A good smile becomes great

Just wanted to post a few photos of a smile change I completed last week. Even people with good smiles want their smiles improved. I think this made a huge difference.

Full Face Before

Smile Before

Full Face After

Smile After

Side by Side Comparison

Brandy wasn't happy with how her smile looked. She didn't like several of the restorations that she had done, wasn't happy with some of the spaces, and didn't think her smile was bright enough. Her smile was dramatically improved through porcelain crowns and veneers in less than three weeks. She says she has never been happier to smile!

Adult Orthodontics?

Interestingly enough, one of the fastest advancements in dentistry is in orthodontics. Yes, braces. And believe it or not, for adults! As we get older, teeth tend to drift causing crowding and spacing. Almost every adult over the age of 50 has crowding on their lower front teeth. Not only is this a cosmetic concern, but it also creates areas where food and plaque can accumulate, leading to an increase in cavities, periodontal disease, and even premature tooth loss. So, what are your options... and I know you don't want that "train track" "brace face" look. Keep in mind, these advancements were designed with adults in mind.

As with everything in dentistry, it depends on your current condition. Often times if a patient of mine has just a small amount of crowding or spacing, I do what's called Smart Moves. These are thin, clear trays, which are very similar to bleach guards, except they are very rigid. These trays are strong enough to move teeth gently into their proper position. Another plus is that these are fairly inexpensive, but again, they are just for extremely minor movement.

For patients with more advanced crowding or spacing, we have a couple options. Invisalign is a great way to straighten teeth. Like the Smart Moves, patients wear these clear trays throughout the day and night (except when eating, drinking, brushing, and flossing). These trays are replaced every two weeks with a new tray which progressively make your teeth straighter and straighter. Most cases can be treated in approximately 12-18 months. On the negative side, I find that patients get a little tired of dealing with trays once they hit the 12 month point and often times it takes extra time to fine tune the results. Also, these tend to be more expensive due to the high material cost and treatment time.

What I have become so excited about is something "new". I say "new" because it is a new technique using somewhat traditional materials. It is called Powerprox and not many people know about it yet, but they will. I can fix most smiles in SIX MONTHS!!! This is obviously a huge benefit. By starting today, I could have someone finished by Thanksgiving. By using clear brackets and clear wires and a newly developed technique, smiles are straightened quickly, comfortably, and in record time. Plus, in my opinion, you end up with a better result than with Invisalign because it is much easier to put the finishing touches on cases with Powerprox than with Invisalign. And, Powerprox is less expensive than Invisalign due to the shorter treatment time.

I offer complimentary consultaitons to anyone interested in possibly straightening their teeth. If you know of anyone who might be interested, pass my information along to them. You'd be surprised how many adults are getting the smiles they've always wanted!

Could this be.... cancer?

Most of the time, I love my job. I actually don't think of it as a job I like it that much. But, there are times when I wish I could just crawl in a hole and leave the dirty work to someone else. No time is that more true than when I find a suspecious lesion in someone's mouth that could be the dreaded C word.

See, my family has a long history with cancer. I lost my father to it at the young age of 48, as well as both of my grandfathers. I hate cancer... almost as much as telling someone they might have it.

With oral cancer, there are a couple of things that should be known, primarily what factors contribute to it, where is it generall found, and how is it detected. Oral cancer is especially deadly due to the fact that it is often found after it has metasticized to other organs, including the lungs, brain, and lymph nodes.

So, what causes it? I can't answer that for you, but there are several habits that increase your odds of getting it. First is tobacco use. Smoking cigarrettes and chewing tobacco are known to significantly increase your odds. The nicotine content and long contact time are a deadly combination. Quit smoking (or never start) and your odds of never getting it go way up. Also, alcohol abuse and HPV (yes, the STD) can cause oral cancer.

In terms of where it is found, the most common area is the side of the tongue towards the back. But, that is certainly not the only area. Other common places include the soft palate, insides of the cheeks and lips. These areas should always be checked by your dentist and general physician.

Several newer tests to find oral cancer are the Velscope and ViziLite, which use a special light to detect tissue changes. These tests certainly do have their place, but should not be the sole means of detecting oral cancer. I always perform and visual check first and then sometimes I will follow that with one of the two "light tests". These tests only show that something is different, but does not tell me if it is a bacterial lesion, fungal infection, traumatic lesion, or cancer. If I still see something that concerns me, I will send my patients to an oral surgeon for a biopsy. A biopsy is a small tissue sample which is then run under a microscope to view the cells. This is the only way to truly tell if there is cancer or not.

As I said, I really do love my job. But if I never saw another patient who I thought had oral cancer again I'd be pretty damn happy.

Unhappy with my smile

I was talking with a friend of mine the other day and somehow the topic of smiles came up. I came to the realization that EVERYONE wants to improve their smiles. Some want their teeth a little brighter, some want a complete overhaul. So, what's the best?

There is no simple answer to that question because it varies for different people. But, for someone that wants a drastically improved smile, porcelain veneers could be the answer. Porcelain veeners are ultra-thin pieces of porcelain that are adhered to the fronts of your teeth in order to dramatically change your smile. Depending on your situation, sometimes a small amount of your enamel needs to be removed prior (traditional veneers) or sometimes the porcelain veneers can be adhered directly on top of your natural teeth (Lumineers or prep-less veneers). These are fantastic ways to correct discolored, misshapen, chipped, or mal-aligned teeth in a very short period of time.

So, what's the down side to porcelain veneers? Well, as I mentioned before, for most people at least a small amount of your natural enamel must be removed in order to create a beautiful, natural looking smile. This means that it is something that must be maintained indefinitely. Also, the price of porcelain veneers can also cause someone to shy away from them. Porcelain veneers range from $1000-1500 per tooth. The difference in the cost from office to office has to do with the experience and training of the dentist and also the technician fabricating the veneer. I use a technician in California who I think does a phenomenal job making my patients look great! Take a look at one of my patient's smile transformations. She feels much younger and more self-confident with her new smile.

On a side note, my new office Kenwood Complete Dentistry is off to a great start. Our patients have been so happy with the comfort, convenience, and advanced technology. If you or your friends or family are looking for a new dentist, we are accepting new patients. 513.531.5050.

Back to dentistry... How bad are silver fillings?

I get asked this question all the time. Most people over the age of 30, if they have fillings, have silver (amalgam) fillings. Every day at my office I examine patients with these old fillings and have to make a decision. Either I tell the patient to leave them alone or tell them they need to be replaced. So, here is what is going through your dentist's head (well, at least if you are my patient).

Silver fillings in my opinion are not in of itself bad. For years and years, they were the material of choice. But, they do have some negatives. First and most obvious, are the cosmetics. There is nothing natural about a smile full of silver fillings. They make your teeth look darker and your smile not as clean as it could be. If my patients want these fillings replaced for this reason, I have no problems doing so.

Secondly, they cause teeth to crack. Virtually every day at my office, someone calls up and says they lost one of their old fillings. When they come in, their filling is right where it was for the past 20 years, but the enamel holding that filling in place has been broken off. The reason for this is that metal fillings expand and contract with temperature change and enamel does not. Once the enamel is cracked, all it takes is biting down on something the wrong way, and you have a broken tooth. Sometimes the fix is easy, but sometimes the tooth can break so badly that the tooth needs to be removed (see my previous post on dental implants).

The third, and most controversial, factor is mercury. This is a hot topic and one that people feel very passionate about on both sides. Some people believe that the mercury in these silver fillings cause all types of neurological conditions like Alzheimers, chronic fatigue syndrome, dimentia, etc. I personally don't know if this is true or not, so I don't recommend my patients have their silver fillings removed strictly because of the mercury. But, if a patient of mine feels strongly about it, I will do as they wish.

So, when someone comes in to my office and I see these silver fillings I ask if they bother them cosmetically and I check for any visual signs of cracks. If both of these check out, in my opinion there is no reason to replace them. But, if one or both of these is an issue, we will talk about replacement with either a tooth colored filling (called composite fillings), porcelain onlays, or porcelain crowns. Which one we choose depends upon the size of the filling, any decay present, or cracks in the enamel.

I hope this helps answer a few questions.

Kenwood Complete Dentistry is Open!

After many months of planning, Dr. Sherman and I are proud to announce that our office, Kenwood Complete Dentistry, is officially open. Monday, November 9 was our first day of seeing patients in our brand new facility. I am completely thrilled with how our office turned out, and I am so proud to show off a sneak peek.

A view of the exterior. We're located at the corner of Kenwood and E. Galbraith Roads

Our sign in the lobby

One view of the reception room. You can see our logo

wall, which is one of my favorite parts of the office.

Another view of the reception room

A view down the main hallway

The patient restroom

A glimpse inside one of the treatment rooms

The sterilization center

It's even better in person—very warm and welcoming and the perfect place for our patients and our staff to call home. A special thanks to virtually everyone we know for helping to create the dental office of our dreams and for continuing to spread the word. A very special thanks to our patients (new and existing), our staff, and our friends and family for your continued loyalty and support. We're so very excited to share this new beginning with you.

Kenwood Complete Dentistry

5050 East Galbraith Road, Suite C

Cincinnati, OH 45236

513.531.5050

KenwoodCompleteDentistry.com

Update

We are now less than one month away from the grand opening of Kenwood Complete Dentistry. Walls are now up, painting has begun, and in the next two weeks, construction will be wrapping up. I thought I'd show a few more pictures.

Lobby

Our front door

Front Desk

Main Hallway

One of the treatment rooms

We can't wait to start seeing patients on November 2nd!

A quickie

Things are moving fast on the construction front, but I wanted to show off the creative side of the office. My talented wife has created our branding. Take a peek.

Apparently drywall goes up next week. I told the guys that since I'm unemployed until they finish, I'd help them hang the drywall. They said no thanks. I don't blame them.

Dr. P

More photos

Photos from yesterday. The walls are now up (sort of)...

Thankfully, they don't need my help.

A look down the main hallway.

From the front door.

One of the treatment rooms.

Another treatment room.

So, things are progressing quickly. I'll keep everyone updated as things move along.

This is why I haven't blogged in awhile...

After months and months of hard work, I am thrilled to announce the opening of my new office! What can I say about the new office? Brand new equipment, fantastic location (for those of you in Cincinnati, it is located at the corner of Kenwood and Galbraith, across from Kenwood Towne Center), extremely comfortable environment, and the best that dentistry has to offer. Just as before, we will offer general, cosmetic, and implant dentistry, which is why Dr. Greg Sherman and I decided to name the office Kenwood Complete Dentistry. You will be able to check out our new website KenwoodCompleteDentistry.com shortly and see why we are so excited. You can check in on the progress here. I'll post pictures as things develop!

Kenwood Complete Dentistry

5050 E. Galbraith Road, Suite C

Cincinnati, OH 45236

513.531.5050

kenwoodcompletedentistry.com

When would I need a dental implant?

First, let me explain what an implant is. Basically, it is a replacement root. When there is extensive damage to a tooth, whether it be from decay, gum disease, or trauma, sometimes you are better off removing the root of the tooth and getting a new one. These implants are made from titanium and are incredibly strong and versatile.

Let's take the two most common occurrences for needing an implant and talk about your options. Let's say you have a single tooth that needs to be removed. Your options for replacing it are either a bridge or an implant. With a bridge, your dentist needs to grind on the tooth in front of the space and also on the tooth behind the space. So, basically because there is one bad tooth, you now have to damage two potentially healthy teeth. Not great. With an implant, you never have to touch the teeth on either side of the space.

At least currently, most dental implants are not covered by insurance. But, think about this for a second. The average bridge lasts 7-10 years and costs around $3000. If you have good insurance they will cover half of that, leaving your cost to be $1500. If you have to replace the bridge in 10 years, you are now talking about $3000, which is about the cost of a dental implant. And with the life expectancy of an implant to be around 25-30 years, it more than makes up for it in cost, let alone not having to damage the teeth on both sides.

The other most common use for dental implants is to hold dentures in place. You would be shocked how many people have dentures, and if you were able to get an honest answer from these people, they'd tell you that their teeth slip and slide and those adhesives are nothing but a mess. Especially with lower dentures. If someone has to wear a lower denture, they are a dental cripple instantly. But, if you can anchor the denture to dental implants, they become extremely stable. People say adding these implants instantly transforms their lives, allowing them to eat the foods they want and have the confidence that their teeth aren't going anywhere when they talk or laugh.

So, implants are here to stay. And that is a very, very good thing.

If you think you have a problem with bad breath, you probably do.

A relative of mine (to be kept nameless) asked me how to fix bad breath. Interestingly enough, when I am at work and a patient asks me to close the door to give them some privacy to ask a "personal" question, 9 times out of 10 it is about bad breath. It is such an embarrassing problem, but there are some steps you can take to fix it.

Bad breath is caused by odor-producing bacteria that grow in the mouth. When you don't brush and floss regularly, bacteria accumulate on the bits of food left in your mouth and between your teeth. The sulfur compounds released by these bacteria make your breath smell. Certain foods, especially ones like garlic and onions that contain pungent oils, can contribute to bad breath because the oils are carried to your lungs and out through your mouth. Smoking is also a major cause of bad breath.

There are lots of myths about taking care of bad breath. Here are three things you may have heard about bad breath that are not true:

Myth #1: Mouthwash will make bad breath go away.

Mouthwash only gets rid of bad breath temporarily. If you do use mouthwash, look for an antiseptic (kills the germs that cause bad breath) rinse, such as Listerine. I also really like Crest Pro Health mouthrinse because it doesn't contain alcohol, which dries your mouth out and can lead to a better environment for those bad-breath-causing bacteria. Try the Nighttime version of the Crest Pro Health because the Daytime version seemed to cause (temporary) staining of teeth in about 1% of people that used it.

Myth #2: As long as you brush your teeth, you shouldn't have bad breath.

The truth is that most people only brush their teeth for 30 to 45 seconds, which just doesn't cut it. To sufficiently clean all the surfaces of your teeth, you should brush for at least 2 minutes at least twice a day. Remember to brush your tongue, too — bacteria love to hang out there. It's equally important to floss because brushing alone won't remove harmful plaque and food particles that become stuck between your teeth and gums.

Myth #3: If you breathe into your hand, you'll know when you have bad breath.

Wrong! When you breathe, you don't use your throat the same way you do when you talk. When you talk, you tend to bring out the odors from the back of your mouth (where bad breath originates), which simply breathing doesn't do. Also, because we tend to get used to our own smells, it's hard for a person to tell if he or she has bad breath. If you're concerned about bad breath, make sure you're taking care of your teeth and mouth properly. Some sugar-free gums and mints can temporarily mask odors, too.

If you brush and floss properly and visit your dentist for regular cleanings, but your bad breath persists, you may have a medical problem like sinusitis or gum disease. Bottom line is that bad breath can be prevented and fixed.  Do these things and you won't have to worry about getting close to your special someone and whispering them sweet nothings... 

Can Diet Coke cause cavities?

A friend of mine who lives out of town contacted me over Facebook with a good question. She never had cavities growing up and now that she is in her 20's, she is getting a few. When she goes to the dentist, he makes her feel like she "just ate a candy store." But, this girl takes good care of herself and doesn't really eat sweets. She wondered if the 2-3 Diet Cokes she drinks during the day can cause cavities. So, can something without sugar cause cavities?

Yes, Diet Coke can cause cavities. Basically, you need four things to get cavities: bacteria (everyone has it), sugar, acid, and time. While Diet Coke doesn't have the sugar, it is really high in acid. So, let's say you have a sandwich for lunch (there is sugar in bread) and you have a Diet Coke (acid) and then you sip on your Diet Coke for an hour or two, you then have everything you need to get cavities. So, here is my advice. Have sugar, have acids, whatever, but drink water afterwards. This will rinse the acids and sugars off of your teeth. Another good trick is to chew sugar-free gum, which will do the same thing as water. Don't sip on a can of Diet Coke for a long period of time. Drink it over a shorter period of time and then have water. If you do that, use an electric brush, and floss once a day (I know it's a pain), you'll be home free.

Kiosk Teeth Whitening... yeah right.

So, after a couple margaritas a friend pulled me aside and said that she had been "swindled by those bastards at the mall" saying that they could bleach her teeth for $99. Just as everyone wants their teeth lighter, everyone who hears this kiosk sales pitch first is pessimistic. And they should be...

Ok, so here is how the kiosk bleaching works. They give you a mouthguard (one size fits all sort of thing) with some bleaching gel in it and have you put it in your own mouth. The reason they have you do it is because they are not dentists and by law cannot do it themselves. So, the gel runs all over your mouth, gets on your gums, and down your throat. Think about it, if the gel is safe enough for it to get on your gums and even swallow it, how is it going to be strong enough to bleach your teeth? Oh, and that light they use basically does one thing. It heats up your teeth, which dries them out, which makes your teeth lighter. Lighter until your teeth re-hydrate, which takes a couple of days, then the "bleaching" fades. No good.

So what are your other options. I tell my patients they have three options:

1) Over-the-counter whiteners like Crest WhiteStrips. These are ok, but they are also one size fits all, so the same gel that bleaches your teeth also bleaches your gums, which leads to increased sensitivity. Plus, the strips generally are only long enough to bleach your front six teeth, and most people smile bigger that that. BTW- do not waste your money on whitening gums, toothpastes, and mouthwashes. Basically, these are crap.

2) In-office Bleaching (Zoom or Britesmile). This is actually similar to the kiosk, but it is used with gels that only dentist can purchase and apply. Also, there is no mouthguard so it is more comfortable. There is a lot of debate whether the light used with it actually does anything, but we use it anyway. I like this much better than #1, because it does work, but there are a couple negatives to this as well. It is the most expensive (in our office it is $450), there are dietary and other restrictions for the first 24-48 hours (no lipstick), and you still use custom trays to get the best results possible. To me, this is best for people too busy to use custom trays or for those with something big coming up quickly, like a wedding or anywhere pictures will be taken.

3) Custom Trays used at home. To me, this is the best. Your dentist makes you thin, custom trays that hold the gel against your teeth either for an hour or overnight. You do this for a week or two and your teeth get lighter. It's comfortable, effective, and costs less than the Zoom (in our office it is $250). So, save yourself $200 and do it the way I have bleached my teeth and most everyone in my family's.

One caveat... bleaching does not work on tetracycline-stained teeth (a grey and yellow banding on teeth caused by antibiotics taken as a baby) or on existing dental work. It won't make it worse, but don't expect these teeth or areas of teeth to get any lighter.

So, I hope this info helps. Feel free to post other questions or contact me directly.

Dr. P

Why do I do what I do?

Growing up, I never wanted to be a dentist.  In fact, I hated going to the dentist.  I used to squirm, whine, and even bite fingers.  I'm not proud of that, but it's the truth.  So how does "that kid" grow up to be a dentist?  The best answer is that I'm not sure, but I'm sure glad I did.  

I feel like I have the best job in the world.  Every day I get to talk to people, hear their stories, and joke around with them.  Most of my patients were like me- they hated going to the dentist.  They tell me their horrific stories of past experiences in "the chair" and I quickly see why dentistry gets a bad rap.  The good news is that I think I can change people's views of the dentist.  

I don't have any tricks up my sleeve.  I just listen.  That's what people want.  They want to tell me why they haven't been to the dentist in a while.  In other words, don't do what made me stay away.  Done.  They want to tell me what they want their smile to look like.  Fantastic, now we have a vision.  They want to tell me their restrictions to treatment (time, money, anxiety).  Perfect, now we know what we have to overcome.

Now comes the fun part.  Often times people come in because they don't smile in pictures, they laugh with their hands covering their mouths, or men will even have grown mustaches to cover their embarrassment.  Just think about how this makes people feel.  One of the biggest signs of self-confidence is smiling.  This lack of self-confidence makes people feel that they can't succeed in their careers or even have close personal relationships.  I get to help people transition from a smile they are embarrassed of to one that they can't stop showing off! 

I truly love what I do.  In fact, I'm obsessed with it.  

This is the last bit about me for awhile (unless for some strange reason people actually want to hear more).  On to answering my random social questions...

Dr. P

Why have a dentistry blog anyway?

So, It's Saturday night.  My wife Lauren (the uber talented graphic designer from Giddy Ink) and I have a friend's 40th birthday party to go to at Nada in downtown Cincinnati.  We're having a good time and catching up with people we don't get to see very often.  A friend we haven't seen in a couple of years pulls me over with a very serious look on her face and says the words I hear so often, "I know you don't want to talk about teeth outside of work, but..." 

The odd thing is that for some reason I DO want to talk about teeth.  I love what I do.  I read every journal that comes across my desk cover to cover, I attend continuing education courses all over the country, and I am constantly on the internet researching the latest and greatest advancements in dentistry.  Basically, I am obsessed with what I do and if someone wants advice or just has a question, I am more than happy to help. 

So, in the future this blog will contain (hopefully) helpful pieces of advice from questions people have asked me in social settings.  I know that if one person has the question there must be a hundred people that want to know my answer.  Plus, if people want to ask me a question on here, I'll do my best to answer.

Jordan Pelchovitz (Dr. P)