My Blog

Posts for: November, 2019

By Daniel Brengman DDS, PA
November 24, 2019
Category: Dental Procedures
Tags: teeth whitening  
StainsfromWithinaToothRequireProfessionalWhitening

Whether performed in a dental office or using a home kit, teeth whitening applications are quite effective for bleaching exterior (extrinsic) stains on enamel surfaces. But what if your discoloration comes from inside the tooth? In this case, extrinsic teeth whitening won’t work — you’ll need to undergo an “internal bleaching” method, which can only be performed in a dentist's office.

There are a number of causes for “intrinsic” staining, including too much fluoride exposure or tetracycline use during childhood. One of the more common causes, though, occurs from root canal treatments used to remove the remnants of the pulp tissue inside a tooth’s pulp chamber and root canals. Certain cements used during the procedure to help seal in the filling material and leftover blood pigments can cause the tooth to darken over time.

To alleviate this discoloration, we use a bleaching agent, usually sodium perborate mixed with a diluted solution of hydrogen peroxide to achieve a safe, accelerated color change. After determining that the root canal filling is still intact and the bone is healthy, we create a small cavity in the back of the tooth to access the pulp chamber. The chamber is cleaned of any debris or stained material and then thoroughly irrigated. The original root canal filling is then sealed off to prevent leakage from the bleaching agent.

We then place the bleaching agent in the cleaned-out space with a cotton pellet and seal it in with a temporary adhesive. This step is repeated for several days until we achieve the desired shade of white. Once that occurs we then seal the dentin with a more permanent filling and then restore the cavity we created with a composite resin bonded to the enamel and dentin.

If we’re successful in achieving the desired color, intrinsic whitening could help you avoid more costly options like veneers or crowns for an otherwise healthy and attractive tooth. The end result would be the same — a beautiful smile without those unsightly stains.

If you would like more information on treating internal tooth stains, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Whitening Traumatized Teeth.”


JulianneHoughSharesaVideo-andaSong-AfterWisdomTeethComeOut

Once upon a time, celebrities tried hard to maintain the appearance of red-carpet glamour at all times. That meant keeping the more mundane aspects of their lives out of the spotlight: things like shopping, walking the dog and having oral surgery, for example.

That was then. Today, you can find plenty of celebs posting pictures from the dentist on social media. Take Julianne Hough, for example: In 2011 and 2013, she tweeted from the dental office. Then, not long ago, she shared a video taken after her wisdom teeth were removed in December 2016. In it, the 28-year-old actress and dancer cracked jokes and sang a loopy rendition of a Christmas carol, her mouth filled with gauze. Clearly, she was feeling relaxed and comfortable!

Lots of us enjoy seeing the human side of celebrities. But as dentists, we’re also glad when posts such as these help demystify a procedure that could be scary for some people.

Like having a root canal, the thought of extracting wisdom teeth (also called third molars) makes some folks shudder. Yet this routine procedure is performed more often than any other type of oral surgery. Why? Because wisdom teeth, which usually begin to erupt (emerge from beneath the gums) around age 17-25, have the potential to cause serious problems in the mouth. When these molars lack enough space to fully erupt in their normal positions, they are said to be “impacted.”

One potential problem with impacted wisdom teeth is crowding. Many people don’t have enough space in the jaw to accommodate another set of molars; when their wisdom teeth come in, other teeth can be damaged. Impacted wisdom teeth may also have an increased potential to cause periodontal disease, bacterial infection, and other issues.

Not all wisdom teeth need to be removed; after a complete examination, including x-rays and/or other diagnostic imaging, a recommendation will be made based on each individual’s situation. It may involve continued monitoring of the situation, orthodontics or extraction.

Wisdom tooth extraction is usually done right in the office, often with a type of anesthesia called “conscious sedation.”  Here, the patient is able to breathe normally and respond to stimuli (such as verbal directions), but remains free from pain. For people who are especially apprehensive about dental procedures, anti-anxiety mediation may also be given. After the procedure, prescription or over-the-counter pain medication may be used for a few days. If you feel like singing a few bars, as Julianne did, it’s up to you.

If you would like more information about wisdom tooth extraction, please call our office to arrange a consultation. You can learn more in the Dear Doctor magazine articles “Wisdom Teeth” and “Removing Wisdom Teeth.”


By Daniel Brengman DDS, PA
November 04, 2019
Category: Dental Procedures
Tags: dental implant  
ImplantFailureIsRarebutPossibleHereAreaFewWaystoAvoidIt

Dental implants are all the rage—and for good reason: They’re incredibly “tooth-like,” both in appearance and function. They also have a stunningly high success rate: More than 95% of implants still function after ten years. This means out of thousands of implants installed each year, only a handful fail.

But although that’s an amazingly low number, they’re still failures for real people who’ve suffered a loss. If you’re considering dental implants the chances of that being your experience are quite low. But it could still happen.

Here’s a few things you can do to make sure your implants don’t fail.

Stop smoking. Of the small percentage of implant failures, an inordinate number are smokers. A smoker’s chances of implant failure are roughly double those of non-smokers. Smoking, and to some degree any tobacco use, can make your mouth an unhealthier place: Not only can it increase your dental disease risk, but it can interfere with the healing process after implant placement and increase the chances of early failure.

Manage your health. Diabetes and similar systemic conditions can interfere with the healing process too, which could impact your implant attachment to bone. Diabetics thus run a slight risk of implant failure—but actual failures mostly involve patients who don’t have good control of their symptoms. If you’re a diabetic, properly managing your condition will lower your risk of implant failure to nearly identical that of someone without diabetes.

Treat gum disease. Implants in themselves are immune to disease—but the underlying bone that supports them isn’t. A gum disease infection could eventually weaken and diminish the implant-bone attachment. If this happens around an implant, its stability can be severely compromised. The best strategy is to prevent gum disease through daily, thorough brushing and flossing to remove disease-causing dental plaque. And if you see any symptoms like gum swelling, redness or bleeding, see your dentist as soon as possible.

Your implants could serve you well for decades. Just be sure you’re doing the right things to ensure their longevity.

If you would like more information on dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Implants: A Tooth-Replacement Method That Rarely Fails.”