Four Months Reopening Update

To our beloved patients and family,

it is hard to believe that four months have passed since we reopened the practice. It has been an absolute pleasure seeing our patients to deliver our care, and to reflect on the fact that together we can embrace whatever changes that are going on in the world right now.  One thing our team has realized in this pandemic:  There is no obstacle that cannot be overcome with dedication and hard work.

Every day we continue to strive for excellence in clinical care and patient comfort. Our routines have been enhanced by extra safety measures that make our workdays a little different, yet our patients report that their positive experience has not changed from the perspective of receiving care.  Your overwhelming referrals of new patients to our practice in the last four months have been true testaments to the fact that the practice we have created for our patients is second to none.

As Shelter-in-Place imposes a different life routine for most people, here are some significant dental problems that we have seen happening:

-          Gum inflammation from prolonged lack of professional cleanings and neglect of home care

-          Fractured teeth and restorations due to grinding and clenching from stress

-          Accelerated tooth decay due to frequent use of snacks and beverages

For our patients who are still not comfortable coming in for care, we would like to remind you to be diligent with your brushing and flossing at home.  Gum disease and tooth decay are problems that can complicate treatments if allowed to accelerate beyond control.

Among changes such as paperless documentation, billing, and patient registration, we currently find the following routine to be very effective for our workflow:

A. For the office personnel:

1.       Everyone at the office goes through and answers Covid Health Screening questionnaires.  This is done via a Google Doc that we log in each morning before work.

2.       Everyone at the office takes a temperature reading every morning.

3.       Anyone at the office who may be sick or feel sick will not work.

B.       For the patient coming in:

1.       The patient enters the office with a mask.

2.       The patient answers Covid Screening Questionnaires either from our website or on our iPad.

3.       The patient gets taken back to the treatment room and immediately gets a temperature check.

4.       The patient is asked to rinse with an antiviral solution before sitting down for treatment, only if the temperature is cleared of fever.

C.       During Treatment:

1.       Dentist, Assistant, Hygienists wear N-95 mask overlayed by a second surgical mask.  We all wear droplet repellent head covers and gown.  We all wear face shields to further cover ourselves.

2.       Gloves are constantly changed every time we reach for any other clean instruments and supplies.

3.       We wipe down EVERYTHING with proper disinfectant solutions.

D.       We routinely change out all PPE garments even if we enter a room just to check on a patient.

We as a team all have families to go home to every night.  Hence what we do is not only to protect our patients, but also to protect ourselves and our families.

As we approach the cold and flu season, we ask that you reschedule your appointments if you should remotely feel sick on or near your appointment time.  Furthermore, as the year-end approaches our extremely busy schedule, we do ask that you plan your appointments well in advance and do not wait until last minute due to reasons such as insurance limits or time constraints, etc.

On a positive note, today marks the twenty-year work anniversary for our beloved team lead Stacy Davis.  Please join us to congratulate Stacy on this amazing milestone.  Stacy has played an important role in the success of our practice, and we could not have met a better person twenty years ago.

Thank you for your continued trust in us.  We will continue to work hard in order to make your time spent with us a worthwhile investment.  We wish you and your families continued good health every day.  Cheers to fabulous smiles and excellent dental health!

Best regards,

Alex, Jacob, Stacy, Stephanite, Sienna

Can you floss between veneers?

Of course you can. Unfortunately… Not in this case though.

These veneers were done in a country in Asia. According to the patient, two of them fell off while the patient was still there. The veneers then were rebonded, and the patient was wondering why he couldn’t floss between them any more.

In the photos you can see the excess cement connecting all the porcelain together. I will not comment on the esthetic aspect, however… From a technical standpoint this case is a disaster waiting to happen. By being unable to floss, food and plaque will be trapped underneath and the gum inflammation will eventually lead to bone loss.

Many people travel to have dental work done. What do you do when there is a problem? Is it worth the savings and the risks ?

What is a wax up?

Before I begin…It has been a whirlwind of a year due to my complex travel schedule. I spent this past Spring and Summer traveling to Germany twice, and most recently to Romania to stay updated on the world of implantology, digital dentistry, and dental photography. Most of the digital dental technology development and manufacturing begins in Europe, and I wanted to learn from the best resources available. I am back, and will continue to update this blog as well as my Instagram page to bring you the latest information on my work, in order to help you make confident decisions when seeking dental care for you and your loved ones.

I saw a patient for a cosmetic consultation this past week, and her question is the topic for this blog post: When do you do a wax up?

A wax up is a design of as little as one tooth, or as many as all the teeth in the smile. A wax up is done to modify the size, shape, contour of the teeth prior to prepping the teeth in the mouth for restorations. In the case below you will see a wax up of a design to replace old porcelain veneers and crowns that the patient wanted me to change out. In this particular case “length” was ok for the patient, so the wax up was done to refine shape and surface characteristics which are important in making the porcelain veneers look real. Natural teeth are not perfectly flat, and we need to transfer those details onto the final restoration.

The colors of the wax is the preference of the technician working on the case. Some prefer a white wax because they mimic white teeth. Some prefer colored wax because details show up very well with colored wax.

Depending on the needs of the case, the wax up will tell us how much tooth structure reduction is necessary to achieve the ideal out come of the case. For example, a tooth that needs to be brought out to be more even with the arch form would need less reduction than a tooth that is stuck out in the arch form and needs to be brought inwards. Sometime, by seeing the wax up, the patient can visualize why orthodontic would be an option to even out the arch form in order to minimize the need for more significant tooth reduction as well as to minimize the number of teeth that need to be treated.

Just as an architect would rely on a blue print to build a house, a wax up design is our blue print in dental reconstruction. In the future you will see more and more cases being done with digital wax up using CAD software instead of traditional hand waxing. I will post a digital wax up case later.

A wax up design to restore a previously done smile with 10 upper teeth and 6 lower teeth.

Note the details in the surface texture. They are very visually defined in wax, but in the final porcelain they are very subtle and so important in light reflection to make the restoration look real.

Enhancement of lower anterior teeth in wax.

 

Cosmetic Options for the Young Dentition

For the young dentition, conservative treatments such as teeth whitening and bondings are great options to help enhance a smile. In the case below the patient spent sometime whitening his teeth with the take-home kit we prescribed. After the teeth have lightened up to a shade where the patient was happy with, we used resin filling materials of various shades to bond to his front teeth. Chips and gaps can easily be filled in without any removal of tooth structure.

The “After” smile looks beautiful in person, and at conversational distance it is near impossible to detect where the bondings were placed.

Click on the photos below to see the transition.

Different Veneers for Different Purposes

Veneers are commonly used to enhance people’s smiles. Some patients choose to have a full arch of veneers to help change their entire smile. Some patients choose only a select number of veneers to help restore teeth with imperfections.

In the case below we used only four veneers on the upper four front teeth to rejuvenate the smile and get rid of old broken down composite fillings and bondings.

Click on the image box below to view and before and after photos.