Behind that beautiful smile

[drmittal]

What types of esthetic materials are used today?

Esthetic dentistry has moved beyond ceramics. Composite resins or modified resins are more prevalent today. The other material used is glass ionomer, which is utilized for both restorations and cements. Each of these materials has its own advantages and disadvantages.
It is imperative that dental hygienists know what type of restorations a patient has before beginning the appointment. Dental hygiene procedures should be different for a patient with natural teeth and no restorations as opposed to a patient with class five restorations, especially teeth restored with esthetic materials.

How does the hygienist identify a resin restoration over a glass ionomer or an adhesive dentistry product?
If a patient has had all of her dental treatment done in one office, it is as simple as checking the chart. More difficult is seeing a new patient who has beautiful restorations that may not be easy to visually identify. It is very important to get the patient’s complete dental records from her previous oral health care provider so they can be reviewed first. Hygienists should also ask the patient what type of restorative treatment she has received. Unfortunately, not all patients remember. At that point, the hygienist must become a detective to determine what restorative treatment may have been done.

As far as instrumenting teeth with these particular restorations, what are the limitations?

I do not advise using the prophy jet or a medium or coarse paste on esthetic restorations. Our dental hygiene protocol consists of using fine polishing paste and hand instrument scaling in a lateral direction, being careful not to pull against any margin. We also avoid using ultrasonic instruments on these restorations.

Is glass ionomer only a cement product or is it also a restorative material?

Glass ionomer is an excellent restorative material because it is so esthetic. I use it often with elderly patients who have a lot of caries and even in young patients who have a lot of caries. It is appropriate to use when a problem exists in controlling decay, like in a cancer patient or someone who has had radiation. The glass ionomer material is fluoride releasing.

Is the use of magnification or loupes helpful?

One of the most exciting advancements I have seen in oral health care is microscopic dentistry. Magnification allows you to see what you cannot see any other way. The intraoral camera is also very useful. I think dentistry is missing maybe 70% to 80% of patients’ restorative needs because most clinicians are not using the intraoral camera. The camera can show the patient where there aremicrocracks and any potential fracture. This can motivate the patient to have it restored right away. I believe that microscopic dentistry will become the standard of care, especially in diagnosis. A photo can be taken so easily and then recorded into an image retention system.
Once you use the microscope, you never want to go back. Pits and fissures are not really visible without magnification. If a tooth is enlarged 20 times and then viewed dry, you can see into the pit and fissure to help determine if there is caries involvement that needs to be addressed.

Let’s talk about coarse prophy pastes on some of the esthetic restorations. What cautions should hygienists exercise?
I think a coarse prophy paste is appropriate on a natural tooth that has a great deal of stain. However, I am cautious when it comes to bonded restorations, which is why I don’t use a prophyjet as it can take the finish off. Good light reflection on these bonded restorations is pleasing. Many are hybrid restorations without much luster anyway. The prophy jet or coarse pumice can dull them down. Some stain is removed, which is sometimes necessary. If they are heavily stained, then coarse prophypaste is a useful tool. If this is not successful, the dentist needs to remove the stain with either the air abrasion unit or finishing burs followed by a polishing system.

How about the use of acidulated topical fluorides?

I think neutral-based fluorides should be used. Acidulated topical fluoride should not be utilized on porcelain. I also do not believe that fluorides are used enough in dentistry. In my opinion, patients should be using neutral-based fluoride toothpaste nightly, especially with restorations that involve any gingival recession or margin exposure. Over time, some margin exposure may occur and to avoid caries, fluoride protection should be implemented at least once a day.

How about radiographs? Are there indications for more frequent radiographs with some restorative materials?
The frequency of radiographs depends on the ability of the patient to resist caries. Some patients can have a full set of radiographs every 2 to 5 years, others need radiographs every year, which is why digital radiography is so useful. Patients are very wary about radiation and digital radiography eases those worries. It is one of the fastest growing areas of dentistry. Plus, there is no wait with digital radiography.
Many mistakes are being made in the interpretation of defective margins. Today, you cannot look at an x-ray and diagnose caries because bonded cements are radiolucent so they show through like decay. Both dentists and dental hygienists need to be careful with digital radiographs because sometimes burn-out occurs and it is very easy to interpret this as caries.

How should the hygienist treat a patient who has developed a pocket in an esthetic area with an esthetic restoration? How can we treat the pocket yet preserve the esthetic result that the dentist has created?
It may mean that the patient needs to come in every 4 to 6 weeks. It is our policy to scale pockets to keep them under control, and patients need to understand that they must maintain their tissue level. For example, if it is an anterior tooth and we do surgery to eliminate the pocket on the labial surface, it will cause gingival recession and can ruin the smile. Maintenance is a must along with a lingual access approach for surgery and maintaining it with periodontal therapy.

Are chemotherapeutic agents advised?

I believe that chemotherapeutics are one of the biggest advances in periodontics today. I am also a great believer in vitamin C and vitamin E megadoses, especially when trying to heal tissue after periodontal surgery. In addition to root planings and scalings, we have found Arestin, Periostat, and the Periochip to be very effective.
For the patient who has gingival recession and it causes an esthetic concern and a functional concern (ie, they have sensitivity or it’s a food trap), how can the hygienist assess whether a soft tissue graft or a tooth-colored restoration is the most appropriate treatment?
I believe that if there is not enough attached gingiva, a graft should be used. I also refer the patient for a graft if the recession involves the papilla. A periodontist should be consulted when deciding on whether a graft should be done before the bond or if only bonding is needed or if a graft is better than bonding.

Are there any specific oral hygiene procedures that should be reinforced with patients who have porcelain veneer restorations?
Dental hygienists are the main source of reinforcement because they see the patient every 4 to 6 months. They need to reinforce to patients that if they bite on a carrot with their laminated teeth, there is a potential for fracture. If you apply torque on a laminate, it can break. Many laminates are broken by nail biting. Hygienists should review flossing technique. Is the patient wearing a bite appliance? We make a bite appliance—either a small anterior bite appliance or a full mouthguard—for almost every patient with esthetic restorations. We want to prevent any clenching or grinding because they are the main causes of fracture or breakage of esthetic restorations, especially with porcelain veneers. Porcelain veneers are strong restorations if you can bond to enamel. If you have to bond to the dentin as most dentists do to achieve a positive result, it is not nearly as strong as enamel bonding.

        

[drmittal]

What is the role of the dentist in identifying patients who may benefit from tooth whitening procedures?
The media has influenced our patients tremendously over the years and currently, white teeth are the standard of care. Most people are embarrassed to have dark teeth so they either want laminates or bleaching. I normally ask patients if color is a concern and if they say they would like their teeth to look whiter, the door is opened. Even if patients say no, you can ask them if they could wave a magic wand over their teeth, would their current color be their color of choice? Most people say no. Then you can discuss the options. I believe the dentist can and should play a prominent motivating role in every dental office. The quality time the dentist spends with patients helps build a sense of trust that can encourage patients to obtain the esthetic restorations they desire. So certainly bleaching is just one way the dentist can help patients achieve a better looking smile.

Are there conditions where bleaching is contraindicated?

Bleaching is not indicated for patients with gray teeth, heavy tetracycline stain, and teeth with a great deal of incisal staining. Bleaching is very successful for patients with yellow teeth. Yellow/brown is the next indication, followed by brown. Moderate results are possible with the brown teeth. Gray generally becomes translucent, which can appear to the patient as if the tooth is getting darker not lighter, so you need to be careful. Bleaching is not as effective for patients with tetracycline stain because the final result doesn’t provide the esthetic appearance most patients desire.

Are any esthetic restorative materials adversely affected by bleaching?

Not that I know of, but it is best to wait a period of time after bleaching before bonding. Before performing the bleaching treatment, a hygiene appointment should be scheduled so the tissue is healthy and in good shape.

What can be done about excessive wear facets on anterior teeth?

Dentists are in the perfect position to look at the incisal edges of the anterior teeth. If patients are wearing down the cusp tip, they can lose a great deal of their attractiveness. It is important to diagnose wearing early and not wait until the patient is older. Patients can be counseled about their habits that may cause wear. A biteguard can be recommended and cosmetic contouring can be done to make these teeth look better.

        

[Dr Chetna Bogar]

Informative

        

[Drsumitra]

How is Professional In-Office Teeth Whitening Done?
Professional teeth whitening delivers optimum whitening results in a short amount of time. Available under the supervision of a dentist, this method of tooth whitening is gaining popularity, despite the fact that it is considered the most expensive method of chemically whitening your teeth.
Answer:

You may expect the following during your professional in-office teeth whitening appointment, but not limited to:

* Teeth are polished with pumice, a grainy material used to remove any plaque on the surface of the tooth.

* Your mouth will be isolated with gauze to keep your teeth dry during the procedure. Retractors may also be used to keep your cheeks, lips and tongue away from the whitening solution.

* A barrier is placed along your gumline to protect it from the whitening solution.

* The teeth are then coated with the whitening solution on the front surface of the tooth. Your office may choose to use either hydrogen peroxide or carbamide peroxide as the bleaching agent. Many whitening products require a curing light or laser to be used to add heat to the solution to activate the peroxide. It will then be left on the teeth for 30 to 60 minutes, or reapplied in specific increments of time for up to one hour, depending on the brand.

* Once the optimum shade has been reached, or the maximum application time has passed, the teeth are rinsed with water and a fluoride application may be used to help ease the sensitivity some people experience with tooth whitening.

* You will be instructed to avoid foods and beverages that have a high level of pigment, such as coffee, tomato sauce or juice, yellow mustard, or red wine, and tobacco use for 24 hours after the procedure to allow the enamel pores to close to prevent re-staining

        

[Author]

Posts