Archive for July, 2007

Photography: KirkDonaldsonPhotography.com

Thursday, July 12th, 2007

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

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Porcelain on the back teeth: porcelain, onlays and crowns

Tuesday, July 10th, 2007

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.

Posted in Dental Cosmetics, Fillings, Inlays | 1 Comment »

Enhancing Smiles

Tuesday, July 10th, 2007

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.

Posted in Smile, Teeth Bleaching, Veneers | 1 Comment »

Fast and cheap: it costs

Tuesday, July 10th, 2007

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”.

Posted in Dentistry as a fine art, Smile | No Comments »

Dentistry as a fine art?

Tuesday, July 10th, 2007

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!

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Alternatives to root canals

Thursday, July 5th, 2007

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.

Posted in Ask the dentist, Dental Bridges, Fillings, Fractured Teeth, Root canals | No Comments »