Common questions people have is how bright can a person actually get their teeth and what can happen if someone bleaches their teeth too much?

Most importantly a dental office can do a much better job of teeth bleaching than over-the-counter do it yourself kits. The attention to detail of the application process limits any damage you might receive from self-administered teeth bleaching kits. In a typical dental office an application of hi-potency hydrogen peroxide solution is applied to the teeth. Care is taken to protect the surrounding gums with a protective coating and then an ultraviolet light is focused onto the teeth for around forty five minutes.

The ultraviolet light accelerates photoinitiators in the whitening gel which whitens the teeth. After an initial treatment the teeth can be very sensitive for up to several hours. Taking a dose of acetaminophen or ibuprofen can help ease the discomfort.

After the initial treatment your dentist will create a custom fitted mold for your mouth for maintenance bleaching at home. The molds or “bleaching trays” hold the bleaching agent against the teeth. Using too much of the bleaching agent will cause it to spill out over the gums and cause irritation to the soft tissue.

Most drug-store or mail order teeth whitening kits are not custom made and fit poorly against the teeth which can cause excessive gum irritation and poor results.

After a teeth whitening session most dentists recommend using teeth whitening toothpaste to maintain the teeth between treatments.

Excessive bleaching may lead to long term damage of the enamel of the teeth and in some cases the damage can be irreversible. When it comes to teeth bleaching, moderation is the key. Teeth bleaching should be done no more than a couple times a year in a dentist office with follow up treatments around a few days every couple months. Bleaching too often will cause the teeth to be come dehydrated, brittle and susceptible to staining since the pores of the teeth are free of it’s natural mineral balance. If a person notices that their teeth are becoming blue or too translucent it’s possible you are over-bleaching your teeth.

The long standing question of whether a person can get their teeth too white as a result of bleaching is not true. Teeth have a natural shade that can not be lighter than how they were created.

The specific feature of the temporomandibular joint is the disc. The disc is composed of fibrocartilagenous tissue, like the flexible elastic cartilage of the ear, which is positioned between the two bones that form the joint.

The temporomandibular joints are one of the only two synovial joints in the human body. The synovial joints divides each portion of the jaw into two specific compartments. The lower joint compartment is formed by the mandible and the disc is involved in rotational movement through opening and closing movements.

The upper joint compartment is involved in multiple positioning movements which allows the sliding of the lower jaw forward from side to side. The part of the mandible which connects to the under-surface of the disc and is the part of the temporal bone which also connects to the upper surface of the disk. This is the glenoid ossa – also known as mandibular.

Pain or problems of the temporomandibular joint is commonly referred to as “TMJ”, however, this can be confusing since TMJ is really the name of the joint and Temporomandibular joint disorder is abbreviated as TMD.

TMD is often referred to as a group of problems involving the temporomandibular joints and the muscular-skeletal system of the jaw, including tendons, ligaments, blood vessels, and other tissues associated with them. Some specialists might even include the neck and back while describing problems with temporomandibular joints.

There are certain foods that accentuate bad breath as well, like onions and garlic that contain strong oils. The oils are carried to the lungs and out through the mouth when talking or exhaling. Smoking also contributes to bad breath. However, the primary culprit for bad breath is bacteria.

These bacteria are also the major factor for mouth and tooth related diseases. The key consideration here is preventing the growth of bacteria and the formation of biofilms in the mouth. Frequent brushings of twice a day for two minutes each is a first step in keeping your mouth free from odor and disease causing bacteria. Followed by frequent flossing of the teeth and a rinsing of the mouth with hydrogen peroxide diluted 50% with water.

The SimPlant Software is a fully integrated dental implant treatment planning tool that visualizes a patient’s mouth with exact 3D precision while taking into account both clinical and aesthetic considerations. The benefits to the patient are immediate as a visualization tool prior to treatment and during surgery, increasing safety with precision and reducing pain.

• Gums can often be left intact for faster healing
• Prevents complications
• Avoids expensive and time consuming follow-up visits
• Immediate new smile following treatment

If you have any questions about the SimPlant – painless predictable implant system, contact The Bellevue Center for Cosmetic Dentistry at (425) 688-1345

If you are suffering from excessive teeth grinding and wish to know more about Bruxism contact Bellevue Cosmetic Dentist, Dr. Lynn A. Jones. Dr. Jones is board certified with the American Academy of Cosmetic Dentistry, and is regionally and nationally know for her expertise in General and Cosmetic Dentistry.

The artistry of Dr. Lynn A. Jones is evident in these smile makeovers. Dr. Jones is internationally recognized for her excellent cosmetic dentistry. She is accredited with the American Academy of Cosmetic Dentistry (AACD) and serves as an examiner for AACD Accreditation Board. She has also served on the AACD Board of Directors. In 2003, she won an AACD Gold Medal in Smile Design.

Dr. Jones operates out of her office, The Bellevue Center for Cosmetic Dentistry, conveinently located in the heart of downtown Bellevue, Washington, across the street from Bellevue Square Shopping Mall.

Dr Lynn Jones is an expert at creating beautiful smiles. In this video she discusses all the aspects of creating a beautiful smile through advanced cosmetic dentistry.

Dr. Lynn A. Jones is internationally recognized for her excellent cosmetic dentistry. She passed rigorous examinations to become accredited with the American Academy of Cosmetic Dentistry (AACD) and serves as an examiner for AACD Accreditation Board. She has also served on the AACD Board of Directors. In 2003, she won an AACD Gold Medal in Smile Design.

Dr. Jones lectures locally and nationally, and is the Founder and Director of the University of Washington’s Aesthetic Continuums for Dentists, a series of advanced training courses in cosmetic dentistry developed specifically for practicing dentists, their staff, and laboratory technicians.

Dr. Lynn A. Jones has been actively supporting “Give Back A Smile.” This is a program setup by the American Academy of Cosmetic Dentistry Charitable Foundation that helps survivors of domestic violence regain their life and restore their broken teeth. Bruises and scars will fade, but broken or missing teeth will not.

Dr. Jones has been pioneering this program and is one of its leading supporters.

1. Temporary restorations serve several purposes. They protect the prepared teeth and help to hold them in position while your permanent restorations are being made. In cosmetic cases, your temporaries also serve as a model or reference point for designing the final restorations. They help us to evaluate the tooth size, shape, position, color, speech, lip support and biting function.

2. Your temporaries are made out of a plastic molded material that can be removed from the teeth when it is time to place the permanent crowns, so they require special care.

• A. Avoid sticky foods like taffy, cheese or chewing gum which might accidentally pull the temporaries off the prepared teeth. Also avoid hard foods like nuts, raw carrots chips or crusty bread which can break the temporary restorations.
• B. Brush your temporaries like normal teeth using a standard fluoride containing toothpaste. You may experience some sensitivity. This is normal with temporary restorations. Using warm water can help.
• C. Floss your temporary restorations as shown using a floss threader if necessary and drawing the floss out to the side. Avoid popping the floss back out through the contacts because it is easy to dislodge your temporaries this way.

3. For the first one to three days the teeth and gums may be very sore. Ibuprofin (Advil) used as directed, is recommended to manage this discomfort. Sensitivity to cold, heat and biting pressure is normal with some temporary restorations and is not a cause for concern as it will go away after the placement of the final restorations.

4. If the temporary restoration happens to come off prematurely you can place it back on and snap it into place mechanically. Or for extra retention, a denture adhesive may be placed inside the temporary restorations to hold them on until you can come to the office to have them recemented.

5. Avoid whitening your teeth. This will change the shade of your teeth. There will be additional lab charges for any changes made.

6. Avoid changing medications, supplements or diets without discussing it with the Doctor.

Thank you for allowing the Bellevue Center for Cosmetic Dentistry to provide you with the highest quality dental care.

If you have any questions or concerns please call our office at (425) 688-1345.

Matching a single central incisor is challenging but possible if the dentist and ceramist understand the principles of natural oral esthetics; good tissue health and perfectly reflected tooth contours at the midline are just as important as the actual color of the teeth. If the teeth are rotated or the roots are misaligned, the match can become far more challenging because the ideal contours of the porcelain must, by necessity, be transitioned into the poorly aligned contours of the malpositioned tooth. Some of our color-matching illusions stem not just from matching a color, but also from where that color reflects light. Just by changing the position, of a tooth it is possible to alter the
appearance of a color. Sometimes it is necessary to alter the color of a tooth to match its position, in order to change how that color is perceived by the eye and then interpreted by the brain.

Just by changing the position of a tooth it is possible to alter the appearance of a color.

Ocular Perception and Brain Interpretation

Most experienced cosmetic dentists are familiar with the basic three dimensions of color: Hue, value, and chroma (saturation). In addition to the three dimensions of color, there are other factors that must be managed for a successful shade-matching experience. One significant factor is the color property of metamerism (in which either of two colors of different spectral composition appear identical to the eye of a single observer under some lighting conditions but different under others; or that, under constant lighting conditions, they appear identical to some observers and different to others).1,2 Metamerism occurs when two objects are the same color but are molecularly different in structure. As with two different fabrics, for example, wool and silk, dyed with exactly the same dye—the two colors may match in natural daylight, but may not match in a different type of light (e.g., incandescent).

Interpreting Color Based on Context

Other factors that influence color are the effects perceived by the eye and interpreted by the brain. One example is the way that the brain interprets a color based on its context. In Figure 1, the light gray square in the shadow cast by the cylinder is exactly the same color as the dark gray square in direct light, but our mind probably refuses to “believe� it.3 This is because we have learned to interpret colors based upon their context. A color that is perceived to be in the shade will appear to be much brighter than the exact same color if it appears to be in direct light. Because of this perception, brighter teeth will generally appear to be larger and closer.4,5 Conversely, a prominent tooth that is the same shade as its neighbors that are in the shadows will appear to be darker.

This fact is significant when matching the central incisors, especially if they happen to be prominent. In Figure 2, the two central incisors appear to be lower in value than the lateral incisors. When the lateral incisor is digitally cut and pasted directly onto the adjacent central incisor, teeth #9 and #10 appear to be the same color (Fig 3). The reason for this discrepancy is that our eyes interpret the central incisors as being prominently placed in the light, and the surrounding teeth as being more lingually placed back in the shadows. The brain then interprets the central incisors as being lower in value based upon their context, just as in the example of the gray shadow in Figure 1.

Figure 2: The new all-porcelain restorations are an improvement over the porcelain-fused-to-metal crowns. The hard and soft tissue contours, margins, and translucency look healthy and realistic.

Figure 3: When the left lateral is digitally positioned over the central incisor, the value of the two teeth appears to be the same. This is similar to Figure 1, in which the color of the green dot is affected by its context. The color of these teeth is being influenced by context, not by value of the porcelain. We expect the more prominent central incisors to appear lighter than the lateral incisors.

Figure 4: The color of the porcelain on these central incisors is actually lighter than the adjacent lateral incisors. In spite of this fact, the restorations appear to match because of the inherent expectation that these two teeth will appear slightly lighter than the lateral incisors.

The porcelain restorations on the two centrals shown in Figure 4 appear to match better than the previous set of veneers. In this case, the central incisors are slightly lighter than the adjacent teeth. To achieve the greatest colormatching accuracy with photographic color communication, it is important to place the shade tab in the same plane as the tooth being matched. In my experience, the most ideal shade tab position for color matching is sitting adjacent to and in the same plane as the tooth being matched (just like a bridge pontic). This ideal shade tab position also can be recreated using image manipulation software. This can be done by photographing the shade tab placed in a position incisal-edge-to-incisal-edge in the ex-act same plane with the tooth that is being matched. The photograph of the shade tab can then be digitally manipulated to place that shade tab into the “pontic� position adjacent to the tooth being matched for more precise color comparison (Fig 5). This enables the laboratory to visualize the subtle differences between the shade tab and the actual tooth, and to modify the color of the porcelain accordingly.

Figure 5: Trial shade tabs photographed and manipulated with software to position the shade tabs in the same plane and position as the adjacent tooth.

Successfully matching central incisors involves more than simply choosing the correct hue, value, and chroma.

Conclusion

Successfully matching central incisors involves more than simply choosing the correct hue, value, and chroma in order to match a porcelain restoration to a natural tooth. It requires an understanding of other factors, such as tooth contours and tissue health. It also requires an understanding
of other dimensions of color such as metamerism, visual context, and lighting. Understanding and managing these properties of color, lighting, and perception can help to increase the success of color-selecting appointments and assist with identifying and trouble shooting particularly challenging shade-matching situations.

References

1. MedlinePlus. Merriam-Webster Medical Dictionary.
Definition of metamerism. Accessed
August 23, 2007, at http://www2.
merriam-webster.com

2. Magne P, Belser U. Bonded Porcelain Restorations
in the Anterior Dentition: A Biomimetic
Approach (p. 230). Hanover Park, IL: Quintessence
Pub.; 2002.

3. Adelson E. Checkershadow illusion. Accessed
August 22, 2007, at http://web.mit.edu/
persci/people/adelson/checkershadow_illusion.
html

4. Magne and Belser, op cit., p. 84.

5. Chiche G, Pinault A. Esthetics of Anterior
Fixed Prosthodontics (p. 31). Hanover Park,
IL: Quintessence Pub.; 1994.

Reprinted by Permission, The Journal of Cosmetic Dentistry Fall 2007, Volume 23, Number 3.