. As I mentioned earlier, if cavity just affects the enamel and dentin layer, a direct restoration (a filling) usually suffices. However, if cavity has got so big or so deep that it affects the pulp, a filling will not be enough. Why? It is because the pulp has the blood vessels and nerve. When the pulp is affected, it will go into a chain of reactions what we call inflammation. Think about when you hurt your finger by carelessly stabbed it with an object and it got red, swelling, pain, and quite hot around the area. That is inflammation. When inflammation happens, blood supply to that area will increase, so you抣l see red and hot area (because of the blood), swelling because blood and body liquids accumulate, which builds up pressure (that gives you pain). Now let抯 bring the picture of inflammation in the dental pulp environment. When you just remove the cavity and filled the hole with a filling, while the pulp chamber inside the tooth core has inflammation. Blood is gushing into the pulp but it has a limited space! Pressure will go up, and up, and up until the pressure is so high that it pinches onto the nerve in the pulp. That is why dental pain can become so excruciating! Sometimes it is less painful if the cavity is bigger that it actually creates a big hole to let the pulp communicate with the surface of the tooth.
Procedure of Root Canal Treatment:
So now, what are the treatment options? One is to take out the tooth completely (extraction) as so commonly practiced in the third world countries or poor populations because it is the cheapest and quickest option. The other option is to carry out a procedure called root canal therapy. How do dentists perform root canal therapy? In brief, they drill a hole from the surface of the tooth into the core of the tooth where the pulp is located. Once they get an access to the pulp, they can clean up all the tissues there, including the nerve, the blood vessels. Now the pulp space becomes hollow and clean, ready to be filled with some rubbery material called gutta percha.
You can imagine that once the root canal therapy is finished, the tooth is devoid of blood supply and nerve supply, what dentists call a non-vital tooth (non-living). Why my dentist tell me I need root canal therapy even though the tooth does not bother me at all?
As I mentioned earlier, sometimes the tooth has cavity deep into the pulp but the patient can experience no pain at all. What will happen to the tooth if this situation goes on? The tooth responses to cavity in a different way. Rather than going into inflammation, the pulp just silently dies out. Now the tooth becomes non-vital because the blood vessels and nerve gradually shrink and become necrotic (rotten in a sense). This rotten pulp can be there for quite some time until the tooth comes to haunt you again. How can you tell one tooth is non-vital and has a rotten pulp? You can抰! But your dentist can tell when he/she carries out some specific tests on the tooth. One of the tests is to put some very cold object onto the tooth and ask the patient if he can feel the coldness from that tooth. A healthy tooth normally can tell the coldness but as long as the object is put away, the coldness disappears. A tooth that goes into inflammation will sense the coldness in a dramatic way and the coldness or discomfort can linger for a few minutes, sometimes for hours, when the object is put away. For a non-vital tooth with necrotic pulp, the patient will not feel the object to be cold at all. Same is for the tooth that has had root canal therapy, because in both situations, the tooth is non-vital (non-living). But there is a fundamental difference between the two. The root canal treated tooth has a clean and filled pulp space, while the tooth with a necrotic pulp has rotten tissues inside to harvest the bacteria. In other words, now the pulp is infected even thought it does not bother the patient at the moment. What if the tooth is left untreated in this situation? The bacteria will keep growing inside the pulp space in a situation similar to a covered garbage can with all the rotten stuffs inside. You cannot sense (feel) the foul smell (the infection) yet, but this situation will not last too long. Gradually, the infection will spread beyond this garbage can (the pulp space) to the environment (the alveolar bone that anchors the tooth). Again when this happens, the body responses differently among different people, or even among different teeth in the same individual. Some tooth will give you severe pain when you now touch the tooth or when you bite down or just pain constantly. Some tooth in this situation will not give you pain, at least not yet for now, but it will cause the surrounding alveolar bone which next to the tooth抯 root tip to dissolve. Why? Because now a balloon-like structure will start forming around the exit of this garbage can (at the root tip) which displaces the bone in its way. This balloon-like structure is called a cyst or a granuloma (a small tumor).
This structure will stay the same size or get bigger gradually in the course of time until one day; there comes a severe pain from that tooth. This is often when the person will go to see a dentist for treatment because the pain has become so intolerable. What is the treatment for now? The same as before: either root canal therapy or extraction of this tooth. However, the success rate of root canal therapy in this situation will become slimmer. In other words, the chance of saving this tooth will be less and often the tooth will be painful for a while even after the attempt of root canal therapy. Therefore, the patient normally has less motivation of saving the tooth because they experience more pain during and after the root canal treatment.
In some extreme situations, the patient with a necrotic tooth will not give you the above picture. The infection gradually spreads into an extensive area in the jaw bone and the adjacent tissues silently at first. Then one day, the patient’s face will swell up with severe pain that he/she will be admitted to the hospital as an emergency. This situation can become life threatening if not managed promptly. In this situation, the troubled tooth will be extracted. Sometimes the swelling is so bad that the patient cannot even breathe normally and open his/her mouth for the caregiver to extract the culprit. As an emergency treatment, the physician may need to make some incision on the patient抯 throat or cheek to get access.
Regular checkups can prevent root canal therapy and expensive bills:
I hope none of my patients will ever get to any of these stages. Theoretically, if preventive dentistry is implemented, root canal therapy should never be needed (I should never say never, someone told me). Whenever a tooth has started a cavity, if detected early enough, a simple filling is all what it needs at most. Simple direct filling is much, much cheaper and less time consuming than extensive restorations such as root canal therapy and crowns and bridges. My patients too often tell me that they did not come earlier for checkup cleaning because they are not lucky enough to have dental insurance coverage like other people. What is my answer? I will say just because you do not have dental insurance coverage, the more you need to have regular dental checkup and cleaning so that no expensive dental treatment you will ever need! How much will it cost you, if you do not have dental insurance, to have a checkup and cleaning once a year in a dental office? About $200 to $300. You may need one or two fillings now and then, which costs you another $100 or $200. But this won’t happen every year if you have a reasonable oral hygiene at home. How much for an average person spends in hair salon for taking care of his/her hair? I don’t you. But my guess would be about $200-$300 per year. Think about those people with dental insurance, how much they normally pay for premium each month for coverage? Probably $30 at least (that is $360 a year!). They may not notice this amount because normally their paychecks have already been deducted with the dental insurance premium. They are not much luckier than you. What if you don’t go to see a dentist for 5 years, how much you have saved? $200 times 5 equals $1000. But after five years, now you have an emergency because the tooth is hurting you. How much will this tooth cost you if you want to save this tooth? Root canal therapy and a crown equals to $2000 dental bill! And the tooth is not as good as the one with no filling or just a small filling in it. How about you have two teeth now need these expensive treatments? How about if you have gum disease because your mouth has not been cleaned for 5 years and is now full of plaque and calculus (tartar)? You now need a full mouth deep root cleaning (called root planing), which can cost you at least $1000 to $1500 and you may need three to four cleaning appointments, and often local anesthetics (needles) is required for this treatment!
Sometimes, money cannot make up what you have lost!
I have not included the costs of having a severe toothache one day and the loss of works because of it. I have not included the costs of forfeiting yourself the pleasure of enjoying a sense of wellbeing in your dental health and the confidence of a beautiful smile! Do you get my point?
However, most people do not see my point. They will argue that not everyone who does not go to see a dentist will have gum problems, or severe decayed teeth. The problem is that you don’t know whether you are or will be the lucky one! Let me ask you: do you buy life insurance? Disability insurance? Car insurance? House insurance? Why do you still pay money for these if you may be the lucky one that never needs to claim for these insurances? Do you know the chance of you to claim for any of these insurances is much smaller than the chance you will get a cavity in your mouth in the coming year? How do I know? Because scientific studies have shown that cavity is the most prevalent infectious disease in humankind!
Some people may argue that even if they visit their dentists every year, they still need a crown or root canal therapy from time to time. There are two main possibilities to explain this phenomenon:
- You have some teeth that have had big fillings before and now these fillings have served their time. Remember I mentioned earlier that direct fillings are not long lasting as crowns? In this case, you are just paying the prices for your dental neglects in the past, where cavity was not prevented when it started small in the first place.
- Your dentist did not diagnose cavity early enough when the tooth just needed a small filling. Misdiagnosis or negligence in diagnosis of a dental problem can be due to incompetence of your dentist, his/her practice philosophy (that is not emphasizing prevention dentistry) or lack of use of updated dental equipment (for example taking enough but necessary dental x-rays). Sometimes it is the objection from patients to let the dentist take enough dental x-rays for appropriate diagnos
Full mouth rehabilitation involves extensive dental treatments to reestablish a person’s teeth. Patients who need full mouth reconstruction as it is sometimes being called are those who have lost most or all of their teeth. Tooth loss can be due to cavities, gum disease, severe wear from unwanted habits such as grinding and clenching, or severe erosion from acidic diets such as pop drinking or from caustic exposure to recreational drug such as Met amphetamine or due to gastric juice erosion in bulimic patients. The reasons contributing to tooth loss can be numerous. Once the underlying problem is treated, the patient may want to gain back their teeth to its original shapes and functions. Treatment to reconstruct the teeth may involve full mouth crowns, bridges, removable dentures, and implant supported prostheses etc.
Each tooth is anchored in the alveolar bone of the jaw through its root(s) as a tree is anchored to the soil through its roots. The portion of the tooth that is exposed in the oral cavity is called the crown of the tooth while the portion of the tooth that is buried inside the alveolar bone is called the root(s) of the tooth. How strong the tree stands in the air depends on how much roots are embedded into the soil. If the soil gradually gets lost and more roots are exposed onto the ground, the tree may fall down as too little soil is holding it up. This situation is similar to a tooth. When the alveolar bone gradually gets lost and more of the tooth root is now exposed, the tooth will become loose. Eventually the person will lose that tooth not because there is any decay on the tooth itself but because there is no bone to hold the tooth in place. The phenomenon of losing the alveolar bone, which function is to hold the teeth in place, is called periodontal disease (or more commonly known as gum disease). While cavity makes the teeth rotten and decayed, periodontal disease makes the teeth loose (mobile) in the oral cavity. Both problems can eventually lead to teeth loss if left untreated.
An inlay is an indirect restoration (filling) consisting of a solid substance (as gold or porcelain) fitted to a cavity in a tooth and cemented into place. An onlay is the same as an inlay, except that it extends to replace a cusp. Crowns are onlays which completely cover all surfaces of a tooth.
Invisalign clear aligners differ from traditional braces in that they do not involve any metal brackets or wires. Invisalign treatment is a series of clear, removable teeth aligners that patient wears over a period of time 22 hours a day or more. They have become quite popular among adult patients because they are viewed as more acceptable in appearance than having metal wire in the mouth. However, the mechanics of Invisalign® clear aligners are quite different than traditional wires and brackets in that some movement of teeth cannot be achieved with this type of treatment. Case selection is very important. Not everyone is a candidate for it.
This is a specialized area in dentistry focusing in how teeth are to be aligned straight inside the mouth. A beautiful smile comprises of healthy gum, bright white teeth and straight teeth. Some people have too many teeth or too big in size of the teeth to fit perfectly inside the mouth, while others have gaps between teeth. Orthodontists or dentists with further training in orthodontics can implement braces to straighten teeth. Traditional braces normally required placing metal brackets and wires onto teeth and treatment length often involves 2-4 years time. In recent years, some shortcut options are made available to people such as Invisalign braces or often called invisible braces. I advise that pros and cons of each option should be reviewed together with your dental professional before you choose what option to go for.
An overdenture is a denture which uses precision dental attachments to the denture down so that more stability can be provided to the patient. The precision attachments can be placed in tooth roots or onto a dental implant. When a denture is supported by dental implants, it is called implant supported overdenture.
Periodontal disease is usually due to chronic bacterial infections. While cavity is caused by bacteria’s products (the acidic substances they produce) that dissolve the strong tooth structure (demineralization), periodontal disease is caused by the interactions between the bacteria and the host (the person). Research has shown that the individual’s own immune system reaction in response to the presence of bacteria or to their products directly causes the destruction of the periodontal structure. Because periodontal diseases include a very wide range of disease presentation, I will restrict my discussion of periodontal disease to the most common type: adult periodontitis.
This disease affects about 25-30% of the population in general, and more prevalent in the Asian and the African populations than Caucasians, and more in the older generation with age over 40 than the younger generation. It can be generalized (affecting all the teeth in the mouth) or site-specific (only some teeth). The most typical presentation of this type of periodontal disease has some or all of the following characteristics:
- Pocket formation
- Bone loss
- Tooth mobility
The presence of these characteristics enables the dentist to make the diagnosis of the disease and evaluate how extensive the disease has progressed. Before I move on, let me explain what “pocket formation” means. When you look how a tooth is anchored to the alveolar bone in cross-section, you will see the bone surrounds the tooth root and the tooth crown is exposed to the oral cavity. The gum is covering the bone and surrounding the neck of the tooth as simplified in the following diagram:
If you look close to the picture, you will notice that there is a crevice between the gum and the tooth. Dentist can measure the depth of this crevice by using a dental probe. Normally, this crevice should not be deeper than 3mm or 0.3 cm. When it is deeper than 3mm, we call this crevice a pocket.
Periodontal disease causes the formation of these pockets around the tooth. The procedure of using a probe to measure the depth of the pocket is called probing. It can be quite sensitive to the patient when the dentist is carrying out this procedure, but it has a very high diagnostic value to detect periodontal disease. Pocket formation and bleeding on probing are two positive signs of active periodontal disease existing. How do pockets form? In brief, it is caused by the destruction of the alveolar bone. What destroys the bone? It is the growth of oral bacteria around the area that causes the bone destruction. Why bacteria grow around the area? Normally it is the lack of regular oral hygiene that gave the oral bacteria the opportunity to thrive. The more bone loss happens, the deeper the pocket is formed. What is bad about pocket formation? When we brush our teeth, the bristles of the brush can reach a shallow crevice, so that any food debris can be removed from accumulating in that space. When pockets form, it provides a space for the food debris to hide there because now the toothbrush cannot reach to the bottom of the pockets. This debris is very nutritious for your oral bacteria, so they thrive inside these pockets. This phenomenon then goes into a vicious cycle as more food debris (nutrients for the bacteria) is trapped in a pocket leads to the thrive of bacteria, which leads to more bone loss, which leads to the formation of deeper pockets, which traps more food debris to supply to the bacteria to thrive. Can you imagine the picture?
Taking dental x-ray is another important diagnostic means for detecting periodontal disease because x-ray shows the bone height around the teeth or how much bone has been lost. In the mouth with healthy teeth, we can see the outline of the alveolar bone on x-ray films with a regular scalloping pattern and has the height around the neck level of the teeth. In contrast, in the mouth with periodontal disease involved teeth, the bone level is usually much lower and it is quite uneven across the teeth.
As we mentioned earlier, the more the surrounding bone is lost, the less stable is the tooth. Hence, loose teeth or tooth mobility is another characteristic of periodontal disease. When the teeth become very mobile, they may become quite painful as abscess can form around deep pockets. Mobile tooth will eventually lead to tooth loss.
There are many factors that lead to periodontal disease; my list in the following are the common ones with the first one the commonest:
- Lack of oral hygiene or regular professional teeth cleaning
- Intrinsic host factor (some people are more susceptible than others, may be related to genetic makeup of an individual as people whose parents or siblings with a history of periodontal disease are much more susceptible than other people)
- Diabetic patients
- Bad restorations that prevent you to clean the area well. Examples of these are overhang restorations and crowns.
What are the treatment options for periodontal diseases?
The first line of treatment for periodontal disease is carried out by the patients themselves. Once you have periodontal disease, personal oral hygiene is more important than everything else. Thorough tooth brushing in the correct way practiced at least two times a day and flossing at least one time a day are the minimal requirement if you want to control periodontal disease. I cannot emphasize enough about flossing. I know many people do not floss because they think it is too time consuming, or they find the teeth bleed when they floss, or they are just lazy to do the work. Let me assure you this: once you try flossing everyday, gradually you will find it not much time consuming as you may think. I remember the first few times I tried flossing, it took me at least 10 minutes and I had to look at my mouth in a mirror in order to slide the floss between teeth. Now I can floss all the teeth in less than 3 minutes and I don’t even need to open my eyes to do it! The second thing I can assure you: in the first week of flossing, you may find that your gum bleed when you floss. However, if you keep on doing it everyday, you will start to notice minimal or no bleeding at all. Why? You have bleeding when you start to practice flossing because you have never flossed before or you have not flossed lately. As a result, your gum is in a chronic stage of inflammation and is very easy to bleed. If you keep flossing everyday, gradually you are changing the oral hygiene environment so that your gum now goes back to healthy and tough stage where there is no more inflammation. With healthy gum, flossing will not cause bleeding any more. You have to make this your personal experience so that you can see how much change flossing has brought to your gum! If you are not flossing just because you are lazy, then let me tell you how much your “laziness” can cost you! People with gum disease can spend thousands of dollars in order to control it or improve it. Flossing can help you prevent cavity as well. You can imagine how much money you can save from flossing when you think about how expensive dental treatments are!
The second line of treatment is by your dental professionals such as your dentist or the dental hygienist.
Research has shown that the direct cause of bone destruction and pocket formation is the dental plaque. Have you ever used a toothpick to scratch the surface of the teeth? You can try to do it now. What did you pick up from it? You may notice some white or yellowish sticky material comes off from the surface of your teeth. This substance is called the dental plaque, which is composed primarily of microorganisms, and mostly bacteria. Daily tooth brushing and flossing can efficiently remove the accumulation of this dental plaque. When this dental plaque is left on tooth surface for long enough, it will turn into calculus (more commonly known to the public as Tartar). The soft plaque is now hardened by precipitation of mineral salts found in the saliva. While plaque can be removed by personal oral hygiene measures such as flossing and brushing, calculus cannot. That is why you need to have regular professional cleaning in a dental office. Plaque can turn into calculus as soon as in 4 to 8 hours in some people while some people do not develop calculus easily. How do dental professionals remove calculus? The procedure of removing calculus is called scaling. It can be carried out with hand instruments or by ultrasonic scalers. When scaling is done inside a deep pocket, literally removing the calculus on the root of a tooth, this procedure will be called root planing. Because root planing procedure can be quite sensitive to the patient, local anesthetics (needle injection) is usually delivered for patient comfort.
The rationale of scaling and root planing is to remove plaque and calculus, the source of periodontal disease. Most of the time, root planing can reduce the depth of the pocket or completely eliminate it, as the gum will reattach to the tooth surface when the surface becomes clean again. This is very important if you still remember how pockets cause the progression of periodontal disease in a vicious cycle.
A life-long battle to control gum disease!
Sometimes scaling and root planing is not enough to control periodontal disease. When the dentist reevaluates the situation after scaling and root planing procedure, he/she may decide to go for more aggressive treatment option: periodontal surgery. In brief, the goals of periodontal surgery are to eliminate pockets and to regenerate bone, which has been lost. Unfortunately, it is very difficult to regenerate bone, once it was lost due to periodontal diseases. On the other hand, pockets reduced or eliminated by periodontal surgery (and root planing alike) will come back whenever the oral hygiene of the patient slackens. Therefore, we often say that periodontal disease can only be controlled but not treated and it is a life-long battle for the patients and their dental professionals.
Pit and fissure sealants are used to protect the chewing surfaces of molar teeth from decay. These surfaces often decay because of the deep pits and grooves where the toothbrush bristles will not reach. By placing a thin plastic material over the grooves, the sealant keeps plaque and food out of the crevices, reducing the risk of decay. Have sealants applied soon after the permanent molar teeth erupt, usually between the ages of six and eight and then at twelve years of age. Kids like it because it is easy and painless. Sealants are less expensive than fillings and usually last several years.
A post and core is a dental restoration used to sufficiently build-up tooth structure for future restoration with a crown when there is not enough tooth structure to properly retain the crown, due to loss of tooth structure to either decay or fracture. Post and cores are therefore referred to as foundation restorations. It is often needed for teeth with root canal therapy.
Removable partial denture is for someone who has some missing teeth (partially as opposed to completely missing all the teeth) but who still desires to have replacement teeth for functional or aesthetic reasons, and who cannot have a bridge (a fixed partial denture) for any number of reasons, such as a lack of required teeth to serve as support for a bridge or due to financial limitations. The reason why this type of prosthesis is referred to as a removable partial denture is because patients can remove and reinsert them when required on a daily basis without professional help. Conversely, a “fixed” prosthesis can and should be removed only by a dental professional if needed but mostly is to stay in the mouth permanently instead. Majority of RPD is made of cast metal with acrylic, so sometimes they are called cast partial denture. However, we can have non-metal but still strong removable partial denture to improve aestetics nowadays. Removable partial denture is considered a compromised option compared to bridge or dental implants because they have to be removed for cleaning on a daily basis, not as hygienic, bulkier and food trapping and unesthetics just to name a few disadvantages.
Complete dentures or full dentures are worn by patients who are missing all of the teeth in a single arch (i.e the maxillary (upper) or mandibular (lower) arch). It is usually made of acrylic without cast metal involved.
Scaling and root planing, otherwise known as conventional periodontal therapy or non-surgical periodontal therapy, is to remove or eliminate the etiologic agents which cause inflammation: dental plaque, its products and calculus, thus helping to establish a healthy periodontium (gum and jaw bone surrounding the teeth).
I believe most people have anxiety or fear to a certain extent when they visit a dentist. As far as that anxiety does not become overwhelming and make you avoid receiving dental treatments, you are probably experiencing what most people do. The anxiety or fear can be due to a number of different reasons for different people. Past bad experiences with your previous dentists, fear of pain inflicted on you, anxious about what is unknown to you, scary stories from friends or family members about dental experiences, negative image of dentists causing pain to their patients created in the media, and so on and so forth. All or part of these may be your reasons for your unfound fears whenever you think of going to visit your dentist. A good dentist should make the patients (at least most of them) feel at ease. If your dentist makes you feel very intimidated or very nervous, you have to find out it is his/her problem or yours. If it is his/hers, then switch to someone that you can build a good rapport with. If it is your problem, you should let your dentist know right in the beginning of the appointment, or even better before the appointment. There are a number of ways that dentists can help their patients to reduce their anxiety or nervousness about dental visits. I will discuss a few common ones.
Behavior modifications: when your dentist knows you are nervous, he/she will slow down the pace and try to explain to you what he/she is going to do before he/she actually does it. This method can prepare your mind and ease your fears for uncertainty.
The “gas”: Nitrous oxide gas, also known as the laughing gas, is commonly employed by dentists to reduce anxiety for their patients. Patients are instructed to breathe with a mask over their noses, supplied with the nitrous oxide gas. This kind of sedation can be effective for many people but may not work for everyone. The advantage of it is that it is very quick to recover, almost instantaneously after the gas is stopped supplying to the patient and has very minimal risks for short-term use and the patient is conscious throughout the treatment. The experience can be very pleasant and patients even have a “high”of it.
Oral sedation: Your dentist may prescribe some sedative-hypnotic pills for you to take 1 hour prior to the scheduled appointment. These pills usually belong to a class of drugs called benzodiazepines. Commonly oral sedatives used by your dentists are Valium, Ativan, and Triazolam. There is sublingual form for Valium that you put under your tongue and the drug starts to work in 15 minutes. Some dentists advertised with “sleep dentistry by taking a pill that helps you sleep throughout your dental treatment.” I consider this kind of advertisements misleading and unethical. In fact, oral sedation can hardly put you to sleep throughout your dental treatment! If it does, your dentist probably has prescribed an over dosage for you and put you at high risks for medical emergency! What oral sedation normally does is to make you feel calm and sleepy or less alert during the treatment.
IV (intravenous) sedation:
Sedation is a method of administering drugs directly into the bloodstream in order to diminish consciousness to a patient. This type of sedation is much more effective than oral sedation. Special facility and equipments are required in order for your dentist to administer this type of sedation. The risk of having medical complications are also greater compared to previously discussed sedation methods.
Snoring is common among our populations. In rare cases, snoring can cause sleep apnea, which can be detrimental to a person’s health and efficiency in daily work. In severe cases, sleep apnea can cause heart diseases. Dental or oral appliances have been used to improve or eliminate these problems in minor cases while serious cases will involve a team approach from the dental and medical specialists.
Temporomandibular joint disorder (TMJD or TMD), or TMJ syndrome, is an umbrella term covering acute or chronic inflammation of the temporomandibular joint, which connects the mandible (lower jaw) to the skull. The disorder and resultant dysfunction can result in significant pain and impairment. Because the disorder transcends the boundaries between several health-care disciplines — in particular, dentistry, neurology, physical therapy, and psychology — there are a variety of treatment approaches. What causes TMD? The cause of TMD is not clear, but dentists believe that symptoms arise from problems with the muscles of the jaw or with the parts of the joint itself. Injury to the jaw, temporomandibular joint, or muscles of the head and neck – such as from a heavy blow or whiplash – can cause TMD. Other possible causes include :
- Grinding or clenching the teeth, which puts a lot of pressure on the TMJ.
- Dislocation of the soft cushion or disc between the ball and socket of the TMJ.
- Presence of osteoarthritis or rheumatoid arthritis in the TMJ
- Stress, which can cause a person to tighten facial and jaw muscles or clench the teeth, thus putting excessive forces on the TMJ.
Unfortunately, we still do not have a very effective way of treating TMD. Starting with conservative approach such as taking muscle relaxants, reduce stress from modification of lifestyle, wearing dental splints are some of the options. Sometimes, surgical intervention at the TMJ may be warranted. Thorough investigations from different medical disciplines should be made before surgical intervention is to be pursued. Consultation with your dentist is a good start if you suspect that you have TMD problem.
Tooth whitening also known as tooth bleaching is a common procedure in general dentistry but most especially in the field of cosmetic dentistry. At-home whitening is done with bleaching gel which is applied to the teeth using thin guard trays. At-home whitening can also be done by applying small strips that go over the front teeth. Oxidizing agents such as hydrogen peroxide or carbamide peroxide are used to lighten the shade of the tooth.
Tooth extraction or a dental extraction (a.k.a. exodontia) is the removal of a tooth from the mouth. Extractions are performed for a wide variety of reasons, including tooth decay that has destroyed enough tooth structure to prevent restoration. Extractions of impacted or problematic wisdom teeth (wisdom teeth extractions or wisdom teeth removal) are routinely performed, as are extractions of some permanent teeth to make space for orthodontic treatment.
Topical fluoride treatment is often carried out by your hygienist after teeth cleaning. It can be administered by three different methods. The first method involves the application of fluoride solution called fluoride varnish.. This type of fluoride must be painted on the teeth with a small tip applicator. This first method has been proven to be the most effective so good for patients with high risk of having cavities. The second method of fluoride application is the tray technique, which is used to apply fluoride gels. The third method is the use of a concentrated fluoride rinse. The third method is the least effective but it is mostly preferred by patients, especially those who gag easily
Wisdom tooth removal is also known as third molar extraction. These teeth consist of the mandibular and maxillary third molars; they usually appear between the ages of 17 and 25.They are called wisdom teeth because they usually come in when a person is between age 17 and 25 or older – old enough to have supposedly gained some wisdom. Preventative extractions of them could prevent some potential dental problems later in life. The decision should be made between you and your dentist.
Some of the guidelines to determine if or not you need to have them removed are:
They should be removed if
- They are partially or fully erupted that causes discomfort, pain or difficulty to keep them clean.
- You are still young, say less than 25 years old.
- There is some pathology associated with it (this needs to be determined by your dentist).
They can be left alone if
- They are not in your mouth at all
- You are over 25 years of age.
- They have never bothered you.
- There is no pathology associated with it.
Advanced Power Whitening as it is currently marketed is an up to the minute whitening procedure. This procedure uses a special room Advanced Power’lamp to heat and then activate the whitening gel. This has the effect of stimulating the gel and increasing the rate of the whitening process which changing the structure of your teeth. The dentist will use a stronger bleach solution, which is applied to your teeth. He or she will then use the Power lamp to heat the gel and so kick start the bleaching process. Researchs have shown that this type of in-office one hour tooth whitening procedure is not as effective and as long lasting compared to the traditional take-home whitening. I do not recommend it to my patients because it is not cost effective.