Unexpected Dentistry. Why?

July 18, 2009 alexnguyen

I recently saw a new patient for a consultation on her smile. Throughout our conversation, she expressed her discontent with her smile which underwent 2 orthodontic treatments and several crowns for the upper anterior teeth. Some lower teeth were unnecessarily extracted for the previous orthodontic treatment. At time... There were tears in her eyes.

In fact, this is not the first time a patient came to me with tears in her eyes because of regrets, discontentment, and resentment for past treatments done to the smile. Why?

Cosmetic dentistry is often advertised by almost every dentist you can encounter. Many dentists do have the services offered listed something along the line of ..." General and Cosmetic Dentistry". As a patient, to avoid disappointing results, you may want to consider:

- The dentist's training and credential with reputable institutions such as the American Academy of Cosmetic Dentistry - www.aacd.com

- Ask to see the work in detailed and up-close photographic images

- Ask about what was done and how the result of the dentist's work was achieved

- Pursue multiple consultations with different dentists before you make a final decision on the treatments

- Be prepared to invest in adequate treatment time, because "a beautiful smile in two visits" is a marketing concept: Excellence, Precision, and Quality dental work require dedication to the art and science, and taking the time to help achieve the best possible outcome.

Don't be sold to a business-driven dental office. That is how you can prevent yourself from coming home with unexpected dentistry.

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Alex Nguyen, DDS is a Saratoga Dentist who practices General Dentistry, Cosmetic, and Implant Dentistry. For over 20 years the practice has been serving the residents of Santa Clara County and San Francisco Bay Area.

A New Smile a New Makeover!

April 24, 2009 alexnguyen

Meet patient Kari at our Makeover Photo Shoot today. Photographed on location in Saratoga and at my office. Smile Design by Alex H Nguyen, DDS. www.saratogadentalspa.com

Hair and Makeup by Armando Sarabia www.getyourdoup.com

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Another Case of Sensitivity after Resin Filling

April 22, 2009 alexnguyen

Here is another case where voids in resin fillings will cause the tooth to be sensitive. This patient's complaint was "I had some fillings done on my upper left quadrant, and the teeth on that side have been sensitive since." The black arrow points to a distinct void underneath the white filling. To correct the problem, we will need to redo this filling for the patient.

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SEM proves zero bond between Amalgam and Tooth

April 18, 2009 alexnguyen

I have warned a patient that this particular part of his tooth will break at some point. It finally broke. With the patient being a Chemical/Mechanical/Material Engineer... the fractured tooth was placed under a Scanning Electron Microscope. Interestingly enough, my patient reenforced my everyday discussion that "Amalgam fillings have no true bond to tooth structure."

Based on the information interpreted by the SEM, the fractured piece of enamel showed no bond to the silver filling.

Thanks BM for your insight and photos.

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A Dental Implant Case

December 4, 2008 alexnguyen

Today I had the opportunity to explain to a new patient about the proper treatment protocol for a tooth that she is losing. Here is a great lesson about what to do when you are about to lose a tooth. The patient was told by her previous dentist: "Your tooth has a infection. Let's put you on antibiotic. Then...you come back for us to extract the tooth and to do some bone graft. Then...TWO WEEKS LATER ... we can prep the adjacent teeth for a bridge to replace that same missing tooth."

I have never heard of any bone grafting material that can fully stabilize an extraction site in TWO WEEKS. A typical bone grafting site requires any where from 4 to 6 months of healing time.

In addition, the tooth behind this failing tooth is also compromised. Using it to anchor a bridge also will not provide the patient a predictable long term result.

In a case like this where an active infection is present due to a failed root canal treatment with compromised root structure we must be even more careful with our treatment plan. A Gum Specialist (periodontist) or an Oral Surgeon would be best to handle the surgical aspect of this tooth. The proper treatment sequence would follow something like this:

1. Antibiotic Regiment to suppress the infection

2. Extraction of the failed tooth with proper bone grafting done at the same time

3. Wait for proper healing. Typically 4-6 months

4. Placement of the dental implant to replace the missing root

5. Wait for proper healing. Typically another 4-6 months.

6. Placement of a new crown on top of the dental implant.

As a patient, you need to be educated enough about a complex procedure before agreeing to the recommended treatment. Dental Implant treatments require proper coordination between a surgeon and a restorative dentist in order to achieve a successful outcome. This patient had made a very wise decision to seek multiple consultations with different dentists before choosing her own treatment choice.

Let's take a look at the tooth:

√ The furthest left arrow points to the compromised root which was proposed to be the anchor for a new bridge.

√ The middle arrow points to the fractured root of the tooth in question.

√ The right arrow points to the infection and bone loss around the infection.

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