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Philosophy Meet Dr. Perlaza Before & After Photos Dental Procedures FAQ Contact February 10, 2012

Cosmetic Dentistry Frequently Asked Questions
Provided by Dr. Harold Perlaza of Sherman Oaks


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What is Cosmetic Dentistry?


People choose cosmetic dental procedures for various reasons – to repair a defect such as a malformed bite or crooked teeth, treat an injury, or just improve their overall appearance. For these and many other reasons, cosmetic dentistry has become a vital and important part of the dental profession and one of the fastest growing areas of dentistry. For example, tooth-whitening procedures have tripled over the past five years.

Common cosmetic dental procedures can be performed to correct misshaped, discolored, chipped or missing teeth. It also can be used to change the overall shape of teeth – from teeth that are too long or short, have gaps, or simply need to be reshaped.

Cosmetic dentistry procedures include:

* Cosmetic fillings -- Alternative, natural-looking materials to conventional silver-colored fillings made from porcelain and composite resins, which are colored to match natural tooth enamel.
* Whitening/Bleaching -- Procedures that reverse the effects of such things as aging, food and tobacco stains, and medication use.
* Veneers -- Special thin laminates, called veneers, used to cover stains, correct discolored, worn down, cracked and chipped teeth, and close unsightly gaps between teeth.
* Bonding -- A tooth-colored material that looks like the enamel of your teeth and used to improve the color of a tooth, or close unsightly gaps.
* Cosmetic contouring and reshaping – A relatively simple procedure that can correct crooked, chipped, cracked, and even overlapping teeth.
* Crowns -- Synthetic caps, usually made of a material like porcelain, that can be placed on the top of a tooth to restore its function and appearance, attach bridges, cover implants, or prevent a cracked tooth from becoming worse.
* Crown lengthening -- Performed to reshape gums and bone tissue, and often used to correct a “gummy” smile.
* Bridges -- Natural-looking dental appliances that can replace a section of missing teeth and restore the natural contour of your teeth as well as the proper bite relationship between upper and lower teeth. Bridges are sometimes referred to as fixed partial dentures, because they are semi-permanent and are bonded to existing teeth or implants.
* Specialty dentures – Lightweight dentures that mimic the look and feel of natural teeth. Most dentures are made from a combination of metals and synthetic material such as acrylic resin, and can be either partial or complete sets.
* Excessive or uneven gums – Gum lifts or soft tissue grafts can be used to even gum lines, or cover an exposed root.
* Ridge augmentation -- A procedure that can shore up dents and other abnormalities in your gum line.
* Grafts -- Small pieces of tissue taken from other areas such as the palate and surgically implanted to correct severe gum disease, cover exposed roots, stop bone loss and gum recession, and even reduce pain-causing root sensitivity.
* Replacement of lost gum tissue -- Gum tissue can be augmented or replaced by a variety of means, including soft tissue grafts.
* Implants -- Synthetic structures that are placed in the area of the tooth normally occupied by the root. Implants are sometimes a viable alternative to partial dentures.


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Dental Implants


Before development of dental implants, dentures were the only alternative to replacing a missing tooth or teeth.

Implants are synthetic structures that are placed in the area of the tooth normally occupied by the root. Implants are anchored to the jawbone or metal framework on the bone and act as a foundation for an artificial tooth or permanent bridge. In some cases, implants can be used to attach dentures.

Not everyone is a candidate for a dental implant, however. For a successful implant to take hold, a candidate must have proper bone density and have a strong immune system. In all cases, dental implants require strict oral hygiene.

Implants are so well designed that they mimic the look and feel of natural teeth. Implants are usually made of a synthetic yet biocompatible material like metal or ceramic.

Surgery is necessary to prepare the area for an implant and place the implant in the mouth. Following the procedure, a period of time is required for the implant to take hold and for bone tissue to build up and anchor the device. In some cases, metal posts are inserted into the implant during a follow-up procedure to connect the tooth.

Because implants require surgery, patients are administered anesthesia and, if necessary, antibiotics to stave off infection following the procedure.

Like any restoration, implants require diligent oral hygiene and proper care to ensure they last a long time.


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Laser Periodontal Treatment


In most cases, your dentist will schedule a complimentary consultation to explain how the laser works and give you a demonstration. Next, the dentist will take X-rays to make a definitive diagnoses and determine the extent of the infection. When you return for your first LPTTMtreatment, you''ll receive a local anaesthetic to eliminate any possible discomfort. A general anaesthetic isn''t necessary, because LASER PERIODONTAL THERAPYTMis much less traumatic. A tiny laser fiber (about the thickness of three hairs) is inserted between the tooth and the gum, and the infection is cleared away. The procedure is fast: It takes just two 2-hour sessions. Your dentist will treat one half of your mouth at each session...and you''ll probably feel good enough to go right back to work afterwards.


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Veneers


Teeth that are badly stained, shaped or crooked may be improved by a veneer placed on the surface of the affected teeth.

Veneers are thin pieces of porcelain or plastic cemented over the front of your teeth to change their color or shape. Veneers are used on teeth with uneven surfaces or are chipped, discolored, oddly shaped, unevenly spaced or crooked. Little or no anesthesia is needed. Veneers have a longer life expectancy and color stability than bonding, and highly resist permanent staining from coffee, tea, or even cigarette smoking.
Veneers are usually made by a dental lab technician working from a model provided by your dentist. Veneers are usually irreversible because it`s necessary to remove a small amount of enamel from your teeth to accommodate the shell.

Porcelain veneers can mask undesirable defects, such as teeth stained by tetracycline, by an injury, or as a result of a root-canal procedure, and are ideal for masking discolored fillings in front teeth. Patients with gaps between their front teeth or teeth that are chipped or worn may consider porcelain veneers.
Typically, veneers entail at least three appointments: diagnosis and treatment planning, preparation, and bonding.

During the tooth preparation visit, usually lasting one to two hours, the teeth are lightly buffed to allow for the small added thickness of the veneer. Usually, about a half a millimeter of the tooth is removed, which may require a local anesthetic. During the same visit, a mold is taken of the teeth, and sent to the laboratory for the fabrication of the veneers.

During the final "bonding" visit, also about one or two hours, the veneers are placed on the tooth surface with water or glycerine on the teeth to check their fit and get a sense of the shade or color. While the veneers are resting on your teeth, they can be adjusted with various shades of cement to match the color of your teeth. To apply the veneer, the tooth is cleansed with specific chemicals to achieve a bond. Once a special cement is sandwiched between the veneer and tooth, a visible light beam, or laser, causes a catalyst to be released, hardening the cement.

During a two-week period of adjustment that follows, you may notice the change of size and shape in your teeth. It is important to brush and floss daily. After one or two weeks, you`ll return for a follow-up appointment. Porcelain veneers are reasonable facsimiles of natural teeth, not perfect replacements. It`s not uncommon to see slight variations in the color of porcelain veneers upon close inspection, as this occurs even in natural teeth.

For certain patients no preparation of the teeth may be necessary. Please see our specialties page for more information.


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Crowns & Bridges


Bridges

Bridges are natural-looking dental appliances that can replace a section of missing teeth. Because they are custom-made, bridges are barely noticeable and can restore the natural contour of teeth as well as the proper bite relationship between upper and lower teeth.

Bridges are sometimes referred to as fixed partial dentures, because they are semi-permanent and are bonded to existing teeth or implants. Some bridges are removable and can be cleaned by the wearer; others need to be removed by a dentist.

Porcelain, gold alloys or combinations of materials are usually used to make bridge appliances.

Appliances called implant bridges are attached to an area below the gum tissue, or the bone.

Crowns

Crowns are synthetic caps, usually made of a material like porcelain, placed on the top of a tooth.

Crowns are typically used to restore a tooth's function and appearance following a restorative procedure such as a root canal. When decay in a tooth has become so advanced that large portions of the tooth must be removed, crowns are often used to restore the tooth.

Crowns are also used to attach bridges, cover implants, prevent a cracked tooth from becoming worse, or an existing filling is in jeopardy of becoming loose or dislocated. Crowns also serve an aesthetic use, and are applied when a discolored or stained tooth needs to be restored to its natural appearance.

Procedures

A tooth must usually be reduced in size to accommodate a crown. An impression is made of the existing tooth and an impression is made. The impression is sent to a special lab, which manufactures a custom-designed crown. In some cases, a temporary crown is applied until the permanent crown is ready. Permanent crowns are cemented in place.

Crowns are sometimes confused with veneers, but they are quite different. Veneers are typically applied only to relatively small areas.

Caring For Your Crowns

With proper care, a good quality crown could last up to eight years or longer. It is very important to floss in the area of the crown to avoid excess plaque or collection of debris around the restoration.

Certain behaviors such as jaw clenching or bruxism (teeth grinding) significantly shorten the life of a crown. Moreover, eating brittle foods, ice or hard candy can compromise the adhesion of the crown, or even damage the crown.


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Teeth Whitening


Whitening procedures have effectively restored the smile of people with stained, dull, or discolored teeth.

The darker tissue of your teeth, the dentin, can become exposed as the outer layer of enamel is worn away by the effects of aging or things like caffeine and tobacco.

Food particles are naturally attracted to a tooth's enamel by a certain protein. Products like coffee and tea, berries and soy sauce are notorious for staining teeth. Over time, teeth actually become more absorbent and vulnerable to staining from food and other substances.

One type of stain-caused by traumatic injuries, medications and fluorosis-actually begins inside the tooth; brushing and flossing don't help. Another type of stain-one that can be more easily attached by brushing, flossing and rinsing-is caused by external factors such as foods.

More and more people today are choosing tooth-whitening procedures to reverse the effects of aging and abuse from food and tobacco stains.

Some commercially available "whitening toothpastes" can be somewhat effective at removing stains and making teeth a few shades brighter. However, many of these products have abrasive substances that can actually wear away your tooth's enamel.

Whitening agents actually change the color of your teeth, but only are effective on certain types of stains. For example, bleaching agents have a difficult time removing brownish or grayish stains. These products also are not as effective on pitted or badly discolored teeth, or on restorations such as crowns, bridges, bonding and tooth-colored fillings (porcelain veneers or dental bonding may be more appropriate in this case).

Professional whitening performed by our office is considered to be the most effective and safest method; done properly, tooth whitening can last as long as five years. Over-the-counter whitening systems are somewhat effective as long as they are monitored and directions followed closely.


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Root Canal Therapy


Root canals are tiny passageways that branch off from beneath the top of the tooth, coursing their way vertically downward, until they reach the tip of the root.

All teeth have between one and four root canals.

Many tooth problems involve infections that spread to the pulp, which is the inner chamber of the tooth containing blood vessels, nerves and other tissues. When the infection becomes worse, it can begin affecting the roots. A traumatic injury to a tooth can also compromise the pulp, leading to similar problems.

A diseased inner tooth brings a host of problems; pain and sensitivity are some of the first indications of a problem; but inside, a spreading infection can cause small pockets of pus to develop, leading to an abscess.

Root canal therapy is a remarkable treatment with a very high rate of success, and involves removing the diseased tissue, halting the spread of infection and restoring the healthy portion of the tooth. In fact, root canal therapy is designed to save a problem tooth; before the procedure was developed and gained acceptance, the only alternative for treating a diseased tooth was extraction.

Procedure

Root canal therapy usually entails one to three visits. During the first visit, a small hole is drilled through the top of the tooth and into the inner chamber. Diseased tissue is removed, the inner chamber cleansed and disinfected, and the tiny canals reshaped. The cleansed chamber and canals are filled with an elastic material and medication designed to prevent infection. If necessary, the drilled hole is temporarily filled until a permanent seal is made with a crown.

Most patients who have root canal experience little or no discomfort or pain, and enjoy a restored tooth that can last almost as long as its healthy original.


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Invisalign®


Invisalign's® invisible, removable, and comfortable aligners will give you the beautiful straight teeth you've always wanted. And best of all, no one can tell you're wearing them. Invisalign is great for adults and teenagers.

What is Invisalign®?

* Invisalign® is the invisible way to straighten your teeth without braces.
* Invisalign® uses a series of clear, removable aligners to straighten your teeth without metal wires or brackets
* Invisalign® has been proven effective in clinical research and in orthodontic practices nationwide.

How Does Invisalign® Work?

* You wear each set of aligners for about 2 weeks, removing them only to eat, drink, brush, and floss.
* As you replace each aligner with the next in the series, your teeth will move little by little, week by week - until they have straightened to the their final position
* You'll visit us about once every 6 weeks to ensure that your treatment is progressing as planned.
* Total treatment time averages 9 - 15 months and the average number of aligners during treatment is between 18 - 30, but both will vary from case to case.

How Are Aligners Made? You'd Be Amazed...

* The aligners are made through a combination of our expertise and 3-D computer imaging technology.


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Dentures


A denture is a removable replacement for missing teeth and adjacent tissues. It is made of acrylic resin, sometimes in combination with various metals.


Types of dentures

Complete dentures replace all the teeth, while a partial denture fills in the spaces created by missing teeth and prevents other teeth from changing position.

Candidates for complete dentures have lost most or all of their teeth. A partial denture is suitable for those who have some natural teeth remaining. A denture improves chewing ability and speech, and provides support for facial muscles. It will greatly enhance the facial appearance and smile.

Complete or full dentures are made when all of your natural teeth are missing. You can have a full denture on your upper or lower jaw, or both.

Complete dentures are called "conventional" or "immediate" according to when they are made and when they are inserted into the mouth. Immediate dentures are inserted immediately after the removal of the remaining teeth. To make this possible, the dentist takes measurements and makes the models of the patient`s jaws during a preliminary visit.

An advantage of immediate dentures is that the wearer does not have to be without teeth during the healing period. However, bones and gums can shrink over time, especially during the period of healing in the first six months after the removal of teeth. When gums shrink, immediate dentures may require rebasing or relining to fit properly. A conventional denture can then be made once the tissues have healed. Healing may take at least 6-8 weeks.

An overdenture is a removable denture that fits over a small number of remaining natural teeth or implants. The natural teeth must be prepared to provide stability and support for the denture.

Partial dentures are often a solution when several teeth are missing.

Removable partial dentures usually consist of replacement teeth attached to pink or gum-colored plastic bases, which are connected by metal framework. Removable partial dentures attach to your natural teeth with metal clasps or devices called precision attachments. Precision attachments are generally more esthetic than metal clasps and are nearly invisible. Crowns on your natural teeth may improve the fit of a removable partial denture and they are usually required with attachments. Dentures with precision attachments generally cost more than those with metal clasps.

How are dentures made?

The denture process takes about one month and five appointments: the initial diagnosis is made; an impression and a wax bite are made to determine vertical dimensions and proper jaw position; a "try-in" is placed to assure proper color, shape and fit; and the patient`s final denture is placed, following any minor adjustments.

First, an impression of your jaw is made using special materials. In addition, measurements are made to show how your jaws relate to one another and how much space is between them (bite relationship). The color or shade of your natural teeth will also be determined. The impression, bite and shade are given to the dental laboratory so a denture can be custom-made for your mouth.

The dental laboratory makes a mold or model of your jaw, places the teeth in a wax base, and carves the wax to the exact form wanted in the finished denture. Usually a "wax try-in" of the denture will be done at the dentist`s office so any adjustments can be done before the denture is completed.

The denture is completed at the dental laboratory using the "lost wax" technique. A mold of the wax-up denture is made, the wax is removed and the remaining space is filled with pink plastic in dough form. The mold is then heated to harden the plastic. The denture is then polished and ready for wear.

Getting used to your denture

For the first few weeks, a new denture may feel awkward or bulky. However, your mouth will eventually become accustomed to wearing it. Inserting and removing the denture will require some practice. Your denture should easily fit into place. Never force the partial denture into position by biting down. This could bend or break the clasps.

At first, you may be asked to wear your denture all the time. Although this may be temporarily uncomfortable, it is the quickest way to identify those denture parts that may need adjustment. If the denture puts too much pressure on a particular area, that spot will become sore. Your denture can be adjusted to fit more comfortably. After making adjustments, you may need to take the denture out of your mouth before going to bed and replace it in the morning.

Start out by eating soft foods that are cut into small pieces. Chew on both sides of the mouth to keep even pressure on the denture. Avoid sticky or hard foods, including gum. You may want to avoid chewing gum while you adjust to the denture.

Care of your denture

It's best to stand over a folded towel or a sink of water when handling your denture, just in case you accidentally drop it. Brush the denture (preferably with a denture brush) daily to remove food deposits and plaque, and keep it from becoming permanently stained. Avoid using a brush with hard bristles, which can damage the denture. Look for denture cleansers with the American Dental Association (ADA) Seal of Acceptance. Pay special attention to cleaning teeth that fit under the denture`s metal clasps. Plaque that becomes trapped under the clasps will increase the risk of tooth decay.

Hand soap or mild dishwashing liquid to clean dentures is also acceptable. Other types of household cleaners and many toothpastes are too abrasive and should not be used for cleaning dentures. A denture could lose its proper shape if it is not kept moist. At night, the denture should be placed in soaking solution or water. However, if the appliance has metal attachments, they could be tarnished if placed in soaking solution.

Even with full dentures, you still need to take good care of your mouth. Every morning, brush your gums, tongue and palate with a soft-bristled brush before you put in your dentures. This removes plaque and stimulates circulation in the mouth. Selecting a balanced diet for proper nutrition is also important for maintaining a healthy mouth.

Adjustments

Over time, adjusting the denture may be necessary. As you age, your mouth naturally changes, which can affect the fit of the denture. Your bone and gum ridges can recede or shrink, resulting in a loose-fitting denture. Loose dentures can cause various problems, including sores or infections. Dentures that do not fit properly can be adjusted. Avoid using a do-it-yourself kit to adjust your dentures, as this can damage the appliance beyond repair. Glues sold over-the-counter often contain harmful chemicals and should not be used on a denture.

If your denture no longer fits properly, if it breaks, cracks or chips, or if one of the teeth becomes loose, see your dentist immediately. In many cases, dentists can make necessary adjustments or repairs, often on the same day. Complicated repairs may require that the denture be sent to a special dental laboratory.

Over time, dentures will need to be relined, re-based, or re-made due to normal wear. To reline or re-base a denture, the dentist uses the existing denture teeth and refits the denture base or makes a new denture base. Dentures may need to be replaced if they become loose and the teeth show signs of significant wear.

Common concerns

Eating will take a little practice. Start with soft foods cut into small pieces. Chew slowly using both sides of your mouth at the same time to prevent the dentures from tipping. As you become accustomed to chewing, add other foods until you return to your normal diet.

Continue to chew food using both sides of the mouth at the same time. Be cautious with hot or hard foods and sharp-edged bones or shells.

Some people worry about how dentures will affect their speech. Consider how your speech is affected when you have a number of your natural teeth missing.

Pronouncing certain words may require practice. Reading out loud and repeating troublesome words will help. If your dentures "click" while you`re talking, speak more slowly. You may find that your dentures occasionally slip when you laugh, cough or smile. Reposition the dentures by gently biting down and swallowing. If a speaking problem persists, consult your dentist.

Denture adhesives

Denture adhesives can provide additional retention for well-fitting dentures. Denture adhesives are not the solution for old, ill-fitting dentures. A poorly fitting denture, which causes constant irritation over a long period, may contribute to the development of sores. These dentures may need a reline or need to be replaced. If your dentures begin to feel loose, or cause pronounced discomfort, consult with your dentist immediately.


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NTI Tension Suppression System


The NTI Tension Suppression System is a new FDA-approved method of headache and migraine prevention that is said to work by reducing night-time teeth clenching. This often intense nocturnal activity is purported to lead to a hyperactivity of the trigeminal nerve, often triggering typical migraine events. The objective of the NTI is to relax the muscles involved in clenching and mastication, thus diminishing the chances for migraines and tension headaches to develop.

The NTI is a small transparent plastic device which is worn over the two front teeth at night to prevent contact of the canines and molars. It is normally fitted by a dentist trained in the technique. It does not involve any drugs, shots, or surgery.

NTI stands for Nociception Trigeminal Inhibitor. This means a device to stop noxious input to the trigeminal sensory nucleus.


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PerioLase®


Do you suffer from red, swollen and tender gums that occasionally bleed when brushed or flossed? Has your dentist told you that you are suffering from moderate to severe periodontal disease? Were you told you had "pockets" that were 4mm or more between your teeth? Did your dentist refer you to a periodontal specialist? If you answered yes to any of the questions above, we have a treatment option in our practice that you may be very interested in knowing more about.


We are pleased to announce that we have completed intensive training in Laser Periodontal Therapy and now offer this treatment using the World's first digital dental laser -- the PerioLase®MVP-7. This laser was specifically designed for treating gum (periodontal) disease. This addition makes it possible for us to effectively treat gum disease problems and establish ideal conditions for healing the gums around teeth that have periodontal pockets, right in our office.


The PerioLase®MVP-7 laser now gives us a gentle and effective way to stop the damage being done by the infections in the gums. Patients who have had this form of laser treatment report that they have little or no discomfort after the procedure. We are proud to be among the first of the growing number of dental offices in the country to provide this breakthrough laser treatment to our patients.


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Harold Perlaza, DDS
Cosmetic Dental Studio

Office Address:

4955 Van Nuys Blvd.
Suite 202
Sherman Oaks, CA 91403
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