Before Teeth Whitening

We do a lot of cosmetic consultations in our office and during those appointments, we go to great lengths to make sure that we understand exactly what the patient is looking for.  I like to tell my patients that they are the “pilot” (telling us where they want to go) and we are the “navigator” (telling the patient how we can get there).  Cosmetic dentistry is definitely not one size fits all. 

We look at the tooth position, shape and color of the teeth.  We also look at the gum position as often irregularities in gum position can itself affect the appearance of the overall smile.  And we especially take a close look at the bite as many times it is the bite that is the underlying cause of the esthetic problems.

For the patient who is happy with everything but the color of their teeth, teeth whitening is typically the answer and I have never found a process that has been as effective as KöR Deep Bleaching™.  Believe me when I say that I’ve tried a bunch of systems and products over the past twenty plus years.  This teeth whitening system was developed by a friend and colleague of mine in California and it has certainly taken off.  KöR Deep Bleaching™ was recently ranked highest as the most effective, reliable way to whiten teeth by a respected dental products journal.  I’ve even seen this process work on tetracycline stained teeth. 

After Teeth Whitening

As you can see with this patient, the results are pretty dramatic.  In the “after” photo, I used the shade tab that shows how dark the teeth were prior to the KöR Deep Bleaching™ just to emphasize how effective this teeth whitening process is.  By the way, for this patient, the teeth whitening process required only two weeks time.

If you’re too embarrassed to smile, have dark-stained teeth, or just simply want a whiter smile, the superiority of KöR Whitening is just what you need.

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Undersized lateral incisor tooth

Matching a single veneer or crown on a front tooth to the adjacent natural teeth is one of the most difficult procedures to do in dentistry.  This patient had recently finished wearing braces for a few years but found himself dissatisfied because of an undersized lateral incisor tooth.  He wanted the gap filled but wanted the treatment to be long lasting.  Together we decided that a porcelain veneer would fit the bill.

Whenever we do a case like this, we carefully evaluate the adjacent teeth first.  We don’t just look at the color or shade, but also the size and shape and even little nuances such as the white splotching on the teeth so that the veneer seems to disappear when it is placed.

Porcelain Veneer to fill the gap

Using our CAD/CAM technology, we made the actual porcelain veneer in our office and then color-matched the veneer to the patient’s natural teeth.  We have the technology that allows us to do that as well.

The result was awesome, the patient was happy and it was all done in one appointment.  I love it when a plan comes together!

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I got a call last night from a new patient in a panic. She was just playing with her dog and it jumped up on her – the dog’s head hitting her front teeth. Low and behold one of her porcelain veneers chipped. To make matters worse, she was heading out of town this week on an important business trip.

 With her regular dentist being out of town, she turned to me for help. Fortunately, we begin seeing patients at 7 a.m. on Tuesdays, so I scheduled her for an early appointment this morning, allowing us to immediately assess the damage.

The bad news was that the veneer had to be replaced. The damage was beyond the point where we could just smooth it out. The good news was that with the technology we possess, we were able to create the new veneer for her in 90 minutes. By balancing artistry with technology, the new veneer is a beautiful color match to her existing veneers. 

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Let’s see if you remember some of your high school chemistry.  pH is the measure of acidity or basicity of a solution.  Pure water is neutral and has a pH of 7.0.  Solutions with a pH less than 7.0 are considered acidic.  Solutions with a pH higher than 7.0 are considered basic or alkaline. 

The lower the number the more acidic a solution is.  The important thing to understand here is that when the pH of a solution on a tooth surface is less than 5.5, tooth surface damage occurs. 

Gatorade, for example, has a pH of 3.3.  In fact, research by a British dentist, Dr. Milosevic, found the pH levels of sports drinks ranged from approximately 4.5 to 2.4. 

Why do sports drinks have such a high acid content to begin with?  My understanding is that the acidity improves the taste and increases the shelf life of the products. 

But the acid components are just one part of the equation.  Sports drinks can also have a rather high amount of refined sugar.  Any beverage that has high acid content can weaken the enamel.  Sugar can worsen the situation by encouraging bacterial growth.  So acid is bad, sugar is bad and many of these sports drinks have both.  Together, they cause tooth decay. 

Realize that there are a lot of liquids that we consume that contain acid – sodas, sports drinks, wine.  So why aren’t everyone’s teeth just rotting away?  Your saliva contains minerals that naturally re-mineralize or re-harden teeth after they have been exposed to acid solutions.  But in the presence of a significant exposure to acid, there is only so much repair that saliva can do. 

Fortunately, there are sports drinks out there that don’t have so much sugar and aren’t so acidic.  One that I have personally used is HEED made by Hammer Nutrition.  This company has been around since 1987, developing a wide range of nutrition products for the endurance athlete. 

For sweeteners, HEED contains Xylitol and Stevia, which are both healthier alternatives to the refined sugars and/or artificial sweeteners found in most sports drinks.  In addition, HEED doesn’t contain the high amounts of citric acid found in most sports drinks.  The result of these modifications, according to Steve Born at Hammer Nutrition, is that the pH of HEED is 7.04 – almost neutral.   Pretty impressive. 

So what exactly is Xylitol and Stevia?  Xylitol and Stevia are both natural sweeteners.  Xylitol can be found in a variety of fibrous fruits and vegetables.  The human body even naturally produces some Xylitol via normal metabolic processes.  Stevia comes from a plant found in subtropical and tropical Central and South America.

From a dental standpoint, Xylitol and Stevia are very “tooth-friendly”.  Remember, bacteria in the mouth love refined sugars.  They metabolize it to create acids that cause cavities.  On the other hand, oral bacteria are unable to ferment Xylitol and Stevia. 

The result is that the number of cavity-causing bacteria is remarkably reduced, no acid is created, and thus no cavities are formed. 

“Tooth-friendly” sports drinks can be found in almost any triathlon, running and cycling store. But for those people who continue to drink sports drinks that are high in refined sugar and acid components, There are things you can do to at least reduce their risk of damaging your teeth. 

First, use the sports drink for its intended purpose during and after extended exercise, training or competition, and not as an everyday beverage. Second, one of the most important factors is how long one holds the liquid in their mouth.  The longer the drink sits in the mouth, the more damage it will cause. Third, there are some toothpastes on the market that are designed to re-mineralize teeth that have been exposed to liquids that contain acid such as wine, soda and sports drinks.Lastly, research suggests that brushing your teeth immediately after consuming a sports beverage can actually make tooth erosion matters worse. 

 Better to rinse with water to dilute the acid and then wait 30 minutes before brushing your teeth to allow softened enamel to naturally re-harden via the minerals in saliva.

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Interview from Charlotte Weekly, 7/17/09

Q: Dr. Van Gurp, I understand that today’s focus is on hormones and women’s oral health.

Dr. Van Gurp: Women have an increased propensity for oral health problems because of the hormonal changes that take place throughout their lives.

In general, these hormonal changes affect both the blood supply to the gum tissue and the body’s response to the toxins (poisons) that result from plaque build up.  As a consequence of these changes, women are more susceptible to the development of periodontal disease at certain stages of their lives, as well as to other oral health problems. (more…)

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This interview with Dr. Richard Van Gurp first appeared in The Charlotte Weekly – 4/25/2008

Q: I think that most parents recognize that fluoride is a proven means to protect the dental health of children primarily by making teeth more resistant to cavities. But today, you wanted to talk about how fluoride can benefit adults as well.

Dr. Van Gurp: That’s right. Research now indicates that everyone – children and adults – can benefit from fluoride. (more…)

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