When you have your teeth bleached in a dental office, the results almost seem like magic. Let's push aside the magician's cape and see what is really happening in professionally-applied, in-office tooth whitening.

How do teeth become discolored?
A tooth's enamel covering is mostly composed of mineral crystals. At a microscopic level, you can see a framework or matrix of organic (living) matter interspersed between the crystals of enamel creating a very irregular surface capable of retaining stains. Chromagenic (color generating) organic compounds can become part of this organic matrix resulting in tooth staining. They can be bleached without affecting the mineral structure of the tooth's enamel.

As people get older and their teeth wear, the enamel loses its youthful translucency and the underlying layer, called dentin, thickens and becomes more yellow. Such changes to the actual tooth structure are called intrinsic staining. Other causes of intrinsic discoloration are exposure to high levels of fluoride or tetracycline antibiotic administration during childhood, tooth decay, or root canal problems, among others. Discoloration can also be caused by external staining from certain foods, drinks, or tobacco products. Such surface stains are called extrinsic staining.

Behind the Magic
Materials used for tooth bleaching are hydrogen peroxide and carbamide peroxide. Peroxides are commonly used as bleach, and you may have seen them used as hair bleaches, for example. Hydrogen peroxide is a strong oxidizing agent that attacks the organic molecules responsible for tooth discoloration, bleaching them until they lose their color. Carbamide peroxide also contains urea, which is a compound that permits the peroxide to remain in contact with the teeth for longer amounts of time without harming them.

Often called power bleaching, the in-office technique uses a high concentration of peroxide solution (35-45% hydrogen peroxide), placed directly on the teeth in the form of a gel. A heat or light source may enhance the peroxide release. The gel is applied with trays custom fitted to your mouth, and specific barriers are applied to protect sensitive gum tissue from the solution. Results show teeth becoming up to ten shades lighter in about an hour.

In-office bleaching under the supervision of my staff and me is recommended if you have severely stained teeth, and particularly if you are about to have veneers or crowns made. It's a way to rediscover the pearly translucency of your youthful smile.

Contact us today to schedule an appointment to discuss your questions about tooth bleaching. You can also learn more by reading the Dear Doctor magazine article “Teeth Whitening.”

We say that we are going to have our teeth cleaned — but a lot more than simple cleaning takes place during a visit to a dental hygienist.

1. Health History
   Your hygienist will ask you about your general health and your dental health and any recent changes in either. By doing so she will pinpoint any issues that require special precautions during your cleaning.
2. Cancer Screening
   Next, the hygienist carefully examines the skin in and around your mouth looking for lumps, bumps, sores, tenderness or swellings and refers areas of concern to the dentist for further evaluation. The hygienist is one of the few people who get to closely assess your whole mouth, so she is trained to spot cancer and other diseases.
3. Evaluating Your Periodontal Health
   Your hygienist will look closely at the state of your periodontal health (from peri meaning around and dont meaning tooth). This includes checking your gums and the other tissues surrounding your teeth for inflammation (gingivitis) or bleeding.
4. Checking for Decay
   The hygienist will examine your teeth for decay and will note the location and condition of stains or hard mineral deposits (calculus or tartar). These deposits result from a buildup of plaque (a film of bacteria) that has not been removed by daily brushing.
5. Scaling
   The hygienist uses hand tools or a sonic scaler to remove the calculus from your teeth.
6. Polishing
   A mechanical polisher and an abrasive polishing compound are used to polish the surface of your teeth so that they are smooth, making them more resistant to plaque, removing stains and leaving your teeth feeling squeaky clean.
7. Measuring
   The hygienist uses a tiny probe to measure the space between your teeth and gums. Periodontal disease begins by forming pockets between the teeth and gums, so this measuring is key to your periodontal health. Generally a space of 3mm or less indicates healthy gums, pockets of 4 to 5mm indicate periodontal disease that may be reversed with good oral care at home, and pockets that are 6mm deep or more require specialized treatment by a dentist or periodontist (a dentist who specializes in care of gums).
8. Education
   Based on the observed conditions of your gums and teeth, the hygienist will provide information aimed at improving your home oral cleansing routines and about your risk for tooth decay and gum disease.
9. Making Your Next Appointment
   The hygienist will make an appointment for your next cleaning — in three, four, or six months depending on the health of your gums and teeth. Keeping these appointments not only keeps your teeth looking their best, but it also assures good management of your dental health.

Contact us today to schedule an appointment to discuss your questions about dental hygiene. You can also learn more by reading the Dear Doctor magazine article “Dental Hygiene Visit.”

If you are the parent or caregiver of a special needs child or a child with a chronic disease, you face additional challenges when it comes to life's everyday routines. This includes establishing and maintaining good oral health so that your child is not at risk for other healthcare issues due to poor oral hygiene. For these reasons, our office has put together real-world advice that will make a difference in the life of your child.

The visit to our office that can make the biggest difference is your child's first one. However, be sure to contact us in advance of your child's appointment to let us know the details of your child's special needs or chronic disease state. This will give us the opportunity to contact your child's primary care physician or one of his/her specialists before starting treatment to obtain any medical information or special instructions. It will also enable us to be prepared so that we can pay special attention to these needs, as well as to make any necessary modifications to our office and/or equipment. Our primary focus is to work with you and your child's healthcare team towards the same goal. We all want your office visit to go smoothly and comfortably so that your child's first dental experience is a positive one.

Depending on the age of your child and his/her special needs, we most likely will start a gentle process of training and education. For example we will teach your child how to brush properly. It is important that you sit in and participate in this educational process so that you can reinforce this training at home. And little things count; before working with your child at home, you should set the stage so that it will be a comfortable setting with adequate light, fresh water for rinsing, and a mirror. You also need to have all of your supplies handy, such as a toothbrush, toothpaste, floss and rubber gloves (if needed).

To learn more tips, continue reading the Dear Doctor magazine article “How To Care for the Oral Health of Children with Disabilities and Special Needs.” Or, you can contact us today to schedule an appointment or to discuss your questions about your child's special oral healthcare needs.