Pros/Cons of Whitening

[BassDominator]

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I've never had very white teeth despite brushing and flossing religiously. Bad genes I think.... because it's the same story with my folks. I see these flyers in the dentist's office for veneers and bleeching. I've been meaning to ask the dentist about the subject, but I thought you guys might be able to give me an unbiased opinion.

Veneers sound a little scary to me. I'm curious about them... but I think bleeching may be a better idea for me. Is there any way to predict how much bleeching will help? Will it make my teeth sensitive? Will they be more prone to decay? Any good studies I can read?

I know I should really be asking my dentist these questions.... I'm just afraid he'll try to sell me something that I don't really need or might have consequences in the long run. Thanks in advance.

 

[DcS]

Okay, here's my humble opinion.

Unless you are unsatisfied with the appearance of your teeth (minus the color), veneers are not necessary. They remove virgin healthy tooth, and although it isn't much, you should never take away healthy structure unless you absolutely need to. In addition, veneers are very expensive and are something that will need maintenance the rest of your life.

As far as bleaching goes, whether or not it will work depends on a lot of things. If your stains are extrinsic, ie from coffee, food etc that was obtained over time, then bleaching will indeed work well. If you have intrinsic stains from tooth development, medications, etc, then the bleaching will not work. If you have any type of crown or filling, those also will not change color with the bleaching. Now, as far as what type of of bleaching method to choose. The quickest and most effective way is to have bleaching trays made by your dentist and to purchase a bleaching kit from him. This has a few benefits...it works much faster than over the counter products, and the custum trays cut down on gum irritation. Also, your dentist can assess what type of staining you have and how effective bleaching will be. The downside can be the cost, it can range anywhere from 300 to 500 bucks or so. On the other hand, you can use Crest Whitestrips. I was taught at UNC Dental School (where I am a 2nd year student presently), that currect research actually shows that whitestrips work as well as a bleaching kit from the dentist. The catch...it takes a lot longer, and the strips only work for your anterior (front) teeth because that is all that they cover.

Side effects: Mainly there are 2 side effects. The first is increased tooth sensitivity. It's not a problem for most patients, but if it is a problem your dentist will simply advise you to space out your bleachings more and it should help. If you discontinue the treatment, the sensitivity should resolve. The 2nd most common side effect is gum sensitivity, but if you get trays made by a professional the gels should stay off your gums, and if they seep a little when you seat the tray simply wipe it off. All current research has show bleaching to be one hundred percent safe. It does not weaken your tooth structure whatsoever, nor will your teeth be more likely to decay.

I think I covered all that you asked, I hope this helps.

 

[BassDominator]

Many thanks, DcS. That's just the info I needed before bringing up the topic with my dentist.

Another question: I'm told my most posterior lower molars on both sides are in bad shape.... and they won't tolerate a root canal and crown. My dentist recommends having the teeth extracted and implants placed. I'm curious how much these implants will cost and how long the will last? I forgot to ask the last time I was in the chair. Anything else I should be worried about down the road?

 

[DcS]

That's funny, I just posted a thread about my implant course, I'm just being lectured on it but I will tell you what I think. Im sure Tom or Dr. Jeff or Rob can come in and correct me if I'm wrong. I think when it's all said and done a single implant can cost in the range of 2-3 grand. If you are in NC, you can get it done for 1100 bucks at the dental school in the undergrad clinic 😱 Check your local school, I know NYU does a lot of implants as well. I think implants will last as long as you take care of your oral health. The nice thing about implants versus crowns is that a patient always has to take care of crowns, and even if they do the tooth can decay and impair the integrity of the crown. An implant is synthetic, no decay is really possible and the titanium should last a lifetime. You DO have to maintain good oral care to take care of your gingiva and maintain good periosteal health. With good health an implant should last a lifetime I believe. Of course, the crown of the implant can always fracture, it's possible, and you would have to pay for that repair unless it was very soon after placement. In addition, a downside is the surgery that you would have to go through. If crowns aren't an option, implants are a great alternative IMO.

 

[BassDominator]

Ouch! And I'm guessing my dental insurance will not cover that? By the way, what does taking care of a crown entail?

My situation is actually kind of interesting. I had all my wisdom teeth out during middle school. For some reason, my lower wisdom teeth were reimplanted in a molar position. Unfortunately, the teeth were at a funny angle... creating a pocket where decay ocurred and undermined the teeth.

 

[UBTom]

Yep, Dcs is right on the money.

to BassDominator: You need to get an evaluation from a periodontist, oral surgeon or general dentist who does implants to see 1) if you are a good candidate for implant surgery and 2) what needs to be done.

Osseo-integrated implants are indeed a good option for replacing hopelessly broken-down teeth, but sometimes may require additional procedures like bone grafts/recontouring, uprighting of a tilted adjacent tooth, etc. If an implant is done right and is maintained properly (assiduous home care-- Brushing and flossing correctly at the appropriate times) like Dcs said, it can last you darn near forever.

Unfortunately, implants are rarely covered by insurance. BUT:

Since you are from the Bronx, you should check out NYU Dental School's OMFS department. I heard that they can do implants for real cheap down there... Some ridiculously low fee like $800 per implant surgery because they have an exclusive contract with a particular manufacturer. (Not sure if this is still current though).

Also, isn't Long Island Jewish affiliated with Albert Einstein? LIJ's OMFS program does implants too-- Maybe you can get a discount since you are affiliated with Albert Einstein.

Albert Einstein... Cool. My brother-in-law is an anesthesiologist on the faculty at Winthrop and he is an Albert Einstein grad. 🙂

HTH!

 

[BassDominator]

Thanks, UBTom. My dentist says I'm a good candidate for implants. I think I'll check out NYU.... they probably have a really long waiting list, I imagine.

 

[DcS]

Thanks, UBTom. My dentist says I'm a good candidate for implants. I think I'll check out NYU.... they probably have a really long waiting list, I imagine.

Our professor just referenced how NYU likes to pump out implants, so you might be in luck.

 

[DcS]

Just an FYI on implants and survival rates for those who like to see some data/numbers.

Implant survival analysis has show success rates to vary between 82-99%, location in oral cavity showing best:worst survival: mand ant>max ant>mand post>max post>grafted areas.

A meta-analsis of 19 separate trials included 570 single crowns and 2116 implants supporting FPDs: cumulative success rates for implants replacing single teeth were 97% and FPDs was 94% ranging 1-8 years.

Have a fixed pros final monday, which is where I picked these numbers up from...arrghgh.

 

[DDS2BE]

There is this guy selling custom whitening trays on ebay. Basically he sends you the imprint kit, then you send it back and then he sends you back the molds made for your teeth. You can also get that kit with different whitening agents.

I am thinking about getting one of those kits, since the price is very reasonable.

What do you guys think of it? Should I do it? Don't get me wrong, I am not advertising anything 🙂 , just want a professional opinion.


Here is the link to check it out: http://stores.ebay.com/Z-Whitening-Store_W0QQsspagenameZl2QQtZkm