Tuesday, December 17, 2013

The Beauty of Bonding

Many of the techniques used to repair and improve your smile require artistic ability on the part of the cosmetic dentist, since the work is done freehand. Composite tooth bonding is one such technique.  It can work wonders for your smile if it is done right.

Cosmetic Bonding

Dental bonding can repair cracked, chipped, and discolored teeth.  The same material can also be used to replace silver amalgam fillings. Cosmetic bonding can repair misaligned teeth, providing a straighter and more confident smile.

Tooth Bonding Procedure Cost, Care, and Advantages

Tooth bonding is quick, affordable, relatively painless, and long lasting. Bonding involves the layering-on of a strong composite resin which is precisely color-matched to your teeth. After each layer is applied, it's hardened with a special, high-intensity light. When enough resin layers are applied, hardened and bonded, the tooth is sculpted and polished to a comfortable, natural-looking result.

Although porcelain veneers are most often considered the state of the art for cosmetic dentistry, bonding with composite resin can often times satisfy a cosmetic need for a fraction of the cost.

Dental bonding can be considered:
·         to repair decayed teeth (composite resins are used to fill cavities)
·         to repair chipped or cracked teeth
·         to improve the appearance of discolored teeth
·         to close spaces between teeth
·         to make teeth look longer
·         to change the shape of teeth
·         as a cosmetic alternative to amalgam fillings
·         to protect a portion of the tooth's root that has been exposed when gums recede

Anesthesia is often not necessary unless the bonding is being used to fill a decayed tooth. If you are using bonding for cosmetic repair the surface of the tooth will be roughened and a conditioning liquid applied. Then the tooth-colored, puttylike resin is applied, molded and smoothed to the desired shape. A visible  light or laser is used to harden the material and that’s when the artistry kicks in – your dentist has to shape  and sculpt your new tooth by hand.
It takes about 30 to 60 minutes per tooth to complete and can range between $250 to $500.

Author Bio:
Dr. Steven Goldy, DDS is a cosmetic dentist practicing in Beverly Hills. His approach to cosmetic dentistry is founded in his belief that everyone deserves to have the best possible oral health and a confident smile. You reach Dr. Goldy at 310 550 1511. His office is located at 416 N. Bedford Center in Beverly Hills, California. Learn more at http://www.stevengoldydds.com 

Creating Confident Smiles
416 N. Bedford drive, suite 409
Beverly Hills, CA  90210

Friday, November 8, 2013

Poker & Dentistry

Sitting in the Dentist Chair...
by George "The Engineer" Epstein

I was at my dentist's office for extensive dental work. I was sitting in the dentist chair while Dr. Goldy (an excellent dentist, I should add) had his hand in my mouth operating a drill. I felt the need to communicate with him. But, that was barely possible with the drill grinding away while my mouth was immobilized. I made strange guttural sounds, only he could interpret. (That must take lots of dental training and experience.) Then, sitting in that chair, a thought came to mind: "This remind me of using tells at the poker table." So, I decided to share this with you. Thanks to Dr. Goldy and his dentist chair for this column...

As most of you know, a "tell" at the poker table is anything you might do that gives your opponent information about your hand - a body movement ("body language"), a facial expression, eye movement, words you might say, even the tone of your voice. FYI, here's a preview of a section of my new poker-book-in-preparation, The Art of Bluffing (due to be published early 2014).

Tells When Bluffing

When you suspect an opponent is bluffing, it pays to look for tells. It can be very rewarding when your small pair takes the pot away from the brazen bluffer. Here are typical tells to look for if you suspect your opponent is trying to bluff you out of the pot. Give serious thought to calling his bet when you spot any of these tells:
  • Covering his mouth with his hand;
  • Leaning back in his chair,
  • Touching, stroking or rubbing his neck;
  • An apparent departure in his normal behavior, such as speaking more or less often;
  • "Freezing" in his seat, becoming relatively immobile;
  • Taking a deep breath and holding it;
  • Taking a big swallow (gulp!);
  • Licking his lips.

If you look hard enough, you may spot some of these. But must deliberately look for them. It's not likely to happen by accident. Study your opponent carefully.

Of course, the complementary also applies: If you are the one who is doing the bluffing, be sure you steer clear of these tells. (Don't give an opponent an excuse for calling you while you are trying to bluff him out. )

Tells Before the Flop

Note: There are books by experts like Mike Caro and Joe Navarro that provide profound information about many poker tells.

In my opinion, among the most valuable are tells before the flop. I teach my Claude Pepper Seniors Poker Group to focus on the opponents seated to their left as they first peek at their holecards. (Look at your own holecards a bit later.) Those are the players who will be betting after you; so the information can be extremely valuable in helping you decide whether to call, fold or raise. For example, a tight player to your left peeks at his holecards as the dealer delivers you that he has a very strong starting hand! Next, you examine your own holecards. You have 9-8 offsuit, a marginal drawing hand that you might have otherwise played had you not seen his tell. So, you fold and save yourself a bunch of chips!

I am sure you can identify still other tells...

Thanks to Dr. Goldy

Perhaps this column has served to help you to be more aware of tells, to try harder to observe-and interpret-them. If so, you can thank my dentist, Dr. Goldy. My guess is that he is much too busy to join us in a game of poker - even with his expertise in interpreting my tells while seated in his dentist chair...

Creating Confident Smiles
416 N. Bedford drive, suite 409
Beverly Hills, CA  90210

Monday, November 4, 2013

A Healthy Framework For A Beautiful Smile Making Smart Choices in Cosmetic Dentistry

Cosmetic Dentistry 

A beautiful smile is an essential part of looking good these days. Wanting to look your best is one thing, but feeling secure in the knowledge that you have a perfectly healthy mouth as well is even more important. Beyond improving your appearance, cosmetic dentistry has the unique advantage of being able to improve your overall health.

Dental Health 

According to the Surgeon General, our dental health contributes to serious health problems including heart disease, lung disease, diabetes and low birth weight in babies. Many people have historical dental work that is compromising their oral health. Others have worn their teeth to the point that their bite is causing symptom of "TMJ," such as headaches, muscle pain, and even dizziness.

Top cosmetic dentists address these problems first. Before you add porcelain crowns or veneers, a full evaluation of your oral health must be done. If the cosmetic dentist does not do a full examination and evaluation of your dental health before you start to talk about the cosmetic work, get out of there fast! Without this step, you could find yourself with serious health problems down the line. Not to mention an investment in a smile with little to support it over time.

Cosmetic dentistry should never be about an aesthetic "quick fix." It's about being the best you can be and when you leave old health issues unhandled and simply cover them up with porcelain veneers or other cosmetic dentistry methods, you’re headed for trouble.

What are the oral health issues that have to be taken into account and handled before starting cosmetic dentistry?

To Be Filled in With Dr. Goldy:
Healthy gums
Decayed teeth
Missing teeth
Old dental work/ Destructive broken down filling
Impression taken, if needed
Photographs taken for imaging

Evaluation and Diagnosis

A complete evaluation and diagnosis should be done and a full treatment plan devised that addresses both your oral health and aesthetic concerns.

Cosmetic and restorative dentistry has to be done in phases:

If you are young and healthy with no decay, and you have been taking good care of your teeth with regular cleanings, you can probably go straight to cosmetic dentistry.

The more extensive your dental history, and the more time has elapsed since you last saw a dentist, the more likely it is that you will need to address basic health issues first.

If you have started thinking about having cosmetic dentistry done, you're already on the path of wanting to look your best. Don't sell yourself short. Make this a choice to take the very best possible care of your physical appearance and your long term health. Find a cosmetic dentist in your area who will do all the work necessary to create a healthy framework for your beautiful smile. 

Creating Confident Smiles
416 N. Bedford drive, suite 409
Beverly Hills, CA  90210

Friday, October 18, 2013

Periodontal Disease

Also referred to as gum disease (pyorrhea), it is an infection that invades and destroys the tissues that support and surround the teeth. An estimated 67 million people (nearly one in three adults) in the U.S. suffer from some degree of periodontitis. It is the leading cause of tooth loss in adults; it insidious onset and slow progression (usually); along with the fact that it is nearly always painless make it a challenge to mange and treat. Even the most successful treatment outcome allows for an "arrest" of the disease; not a cure. The common cold is the only disease known to mankind that is more prevalent than periodontitis.

Stages of Periodontal Disease

Periodontal disease most always begins as gingivitis, inflammation of the gum tissue (gingival) that has not yet advanced to the bone. Its silent progression starts with a growing colony of toxin producing bacteria called plaque. In time this plaque gets mineralized from bathing in saliva and becomes calculus (tartar). the calculus that exists underneath the gumline (subgingival) is the most destructive element of periodontal disease. Lack of proper oral hygiene and a variety of other risk factors result in an accumulation of plaque and calculus that inflames and infects the gingival and bone. A periodontal pocket forms (crevice/space between the gum and bone) forms along with swelling, bleeding and tenderness of the gum tissue; and eventually permanent gum and bone damage; and ultimately tooth loss.

Scientific research has uncovered a relationship between periodontitis and other serious health conditions such as heart disease, stroke, diabetes, respiratory disease, pregnancy; and pre-term, low birth weight babies. Genetic makeup, smoking, stress, hormonal changes and various medications are also risk factors.

Periodontal Treatments and Procedures

Early detection and appropriate treatment is the key to halting disease progression. During and after treatment; a serious long term commitment is necessary for a patient to arrest the disease process.

Treatment is basically divided into 2 types: Surgical and non-surgical. Surgical treatment is usually carried out by a periodontist; although some general dentists have been known dabble. The extent and success of Non-surgical treatment vary from dentist to dentist. I have recently organized and implemented a proactive, comprehensive Soft Tissue Management (STM) program which utilizes various modalities to offer my patients the best chance of treating their conditions without surgery.

1. Scaling: this should not be confused with a dental prophylaxis/teeth cleaning that is performed only in a healthy mouth for primarily preventive purposes.

A. Gross Scaling: carried out with an ultrasonic device, it removes the gross or large particles of calculus that can be very tenaciously adhered to the tooth/root surface.
B. Fine scaling: uses hand instruments called scalers or curettes which are intimately adapted to the root surface to remove the finer particles of plaque and calculus above and (mostly) below the gumline.

2. Root Planing: a meticulous and technique sensitive procedure to remove bacterial plaque, biofilm calculus and diseased root surface to allow for healthy reattachment of the gums. This usually requires local anesthetic.
3. Irrigation: although there are different ways to accomplish this; we use a specialized blunt tip needle (with 4 ports)  attached to a "piezo electric device which pulsates medicaments into a periodontal pocket. This device allows the solution to be warmed. The most common medicament is Chlorhexidine. It is an FDA approved antibacterial mouthrinse that is available only by prescription. The goal is obviously to minimize the amount of bacteria in the pocket. This procedure is usually carried out along with Scaling and root planing.

4. Antibiotic therapy. Although there are a few different topically applied antibiotics; we prefer "Arestin" a crystal/powder form of minocycline (cousin to tetracycline) that is manually placed ina pocket (indicated in pockets over 4 mm that do not respond to scaling/root planing alone). Arestin dissolves in the pocket over a 21 day span.

5. Personal Oral hygiene. Besides the conventional brushing and flossing, there are specialized toothbrushes (Rotadent: recommended and sold only by participating dentists) and other periodontal aids that assist in the daily removal of plaque at home. A good dental hygienist/dentist should suggest an individual program for each patient undergoing our STM program. This is essential for successful treatment.

6. Recall/Supportive periodontal therapy. There is some evidence and immense clinical observation to support the facet that 90 days is the time necessary for bacteria to re-establish to the point they can cause more damage to periodontal tissues. This time interval is often the benchmark for successful follow up aftercare from STM and conventional Scaling, Root planing. 4 months is permissible in some patients.

The goals of non-surgical periodontal therapy are as follows:
A. Gingival tissues that are not red, puffy, swollen and DO NOT BLEED.
B. Fresher tasting/better smelling mouth.
C. Continuous personalized home care/oral hygiene.
D. Healthy periodontal pocket depths.
E. Avoidance of surgical periodontal treatment.

Creating Confident Smiles
416 N. Bedford drive, suite 409
Beverly Hills, CA  90210

Friday, October 4, 2013

Halloween Candy: Frequency, Not Amount, Raises Cavity Risk

Halloween can present a very scary time of year for any parent concerned about their child's oral health, since your kids will probably come home with that big haul of candy from trick or treating. But should you let them immediately gorge themselves on the candy and get it out of their system?

Risk of Cavities

Temple University pediatric dentist Mark Helpin thinks that might not be such a bad idea. "The frequency of eating candy, and other refined carbohydrates, and their stickiness, are big factors in creating the risk of caries (cavities)," he said. 

Eating carbohydrates can change the pH balance of the mouth, making it more acidic, which can increase the risk of cavities. Each time candy is eaten, the acid environment in the mouth can take up to an hour to dissipate. "If I eat a piece of candy now, the pH in my mouth will become acidic, and it will take 30-60 minutes for it to become normal," said Helpin. "If I eat 2 or 3 pieces of candy when I eat that first one, my mouth stays acid the same length of time that it would if I ate just that single piece. It's still 30-60 minutes. If I keep eating candy throughout the day, there is acid in my mouth for a much longer period of time. The longer teeth are in an acid environment, the greater the risk they will become decayed."

Helpin, the acting chair of pediatric dentistry at Temple's Maurice H. Kornberg School of Dentistry, says that there are a number of ways parents can minimize this risk while still letting their children enjoy the holiday.
"Parents can let kids eat a bunch [of candy] now and a bunch later. But don't let them have one piece now, then an hour later let them have another piece," he said, adding that candy can also be dispensed as a dessert or snack.


Meals are a good time at which to have treats as dessert because the production of saliva increases, which helps to wash away acidity in the mouth. Helpin also recommends that parents have their children brush their teeth after eating candy, or if that's not possible, tell their children to rinse their mouth with water three or four times after eating, which will help reduce acidity in the mouth.

Helpin warns that substituting small bags of chips or pretzels for candy doesn't solve the cavity problem, either. "Chips and pretzels are also carbohydrates and they also will create an acid environment that can create cavities," he says. "These treats and snacks get stuck on your teeth, and that's the stickiness factor," he said.

When trick-or-treaters come to his door, Helpin likes to give out sugar-free candies, and avoids the sticky, gummy candies, which stick to the teeth promote cavities because they allow bacteria "to feed" for a longer time. Ultimately, "it's not realistic to think you can tell your child you can't have candy, cookies, cakes, or other treats," says Helpin. "Those are the things most people enjoy -- and we want our kids to enjoy life."

Creating Confident Smiles
416 N. Bedford drive, suite 409
Beverly Hills, CA  90210

Friday, September 20, 2013


What is bruxism?

Bruxism is the term that refers to an incessant grinding and clenching of the teeth, unintentionally, and at inappropriate times. Bruxers (persons with bruxism) are often unaware that they have developed this habit, and often do not know that treatment is available until damage to the mouth and teeth has been done. Damage caused by bruxism often includes the following signs and symptoms. However, each individual may experience symptoms differently. Signs and symptoms may include:
  • Abraded teeth
  • Chipped or cracked teeth
  • Facial pain
  • Overly sensitive teeth
  • Tense facial and jaw muscles
  • Headaches
  • Dislocation of the jaw
  • Wearing away of the tooth enamel, exposing the underlying dentin (inside of the tooth)
  • A popping or clicking in the temporomandibular joint (TMJ)
  • Tongue indentations
  • Damage to the inside of the cheek

The symptoms of bruxism may resemble other conditions or medical problems. Consult a dentist or your physician for a diagnosis.

What causes bruxism?

Although this habit is unintentional, oral health specialists often point to excessive stress and certain personality types as typical causes of bruxism. Bruxism often affects persons with nervous tension such as anger, pain, or frustration, and/or persons with aggressive, hurried, or overly competitive tendencies.

How is bruxism diagnosed?

During regular visits to the dentist, the teeth are examined for evidence of bruxism -- often indicated by the tips of the teeth appearing flat. If signs and symptoms are present, the condition will be observed for changes over the next several visits before a treatment program is established.

Treatment for bruxism

Specific treatment for bruxism will be determined by your dentist or physician based on:
  • Your age, overall health, and medical history
  • Extent of the disease
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

In most cases, bruxism can be successfully treated. Treatment may involve:
  • Behavior modification
  • NIGHTGUARD: A specially-fitted  mouth appliance may be worn at night to absorb the force of biting. This appliance may help to prevent future damage to the teeth and aid in changing the patient's behavior.
  • Biofeedback: Biofeedback involves an electronic instrument that measures the amount of muscle activity of the mouth and jaw -- indicating to the patient when too much muscle activity is taking place so that the behavior can be changed. This is especially helpful for daytime bruxers. Further research is needed to develop a treatment program for bruxers who clench during the night.

Creating Confident Smiles
416 N. Bedford drive, suite 409
Beverly Hills, CA  90210