How do you correct crowding using Invisalign?

Invisalign can be an excellent way to correct minor anterior crowding. Without extracting teeth there are two methods dentists use to create the space needed. We can either push teeth out to create a greater circumference to an arch form or we can 'slenderize' some of the teeth. If a patients teeth are already in the right place (in relationship to their lips) than slenderization is the technique I most commonly employ. This involves using interproximal diamond coated strips to slightly abrade the proximal surfaces of teeth as needed. The amounts removed usually are from .2-.5mm per surface and when done properly, 'stripping' of the proximal enamel surfaces does no real harm.

When are you closing the office for the holidays?

December 23rd is the last day our office is open. My staff and I are taking the week off for vacation and spending some time with our families. We wish all our patients happy holidays and will return back to work on January 3rd. Hopefully when we see you next year all will be well.

Anterior night guard vs. maxillary guard?

(Photo shows an NTI Appliance)

Question: I've been wearing the latter for 30+ years but the new dentist Kaiser referred me to for a new guard to a dentist who recommended an anterior guard. He switched from giving patients maxillary guards to anterior ones after attending a seminar from a Frank Spears,DDS, who seems from his website to be an adjunct prof. at U of Wash. and spends a lot of his time giving lectures and selling DVDs.

I've come across articles saying that if you have any joint damage you shouldn't use the anterior appliance, but I only know 30 yr. old xrays showed that I had spurring in one joint and I have a history of pain that has improved in the last 10 years or so to a degree that I'm usually asymptomatic. The new dentist says I'm ok since I have no jaw clicking.

I also read that there's a chance of "eruption" of back teeth in certain circumstances, although the dentist says there's no problem if one only wear it while sleeping. An internet source says there's danger if you wear it more than 8 hours (I sleep 9 hours).

The orthodontist who made my old max. night guard said I should stick with the maxillary type and that anterior ones put too much pressure on the TMJ.

When I told the new dentist what the old one said, he replied that the old one is living in the past century.

Are anterior plates the preferred type now? It seems there is a lot more downside for anterior ones, especially since no one has suggested doing tests to ascertain if I have joint disease in the jaw.

Answer:I just attended a Spear seminar and he did advocate using the anterior bite ramp appliance for patients without any 'joint derangement'. He reported that the literature indicated that it might be more effective in discouraging bruxing. The type that he likes is actually full arch night guard with an anterior bite ramp included. As to posterior eruption, You are unlikely to experience permanent posterior eruption as long as you do not wear it all the time. Certainly 8 or 9 hrs per day won't cause this. You may notice some alteration in your bite in the morning when you wake up, but after 20 minutes or so, your bite will return to normal.

Since the type that Dr Spear recommends covers the entire arch,. it can't possibly allow eruption. Ask you dentist about this.

In my opinion, you can have either type and its OK. I still use the older style night guard and it works. Sometimes patients do report that they are still bruxing with it, but at least it seems to offer some protection to their teeth. Choose which ever style you feel comfortable having and be done with it. Sometimes dentists are caught up in fads, just like anyone. I do believe that either choice is acceptable.

What are the symptoms of a failing root canal?

Root canals fail due to the presence of an infection. Although some infected teeth that have had root canal are not symptomatic, many people with a failing root canals may experience localized swelling and/or pain. The pain may be manifested either as a general ache or could be experienced when chewing. Sometimes it is possible to palpate a small tender area located adjacent to the end of the root that has a slight localized swelling.

Some failing root canals can develop a fistula to help allow the periapical infection to drain. Fistulas can look like red spots or can look like red spots with, a white area in the center. when gently massaged a fistula may or may not demonstrate a small amount of purulent drainage.

If you think you may have a failing root canal, the best thing to do is to visit a dentist and have him examine you. He will perform any tests needed to clinically diagnose your condition.

Waiting to see if an infection subsides on its own is not usually a good idea, since untreated infections can spread and make succesful treatment more difficult. Visiting your dentist is clearly the best course of action, since diagnosing the cause of the infection will allow the most appropriate treatment before a patients condition is allowed to worsen.

Do you offer Invisalign?

Yes, we do offer Invisalign. I enjoy using Invisalign to enhance my patients smiles. Often I recommend using Invisalign as the best option,when performing a smile consultation. Many patients coming for a smile consultation have perfectly nice teeth but may have a problem with anterior crowding,spaces, or anterior flaring. If I feel that Invisalign can handle their problem I believe it is preferable to a commonly recommended alternative-6-10 porcelain veneers. Although porcelain veneers can look great, the procedure involved with fabricating them usually involves prepping the teeth and the life expectancy of well done porcelain veneers is about 10-20 years.

Can a problem with a back tooth refer pain to a front tooth?

In my experience this does not usually happen.Often patients who haven't been to a dentist for a while may have multiple problems, but I try to deal with the problem that is bothering them the most. Occasionally patients with a problem on a top back tooth report that the pain is coming from the bottom teeth on the same side, but not from the anterior teeth. Accordingly when a patient presents with pain in the segment, I usually try to focus on the anterior teeth in the quadrant that a patient reports their pain.