As you all know I am a General Dentist.  There are eight dental specialties: General, Endodontic, Oral Pathologist, Oral Surgeon, Orthodontic, Pediatric, Periodontic, and Prosthodontic.   General dentists provide services at their comfort level in some or all of the dental specialties.  For the majority of the cases, I am able to provide services in all areas; however, I would not be insulted if you would prefer to have a specialist handle your case.

I started providing the service of braces 14 years ago.  When we straighten teeth, we can do the traditional way with brackets, or we can use clear aligners to straighten teeth.  Both services are offered in my practice.

There are three options with clear aligners- Invisalign, Clear Correct, and lab fabricated aligners.  The first two use computers to make small, predictable moves of your teeth.  The computer then makes an aligner for each of those moves.  This slowly straightens your teeth; however, you must wear the aligners 22 hours per day to accomplish those changes.  In most cases movement of teeth can be accomplished with traditional braces as well as computer generated aligners.  When using aligners, to assist with the more difficult movements, composite buttons are placed on some of the teeth.

The advantages of computer generated aligners are that most people won’t notice you are wearing them and you and you can take them out to eat.  Daily brushing and flossing is easy.

The disadvantages of computer generated aligners are the process is slower, often by several months and certain tooth movements are difficult for aligners.  Sometimes, to obtain perfectly straight teeth, a little tweaking is necessary.  For example, I have occasionally had to place brackets for a month or two on bottom teeth that just would not straighten.  Of course, some patients are so thrilled with the major change their smile underwent; they are unconcerned with some minor imperfections.   Also cost is usually several hundred dollars more than conventional braces, so there are times conventional braces are a preferred choice. 

The lab fabricated clear aligners are for very easy cases with only mild crowding of the front teeth.  In this case, the changes in the aligners are performed on models, not the computer.  The cost is much less; anywhere from $500 to $1200 for the total fee compare to $3200 to $4500 for Invisalign or Clear Correct.

   DenMat, the people who make Lumineers have a new product on the market. They call them Cerinate One Hour Veneers. They are made of the same material as their Lumineers, but they are made in bulk in various generic sizes. This allows me to charge a similar price for porcelain veneers as I would for bonding and you get a much more durable result than bonding. 10 of these veneers can be placed for about $3000. That's less than braces. 10 veneers covers most peoples smile line. Some people only need 8, some need 12. Compare that to the average custom veneer cost of $7000 to $9000.

   While they are not as good as custom veneers fabricated one at a time, they are still a quality restoration. If you elect to do this procedure or if you are curious, I would be happy to explain the difference. But they look very nice at 1/3 the cost. The change can be quite dramatic.

   The procedure takes 2 visits. The first involves taking an accurate impression of your teeth. no shots are needed. We will make a model upon which I will shape the veneers to fit your teeth. On the 2^nd visit, we try them in and when you approve, I secure the veneers to your teeth. Depending on the case I may need to do some re contouring for a better result. You may or may not need to have anesthetic on the 2^nd visit. That's it.

    This procedure will work to correct minor crowding, discoloration, spacing, wear or even worn cracked looking teeth. It can be used just to lighten teeth but I would recomend bleaching first.The advantage of porcelain is that it is stronger than your teeth and it will not take up stain. DenMat offers a limited lifetime guarantee. That means they will supply me with a new veneer at no cost. My guarantee is 5 years. You can still get decay around them like any other restoration.  

One of my assistants suggested I explain the technique I use when I give injections. She had some dental work done and was surprised that there was no pain. It's a technique I learned around 15 years ago and I don't think much about it now, but my assistant thought it was important.

One of the nicest complements I receive is when someone says “That was so easy”. Fortunately that happens frequently. It hurts me when, in order to complete a procedure, a patient feels pain. Of course injections can't always be given painlessly. It is most difficult when someone comes in with a lot of pain or swelling and some people just have very sensitive gums. I would guess that 90% of my shots are painless, 9% are equivalent to a mosquito bite and the other 1% hurt a bit.

Here is the boring part. The procedure is as follows. Topical anesthetic for 1 to 2 minutes. I then very slowly inject one half cc of Citanest local anesthetic. The purpose of the Citanest is only to “numb” the gum. Citanest is a short acting anesthetic that has a higher PH than most other anesthetics. On most people Citanest, by itself would not anesthetize your tooth. But it does inject almost painlessly. Injecting slowly is also important in reducing pain. I then follow with Articaine. Articaine is the anesthetic that removes sensation from your teeth.

A few other notes while I'm on the subject. Novacaine is rarely used anymore because other anesthetics work better. Articaine, which I use now, is the latest. For whatever reason it works better than past anesthetics. I now very rarely do a block on the lower jaw. Because of this, it's much more comfortable to do fillings on both sides of the jaw. You can still talk when we are done because your tongue isn't anesthetized.

Before Articaine, at least once per month, I would have a patient where I would be unable to get them numb. It was usually someone in a lot of pain. Now it might be once per year.