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Bleaching teeth just got easier and more comfortable

New research over the past 4 years has proven that using a light or laser to speed up or
improve bleaching results was not warranted. The percent increase in whitening did not offset
the discomfort it caused in so many people. So, we no longer use the light, and still have the
same beautiful results, but with much less or even no sensitivity! No more zingers!

For most people, 3-4 in- office sessions is all that is needed for a sexy white smile. Research
shows that the color should last 1-7 years depending on the individual. Naturally, red
wine,smoking, coffee and soda decrease that length.

If in office procedures are not your thing, the custom trays are the next best alternative. This is especially helpful for people with extremely sensitive teeth. The trays are also used with a desensitizing gel to calm the teeth before and after placement of a mild bleaching gel. In addition, the trays are your most economical alternative to a whiter smile, as they may last up to 7 or more years. Since we suggest a touch up whitening every six months, simply put a little gel in your trays and keep those pearly’s white!

Are all crowns created equal?

No. There are many different types of crowns, or caps, that you can choose from when and if you are ever in that situation. Hands down, if you need a crown on one of your back top teeth, consider gold! The author has all of his back upper and lower teeth crowned in gold. The reason is that gold lasts, even up to 40 years! Gold wears like natural teeth and most importantly, it never breaks like a porcelain crown. Porcelain is like glass and can and will break at some point in time.

Since most of us do not want gold or metal teeth, tooth colored crowns are what are made about 99% of the time. There are a number of different kinds to choose from, so ask your dentist which ones are available for you. The strongest one to date is the Zirconia crown. These crowns have been more opaque in the past, but are becoming more esthetic due to their popularity with dentists! So, remember, purchasing a dental crown is like purchasing a new phone. What features are important to you, since even the most unattractive flip phone still lets you talk to the other person, just like every crown still lets you enjoy a good meal!

5 Ways to Restore Your Smile

Cosmetic dentistry is generally used to refer to any dental work that improves the appearance (though not necessarily the function) of a person’s teeth, gums and/or bite.

The five most used procedures at our practice are:

Cosmetic reshaping

Cosmetic reshaping removes parts of the enamel to improve the appearance of the tooth. It may be used to correct a small chip, or to alter the length, shape or position of teeth; it can be used to correct crooked or excessively long teeth. The removed enamel is irreplaceable, and may sometimes expose dentin. It is also known as enameloplasty, odontoplasty, contouring, recontouring, slenderizing, stripping or sculpting. This procedure offers fast results and can even be a substitute for braces under certain circumstances.


Bonding is a process in which an enamel-like dental composite material is applied to a tooth’s surface, sculpted into shape, hardened and then polished.


Whitening, or “tooth bleaching”, is the most common cosmetic dental procedure. While many whitening options are now available, including over the counter products, dentist-supervised treatments remain the recommended procedures for lightening discolored teeth.


Veneers are ultra-thin, custom-made porcelain laminates that are bonded directly to the teeth. They are an option for closing gaps or disguising discolored teeth that do not respond well to whitening procedures. Depending on the procedure, tooth reduction may be necessary.

Dental Bridges

Dental bridges are false teeth, known as a pontics, which are fused between two porcelain crowns to fill in areas left by missing teeth. Two crowns hold it in place, these are attached to adjacent sides of the false tooth. This is known as a fixed bridge. This procedure is used to replace one or more missing teeth. Fixed bridges cannot be taken out in the same way that partial dentures can. In areas of the mouth that are under less stress, such as the front teeth, a cantilever bridge may be used. Cantilever bridges are used when there are teeth on only one side of the open space. Bridges can reduce the risk of gum disease, help correct some bite issues and even improve your speech. Bridges require commitment to serious oral hygiene, but may last up to ten years or more.

Benefits of Dental Implants

The mouth is restored as closely as possible to its natural state. By replacing the entire tooth, including the root, it is possible to replicate the function of natural teeth, with a strong, stable foundation that allows comfortable biting and chewing. In addition, nothing in the mouth looks, or feels artificial.

Implants preserve the integrity of facial structures. By preventing the bone resorption that would normally occur with the loss of teeth, the facial structures remain intact. This is particularly important when all of the teeth are missing, as the lower one-third of the face collapses if implants are not placed to preserve the bone.

Your smile is improved when replacement teeth look more like natural teeth. Even when only one tooth is missing, long term esthetics are usually much better with an implant supported replacement tooth than with a traditional tooth supported bridge. This is particularly important in the front of your mouth, where preventing a visible bone defect is critical for natural appearance.

Adjacent teeth are not compromised to replace missing teeth. Tooth replacement with traditional tooth-supported bridges requires grinding down the teeth adjacent to the missing tooth/teeth, so that the bridge can be cemented onto them. This tooth structure can never be replaced and the long-term health of these teeth is compromised. Partial dentures have clasps that hook onto adjacent teeth, putting pressure on them as the partial rocks back and forth. Eventually these teeth can loosen and come out as a result of this pressure. Replacing missing teeth with implant supported crowns/bridges does not involve the adjacent natural teeth, so they are not compromised, or damaged.

Overall quality of life is enhanced with replacement teeth that look, feel and function like natural teeth. With implant supported replacement teeth, the appearance of the smile is more natural and the teeth function more like natural teeth. The result is increased comfort and confidence when smiling, speaking, and eating. If dentures and partials are replaced with implant supported teeth, the overall enhancement in quality of life is even more significant, with an ability to eat all types of foods, elimination of messy adhesives, and improved speech, comfort and appearance.

Convenient oral hygiene. It is much easier to care for an implant supported crown, which can be cleaned like a natural tooth. In comparison, a tooth supported bridge requires the use of a floss threader for proper cleaning. It is also more convenient to clean a full set of implant supported replacement teeth than a traditional denture.

Improved appearance. Since implants preserve bone, preventing deterioration of the facial structures, appearance is improved. Collapse of the lower one-third of the face caused by complete tooth loss can be visually corrected and the remaining bone preserved. The appearance of wrinkles around the mouth caused by posterior bite collapse, or complete facial structure collapse is virtually eliminated.

Restored self-esteem and renewed self-confidence. Many of the people who now enjoy the benefits of implant supported replacement teeth state that their self esteem and self confidence have been restored as a result of improved appearance, function, comfort, and health.


What You NEED to Know About Gum Disease

The word periodontal literally means “around the tooth.” Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth. Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed.

Periodontal (gum) diseases, including gingivitis and periodontitis, are serious infections that, left untreated, can lead to tooth loss.

Gingivitis, the first stage and the mildest form of periodontal disease, starts when the bacteria in dental plaque irritate the gums and cause infection. The bacteria in dental plaque irritate the gums and cause infection. When your body launches an immune response against these invaders, the gums become inflamed. People with gingivitis usually experience little or no discomfort. Therefore, it is important to recognize the symptoms, such as gums that are red, swollen or bleed easily. Gingivitis is reversible with professional treatment and good home oral care. Left untreated, gingivitis can lead to periodontitis.

Contributing Risk Factors:


  • Diabetes
  • Smoking
  • Genetic predisposition
  • Systemic diseases and conditions
  • Stress
  • Inadequate nutrition
  • Hormonal fluctuations
  • Pregnancy
  • Substance abuse
  • HIV infection
  • Certain medications

gingi2With time, plaque from untreated gingivitis can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

The most common forms of periodontitis include the following.

Aggressive periodontitis occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.
Chronic periodontitis results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gingiva. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.
Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.
Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.
Periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment, including scaling and root planing (a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins), followed by adjunctive therapy such as local delivery antimicrobials and host modulation, as needed on a case-by-case basis.

Usually after scaling and root planing, many patients do not require any further active treatment, including surgical therapy. However, patients will require ongoing maintenance therapy to sustain health. Non-surgical therapy does have its limitations, however, and when it does not achieve periodontal health, surgery may be indicated to restore periodontal anatomy damaged by periodontal diseases and to facilitate oral hygiene practices.

Q: Is tooth loss a normal part of aging?
A: With good oral hygiene and regular professional care, your teeth are meant to last a lifetime. However, if left untreated, periodontal (gum) disease can lead to tooth loss. It is the primary cause of tooth loss in adults 35 and over.

Q: Does gum disease mean I have a “dirty mouth”?
A: Research proves that up to 30% of the population may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be six times more likely to develop periodontal disease.

Q: Does gum disease affect overall health?
A: Emerging research links periodontal disease to other health problems including heart and respiratory diseases; preterm, low birthweight babies; stroke; osteoporosis; and diabetes.

Q: Is gum disease a mild infection?
A: The mass of tissue in the oral cavity is equivalent to the skin on your arm that extends from the wrist to the elbow. If this area was red, swollen, and infected, you would visit the doctor. Gum disease is not a small infection. Its result, tooth loss, leads to a very different lifestyle including changes in your appearance, breath, and ability to chew food.

Q: Are bleeding gums normal?
A: Bleeding gums are one of the warning signs of gum disease. Think of gum tissue as the skin on your hand. If your hands bled every time you washed them, you would know something is wrong. Other signs of gum disease include: red, swollen or tender gums; sores in your mouth; gums that have pulled away from the teeth; persistent bad breath; pus between the teeth and gums (leaving bad breath); loose or separating teeth; a change in the way the teeth fit together; and a change in the fit of partial dentures.

Q: Why can’t I just take oral antibiotics to treat my gum disease?
A: Periodontal bacteria live on the root surfaces of the teeth. Deep below the gumline, these bacteria develop a protective biofilm resistant to systemic antibiotics. The medicine is simply unable to reach the bacteria.

Q: What is Arestin?
A: ARESTIN® is a prescription antibiotic approved by the Food and Drug Administration (FDA). It is used together with scaling and root planing (SRP) procedures performed by a trained dental professional for the treatment of periodontal (gum) disease.

Q: Is the treatment for gum disease painful?
A: New periodontal procedures including local anesthesia and over-the-counter medications, have made patients’ treatment experiences pleasant and comfortable. Many patients find they are back to normal routines on the same day or by the next day.

Q: Why can’t I just have my regular cleaning?
A: The prophylaxis, or your “regular cleaning” is done to prevent disease. It is for “healthy” gums only. Once you have the disease, more aggressive treatment is now needed in order to get it under control.

Q: What is scaling and root planing (SRP)?
A: For periodontal (gum) disease treatment, dental professionals use a common mechanical procedure known as SRP. Scaling removes plaque, tartar and stains from the surface of teeth and their roots. Planing smoothes the rough areas on the roots of teeth to promote healing.

Q: Is it true that once teeth are lost, the only treatment options are crowns, bridges or dentures?
A: Dental implants are a permanent tooth-replacement option for teeth lost to trauma, injury or periodontal disease. Dental implants feel and look so natural that many patients forget they ever lost a tooth.

Q: Should pregnant women skip professional dental checkups?
A: Teeth and gums are affected during pregnancy like other tissues in the body. In order to decrease the risk of damaging the gums and tissues surrounding the teeth, pregnant women should schedule an appointment for a periodontal evaluation.

Finding a Reputable Cosmetic Dentist

Cosmetic dentistry is the union of science and art. Although it has been said that only a few percent of dentists possess both abilities, there are key factors that will enable patients to select a suitable dentist. Celebrity cosmetic dentist Dr. Cary Goldstein lists what to look for:

Reputation of the Doctor

Word of mouth is a very effective tool in choosing a cosmetic dentist. Take your time to research your doctor and be sure to carefully analyze what you find on the web.

The Doctor’s Office

Although the office alone is not substantial enough to determine a doctors abilities, you may find some valuable indications. Consider the following in your search:

Office Decor: They say beauty is in the eye of the beholder; if you hate the decor of the office, you may find that you have differing opinions on what “beauty ” means.

Office Staff: A doctor whose staff are proud to work for him/her is a good sign.

Office Technology: If the office is not using modern technology, you may be missing out on what’s currently available.

Office Location: A cosmetic dentist practicing in a very competitive location will be much more likely to go the extra mile for his/her patient than one who is in a remote  location.

Comprehensive Examination of the Patient’s Mouth

A cosmetic dentist should always perform a comprehensive examination of the mouth before recommending any cosmetic improvements. It is important that he or she cares for the long term health of the mouth over a “quick fix.”

Communication Skills and Bedside Manner of the Doctor

It is of paramount importance to be able to communicate with your cosmetic dentist; find a doctor who is willing to take the time to understand your personality and your expectations. A caring bedside manner is an indication of someone who is interested in your satisfaction.

The Ceramist

A ceramist is a professional who creates the porcelain restorations, be they veneers, crowns or bridges. This individual or team plays a crucial part in the end result of your smile. Be sure to ask about the ceramist and request to see before and after photos that highlight the dentist/ceramist work. A valuable before and after photograph to see is porcelain work that has been placed next to natural teeth.

Invisalign treatment

Dr Goldstein advises his patients that there are two ways to correct poor position of
teeth in the mouth.

The first option is orthodontics. He advises his patients that are interested in this option
to have Invisalign treatment. Invisalign is an orthodontic option specifically designed
with adults in mind who do not want a mouth filled with metal. We perform this treatment
routinely on patients aged between 25 and 70, Invisalign treatment involves wearing
clear plastic trays that fit specifically to your teeth and are changed periodically thus
gradually moving the teeth into the desired position. On a social level no one will know
you are wearing them, furthermore you can take them off to eat and brush your teeth
which is fantastic!

The second option is to have porcelain veneers for “instant orthodontics” your first visit
would be to take impressions for a wax up which will give you a three dimensional
model of how your teeth will look with the veneers. Once you approve the wax up, your teeth will be prepared for the porcelain veneers. Seven to ten business days later you
will return to have the final veneers permanently bonded to your teeth.
Dr Goldstein states that “porcelain veneers can change the shape, color, and position of
the teeth, whilst Invisalign can only change the position.

How to Maintain the Color of Porcelain Veneers

Dr Goldstein states that a well fabricated porcelain veneer is usually able to maintain its
color over time. However, due to the fact the veneers are bonded to natural tooth
structure which is porous, means that if the teeth under the porcelain veneers are not
well maintained, changes in the tooth structure can actually make the veneers appear
darker over time.

In order to maintain the color of porcelain veneers it is imperative that patients follow
good/excellent oral hygiene instructions. At The Goldstein Dental Center dentistry spa,
patients who have porcelain veneers visit the hygienist every three months. This isBLOG May 2014 particularly important for those with lumineers or minimal preparation veneers, as the
porcelain is very thin, making it easy for stains in the tooth structure to show through.

Cost of Porcelain Veneers

Although the cost of porcelain veneers is anywhere from $1000 to upwards of $4000
per tooth, it is imperative to take into consideration the following factors before choosing
your cosmetic dentist:
Experience of Dentist in placing porcelain veneers
Feel free to ask the cosmetic dentist how many years he/she has been placing
porcelain veneers, and ask to see before and after cases. This will allow you to see the
quality of work you can expect to receive for the cost of porcelain veneers you will be

The porcelain veneers are custom fabricated by a ceramist. This individual plays a
crucial part in the treatment of porcelain veneers. If you are being offered a heavily
discounted cost of porcelain veneers, be sure that the cosmetic dentist is not using an
inferior ceramist to cut costs.

Professionalism of Dental Office
The treatment of porcelain veneers can take up to four weeks to complete and following
placement it is advised to have regular cleanings and maintenance to ensure the health
of the teeth. Chose a cosmetic dentist that takes pride in his/her profession and has
instilled a professional work ethic in his/her office, this will ensure a pleasant experience
with your porcelain veneer treatment .