This week we have had exciting and dramatic results for patients using their oral sleep appliance for sleep apnea and snoring. It is such a good feeling to know we have helped them get better sleep and be on the road to recovery. In most cases we have reduced apneic episodes by 50%, and some even more!

To have a patient call and be so excited about feeling great in the morning free from headaches and afternoon sleepiness!  There is hope beyond CPAP!

THIS JUST IN…..

Refer a friend, family member or colleague and receive a gift from Donaldson & Guenther.  We are always accepting new patients and look forward to meeting new people.

We are excited about the new staff members in our office. Heike and Amanda are new to our office but not new to dentistry. They bring to our office their dental expertise, and a warm, caring approach to patient care.  We are certain you will continue to enjoy the personalized care you have  grown to appreciate with us, through Heike and Amanda.   I

We are pleased to announce that we now offer online appointment reminders via email or texting.  This new service will allow patients to contact our office and request appointments, reducing  the “phone tag” game.  We are really excited about this, so be sure that we have your email address so you can start receiving your email confirmations! You will easily be able to give us the necessary feedback about your visits through this service too!  Your comments allow us to make changes that make us a better team and better able to serve all our patients, along with assisting new patients seeking information about specific procedures as well as our team.  You can still rate us on Google and Yahoo!

Our office will be closed Thursday October 14 in the afternoon and all day Friday October 15 as our entire staff will be involved in a continuing education project.

Enjoy the rest of your summer and good luck to all the students returning to school!

I was a patient the other day, after chipping off a piece of my tooth  (which felt like the Grand Canyon). I was once again reminded of the excellent care we give our patients by being a patient that morning.

I was worried about it being sensitive and I did not really want to have a shot…. We are all human, like that.

Dr. Donaldson carefully did a couple of  gentle checks on the tooth’s sensitivity before beginning and assured me that if that did not bother my tooth, what he was doing would not either. He and Irene worked methodically and restored my tooth to its natural beauty, and investigated further to see if another tooth was the culprit in causing the chip. Dr. Donaldson did some minor shaping and polishing and I was back to work, looking and feeling so much better. My response, once again, was ”Wow.” This is what our patients experience and how lucky we all are to have Donaldson and Guenther.

-Annie

I had a patient yesterday who was really nervous about her appointment. I offered her a headset, blanket, and pillow to get her comfy. She had stated that she did not want to know anything about what we were doing, as she had been given a full explanation at her consult and she could do without the “gory” details! ☺

As her appointment progressed and she saw that Dr. Donaldson and I were having fun, joking about how the materials should come in fun colors instead of “serious white,” she started to relax and by the end of her appointment was also having fun. We explained the procedure and what to expect in the days following her appointment. She was so pleased and must have thanked me at least 10 times for taking such good care of her before leaving.

I explained that is how we do things here; we work hard at keeping our patients comfortable during everything we do.
She enjoyed her appointment and was appreciative of the information and follow up after the fairly complex procedures.

-Irene

Just the other day I had a wonderful compliment!!! As I was working with Dr. Donaldson on a patient that we have seen for some time now he look at me as asked “How long have you been doing this?” At first, I thought that because of the many questions that I asked Dr. Donaldson regarding how we were going to treat this patient’s specific situation, I seemed inexperienced. However, it was the complete opposite. He said “No, it really seems like you know what you are doing!” This made my day!! I work very hard at helping our doctors make each treatment specific to the patient and his or her situation.

- Kara

Happy Holidays!

No More Fear…
We are pleased to be able to offer sedation to our patients apprehensive about dental treatment. We already have several success stories from patients who had previously postponed treatment due to anxiety and have successfully completed their treatment with the use of sedation.

Snore no more! Dr. Guenther has extensive training and experience in the treatment of sleep apnea. Our office has the technology to provide a sleep study in the privacy of your own home. So if someone you love is complaining of you snoring, Dr. Guenther may be able to help you with the fitting of a custom made oral sleep device and work in partnership with your MD for complete comprehensive care. Give us a call for a consultation today!

Thank you to all who have referred others to our office, we are very grateful for your confidence in us. We are always accepting new patients, and we love meeting your friends and family.

Your feedback is essential to our practice, so we have made it easier for you to leave your own testimonials. Your comments allow us to make changes that make us a better team and better able to serve our patients, and assist new patients seeking information about specific procedures as well as our team. You can also rate us on Google and Yahoo!

Words cannot begin to express my deepest gratitude to Dr. Donaldson and his staff for taking such wonderful care of me.  To say that I’m deathly afraid of dentists is a complete understatement.

Having just moved to Ann Arbor from NYC, I was in search of a dental practice for my family.  I stumbled across Donaldson & Guenther as I happened to be in the building for another appointment.    I was immediately struck by Ann’s professionalism and kindess, not to mention the calmness of the office.  I scheduled a cleaning for my husband and reluctantly, one for myself only after being assured by my husband that he didn’t feel a thing.

Surprisingly, I made it through the cleaning and was warmly greeted by Dr. Donaldson who went over what seemed an endless list of dental problems. I listened politely (terrified, honestly), all the while thinking there’s no way I’m ever stepping foot in this office again. I was sure that I could come up with some reason to avoid coming back.

Three months later, much to my dismay, a piece of my tooth chipped off and I thought, oh boy, this is it, my teeth are all about to fall out because I didn’t go back. I went back to see Dr. Donaldson who, again, very professionally explained the work that needed to be done and without judgement, listened to my fears. Dr. Donaldson and his staff showed such a true concern for my health and fears – I trusted them.

The morning of my appointment, I walked in and was greeted by warm smiles and was literally hand held through the entire sedation process.  The assistants went over the process with me step by step. Dr. Donaldson went over the dental work with me and explained what and how I would feel. Despite being treated with incredible patience and compassion, I was still extremely anxious. I was given some sedation meds which I was sure wasn’t going to work since I felt fine, not a bit sleepy, wide awake and very aware about everything going around me. The assistants came in and tried to relax me, but my heartrate was sky high, my knees were shaking, and you couldn’t pry my hands apart if you tried! The last thing I remember is hearing one of the assistants telling me everything was going to be all right.

I was told I left the office around noon but I can’t really remember a thing. When I woke up later that evening, my husband told me Dr. Donaldson had called to check on me and offered some tips in the event that I had any discomfort, which I never did.

I have now undergone two dental appointments under sedation and this last appointment, without. Thank you, Dr. Donaldson, and your entire staff for your support and for giving me the confidence to have dental work done without the use of sedation.

-Janice

A previous patient had a dental emergency that her “new” practice could not see her for. She had a temporary crown that had come out of place. The dental practice that had done the preparation for the crown was not available to see her for a few days and the tooth was beginning to hurt. Her concern grew, so she called our office, where she had been a regular patient, years prior. Ann got her in right away.

When I looked at the existing temporary, I was immediately concerned, because the shape and edges of it had caused her gums to become very inflamed, which made the whole area painful. I showed Dr. Donaldson, and asked if I could remake it so that the tissue around it could heal better and reduce the discomfort. He agreed that a new temporary was just the right thing to do. After the new temporary was placed, the patient had an immediate and positive response: no more pain! It was far better now than at any time since it had been worked on. She appreciated the time we took to care for her and felt that she would prefer that we make her permanent crown. She returned to our practice and has become a regular patient once again!

We have seen stories like this from time to time over the years. Patients sometimes go to other practices in town to save $40 or $100 dollars. Most of those patients actually return a year or two later with a comment along the lines of, “Now I get it!” At Donaldson & Guenther, we are guilty of trying. We try to get it very right the first time. That means appointment times that are long enough to do it right, great temporaries and restorations for happy gums and teeth, and using superior materials and technicians.  We do not see allergic reactions that come from cheap materials (like crowns from China) because we don’t do stuff like that. In fact, we pay double to triple for our lab work than the average. Why? We use only world class technicians and the finest materials, so our work fits well, is biocompatible, and is beautiful.

Discount dentists simply cannot afford to consistently do it like that. That is why many of our patients that move out of state continue to see us. Sometimes, they just send a note of appreciation after their new dentist comments about the high quality of their previous dental work. Some dentists even take the time to send us a note. It makes us feel great about how we care for people. So when people return, we have an open door with no strings (or guilty feelings) attached.

-Kara

I recently saw a new patient who was petrified to be in the dental chair.  I calmly spoke to him, letting him know he was in control and I would stop any time he became uncomfortable. He listened to his iPod while I cleaned his teeth. Although that’s routine here at Donaldson and Guenther, it was new for him and helped him relax a bit.  When I was all done he couldn’t believe the difference in how clean his teeth felt and how comfortable he had been. He was very appreciative of my work and caring approach. He said, “My teeth have never felt this great before! Thank you so much.” That just made my day, and this is why I love what I do everyday!

-Kelly

Although I was aware that I was snoring at night, as I was reminded by my wife in the mornings, I was not aware of the “less than restful” sleep I was getting at night until I started using my mouth appliance from Donaldson and Guenther.  I am now getting a more restful sleep at night and wake fully ready for a full and challenging day.  The added benefit is that I am no longer snoring and being an irritant to my wife.  Dr. Kristen Guenther did an excellent job in fitting me for my “sleeping appliance,” which took only 3 visits.  The device fits naturally in my mouth at night and does not cause me any difficulties in falling or staying asleep at night.  I found the people at Donaldson and Guenther extremely helpful when I had questions or if I needed the device “tweaked” after or short time of initial use.  I would highly recommend Donaldson and Guenther to anyone who is seeking help with a snoring condition or who has even a mild case of sleep apnea.

-David R Sarns

When our doctors are out of the office and one of our patients has an emergency, we have them stop by to see if there is something we can do. Otherwise, we refer them to the doctor we have asked to cover for us while they are out.

In this case, one of our patients had an emergency and I was able to help her.  One of her front teeth had become so loose that it fell out completely.  She wasn’t in any pain (the tooth had a root canal and post) but was mortified because she had this gaping hole when she smiled!

As an assistant, I am limited as to what I can do to help.  So after thinking about it, I was able to affix the tooth back into place long enough to take an impression.  By doing this, it allowed me to make her a clear retainer which would hold her tooth in place until Dr. Donaldson could restore it more permanently.  The patient was so happy that I was able to help her!  She still remembers how “Irene made me a retainer and saved my smile.”

-Irene

I just had the pleasure of visiting with one of your patients who recently moved to our area. I discussed with her the wonderful dentistry that I saw in her mouth – particularly the veneers. Nice job! kudos to the dentist and lab. This is the type of work that I strive to emulate, with varying degrees of success.

regards
Barry Kliger

I had a powerful experience with a new patient this week. This man had avoided the dentist for ten years and was scared to death to return. He was afraid and ashamed that his mouth might be falling apart. He had had very bad experiences years ago that left him feeling awful about himself and resentful toward dentists. As my new patient consultation appointment proceeded, this man would stop, shake his head, bring his hands to his face holding back inner emotions and say “wow.” He was overwhelmed by genuine, non-blameful caring.

He hung out with my office manager afterward and went on and on about how relieved, hopeful, and genuinely excited he was. He knew he could have good dental health and how we were going to help him with sedation dentistry to get a few things back under control. He could have confidence in himself again and the dentist wasn’t going to be the enemy any more. As a dentist, this is what it is all about for me: helping people get to a better place in their lives.

It is almost a daily goal and practice for me to help people get past their fears, resentments, and shame related to their dental health. When I meet new people, I try to find out what they want for themselves and what obstacles they need to overcome, like fear, trust, and shame. I see people start to relax as they realize I want to know what is on their mind. They slowly drop their walls as they realize that I’m not going to tell them how bad they are.

Instead, I help them see what the status of their health is and explain what they can do for themselves. We talk about what is important to them and a reasonable phased approach of how to get there. The confidence and trust build over time. I have seen so many guarded personalities become warm wonderful professional friends over the years. I know that is why our out-of-state population continues to grow. It just comes from walking the talk. And we are guilty of trying.

At Donaldson and Guenther, we do our work when it is right for you, our patients. In these hard times, there are many people we are just keeping stabilized until they can do more definitive work later. We do world class dentistry at realistic fees… Work that rarely needs to be re-done. Comprehensive Care in a supportive environment: implants, sleep apnea and snoring devices, root canals, cosmetic and restorative dentistry, and general care. More and more patients are making use of sedation dentistry with excellent results and little memory of the process.

It is for good reason that people like the man I saw this week sometimes try to hold back tears. In this world is seems unfortunately hard to find old-fashioned caring blended with state of the art quality. We do it every day at Donaldson and Guenther. Real people, real caring, real talent. Yep…. For real.

Dr. Guenther replaced  a crown for me recently.  She helped me feel comfortable throughout the two sessions and did such excellent work. My tooth feels great! Thank you so much, Dr. Guenther. I never thought I would feel comfortable at the dentist office, but I do with you! Ann Arbor is so fortunate to have such expert dentists in a perfectly innovative and most modern office. You also have a warm, professional staff – Mary (technician) is the best! and Ann (front office). Thank you all!

S. Thatcher

Thank you so much for seeing my son at a moment’s notice while he was visiting. That was “awesomely wonderful!” I am so appreciative of your professionalism, technical skills and overall knowledge. It means so much to have people like you in our life. We all thank you for being there.
C. Gilman

It is a pleasure to come to your office and enjoy the lovely environment created by you and your staff. I truly appreciate the artistry and professionalism, your attention to detail both during and after my appointment, it is wonderful. I do appreciate you and your staff.

What is service? People use many “buzz” words to give the impression that they are service oriented, but what does it really mean?

At Donaldson & Guenther, it is making the ordinary extraordinary. The only buzz word here is service.

When your insurance denies your claim, we continue to fight for coverage when others may say, “sorry, that is between you and your insurance carrier.”

When your health savings or pre tax account administrator needs documentation to validate a charge, we go to work and provide exactly what you need to remove the hassle, when others may say, “sorry, it is important to save your receipts.”

When you have no idea what or how a health savings account works, we can provide information to “fill in the gaps.” We help lessen the confusion and pave the way to utilizing a great benefit, when others may say, “sorry, it is in your plan booklet.”

We are excited every day to have the opportunity to provide the highest level of service to each patient. It is a pleasure to know that by doing a little something extra on our part makes a big difference to someone else.

Donaldson & Guenther is now on Youtube! You can watch our video to catch a glimpse of what our office in Ann Arbor, MI looks like and meet the people that you will interact with.

Dr. Guenther and I (Dr. Donaldson) are attending our annual Academy of Fixed Prosthodontics meeting in Chicago this weekend. It is the meeting I most respect in dentistry – the finest dentists in the world attend and present lectures.

Most of the major new clinical directions I have taken have come from this organization. This year, the subject is on failures in dentistry. As Kristin and I listened to today’s speakers, we had a tremendous sense of commitment to how we do dentistry. We know we are committed to “doing it right.” We always have been. But today, listening and seeing the problems that develop from lack of attention, not listening to patients, poor choice of materials, not taking the extra time to shape teeth correctly etc., we were more convinced than ever that quality is the best value.

Other approaches cost patients and dentists far too much because work needs to be redone prematurely. In this time of economic stress, I know there are pressures to go cheap – both for patients and dentists. The public is bombarded with cheaper, easier answers like Lumineers and instant or overdone dental implants. What a tragic mistake that becomes in often too short a time.

How I practice is not just a personal choice. It is also about integrity, ethics, caring, and commitment. I see the bulk of practices competing on price. At Donaldson & Guenther, we will remain committed to dentistry that enhances people’s lives. It will be quality and patient satisfaction that lasts long after treatment is completed or a fee paid. It is best to do it right the first time. We may not be perfect, but we are guilty of trying. I like trying. It makes my patients happy and I sleep well. Today’s dentistry can do amazing things. It is great to be a part of it.

Today I completed the 3rd and final phase of my crowns. I took a look at my before picture on this website and am amazed at the transformation. Thank you Dr Donaldson, my smile it a masterful piece of art. If I didn’t tell everyone how fantastic you and your staff are, they would never know my smile is not natural.

- Linda Barry

The professionalism and caring environment was evident from my first telephone call when I spoke with Ann.

Doctor Guenther was great, very thorough in her examination to determine the exact cause of my pain. During the root canal, Dr. Guenther was concerned whether I was experiencing any pain and took the necessary steps to minimize and alleviate the pain.

The next day I received a telephone call to see how I was doing – that has never happened with any of the dentists I have seen.

I highly recommend Dr. Guenther to anyone seeking a caring and professional dentist.

Kerry Wendt

The Problem: The patient had overlapped, angled teeth that were unattractive. The patient did wish to straighten them with braces. Instead, the patient chose to come to Donaldson & Guenther for cosmetic dentistry.

After porcelain crowns:
The Solution: Crowded teeth can often be made straight and beautiful with the help of creative reshaping and cosmetic porcelain veneers. In this case we made things straighter, a little brighter, improved the proportions, and even improved how the gums look around the teeth. That is dentistry as a fine art: a daily event at Donaldson & Guenther.

Before porcelain crowns:

I have been going to Dr. Donaldson and Guenther for over 12 years and the longer I stay, the more difficult it is to envision seeing another dentist! I even convinced my husband to start going to the practice in 2002 and he is just as happy with the professionalism, family atmosphere, and caring staff as I am! We still do all of our dental care with D&G after moving to Florida, then again to Pennsylvania. We have tried other practices and I can honestly say none measure up to the overall quality we receive with this wonderful practice! Thanks so much!
Kristine and Edward
Chester Springs, PA

About 50% of adults snore. Half of these people have a sleep disorder called sleep apnea which can have very serious health consequences if left untreated. Most recommended treatments involve a mask that fits over the nose and mouth called a CPAP breathing device. Surgery in the back of the throat has also been a treatment for those severe cases of sleep apnea or those not wanting to use a CPAP. Where surgery or CPAP is not an option for the individual, an oral sleep device (OSD), or oral appliance, has been shown to be effective for mild to moderate apnea. Your physician is the best health care provider who can advise you in this decision.

An OSD is a dental device, which is precisely fitted to your mouth by an experienced dentist. The OSD holds your lower jaw down and forward, thus keeping the tongue from falling back into the throat and blocking your airway. It is like the position used in cardiac pulmonary resuscitation (CPR).

Dr. Guenther has been successfully fitting these oral sleep devices (OSD) for several years. Our office gets referrals from your pulmonary physicians and ENT physicians after a sleep study has been done and your doctor has determined if an oral sleep device is a viable option. Dr. Guenther then examines your teeth and oral structures to determine if you are a good candidate for the oral device.  Impressions of your teeth are taken and a recording of the most ideal jaw position is registered. This information is then sent to the dental laboratory where the custom device is fabricated. At your second appointment, the OSD is fitted and adjusted in your mouth to be comfortable and in the most ideal position for effective opening of your airway.

The two oral devices used in our practice are the TAP 3 thermal acrylic and the Sonomed Mas. Both of these devices are made of high quality materials and can be easily adjusted to bring the lower jaw position further forward or back depending on joint comfort or lack of effectiveness. A yearly follow up appointment is highly recommended to ensure that your device is working properly.

Since a dentist is providing treatment for a medical condition, we encourage patients to explore coverages with their own insurance, due to the fact that each insurance carrier views this method of treatment differently.  We supply our patients with supporting documentation to assist in the reimbursement of this device.

“Wow. You are one extraordinary team, and have built a singularly remarkable dental practice.  The way you enjoy your relationships with one another, speak positively about your work and your co-professionals, care enthusiastically for your patients, and do what each of you do with such excellence and attention to detail – it’s no less than an inspiration.

“Kirk, I’m blown away by the thoroughness of your exam, and the transparency of your conversation with your team. I felt a full partner in what was happening, and never felt unsettled in the least (you know, that feeling that comes when you’re not sure what’s going on or why, like you’re caught in some sort of current that you’re discouraged from resisting).  And the way you praise your staff, and elevate them at every turn made me think, “Dang, this is the kind of place I’d like to work!”

“Not to mention the sense of incarnated love in the physical space: stunning photography and interesting abstract, sculptural artwork, comfortable seating, intelligent magazines, flat panel displays arranged at patient height and in full view, a flow chart on the paperwork…  Seriously, I could go on.

“Anyway, all that to say thanks.  I get the sense none of what I’ve written will be news to any of you, but good things happening in the world should never lack from encouragement.  And there is no doubt that what’s happening among and through all of you falls in the good thing category.

“Have a great week.  Looking forward to coming back next week.”

-Jesse

Ninety million people in the US don’t see a dentist because of fear. One million people have conquered that same fear with safe, effective oral sedation dentistry. It’s not just a trend. It’s a new level of dental care.

Oral sedation dentistry has been featured in The Wall Street Journal, The New York Times, and Good Morning America. For Donaldson & Guenther, it is another part of practicing dentistry as a fine art. And our patients really appreciate it. Some fly in from out of state to see us.

Ann Arbor is one of the areas where sedation dentistry is becoming more available without the need of referral to a hospital or specialty setting. Drs. Donaldson and Guenther have both completed comprehensive and rigorous training in oral sedation through the Dental Organization for Conscious Sedation (DOCS). DOCS has trained over 10,000 dental professionals in North America and has developed the sedation protocols that are becoming the broadly accepted guidelines in dentistry.

The process for patients is simple. We listen to your concerns, do a medical and medication evaluation, and choose sedation levels to meet your needs. Patients generally take something to help them get a good night’s sleep before their appointment date. They don’t eat the morning of the appointment to help with absorption of the medication. They need a driver to and from their appointment. The sedation medication is allowed to dissolve under the tongue. Patients are very relaxed before any procedures start. The patient’s companion drives them home and stays with them while recovering (4-10 hr). Most patients have little sense of time during the appointment and experience little to no memory of their time in the dental chair.

Sedation dentistry not only creates a relaxing and anxiety-free experience for you, it also allows us to accomplish more dentistry in a single visit, meaning fewer appointments to complete care.

I have heard many sedation patients say after receiving extensive dentistry, ”Wow! That was the fastest and easiest appointment I have ever had!” They are thrilled. Sedation dentistry makes fine dentistry possible for them.

To find out more, give Donaldson & Guenther a call at 734-971-3450. Ann or Kara will be happy to discuss your fears and dreams and questions. You will enjoy talking to them. You can also go to the consumer website SedationCare.com to learn more.

Cosmetic dentistry covers a broad range of services that restore or enhance the appearance of teeth, a smile, and even general facial aesthetics. Cosmetic improvement can result from simple lightening of natural teeth, to creating a pleasant natural look, to a dramatically light, bright, and bold look. Often, cosmetic improvement is the natural result of doing “normal and necessary“ dentistry, such as when old, poor looking restorations are replaced with something that looks beautifully real. Let’s review what some of the more common treatments are, some cautions, and how to find a great cosmetic dentist.

Cosmetic Services

Bleaching or tooth lightening:

Lightening natural teeth is done with the help of peroxide based materials, from tooth pastes, over the counter applications, thin custom fitting clear trays that hold the lightening gel on the teeth, and in office accelerated treatment. Toothpastes are the most mild and basically help maintain existing color. Over the counter products show mixed results from terrific to disappointing. They work best for mild to moderate enhancement of front teeth. The gel-in-custom tray system is the most widely used and accepted. A patient wears the tray on their teeth for a period of hours each day. Lightening occurs and slows down over a period of weeks. Improvements are more predictable on teeth that are “yellow/orange” in tone and more difficult on teeth that are “blue/gray” in tone. In-office procedures (like Zoom) basically give the equivalent of a two week “jump start” to lightening. It is best to continue with the tray technique to reach optimum desired results.

Bonding:

The word “bonding” has multiple meanings. It can refer to applying tooth colored composite material to teeth as a filling to change tooth shape, or even as a one step add-on method of cosmetic veneers. Bonding is also the way dental restorative materials like composite and porcelain/ceramic is fused to teeth. The bond is achieved by first mildly etching the surface of a tooth to create a micro-rough surface. Fluid polymer materials are then painted on the etched surface and interlock the micro-roughness when set. The new polymer surface can actively link up to the filling materials like composite or porcelains that also have activated surfaces. The methods and materials of bonding have dramatically improved over the last 25 years. Today, bonding methods leave teeth strong, healthy, and beautiful.

Inlays and Onlays:

Inlays are bonded inside the tooth similar to a filling. Onlays also replace part or all of the biting surface. They are made outside the mouth and bonded in place similar to a cap or crown. Onlays help hold a tooth together more than an inlay. Porcelain inlays and onlays are state of the art precision restorations that can be the best of all worlds. They leave much more natural tooth structure so they are much less invasive than what might otherwise be a crown or cap. They have no metal, so light transmits naturally through the tooth, making them often nearly undetectable (even on an X-ray). Their rigidity and the fact that they are bonded to the tooth means that the tooth is re-strengthened by a well designed restoration. More real tooth, natural beauty, improved strength: win, win, win. They are more costly than a regular filling, but are also a more definitive, long term approach.

Veneers:

Porcelain veneers replace the outer face surface of teeth seen when you smile. They are a thin porcelain shell that gets fused to the underlying tooth to create the desired smile design. They are art. Subtle things make big differences. They take many forms and styles. They can create a beautiful smile from teeth that have unsightly surface coloring, spotting, spacing, poor shape, and poor positions. A patient’s preferences and priorities should dictate the final look; from very “natural” to very white, bright, straight and full – or anywhere in between.

A word of warning: Like acrylic nails, quality varies widely. Simple cheaper add-on style veneers can leave a person with thick edges that are hurtful to gum health and leave compromised speech patterns. A brand like Lumineers advertises widely about needing no tooth reduction. That sounds nice, but their small print lets you know tooth shaping may well be necessary. Their message is “easy, fast, cheap.” Food for thought.

Caps or Crowns:

Caps or crowns are the traditional way to rebuild a whole tooth. They are like an entire new outer shell of the tooth. They can be pure porcelain, porcelain with hidden metal underneath to increase strength, or gold for ultimate strength. Gold is still commonly used on teeth hidden in back that come under high pressures from clenching. Patient preferences again dictate the treatment of choice.

Improving the Gumline:

Lovely teeth alone do not make a beautiful smile. The gums around the teeth are the frame on the picture. If too much gumline shows, or the form is unbalanced, the appearance can be distracting. Finer dentists look at the gum architecture and may recommend getting the health and forms of gumlines good as part of cosmetic treatment.

Implants:

Implants have revolutionized dentistry as much or more than bonding techniques. In short; it is possible to re-create very natural looking and feeling teeth with implants. This is true for single, multiple, and even full arch restoration. Having the proper bone and surrounding gums is critical. It is very important to have your treatment coordinated if multiple providers are involved. Don’t just go and have an implant and expect the follow up dentist to get a perfect result. There is a growing number of highly trained and talented dentists that are able to do bone or gum grafting, implants, and the final restoration. Many cosmetic cases involve an implant in the mix.

Comfort:

Most people have some fear of dentistry. Some have a lot. Today, more dentists are using conscious sedation to help patients safely relax and have very positive experiences while receiving dental treatment. Most patients are happy with traditional local anesthesia, but the use of safe oral sedation protocols is becoming common. Patients are overwhelmingly pleased.

How do you find a great cosmetic dentist? I address that in another blog post

Kirk Donaldson practices cosmetic, restorative, and implant dentistry in Ann Arbor, Michigan as a partner of Donaldson & Guenther: Dentistry as a Fine Art (www.DGDent.com). He got his degrees from the University of Michigan.His  Masters is in Fixed Prosthodontics (Crown & Bridge Restorative). He taught in the graduate prosthodontics program before entering full time private practice.

Kirk belongs to recognized national/international organizations including: The American Academy of Fixed Prosthodontics, American Academy of Implant Dentistry, and the Dental Organization for Conscious Sedation

Kirk is also a serious photographer (KirkDonaldsonPhotography.com).

Examples of case studies can be viewed on the blog and transformations pages of DGDent.com.

Cosmetic services are highly personal. Cosmetic dentistry can not only improve smiles, but also improve personal confidence and even careers. It can make a smile beautiful, healthy, and strong. It can also be a disaster. Bonding and cosmetic techniques are very creative and technically demanding. Done well, they are fabulous. Poor technique and quality can lead to premature failure of the restoration and disease to the surrounding supportive gums and bone. There is an old saying. You can usually get cheap, fast or good; but one at a time. Fast and cheap often have briefly hidden long term costs.

How Do I Find a Great or Excellent Cosmetic Dentist?

Check out websites. Look for dentists that show their own work and not just stock photos from some marketing group. Look also for customized sites that have some measure of artistry that appeal to you. The website’s aesthetic is an indication of the dentists artistic sense. Is it a custom look or just “off the shelf?” That may tell you about how the dentist picks a lab to make your teeth.

Excellence in technical laboratory work is paramount to excellent cosmetic dentistry. Ask about the dentist’s lab support. Is it a big commercial lab or small and custom or in office? Ask to see examples of cases. Does the style and look match what you want? There may even be a link on their website.

Look for patient testimonials on the dentist’s site. We all love to read those. Get testimonials or talk to patients. Fine dentists have extremely pleased patients that would be glad to talk to you. Call the office you are interested in and ask.

Try calling your local gum specialists and ask them. Gum specialists (periodontists) like excellent dentistry because it makes for healthy gums. They hate bad dentistry. Things like “Lumineers” make a lot of us just cringe.

When you meet the dentist, is he/she interested in helping you get what YOU want or just selling you a bunch of dentistry? Fine dentists try to give patients enough clear information so the patient is empowered to make their own best choice. Well informed patients are also usually the happiest.

Credentials and organizations are helpful but not a guarantee of excellence. Advanced degrees and continuing education speak of training background and commitment. Belonging to organizations is important for a dentist engaged in his/her profession. Unfortunately, some organizations can be more about marketing than real quality care. I recommend that you look for good qualifications without having them thrown in your face as the means to impress you.

Use your own common sense and gut feeling. Treatment should fit your desires and into your lifestyle. You should be very comfortable with the dentist caring for you. A little homework will help you get what you have been hoping for. There are few things more beautiful than a light fresh healthy and happy smile.

The Problem: The patient wanted straighter teeth that looked very natural and matched the color of her other teeth.

The Solution: We put porcelain crowns on her front four teeth which permitted a nicer alignment. We made them just a touch lighter so they would look nice and still blend in with her natural teeth.

Before porcelain crowns:

After porcelain crowns:

Recently in the office, a young college student told her mother “I didn’t know dental work wasn’t painful. I had no pain today!”  Her mother replied, “Wow, I am glad she is with your team!”
-Haley Decker and Shelley MacMillan

Your entire team is so professional and yet friendly and human. Dr. Donaldson put on his photography for me. He didn’t have to do that, and yet he was thoughtful enough to do so. Going back as far as a I do with Dr. Guenther, there is something to be said for longevity and continuity. I do appreciate the follow-up.

Jim Horton

The Problem: The patient had short, worn teeth and too much gumline showing in the smile.

Before cosmetic gum surgery:

The Solution: AT Donaldson & Guenther, we raised the patient’s gumline with cosmetic surgery and gave back beautiful, youthful proportions with porcelain crowns.

After cosmetic gum surgery:

The Problem: Old fillings can lead to a number of problems. They can make your teeth dark. Your teeth often develop fractures and become weak. However, simply replacing old fillings with new ones does little to strengthen a tooth weakened by stress fractures. I have seen too many of those teeth end up with large areas breaking away, in need of root canal treatment, or even split and be lost because the stress crack kept growing. Like a cracked windshield, the big fracture often occurs unexpectedly, suddenly, and at an inconvenient time. Those tragedies can almost always be avoided with appropriate and timely intervention.

After porcelain onlays:

The Solution: Porcelain onlays have become a premier choice for restoring back teeth. They are the best in many situations for several reasons. They look amazingly real. More than 95% of our patients look in the mirror and say “WOW! That looks so real!” And they do. Porcelain onlays make the tooth stronger again and we leave a lot of the natural tooth. They offer beauty, strength, and preservation at the same time. Like most of today’s dentistry, onlays can be fantastic if your dentist pays attention to the details and has some artistic finesse. At Donaldson & Guenther we are guilty of trying. We work hard to exceed your expectations and consistently provide world class dentistry.

Before porcelain onlays:

The Problem: The patient no longer liked the old bonding on her front teeth. It was yellowed and worn. Her center teeth were too short and the sizes were out of proportion. This made her smile look worn and slightly up-side-down.

The Solution: Donaldson & Guenther created a more youthful and healthier smile with porcelain cosmetic veneers. The patient’s center teeth are now larger and longer. Her side teeth are prettier by being a little smaller and delicate in shape. The patient is thrilled with the results.

Before porcelain veneers:

After porcelain veneers:

The Problem: This wonderful young lady and her family wanted a fuller, more beautiful smile. As a graduation present, her grandmother paid for her to come to Donaldson & Guenther to get it. When she came to us, she had spaces between her teeth; also, the center left tooth had been fractured and bonded previously.

The Solution: It is very important to develop good proportions when closing spaces and not just fill the gaps. The two front teeth should be prominent and the side teeth smaller with a slight angle. Most “cosmetic” dentistry I (Dr. D) see looks too plump and without natural inclinations. The porcelain veneers we did here compliment the patient’s fresh youthful beauty. Click on the photo of her face to see her smile more closely.

Before porcelain veneers:

After porcelain veneers:

There are many things that please me deeply as a dentist. One of those is watching patients warm up, relax, grow in trust and simply have more fun as they get to know us. Most people have a bad dental experience in their past that has left them afraid, nervous and even suspicious of dentists. My whole career, I have tried to help people get past “dental guilt and fear” imposed by someone in their past and to help them enjoy good health and a beautiful smile; all as they experience comfort throughout their care.

Both Dr. Guenther and Donaldson (and our hygienists) get very positive feedback about how we make people comfortable and reduce pain with good gentle anesthesia technique as well as many other factors. To make dentistry even more anxiety free, more comfortable, less stressful, safer and even possible for more people, Dr. Donaldson & Guenther are advancing their training in oral sedation techniques from DOCS (the Dental Organization for Conscious Sedation).

The medical word is “anxiolysis” which means “anxiety free.” With the help of light oral sedation (as directed in Michigan, where we are located) many many people can overcome their fear, gagging problems, problems with not getting numb enough and post treatment discomfort. If you are one of those people, you should contact us to find out more. You may well be able to have the smile and dental health you only dreamed of until now.

The Problem:This patient was no longer happy with her old bonding. She wanted a bold bright look.

The Solution:Eight porcelain veneers on top and eight below rendered a beautiful result. Sorry, we can’t show you more, like her full smile. People just think her teeth are bleached. Only her husband and best friend know. Her teeth are truly bright and beautiful.. and very natural looking when you see her smile.

The Problem:This young man had a number of congenitally missing teeth and many poorly formed teeth. He and his parents wanted a great smile and better chewing with the back teeth. They also preferred implants to replace missing teeth instead of bridges.

The Solution: We fulfilled the patient’s hopes by grafting in bone to permit several implants in the back areas and developed a beautiful smile and functional bite with comprehensive porcelain crowns and veneers. What a great gift before heading off to college!

Before restoration:

After restoration:

The Problem: This patient had heavily worn out teeth as well as many broken teeth and fillings. Gum disease was starting to undermine the stability of his teeth. Unfortunately. one of his front teeth was hopeless.

The Solution: At Donaldson and Guenther, we increased the patient’s tooth size and length by opening the bite dimension. He had gum treatment while in beautiful temporary restorations. Finally, we added full mouth crowns with a bridge replacing the top left front tooth. John and his wife are both thrilled with the results. John’s testimonial appears in our blog. The result is a wonderful and healthy smile!

Before Restoration:

After Restoration:

When patients come in to see us, they are not very excited. They have had only “ho hum” experiences with other dentists, always being told what they need with no options, like they were only a mouth not a whole person.

“Wow” is what I hear after their appointment with us. I am always honored and amazed at how moved they are by their experience. It is what sets us apart! We provide excellent information to assist our patients in making good personal decisions. We do this by providing a long and short term plan, with a focus on current, emerging, and completely optional treatment. We help fit treatment into their life.

This is why I love what I do and why I look forward to coming to work after 15 years! Wow!

As experienced dentists, we know what can happen as stress fractures develop in teeth. Today, more people have teeth with small to medium sized fillings than in decades past. That is good. However, if those teeth start to show stress cracks, the part of the tooth that eventually splits away is large because there is more tooth. This is particularly true when the crack runs vertically up and down the tooth.

Unfortunately, a simple filling does nothing to help strengthen the tooth or stop you from getting a broken tooth. A filling sits within the fracture (almost like a wedge in a log). It is only a matter of time for the crack to grow.

The ideal strategy for keeping your own tooth is to use restorations that reinforce the tooth, holding it together and making it strong. You thereby dramatically improve the chances of avoiding more extensive treatment. The longer we wait, the greater the chance that pain and loss can occur.

Insurance companies bet it all happens on someone else’s plan. Unfortunately, as a patient you are confronted with a choice. Do you invest in your own preservation or bet that when the tooth finally splits, it will be minor and the insurance company will then help out?

From almost 25 years of experience here is a close estimate of the risks:

• Teeth with angular cracks at the corners of a filling usually break off a corner or a half of the tooth to the gumline. These teeth are successfully treated with a build up and a type of crown. We see this almost every week.
• Teeth with a vertical crack eventually become occasionally tender to biting. If restored early enough, we avoid the additional need for a root canal about 80% of the time. We see this many times a month.
• If a cracked tooth always hurts upon biting, it probably needs a root canal, build-up and crown to save it. We see this a couple or few times a month. If the fracture runs deep there remains a small chance of fracture progression.
• If a large part of the tooth breaks away under the gumline, it becomes increasingly difficult and risky to treat and save the tooth. We see this a few times a year.
• If the tooth splits in half or far under the gumline, it needs to be extracted. Replacement, usually means a three tooth bridge or an implant. We see this several times a year.
• Every day we see prominent stress cracks growing under fillings we are removing. Crown type restorations save these teeth.

With each of the above situations, the increased treatment of a root canal and tooth build-up doubles the cost. If a tooth is lost and you have a bridge or implant, the cost is 3-4 times a single overlay or crown.

At Donaldson and Guenther, your personal best interest is our foremost concern. We repeatedly see patients and their teeth stay happier when appropriate treatment is done “in time” before something breaks or becomes painful. We understand dentistry is expensive. That is why we try to do the right thing – the first time. Nothing is more expensive and frustrating than needing more extensive treatment later because an insurance company encouraged people to gamble against themselves.

When our car windshield gets a crack, does our car insurance policy say, “No coverage until it breaks in half or until it shatters?” Does your medical coverage say, “No coverage on a fractured bone until it breaks all the way through?”

Of course not. We all understand that the situation can become much worse if we let fractures expand. However, many dental insurance companies eliminate coverage for restorations that are designed to make a broken tooth strong again. Why? And why is it an important issue to you?

Why do insurance companies have an elimination clause on fractures and wear?

• Many broken teeth have relatively small fillings or none at all. So, from looking only at an x-ray that doesn’t show the crack, it can look like over-treatment. (That is why we also send photos, but even that does not usually help)
• There may not be pressing painful symptoms at the time.
• Broken teeth may take several years to split or need a root canal treatment.

Also, insurance companies “bet” that you will be gone before the problem becomes a crisis. They know the average subscriber will be on a different plan in two years, which means another company will have to pay. Insurance companies eliminate benefits on fracturing and heavily worn teeth as a short term strategy to get cash flow savings.

We wish we could predict exactly when teeth will fracture away, need a root canal treatment, or be lost due to splitting in half. We do know that timely, adequate treatment most often prevents bigger problems later. The next post will describe the risks of not investing in early preservation of your teeth.

I had a car accident 15 years ago and injured my front teeth. One tooth, in particular, was going to be lost. I had a root canal and two dental surgeries to buy some time but, eventually, loss was going to happen.

Well, this year it happened. I lost the tooth. I was terrified of losing my front tooth and the aesthetics of the replacement. I was excited and relieved to be working at Donaldson & Guenther because I knew they were the ones to do the best work.

Dr. Donaldson removed the tooth, did an implant and made me a beautiful temporary. I had little to no pain. My family and close friends have noticed my “happier smile” but don’t know about the procedures. My natural smile has been enhanced. I had worried about this for years. I couldn’t be happier!

Lori

In the early years of my practice, i worked for an older dentist that people loved. Patients loved him even though their dental work needed to be replaced often. I realized there were serious quality issues and decided my future practice would be different. In 1990, I moved into a new office and developed a dream practice that is committed to excellence.

For the last 17 years we have provided dentistry that rarely needs replacement, is beautiful and done in a comfortable caring way. I am constantly overwhelmed by how much patients appreciate how they are cared for. I am reminded of the saying, “Excellence is a habit, not a single occurrence.”

Kristin Guenther

I recently cleaned the teeth of a patient I have known for years.

As he stood up he asked me, “How long have we been together?” I laughed, as this patient has been with me since I started practicing, 19 years ago.

“Quite a while.” I answered.

Through the years I have been privileged to know many patients far beyond their dental health. We have shared life happenings, fun stories and have developed a deep sense of trust. It is that trust that allows me to help my patients choose the dental work they feel is best for them.

That is why I have been with this practice for 13 years- it has allowed me to develop and maintain lasting relationships.

Looking back at my patient, “Quite a while…” I answered- …”longer than either of our marriages!” We both laughed.

Mary

Many patients come to our office requiring dental gum treatment. To ensure patient comfort and allow me to be thorough, I commonly numb up the area I am working on. Many patients have a fear of the shot because of their previous experiences. They describe a horrible past experience that was very uncomfortable.

When I hear patients express their anxiety about “the Shot,” I am reminded of a patient, Carol, who was very nervous. I explained to Carol that our practice is well trained and committed to our patients’ comfort and quality of experience with our practice. I was able to relax her with explaining my technique and helped her through the numbing part. She couldn’t believe afterwards that she didn’t feel a thing. She has had several visits since and now tells me she enjoys coming to see us and is no longer afraid.

I really enjoy being able to provide this service for our patients and help them overcome their fear of a shot. If you or anyone you know is afraid of having dental treatment done because of the shot you should come and see us.

Kelly

Dr. Donaldson follow-up comment:
The State of Michigan certifies dental hygienists for administration of dental anesthetic. In the several years since my hygienists have been providing anesthesia, I have only heard very positive feedback from patients. Dr. Guenther and I work with our hygienists to ensure they use the same subtle techniques we use to make “the shot” very comfortable. It is a satisfying part of helping people overcome their past experiences and fear and build trust.

I feel fortunate working at Donaldson & Guenther. From the time I interviewed I knew things were different. The staff interviewed me, which I thought was pretty cool. “This doctor actually cares about the team’s opinions!” It makes sense if they’re the ones who have to work with me.

As a result, we work well together. As I started with the practice, I realized it was the organized protocol that allows me to focus on providing excellence. I thought the doctor I worked for previously did good work until I saw the quality of work at Donaldson & Guenther.

My reward is when patients look in the mirror at the end of their appointment and all they can say is “Wow”. This is what puts us above the rest and I am honored to be a part of making that happen!

Irene

Normally, when I take a phone call from a patient who has a toothache I get as much information as possible. Just recently I took a brief phone call from a patient who was confident that she only needed the doctor’s advice about her situation and declined an emergency appointment. As for most patients who have a toothache, we would have tried to see her that day.

That evening I happened to see her at Meijer. We talked about her toothache and concluded that the Orajel she was about to purchase was not going to help her situation, but an anti-inflammatory she already had at home may be better to help her short term. She was thrilled and excited that I took the time to stop her and get more information. Sure enough, Aleve took care of her situation, temporarily. After the weekend she came to see us promptly as planned. She was happy that she was able to go to Mackinaw for the weekend and enjoy a five course dinner at the Grand Hotel, and still very happy that we going to help her fix her toothache, just in time.

Kara

“Pre-tax” savings accounts have become a powerful employee benefit. However, it is amazing how many people are unaware of this benefit or hesitate because of the paperwork. We have assisted many of our patients wit setting up and utilizing their “Pre-Tax” spending accounts by sharing our knowledge about their employers plan and by helping with the paperwork necessary for reimbursement. Many patients have thanked me and said,” No one ever told me about this!” (Including major executives and Deans). It is worth checking into.

Over the past 15 years, I have watched dental insurance companies pay less and less of the true cost of dental care. Patients are having to assume greater financial responsibility for their care and are planning their treatment more strategically. At D & G, our patients learn about their current, emerging, and optional dental issues. By prioritizing and dividing treatment into phases, I help patients plan their care for the next year so it optimizes their combined insurance and pre-tax plan benefits. This strategic approach to dental care often allows our patients to elect treatment options that are longer lasting and/or more beautiful than the typically lower levels of care encouraged by the insurance companies.

Dr. Donaldson
Thanks for taking the time to get my crowns all squared away today. I know how easy it would have been to do an “ok” job. It is reassuring to me that when I come in to see you or any of your staff, I leave with the best possible job done! I wish I didn’t need any work done but since I do, I’m happy you’re all there! Bless you all!

H. King

Dear Drs. Donaldson and Guenther and Staff,
Thank you so much for your patience, kindness and expertise. The confidence and professionalism of your group is eclipsed only by your warm and friendly personalities. Thank you for the gift of my nice smile!

Best Regards, J. Coughlin

You can read the case study on this patient!

Thanks for taking the time to get my crowns all squared away today (10/25/07) I know how easy it would have been to do an “ok” job. It is reasurring to me that when I come in to see you or your staff, I leave with the best job done. I wish I didn’t need any work done but since I do I’m happy you’re all there! Bless you all! Hilary King

Mary Weiss writes in a comment:

Dr. Kris; I just wanted you to know that when I moved to Sedona and went to a new dentist, he cataloged all the crowns in my mouth. When I saw the list, I had to add one they had not detected — my front incisor, that fractured and you crowned so many years ago! They thought it was real!!! Having read your notes on porcelain, I can’t help but wonder if you were using some of the newer techniques on me. I am certain, however, that my crown is an almost perfect copy of my original tooth. Thank you, and I miss you!

How do we put an implant in? (by Kirk Donaldson, DDS)

There are several approaches. My most common way is to have my patient lightly sedated, so they are relaxed. After thorough numbing, I open the gumline so I can see the bone clearly. This helps me choose the precise orientation and height of my implant. A pilot hole is gently drilled in the bone, double checked and enlarged. The implant is then carefully rotated into place. In complex cases, I will use a CT scan and a digitally designed guide system to aid in precise implant placement.

I have seen too many poor results because implants were not carefully planned and placed. I generally prefer to close the gums completely while the patient’s bone fuses (integrates) to the implant over a period of 2 to 6 months. In the mean time, patients have a temporary tooth or teeth so they always have teeth in aesthetic areas. Back teeth are often left as just the natural gums during the integration period. The advantage to this approach is highest success rates ( high 90’s) and the best gums later.

I do some clever things to make the gums look very natural on most front teeth. This happens when we uncover the implant and make a beautiful temporary that promotes a natural looking gumline. It is one of the “art parts.”

In special carefully selected situations, we may remove a tooth, place the implant and build the temporary tooth all in one step. Placing implants and teeth all at the same time is becoming more common, but some of the precision and success rates can drop. It is a decision that is important to make with plenty of information.

Once the implants have integrated, the patient is ready to have their new teeth made. We are able to replace a single tooth or several; all the way to an entire arch. Many people do single individually flossable teeth. With two implants, we make lower dentures much more secure. With 4 – 8 implants we can make a whole arch of secure teeth that stay in place and are not removable.

Kirk Donaldson DDS MS

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Enjoy your smile again. Schedule an appointment today. Call us at (734) 971-3450.

A little history:

I (Kirk Donaldson DDS MS) have participated in implant dentistry since the current styles were first introduced to North America in 1982. As a graduate student at the University of Michigan, I listened to the Swiss research team present their material to U of M. They wanted Ann Arbor to become THE implant center in North America. U of M was apprehensive because implants had a bad history. Toronto took up the Swiss on their offer and most of the patient studies came from there for years.

As implants became available to the general public, Brannemark’s system was considered the gold standard. They are now owned by Nobelpharma. For historical reasons many dentists still cling to this “godfather” company. I still use them when patients come to my practice from an oral surgeon that still uses the system. Personally, I prefer and use the Biohorizons Implant system. They have the highest level of bone healing and maintenance around the implants. Plus, I can get consistently nice looking gums around them; it’s a joy to use.

There are many good systems out there. I prefer to use a few systems very well and don’t experiment with every new variation until I see some good research that shows significant improvement.

I have been seeing Dr. Donaldson and Hygienist, Mary Palawski for a number of years. From the moment of my initial consultation with Dr. D to my initial cleaning with Mary, I have been thrilled with not only how they worked with me to get my teeth & gums back into great healthy shape, but I prefer to use natural alternative products, such as no fluoride, and they have always listened to my requests and carried out them to the best of their ability. They are also very knowledgeable about the latest technology and share their ideas with their patients to help give them a few alternatives. The office is a very friendly environment and you always feel like “family”. I openly recommend Dr. Donaldson’s office to all my co-workers and friends. They love their jobs!

My photography is based on themes of design, beauty and spirit. Subjects include nature, people, place, details and abstract. The hope is to capture images both for artistic pleasure and to ultimately advance environmental and social justice issues.

Art has been a lifetime interest for me. There is something about shape, pattern, texture, color, time and motion that have always drawn me. I suppose my hidden aspiration was to be a fine painter and go to art school. My athletic endeavors reflect the same concepts. Form, timing, strength and strategy are involved in sailing, tower diving, skiing and technical climbing: not that different from dance. Over the years I realize that much of what I consider rich in my life comes through the fine arts: visual, musical, and creative movement. Dentistry is my profession. The work I do there places the same artistic demands of form and motion in the process of providing care to a patient. For me, life is art: in all its experiences.

See Kirk’s photography at KirkDonaldsonPhotography.com

Wonderful changes have developed in today’s dentistry. We are able to create restorations on teeth that look more beautiful, improve strength and leave a lot more of the original tooth than the old days. When patients look in the mirror, “Wow!” is frequently the first word out of their mouth. This is dentistry people love. When I finished my graduate training in 1983, I could do some pretty fancy dentistry, BUT– it was all too often done with ugly metal showing or porcelains that looked blah. Times have changed, thank goodness.

The ability to bond porcelain to teeth has been one of the great changes. The porcelain is bonded or fused to the tooth making them almost one. When restorations don’t have any metal underneath, light transmits through the teeth naturally; solving the problem of dark gumlines and dull looking porcelain. The cement between the tooth and porcelain creates a seamless interface that locks them together and allows natural light transmission. The third great thing this bond does is improve strength.

Old silver fillings and inlays weaken teeth. Porcelain restorations help reinforce the tooth they are fused to. It is one of the great material science advances in dentistry. Over the past twenty years, the quality and consistency of the material and technique have steadily improved. Years ago, many patients experienced post-treatment sensitivity or leaking and loosening or porcelain restorations. Today, these are infrequent occurrences even rare. I would say the porcelain work (and implants) we do today is the finest dentistry I have seen in my career. It makes dentistry very enjoyable for me and incredibly positive for my patients.

When teeth have a smaller cavity or old silver filling, they can be repaired with a porcelain inlay. Inlays are like inlayed woodworking. A precision porcelain piece is carefully inserted into the tooth where it has been shaped to remove the decay or old filling. The result is a tooth that just looks normal and is also re-strengthened.

If the tooth has a larger cavity, old filling, or stress cracks; today’s choice solution may be a porcelain onlay. An onlay is a restoration that covers the biting surface of the tooth an slightly wraps over the edges; sort of like an umbrella sitting on the top. By reaching over the edges of the biting surface, it effectively holds the tooth together. If a tooth has a crack, it is no longer being forced apart when you bite down. Or if the tooth had a weakened area, the porcelain helps strengthen it again. If the tooth has problems on the outer face or is very undermined in strength, a full porcelain crown does the same as above, but covers the whole tooth like a new outer shell layer. Beautiful again.

Porcelain restorations are not the cure-all though. Teeth under heavy pressure can have porcelain fracture. Full crowns on the back teeth are still usually done with a metal reinforcement layer underneath; called a porcelain fused to metal (pfm) crown. When properly done they too can have a near life-like look and are quite strong. Teeth that are under very heavy load, like way in the back on patients who clench or grind their teeth a lot, can fracture the porcelain on pfm crowns. This is the place where gold onlays or crowns are still useful.

The key to long term success and patient satisfaction is to clearly understand the patients preferences and priorities. Some people prefer stronger, others prefer prettier. In our practice we often have a few ways something can be done and choose the one that most closely matches the patients preference. We provide highly customized care. Is is care people choose for themselves, not imposed by us. We are here to help.

Today’s dentistry can lighten, straighten and enhance smiles so they are healthy and vibrant looking. A bright straight smile is almost expected in our culture. A smile that lacks those qualities becomes a visual distraction that has negative impact. Like cosmetic surgery, the results can be quite natural or “stretched.” Enhancement can blend in or draw attention to itself. The choice is or should be, the patients. Most of my patients seek a vibrant, healthy look that still looks real and doesn’t overly draw attention to itself. The goal is for friends to say, “You look great! What did you do? New hair, working out?” I have a patients that say, “I want super bright” or even ,”fake white.” That’s ok, because enhancement is about making good choices for yourself. We try to help our patients do that, by giving enough information for them to make intelligent choices that suite their life.

When I analyze a smile, the first thing I ask is, “Are there any visual distractors?” Color, shape, proportion, length, alignment, gumlines, and lip frame are all important factors. Most of us can tell the visual distractor if we pay attention to where our eye travels when we look at a smile. That is the key to solving the problem. Some people don’t have a distractor and simply desire enhancement. The possibilities are great.

Bleaching is a way to lighten natural tooth enamel. Home and in-office systems can both be successful. Subtle reshaping of natural teeth can improve and freshen the smile. Bonding can close smaller spaces and improve the shape of teeth. Porcelain can almost magically change a smile. Veneers are a new outer face on the teeth. Crowns wrap all the way around teeth. Often, we take a hybrid approach, resurfacing the front surface, biting edge and even the in-between surfaces without going all the way around the tooth. The more natural tooth we keep the better.

One question we often address is ,”How many teeth should be done?” That is a highly personalized question. My preference is to treat as few teeth as possible. Working on a single front tooth is one of the most challenging things in dentistry. It sometimes takes a couple try-in steps to ensure an excellent result. Doing two, four or six teeth is quite common. If we want a brighter and perhaps wider look to fill the smile, then we add one to three teeth on each side. So, it all varies greatly; again depending on the patients goals and desire.

I am biased. I want my work to be great for my patients now and for a long time to come. I love a beautiful smile. Plastic surgeons, hairdressers, make-up artists all know that a great smile is the most important part of making a person look more attractive and vital. We are able to enhance smiles so they are brighter, more uniform and attractive while still looking real. Last week while out to dinner, I saw one of my patients; a school teacher. She was dressed up, with make up on. Her face just glowed. The smile she flashed was our secret. No one would ever guess you were looking at dental artistry. It was bright and beautiful without being overdone.

Unfortunately, I almost squirm when I see a lot of the Hollywood smiles that almost scream, “FAKE!” Doing big bulky plain white teeth is easy. Lots of high volume production labs produce that stuff. When a dentist doesn’t need to pre-shape the teeth or gums, they are just going to bulk up the teeth like adding cheap false fingernails. The unfortunate consequence is usually a negative impact on the gum health, and difficulty speaking clearly and biting efficiently. How can you bite an apple when the edges of your teeth are two to four times their normal thickness? That is what happens with “instant” veneers and similar highly marketed procedures.

Too often, someone who buys the cheap, quick fix feels dissatisfied later and then looks for a more thoughtful approach. Treating something again is a lot more expensive than doing it well the first time. Quality is almost always the best long term value.

I have a saying; Run to failure, walk to success. Careful planning is essential to achieve consistent excellence. When I am doing important cosmetic, implant and restorative work for someone, I give reserve the time necessary to work on the small details that make that lifelike difference. It takes training, an eye and discipline. Some of the comments I hear patients make is, “ These are MY teeth. That’s how they feel! Not fake at all!” or, “ This is how they used to be! How did you know?”, or , “This is what I have always wanted. “ It’s why we say, “Dentistry As A Fine Art”.

This is not a bunch of hype. It is really how we practice day by day.

Yes, that’s how I look at it. Providing extraordinary dentistry takes a special blend of skills. People want to be heard and understood. They want enough pertinent information to make their own choices. They have come to expect the quality of their experience to match the technical and artistic excellence of our dentistry.

Consistently living up to those expectations does not happen by accident. Our entire staff is trained how to be attentive to each patients unique needs. It is wonderful to repeatedly see people who start out nervous, skeptical, afraid or untrusting; learn to trust, relax and thoroughly enjoy their experience with our office. Once people figure out you genuinely care about their comfort and are able to provide their dentistry comfortably; they relax.

When you anticipate things for your patients, they learn to trust your knowledge and experience. When you don’t tell them what they have to do, but show them how to get what they want (like health, beauty, strength, or avoiding future problems), they make good choices for themselves.

To make all that happen takes an orchestration of many factors, including;

• integrity first and foremost. What you are will speak for itself.

• a comfortable “we care about you” health environment

• a staff that has excellent technical, communication and organizational skills

• doctors that understand what their patients are looking for and can get them there comfortably and with a smooth efficiency.

• state of the art equipment and the finest available materials

• superb laboratory technicians who have the skill to consistently produce beautiful real looking restorations. (“WOW” seems to pop out of patients’ mouths when they look in the mirror when we are done.)

• a dedication to being a lifetime student.

• enough humility to love learning from anyone any time.

Putting all the above for consistent high level care is an art. We care enough to work at it every day for every patient. No kidding!

Dear Cathy,

Thanks for your inquiry about alternatives to root canals. I took the liberty to watch a Mercola video to learn where he was coming from.

Your tooth has a big filling. That means the tooth is weakened a bit because a traditional filling does nothing to reinforce the tooth. Teeth like that often get stress cracks over time because of fatigue. If the crack goes off at an angle, a part of the tooth might break away and is easily repaired. However, if the crack moves vertically up the tooth, it can move into the nerve area or even split the tooth in half.

To strengthen a tooth with a crack, the tooth needs to be held together. The most common way to do that is with a crown. A crown is like a new strong outer shell for the tooth ; binding it together. Often an insulating build up is done to clean up , and strengthen the deeper areas where the old filling and or decay was.

When the nerve of a tooth becomes involved, either from a fracture, decay bacteria, or inflammation from trauma; the tooth can slowly or abruptly die. As Dr Mercola describes, a root canal seals the main micro tubes inside the tooth; usually three on a molar. However, like a river system, there are microscopic tributaries or side canals that the cleaning instruments don’t enter. However, as the tooth canals are cleaned out, the tooth is repeatedly irrigated with a disinfecting bleach solution. That important irrigation cleans the auxiliary canals.

About ten years ago the technology for doing root canals dramatically improved. Post operative discomfort and infections are rare. Millions of people enjoy keeping their teeth, thanks to root canals. Do some fail? Sure, but that is fairly rare these days– IF, the root canal is done well.

Back to the crack. The further a crack goes up a tooth, the poorer the outlook. When you bite, it stresses the tooth. The gross majority are saved without a problem, but depending on the situation, it’s possible to overload anything– even a tooth with no prior treatment.

Alternatives: Dr Mercola says extract all root canal teeth. Or maybe your fracture is far gone. Or the infection has gone on so long that a lot of bone has been destroyed around your tooth. OK, the tooth is lost.

The tooth can be left as a space, replaced with a removable appliance, replaced as a bridge, or done as an implant. For an implant to work, you need enough bone. In most cases these days, it is the preferred way too replace a tooth because it is strong, you can floss it normally and it does not force you to treat the adjacent teeth.

It is a complex subject. A good look at what is happening, and an understanding of your personal preferences should help you solve your problem. The tooth sounds like it is feeding an on going infection. Antibiotics help you short term, but are unable to treat the infection at its source inside the tooth (no longer a blood stream to deliver the drug and the pulp tissue inside and it won’t regenerate or heal).

If you are interested in seeing me for an exam, please set up an appointment. You will probably speak with Ann. 734-971-3450

I hope this was helpful to you — and I learned about Dr Mercola. I do disagree with him fundamentally though. I have seen way too many happy patients who have successful root canals, including myself.

Sincerely,
Kirk D.

Dr. Kirk Donaldson

Kirk went to the University of Michigan for college, dental school (1980) and graduate school (1983). His masters degree is in the dental specialty area of prosthodontics. Basically he is trained to handle very complex dental crown and bridge work for patients with tricky bite problems. That is where his expertise in dental porcelain and cosmetics started. Kirk has also always been precise and comfortable in surgical realms and root canal treatment. He received high academic and clinical honors from dental school and has served on the board for a large dental continuing education society. Continuous improvement is a character trait with this fine dentist. Kirk has a broad array of interests, is the proud father of two growing boys and husband to Kristin. Yes, Donaldson & Guenther are partners both ways-at work and at home. The whole family enjoys theater, opera, classical music, art, reading and the great outdoors. Kirk is a person of faith and started going to Guatemala on mission in 2003. Athletically, Kirk was a UM diver and a nationally ranked sailor in the Snipe class. In recent years his outdoor interests have turned to the mountains; hiking, backpacking, climbing and skiing. He still gets in a sailboat race now and then.

Dr. Kristin Guenther

Kristin climbed the dental ladder and put herself through school in the process. She worked as a dental assistant to pay for college and hygiene school. The chemistry department tried to recruit her for grad school, but her heart was in dentistry. Kristin worked nights and weekends while attending dental school and received her DDS in 1982. All her degrees are from the University of Michigan. Kristin was one of the top students in her class and received high honors and recognition. Since graduating, Dr. Guenther has sought out the finest in advanced training in high tech root canal treatment and advanced restorative and cosmetic dentistry.

Kristin takes great joy in her boys-Ian and Nathan-and Kirk (yes, they’re married). Kristin enjoys taking piano lessons and attending concerts, plays and art exhibits. She is a skilled horseback rider, a wonderful gardener and puts up with Kirk’s adventure vacations with a smile most of the time.

Ann Schrot

Ann is the practice manager for Donaldson and Guenther. She is a delightful person and a true expert in dental insurance and financial arrangements. She helps patients plan financially so the dental work they want fits into their life. Ann is well versed in flex spending accounts, insurance issues, financial arrangements and scheduling. Ann is one organized lady. She keeps a great smile and a chuckle intact as she manages the office of Donaldson & Guenther while raising six boys. She is the room mom for one class and sits on the administrative board for her boy’s school and church. She also is the primary social director for her extensive list of close friends.

Kara Lund

If you hear the laughter in our office, it’s probably around Kara. Kara is our everything person. She is skilled at the front desk with scheduling and records as well as in the treatment rooms. She has excellent experience in both realms. Kara is a skilled archer. In the fall she is up in her tree stand, ready with her bow before getting to the office by 7 am. Having lived in Texas for a number of years, Kara retains a bit of the accent and can do a mean two step.

Our Hygienists

Carol has worked with Dr. Donaldson since the late 1980’s and has been our steady positive torch. Carol comes from a deep caring perspective that is expressed in and out of work. She blends kindness and thoroughness in the office and volunteers extensively in the community. “Still waters run deep” applies to Carol. She and her husband also play host to some of our office events. Just don’t get in a canoe with her unless the sun is shining and the water is warm.

Mary has as passionate a following of any hygienist we have ever met. She is known for her brief therapeutic head/face massage prior to starting procedures. She is a leader in our practice and keeps us all on our toes with new and better ideas, techniques and continuing education. Mary was one of the very first hygienists in the State of Michigan to receive her license for dental anesthesia- which she does with her characteristically wonderful gentle touch. Mary is also an avid horseback rider and does volunteer work with handicapped children each summer and with indigent women each week.

Kelly is a superb clinician. She has a gentle, personable style and excellent diagnostic and technical skills. Kelly is also licensed in dental anesthesia. Kelly and her husband add greatly to the office fun factor. She even got the doc’s to sponsor her bowling team where she has missed a 300 game by only one strike.

Clinical Assistants

Donaldson & Guenther is very fortunate to have two (three including Kara) very advanced chairside clinical assistants. They share responsibilities between the two doctors and have a wealth of knowledge and experience between them. Irene is particularly talented with technical aspects of dentistry. She now designs and fabricates many of our laboratory appliances like bite guards. She is also a stellar Mexican cook. Ask the staff who they want to cook for us-it will be Irene.

Lori comes to us with a wealth of background in hospital and specialty dentistry form her years on the northeast side of Detroit. She was very fussy when she selected her new practice. We count ourselves very fortunate to have this organized and talented assistant. Lori has a young family and is quite active with her church.