Permanent Rejuvenation, Without Painful Injections
White Fillings… Good Or Bad?
Dental Plan Dilemmas
Are Veneers For You?
Returning To A Pearl White Smile
No Pain, No Drilling, No Injections
Bonding or Whitening, Which Is Better?
Metal Fillings… To replace them or not to replace them, that is the recent question.
Helping Your Gums to Health – Nature’s Medicine
Diabetes and Your Dental Health
As We Age Our Dental Needs Change…

The medicine of today, with its explosive new technologies and further discoveries, enables us to enjoy our life’s increased longevity along with a degree of health that was unimaginable before. Furthermore, genetic research promises to increase human life expectancy in the future even to a greater extent than we can even contemplate today. Researching of the aging process through dietary research, the molecular and nano-medicine and other departments of medical research is enabling us to understand the complexity and magnitude of the factors influencing a biological system such as our own body and its proper functions. From the dental perspective, the necessity of maintaining a properly functioning dental apparatus – the system of teeth, gums, chewing muscles, jawbone, etc. – over a much longer period of time than in the past, imposes itself as the newest and most important challenge of 21st century dentistry.

As we age, several mechanical, biological and physiological processes are starting to erode our dental apparatus. Our teeth are starting to show cracking lines, discolorations and grinding surfaces followed by loss of tooth structure, leading to discomfort and pain. Our gums, as we get older, will show the well known sign of recession, increasing exposure of the necks of our teeth– commonly referred to as being “long in the teeth”. One cannot avoid the fact that as teeth are aging, their structure will become increasingly brittle. It is a natural process leading to a slow erosion of their chewing surfaces if not helped.

The degradation of our gum structure will inevitably reduce the connection of our teeth to the jawbone, having the consequence of increased tooth mobility and, if not treated, irreversible decay and tooth loss.

In response to the daily stress of chewing, the muscles of our dental system will demonstrate increased and uncontrolled activity during the night and hours of sleep. The grinding, pressing and the generally categorized parafunctions will have a dramatic and very undesirable effect on our teeth and gums. Young people also grind their teeth but in an older age this extra activity in the night will be much more likely to fracture the less resistant dentition than in younger years.

On the other hand a large number of diseases and afflictions will influence the aging dental apparatus, contributing even more to its destruction.

It is a well known fact that diabetes will affect your gums’ integrity considerably. Vitamin deficiencies of many kinds will influence our gums even more. It is important to know that the presently established facts in modern nutritional science show that our body must fight a permanent starvation in vitamin C – no matter how many fruits and vegetables are consumed or even if daily vitamins are taken regularly. The newly suggested intake of vitamin C is several times higher than the commonly suggested rate. Of course, the individual need must be established by your dietitian based on exact calculations and investigation.

A large variety of medicines can negatively affect our gums. Examples are countless but just a few to mention would include epileptic medications such as Dolantine, others like Cumadin will increase your gum bleeding. High blood pressure medication can reduce your saliva production; the resulting “dry mouth” can strongly affect your teeth and gums.

A most dramatic dental development of recent years was caused by medication prescribed to osteoporosis patients or preventively given to elderly female patients. This medicine was proposed to prevent the loss of calcium from the aging skeleton, however the effect on the human mandible (lower jaw) was just the opposite. Teeth will develop mobility as the supporting jawbone deteriorates until, finally, the patient loses teeth.

Dietary science today advances at an extraordinary rate. The antique perspective that food is medicine, and the careful observation of what we ingest on a daily basis, will represent a fundamental rule in the future. Knowing your food’s nutritional values and using it with respect and extreme care will definitely be the new way of life. This ideal totally and fundamentally opposes the previous and dangerous way of relying on medication to maintain health and ignoring the food we consume. It is the fact of the 21st century “green wave” that the less medication we take, the better we eat and the less weight we drag around on our bodies, the better our health will be.

In the evolution of dentistry for the aging population: to live longer is everyone’s goal and to keep your teeth in a healthy function for as long as you live is definitely the most desirable. We have today, in our modernized dentistry, a large variety of options to extend the life of our teeth in correlation to the newly increased life expectancy. Implants, crowns and bridges, painless and drill-less fillings, nonsurgical gum treatments, new types of flexible partials and dentures are just a few of the treatments your dentist can employ to extend the life of your teeth as we age.

Can the life of our teeth be extended over its traditional limit? The answer is definitely: YES!

Discuss your options with your dentist and do not wait for a “better economic time”, teeth do not have a care for financial hardship nor will they wait until you are able to make them your first priority. Losing one tooth after the other, just because it is less expensive to extract them when pain is present, is definitely the least desirable option.

Talk with your dentist – develop a long term dental strategy – prioritize your treatment and ask for financial arrangements if needed.

© 2011 All Rights Reserved, Dr Florian Braich DDS PhD

How many times have you examined your old metal fillings in the mirror, wondering what can be done to make them look better?  Have you also questioned your dentist about the options he has to offer in this instance?

Your old amalgam fillings  have been placed in your teeth probably a long time ago by your childhood dentist when you were in your early teens.  Some of them are very big indeed, others are still functioning quite good even though they show multiple cracks and abrasions.

At an early age our adult teeth have not yet reached their later strength.  The development of our teeth is such that their final strength requires a long period of mineralization.  Therefore, teenagers’ teeth are more susceptible to fast developing decay.  In other cases the natural development can be disturbed by different diseases or events, leading to insufficient closing of fissures (the deep depressions in our tooth structures).  In particular cases, the absence of fluoridated water during the developmental stage of teeth will contribute to the fragility of their structure facilitating decay and cracking of the superstructure.

The placement of large and sometimes very deep amalgam or metal fillings dating from this early age was never a choice but a strict necessity.  Your dentist had simply no other possibility to repair and save your teeth.  Now, decades later, those not very attractive metal structures look like they do not belong anymore in someone’s mouth; who would like a more attractive and natural aesthetic?

In our practice, several times a week we are inevitably confronted with the justifiable desire of new patients for replacement of the old metal fillings with the new, modern, white, non-metallic materials.  On the other hand and with the same regularity we examine new patients who have already replaced many if not all of their metal fillings with white ones.

From the patient perspective the replacement with the natural color filling material is absolutely desirable and totally justifiable aesthetically.  By simply comparing the before and after pictures side by side the aesthetic improvement is dramatic enough such that replacement is unquestionable.  With closer analysis and critical observation however, some restrictions and limitations for the recommendation of total replacement of old metal fillings with new white ones must be discussed.

When confronting your dentist on your next visit with the replacement question, it would be of eminent importance to analyze together with the dentist the “pros” and “cons” – the advantages and disadvantages of each individual tooth retreatment.

Some simple and basic guidelines when observed can protect your teeth from future disasters.  One of these such limitations would be presented by the size of the old amalgam filling.  If your tooth was initially excavated to a high degree and your old filling represents more than 60% of your original tooth volume – a new filling will definitely be larger – the tooth walls will become much thinner and consequently your tooth will break or crumble under normal chewing pressure.  The new filling will look much better but will not last .  When the tooth splits or cracks, chances are quite high you will lose the tooth altogether; a split tooth cannot be repaired.

Another restriction hint will come from the necessary radiograph picture (x-ray) taken before such treatment.  If your old filling shows a relative extension towards the nerve chamber of your tooth and at the same time secondary decay has been detected – your dentist will need to excavate even deeper towards the nerve to clean the new cavity prior to filling.  This increased proximity to the nerve as well as reduced structural resistance is of course detrimental to the tooth and undesirable.

There are many other circumstances rendering the replacement non-advisable.  The close observation of the old metal fillings and the analysis of the present tooth condition will determine the ideal course of treatment and the alternative if the  metal to white change cannot be made.
The most conservative advice if the old filling is not visible with a large smile or if it still performs without absolute need for replacement would be to avoid the replacement at all – to check and recheck each filling at every three month hygiene appointment and monitor the integrity of each tooth.

If the structural condition of the tooth is becoming a questionable preoccupation, the alternative treatment after the initial repair / replacement, is a regular crown which is the safest, longest lasting and most reasonable alternative.
Talk to your dentist … do not simply demand replacement with white fillings at any cost.  His experience and guidance can save the life of your tooth and secure the proper, long-lasting functionality of the mouth.

If in doubt, a second opinion could also provide you with the professional and experience-based treatment alternatives, meant to offer your teeth the best, least traumatic treatment.

© 2011 All Rights Reserved, Dr Florian Braich DDS PhD

For over two decades, and even longer, the concept of rejuvenation of the face was exclusively considered to be in the hands of the plastic surgeons.  Any person aspiring to improve their physical appearance and shaking off years of the aging process will seek the services of the plastic / aesthetic industry and will be willing to undergo painful injections with all manner of substances such as Botox, Restylane and others.  Even illegally combined administrations have occasionally made waves in the press.

Considering the generally short duration of these improvements and the necessity of re-treatments, the costs and discomfort–or real suffering—of such repetitive applications had to be always taken into close consideration by the patient pursuing rejuvenation.

Other procedures such as epidermal abrasions, acid peels and so on have also been employed and continue their popularity even in these times, supporting the multibillion dollar cosmetic / aesthetic industry.

The desire to look better and feel decades younger is very understandable particularly in our times when, with the help of modern medicine, the expectation of a full life continues to increase.

The film industry, TV and show businesses are a vivid demonstration of the achievements of cosmetic medicine.  Some cosmetic results are spectacular indeed, but very many cases appear as stuffed, expressionless, overstretched and almost unnatural looking facial expressions.

Some plastic surgeons however have discovered the ultimate recipe for predictable success:  the cooperation and co-treatment with the Aesthetic Dentist.

It is an anatomical fact that the soft parts of your face, skin and muscles, the mechanism of your facial expression movements and appearance are supported by the skeletal understructure.  The jaw structure is majorly influenced by your teeth, their interaction and position.

Can your plastic surgeon improve with any procedure a face missing its teeth?  The answer is categorically, No.  Any cosmetic treatment cannot elevate a collapsing bite.  But what about a more common and very widespread case of worn down teeth – present in almost all ages due to grinding of the natural bite.  Your teeth will shorten constantly under wear due to their function.  Your bite, or occlusion, will diminish in time; your facial dimensions will follow suit and aging will become noticeable.  Compare your photos over the last 20 to 30 years; the facial dimension did change quite a bit, right?

The anti-aging principles developed by cosmetic dentistry today can produce permanent and stable rejuvenation and at the same time rehabilitate your dental system.  There are several principles and goals moving together to amazingly rejuvenate your face.  Remember, the positive changes are permanent, medically necessary, and you are not dependant on permanent, expensive and painful re-treatments of injections.  The rejuvenation you desire is only the side effect – the extra bonus – as a result of your dental rehabilitation.

Since antique times, as determined and described by ancient Egyptians, Greeks and Romans, the classical face was divided into three horizontal segments – the upper, median and lower face.  Our lower dimension, between the nose and the chin, is majorly if not solely determined by our teeth. Reducing the height of teeth or losing teeth causes this one third of the facial dimension to substantially decrease; the folds, wrinkles and all aging aspects will follow – the aging process is initiated.

To reverse this aging process – rejuvenating you permanently – your cosmetic dentist will remodel your bite and compensate in just a few weeks for decades of aging.

Another aspect of rejuvenation will be achieved by revitalization of your smile line – the proportional position of your front teeth.  Did you ever wonder how much your front teeth influence the position and support of your lips?  Why use painful injections to inflate your lips and eliminate wrinkles, an ever repeated process, when your front teeth can do the same – permanently and painlessly?

It has been established that by simply whitening your teeth – the color of your porcelain crowns or veneers can be determined by you in discussions with your dentist – can rejuvenate your smile by more than twenty years;  “before and after” photos are clear evidence.

An extra bonus – and possibly the most important one – is the substantial increase of self confidence.
A patient with the reconditioned front teeth will keep smiling and feel at his or her best all the time.
Can skin injections do the same?

As for the financial aspect of dental rejuvenation, the patient must consider some very clear facts:  the dental rejuvenation is just a bonus of a dentally necessary procedure to preserve your health.  A face lift is purely elective and is not a medically imposed treatment.  In many cases the final aesthetic results of a dental rejuvenation will render the additional cosmetic face lift unnecessary.  The majority of such patients will be psychologically rejuvenated to a point of physical happiness when nothing else appears desirable of change and particularly there is no longer any dependence on painful and expensive, short lasting procedures.

And finally, crowns and veneers – the base of your dental rejuvenation – can cost much less than a permanently running non-dental rejuvenation program.  Remember also, some cosmetic dental offices offer the cosmetic consultation at no charge.  This is the time to explore all your aesthetic options and meet your best and timeless decision.

The permanent dental rejuvenation in today’s economic environment poses the question: how far will your investment go?  Consider that the dental rejuvenation will rehabilitate your teeth, prevent dental destruction, treat your gums, elevate your bite and reestablish the facial dimensions from your younger years, spectacularly elevate your smile with a much brighter color, support your lips and cheeks, reduce wrinkles and again, most importantly, a lasting psychological rejuvenation – a grand palette of advantages to consider – is all this cost effective?  Without a doubt, it is.

Every year or so employers may offer you the choice, when selecting your next dental plan, between a DMO and a PPO type plan.  How will you decide?  Do you have all the facts to select the right plan for yourself and your family?  Who will give you all the facts – clearly stated and unbiased — as well as easy enough for a layperson to understand?  The human resources personnel in your company might not even understand what your questions really imply.  Can you get the answers you desire from the insurance companies themselves?  Not a chance.  Our experience over many years, dealing with insurances, shows us clearly that no patient … and absolutely no one… clearly understands the ideas behind how these convoluted insurances work out their plans.

Where is the place and who is the person to turn to when you are in need of a complete spectrum of answers to your insurance dilemma?  A possibility, of course, would be to discuss your choice with your trusted dental office.  Will they have the answers?  Will they be willing to spend precious time in educating you in this matter?  Well, this all depends on several factors and particularly on your relationship to that office.  The majority of insurance offices will already have many patients on the same plan in question and will be able to tell you what would be the best choice for you and your family.  It also depends on your proposed treatment plan for the future and what aspect of the treatment plan can be financially maximized and optimized for you according to the plan you have selected. Some very simplified decision criteria will be touched upon here to enable you to examine your own dental situation and priorities regarding your options for the future.

Remember, not all insurance years start on January 1.  Some plans may not seamlessly cover your dental treatment in progress.  If you are in the middle of an elaborate reconstructive dental treatment, switching the insurance company and/or plan will, in many cases, completely disrupt the flow of your treatment and in some unfortunate situations, negate part of the treatment plan which is already started.

Some plans may have a waiting period for covering major dental work.  Are you in a position to wait 6 to 12 months for treatment?  Does your dentist urge you to take action A.S.A.P?  If so, do not wait any longer; such plans with waiting periods are not for you.  Simply put, if waiting for your new plan to cover your dental needs may jeopardize the life of the teeth in question, you may end up with an unnecessary root canal treatment which could have been easily avoided following the urgent advice of your dentist.

Do all the plans incorporate a maximum coverage per year?  As a patient utilizing a PPO, you must understand that no matter what your dental needs are, your PPO will never reimburse you or pay your dentist above and beyond the maximum amount stated in your policy.  The majority of plans set this at a mere $ 1000 per year.  More generous ones will add an additional $500.  If you however, or someone in your family, has been diagnosed with major procedures, this coverage will barely scratch the surface of the costs.  Such a PPO in principles, would only serve a patient on either a holding pattern with regard to treatment or needing only minor treatment such as fillings along with hygiene procedures.  Would then DMO’s be better in these situations?  No doubt they would.  The DMO’s will provide the patient with a more reduced fee schedule, therefore you will save out of pocket expense and at the same time, by not restricting the dentist to an annual maximum, you may be able to afford larger and substantially more extensive treatments if necessary.

As you can see the selection of a dental plan can be quite complex and therefore the best advice will always be to educate yourself in advance before choosing a plan and most of all, try to obtain the recommendations of your treating dental office.

In our practice we are spending substantial time just with this kind of insurance education for our patients, in an effort to customize their decisions to the real need of their dental health.  It is our goal to obtain, for our patients, the maximum coverage they deserve and therefore not only treat their dental conditions, but observe their financial needs; particularly in these uncertain times.

Watch for our article in next month’s issue on pre-existing conditions and the value of a second opinion…

© 2011 All Rights Reserved, Dr Florian Braich DDS PhD