Why Over-the-Counter Products Usually Fail

There are two main reasons for the lackluster results of over-the-counter whitening strips.

1. Your teeth are not flat surfaces – they have contours on the sides, and the area where tooth meets gum also creates an uneven surface. Because whitening strips don’t fit these contours, the bleaching agent doesn’t make good contact with or produce good results in those recessed areas.
2. Many over-the-counter products contain a relatively mild bleaching agent. (Stronger OTC agents have recently become available. Continue reading to learn about the risks involved with those.)  Because strips don’t fit snugly, that also allows saliva to penetrate and dilute the bleaching agent. Saliva can penetrate more in some spots than others, once again contributing to irregular and unattractive whitening results.

Over-the-counter products that provide trays (whether “standard” or somewhat moldable) were marketed as a way to overcome the problems with loose-fitting strips.  Their ability to conform to the exact shape of your teeth remains limited, though.  Those who have one or more teeth that are slightly misaligned may find that over-the counter tray systems highlight the misalignment by causing those teeth to be lighter or darker than the surrounding teeth.

Risks That Go Beyond Appearance

There are three primary oral health risks associated with using stronger bleaches at home or having services provided in a mall by someone who doesn’t understand or properly guard against the risks inherent in the services they provide.

1. Strong bleaching agents are far more likely to provide gum irritation. That’s the very reason that the first OTC whitening strips used mild bleaching agents. With the OTC “boil-and-bite” type of bleaching trays, stronger bleaching agents are often provided. Unfortunately, the resulting “custom” trays that are produced can actually increase gum exposure to the bleaching agent, making irritation far more likely.
2. Overuse of whitening agents (too frequent or too strong) can cause tooth enamel deterioration. Tooth sensitivity can also result, but will usually go away with time unless damage to the enamel has occurred. Tooth enamel damage is serious – it leaves the very teeth you’re whitening prone to decay and other forms of damage because the teeth’s natural, resilient coating is no longer there to protect the softer, inner tooth structure.
3. Some tooth whitening services use UV (ultraviolet) light to speed or enhance the whitening process. If you use sunscreen on your skin, you know the risks of too much UV light exposure. You don’t have to feel a burn to have experienced UV light gum exposure that could cause long-term oral health issues to develop.

At RCCD, we can offer you quick, immediate teeth-whitening results or custom-fitted trays that will allow you to perform ongoing at-home treatments. We can also help you understand the type of results to expect before you produce do-it-yourself results you will live to regret. Your natural tooth color is a factor in how much your teeth can safely be whitened, and you have to consider how any restorative work (fillings, crowns, veneers) will be affected by the bleaching process, too. That’s why going to an experienced cosmetic dentist makes good sense when you’re trying to enhance your smile. We can explain all the options, including veneers and other treatments that may be necessary to produce the results you’re expecting. You can count on us to provide a plan that fits within your time, convenience, and budgetary constraints while still preserving your oral health.

Building Confidence

A better smile can deliver more than meets the eye. The change in confidence that many people experience after using Invisalign can positively influence both personal and business relationships. Our own belief that everyone notices imperfections in our appearance can really hold us back. Even those who need relatively minor smile enhancement can benefit from the new-found confidence they feel in their interactions with others.  That’s another reason that Invisalign is a good choice for smile enhancement – your treatment may go completely unnoticed by those around you while you’re having it done.

Investing in Your Future Oral Health

Many people associate wearing braces with cosmetic improvement only. They never stop to consider that braces can be an investment in future oral health. As people live longer and longer, their teeth will need to serve them longer! Consider how problems with the spacing of your teeth can affect you.  Living with crowded teeth increases the likelihood of plaque buildup, tooth decay, gum disease, and eventual loss of teeth. Wide gaps between teeth leave gums more exposed and increase the possibility of developing gum problems (and potential tooth loss) over time.

If your upper and lower teeth do not align properly (crossbite), you will experience greater force and wear on certain teeth, making them more prone to decay on the top surface. If your upper teeth come inside your lower teeth, you are more likely to experience abnormal wear and to chip a tooth – a result that is both unsightly and costly to repair.

Ask us to evaluate what the non-cosmetic benefits might be to using Invisalign or some other form of braces. Every person’s risks are different, based on spacing, bite, and the wear patterns that are developing. We can help you understand the potential long-term consequences of not investing in having your teeth properly spaced and aligned.  When you weigh all the factors, it’s normally more than a purely cosmetic decision.

In a study including 4,200 Japanese adults age 65 or older, the participants received a thorough dental examination and psychological evaluation.  Individuals who had lost more of their own teeth had a higher risk of memory loss or early stage Alzheimer’s disease.  Dr. Nozomi Okamoto, the lead investigator for the study, indicated that individuals who had symptoms of memory loss reported that they rarely or never visited a dentist. Dr. Okamoto said that one possible explanation is that “infections in the gums that can lead to tooth loss may release inflammatory substances, which in turn will enhance the brain inflammation that cause neuronal death and hasten memory loss.”

Gum disease is the most common cause of tooth loss in adults who are 35 and older. Dr. Okamoto indicated that other factors could be involved in the linkage between tooth loss and memory. In general, little is known about the actual causes of Alzheimer’s, in spite of extensive research. The exact relationship between tooth loss, memory, and Alzheimer’s certainly warrants more study. In the meantime, though, it makes good sense to see your Raleigh dentist regularly to prevent or manage gum disease that becomes more prevalent as we age.

Unfortunately, some sedation dentists in Raleigh NC, and across the U.S. have used the term sleep dentistry for what should really be called sedation dentistry. Whether the intent of that was to simplify things for consumers or a marketing tactic doesn’t really matter. In reality, it has done nothing but create confusion for the general public. The confusion particularly affects those who experience dental anxiety to the extent that they would prefer to be put to sleep during their dental treatments. Those people may find themselves looking for a sleep dentist rather than a sedation dentist in Raleigh. That’s because he layman’s term being put to sleep has long been associated with the use of general anesthesia. So that’s why we have to sort through all three terms at once to clear up the confusion!

Sedation dentistry, which is marketed by some dentists as sleep dentistry, does not involve the use of general anesthesia.  Because of the confusion that the term sleep dentistry creates, both the American Dental Association (ADA) and the Academy of General Dentistry (AGD) have discouraged dentists form using that term. Dental regulatory boards in some states have also banned the use of the term sleep dentistry in dental marketing.

While general anesthesia could technically be considered a form of sedation (because the patient is relaxed using a pharmacological approach), sedation dentistry generally refers to the use of pharmacological approaches that do not intentionally cause the patient to become unconscious. This is in contrast to general anesthesia which does intentionally render the patient unconscious.

General anesthesia is used by dentists in some fields of dental specialty, especially oral surgeons. Because general anesthesia causes you to become unconscious, there is a much greater possibility that you might need to be resuscitated. That is why it is usually administered only in a hospital setting where an artificial airway can be maintained to support an instant resuscitation attempt. The hospital (or hospital-like) setting and staffing needed for the administration of general anesthesia also makes it a much more costly option than sedation dentistry. Oral surgeons will normally recommend that lesser sedation techniques be used in conjunction with local anesthesia whenever practical. That recommendation is based not only on helping patients to control costs, but perhaps more importantly to minimize the degree of risk to the patient.

I hope that helps clear up some of the confusion you might have experienced. If your dental anxiety (about have dental procedures done or about the use of needles to administer local anesthesia) is such that you feel you need to be put to sleep, I would be glad to explain why a sedation dentist in Raleigh is probably a good, safe, and comfortable option for you, even if you are not put to sleep with the use of general anesthesia. Part of that is understanding that consciousness is not an on/off state, but rather a sliding scale. The further along the scale you go, the more risk is involved. In 2009, the NC state dental board recently put in force regulations that assure patient safety in the use of various levels of sedation – controlling the amount of sedative used, how it is administered, the dentist’s training/experience level, the staff’s training, and presence of appropriate resuscitation equipment.  If you are interested in using a sedation dentist in Raleigh, give us a call. We will be glad to answer additional questions you might have.

More and more studies continue to link other health issues (diabetes, heart disease, osteoporosis, etc.) to periodontal disease. In some cases, the health issue predisposes you to gum disease. In other cases, gum disease is suspected as being a precipitating cause of the health issue. We are still trying to better understand the full consequences of bacteria and byproducts that develop around inflamed gums on other body parts and systems. In light of these risks, sedation dentistry just makes good sense for those who are putting off regular cleanings and check-ups. Because of the seriousness of gum disease, there is much research going on to assist with risk assessment and detection. This includes research to determine whether genetic testing can identify those at high risk and who really need more frequent dental visits to head off the serious problems. Other types of tests, which would let us easily test fluid in the mouth (not saliva, but fluid that accumulates in crevices between gums and teeth) and determine how advanced gum disease truly is, are also being explored. Even a skilled dentist’s eye may not detect just how advanced the disease has actually become.

Until some of these tests become proven and readily available, periodontal disease will remain, for the most part, a silent predator for those who don’t regularly visit a dentist. Ask us about sedation dentistry if you’re not comfortable with regular dental visits. Especially ask us if you have factors that do predispose you to gum disease (diabetes, smoking, women with hormonal fluctuations, family history of gum disease, receding gums) or indicators that it is already present (bleeding around the gums, a loose tooth). If you already know that you have periodontal disease but can’t stand undergoing periodontal treatments, you should let us explain sedation dentistry to you, as well as the risks you’re exposing yourself to if you don’t get the regular treatments you need. We not only provide sedation dentistry, our comprehensive dentistry services also include periodontal treatments. If you are one of those who has to contend with periodontal disease, this allows you the convenience of scheduling regular checkups and periodontal treatment in the same office visit.

Even if porcelain veneers aren’t a good tooth-straightening approach for you, it’s possible that Invisalign braces could be used to move your teeth into proper position without anyone ever noticing your braces. When the degree of movement required is not extensive or overly complex, the Invisalign system can be a great choice. Invisalign is actually a system of removable aligners. That means that you can remove them to clean your teeth or to eat.

For some, the straightening needs will be such that neither porcelain veneers nor Invisalign is a good solution. Clear braces are another possibility, making them far less noticeable – a concern for many adult patients. With more and more adults wearing braces these days, it may not be as much of a concern as you’ve been led to believe in the past.

The staff here at Raleigh Comprehensive & Cosmetic Dentistry is glad to help you learn more about porcelain veneers, as well as other options such as cosmetic bonding, composite veneers, Invisalign, and braces. Many of our patients are surprised to learn about the different possibilities available to them. Even if porcelain veneers aren’t a good approach for you, we’ll help you understand which ones are possibilities for your personal smile-enhancing treatment plan and budget.

This is somewhat frustrating from my standpoint. There are many people going without needed dental care – from regular exams and cleaning to more serious issues – because of the anxiety they feel about going to a dentist. Those people often wait until the condition becomes serious. At that time, they require much more costly procedures that ARE typically covered by dental insurance.

It’s too bad there’s not an easy way to track what’s happening with these would-be sedation dentistry patients. It’s my guess that accurate comparison data – contrasting costs of early treatment (including sedation costs) versus outlay for treating the more advanced situation – would show that covering sedation dentistry costs could reduce payouts for insurance companies in the long run. Crowns and bridges can be quite expensive in contrast to filling teeth that have small cracks or show small areas of decay.

With time, I hope that dental insurance providers will figure this out. For now, I think patients must do their own financial evaluations. Even without insurance reimbursement for the sedation dentistry costs, it is possible that patients could reduce their out-of-pocket costs in the long run. The later you treat a dental issue, the more expensive it’s likely to be. I don’t advocate using sedation for everyone – only those who need it.

I’m hoping that sedation dentistry will soon be recognized as a (reimbursable) service critical to preventive dentistry for many patients. Until that day comes, our office can work with you to establish a payment plan for sedation dentistry in Raleigh, NC to help you get the treatment you need.

About Regular Checkups

Dental care doesn’t “defer” easily. Try to maintain regular check-ups for all family members if at all possible. A small cavity can be filled relatively inexpensively. Left untreated, it could require a costly root canal and crown. If you’re a new patient, you’ll probably find that I spend a lot more time looking for oral cancer during your checkup than other Raleigh family dentistry practices. It’s more than worth it to me to take the extra time because it’s helped me catch cases early. (Not only is treating advanced oral cancer costly. The Oral Cancer Foundation also says that nearly half of those being diagnosed will not be alive in 5 years. It’s deadly because people don’t normally detect it themselves until it’s in advanced stages.)

About Prevention

As a Raleigh family dentistry practitioner, I can say we’d rather not see any cavities. The cost of preventing most cavities and gum disease is very low. Studies continue to identify ways that poor oral health triggers other general health issues, emphasizing the need to do your part to preserve your oral health. For each family member, annual oral hygiene costs (for twice a day cleaning) are very reasonable. All the items you need for that are:

• Toothbrushes – While sonic toothbrushes are effective, using a manual toothbrush properly at least twice a day is fine. Changing to a new toothbrush every 3 months as we recommend, you’ll need 4 toothbrushes for each family member.
• Toothpaste – Assume one tube of toothpaste per person per month. That’s a generous amount – you don’t need to cover the entire toothbrush!
• Floss – Using 18 inches of floss once a day, one person would use 3 average containers a year, with quite a bit left to spare for extra flossing. We recommend flossing at least once a day.

And regular cleaning can also help you flash a fresher, brighter smile on your next job interview – something that might subconsciously tip the scales in your favor!

Few of my patients know what it took to get to the current state of the art – or how long it’s been since the earliest attempts. The earliest evidence we have dates back to the Mayan civilization about 600 AD. A young woman exhumed in a 1930s archaeological exploration had three implanted teeth, which everyone assumed were inserted after her death. That practice – replacing teeth after death – dated back to the ancient Egyptians. In 1970, a professor analyzing the Mayan woman’s teeth used x-rays to show that bone had actually grown back around two of the dental implants – evidence that they had been placed while she was still living!

It took a lot of additional trial and error to get where we are today. In the 1700’s, they tried implanting human teeth – those were early lessons in transplant rejection by the human body. In the 1800’s, a lot of experimentation with gold and platinum dental implants occurred – with very limited short-term success.

Like many revolutionary discoveries, the person who is credited with the biggest advance was not someone who set out to develop dental implants. It was a Swedish orthopaedic surgeon (Per-Ingvar Brånemark) who had screwed titanium chambers into bone to observe the bone-healing process as part of his 1950’s research effort. He was surprised to discover that the optical chambers couldn’t be unscrewed when he completed his studies several months later! Bone had fused around the titanium screw inserts.

Fortunately for the world of dentistry, he used his surprise finding (bone fusing with metal) to redirect his focus onto developing titanium dental implants. After all, it was easier to clinically observe implants in the mouth than it was to do so internally (in joint and bone repairs). Decades of additional research by Brånemark and his team proved the viability of titanium screw dental implants and very high success rates. While the idea of using metal screws for dental implants dates back to research at Harvard University in the 1930’s, patients in Raleigh can look outside the U.S. for the earliest successes (the Mayans) and the most revolutionary advances (Sweden).

Among the other (non-cosmetic) reasons that we might suggest braces for you or a family member are:

• To improve the function of your teeth. We can help you overcome difficulty with biting or chewing.
• To increase your confidence. Childhood peer pressure can be tough. So can adult self-perceptions. Some misalignments may result in minor or significant speech impediments.
• To make daily tooth cleaning easier. This lets you maintain better long-term oral health.
• To improve your tooth and gum health, in general.
• To reduce wear patterns on specific teeth. When enamel wears off, decay is far more likely to occur.
• To reduce possible injury to front teeth that protrude. This is especially important for those who engage in sports activities.
• To help guide your child’s permanent teeth into better positions as they emerge.

One advantage of going to a practice like ours (comprehensive dentistry) is to have us monitor conditions and advise when orthodontics (or some other type of service) are needed to maintain good oral health – to help you avoid costly future tooth loss and replacement. Conditions that aren’t always cosmetically obvious include bite issues (overlap, underlap, cross bite); uneven wear on teeth; jaw shifts when biting that can cause head or neck pain; and spaces between back teeth large enough to cause problems. You may have been born with these conditions, which can become more serious with age, or a new condition can develop over time.

Don’t try to assess your own needs – that’s our job! We’re a leading practice for general dentistry and provider of orthodontics in Raleigh, NC – just one component of our full range of comprehensive dentistry and cosmetic dentistry services. Our goal is to save your teeth, in addition to giving you the smile of your dreams.