It’s the height of the holiday season 2017 at the time of this writing. The days have whizzed by since Thanksgiving and the much-anticipated rituals and festivities of the holidays are upon us.
The halls of our office are literally decked with boughs of holly. Hanukah gelt is strewn over the counter. Strands of garland surround an inflatable menorah. And of course, the requisite holiday music is streaming through the Sonos system.
Just to be clear, we only play Christmas melodies during the week before Christmas. There’s only so much “Silver Bells” and “All I Want For Christmas Is You” that one can take!
The atmosphere has been festive for patients and office staff alike, with a cornucopia of holiday treats (gifts from patients and friends) to share with all. And, we have been very busy with patients under active care, patients who suddenly realize that they haven’t taken care of that broken tooth and the year is ending, college students who are home for holidays, people about to go on vacation who realize a tooth’s been nagging them and they better get it checked it out before they leave the country, and a seemingly larger than normal influx of patients (new and current) with dental emergencies. Such dental emergencies as an unexpected toothache or an untimely broken front tooth, of which I will now speak. (When, exactly, is a broken front tooth actually timely, anyway?)
Yes, in the weeks since Thanksgiving I have been urgently called upon to tend to and mend a number of front teeth in various states of breakage and disrepair. (Shades of “All I Want For Christmas are My Two Front Teeth”.)
This parade of cosmetic calamities, which threatened to dampen the holiday spirit, was born of various origins. From trauma (a college hockey player), old bonded fillings and facings which suddenly gave way from years of use, biting into an unexpected nut, biting into an unexpectedly hard nut, to an upper incisor which had root canal treatment but never a proper final restoration – and on it goes.
Yes, a conspicuously broken and unsightly front tooth is a blight to smiles captured on cameras and smart phones during holiday celebrations and parties. With that in mind, the office phone has not stopped ringing with emergency calls.
For as many conditions that can wreak havoc on the integrity of a front tooth, there are almost as many treatment options to address it. What follows is a description of the different ways I managed the cosmetic challenges presented to me during this holiday season:
Kathy appeared in my office on the very first day that she arrived home from her first semester in college. Kathy is a hockey player and unfortunately, was smacked straight in the mouth by a puck during a game. A well-hit hockey puck can sure pack a wallop!
Despite the fact she was wearing a protective mouth guard, angular chunks of enamel and dentin (what a tooth is made of) cracked off 1/3 of both of Kathy’s previously pristine front teeth. What’s worse was the next day she had to fly to Florida to spend the holidays with her family. And to further complicate matters, she had committed to head back to school directly from Florida for early hockey team practice. Ergo, no opportunity for follow-up care.
When Kathy arrived at my office sporting her big, warm, now gapped-tooth smile, my mission was to ensure that she would be off to Florida the next day with her heretofore-radiant smile restored.
I just had to figure out how to restore both of Kathy’s broken front teeth in one single visit. My solution?
The Solution: Bonding
Bonding, sometimes referred to as cosmetic bonding, revolutionized restorative dentistry when it was introduced in the 1970’s. The process of bonding gave rise to what we now referred to as cosmetic dentistry.
In the spirit of brevity, let me share with you some facts about bonding. Direct dental bonding is a technique in which the surface of a tooth is chemically treated to allow for the application and adherence of a highly esthetic tooth-colored epoxy-like resin material that is infused with glass, quartz or some type of ceramic. The material can be molded, shaped and polished to a very high and life-like luster.
Bonding is a relatively affordable cosmetic dental procedure. Its success is dependent upon the skill and artistic eye of the dentist. It is performed chairside in one visit without the use of a dental laboratory and the immediate esthetic results can be spectacular. Cosmetic bonding can last for years, but because the material is somewhat porous, it may lose its gleam and color over time.
Moreover, because the bonded material is layered directly onto the tooth, an inherent weakness of the material makes it more prone to breakage. So, The larger the surface being restored and the more material is needed to build the proper shape and form, the greater the likelihood for breakage under strain. The plus side is that if it breaks or cracks, it can be easily repaired or replaced.
Back to Kathy. I was able to recreate what she had before the unhappy collision with a hockey puck: two beautiful front teeth that stood front and center in her glowing and (when she looked in the mirror) appreciative smile.
Perhaps in the future (after she hangs up her hockey skates) Kathy may opt to “renew” her front teeth with Porcelain veneers, which brings me to another recent encounter involving broken front teeth.
Carol arrived at my office as a new patient about a week after Thanksgiving. She had been out of town enjoying turkey day festivities when bonding that was previously placed on her upper front teeth cleaved off and left her incisors looking gritty and ragged. An emergency visit to a dentist in the town she was visiting got the bonding repaired, but she was tired of the accelerated frequency of bonding touch-ups and patches.
Carol came in and was very clear about what she wanted: a brighter smile and two new front teeth before her next wave of holiday parties commenced. That didn’t give us much time!
The Solution: Teeth Whitening & Porcelain Veneers
I whitened Carol’s teeth with a combination of in-office and at-home bleaching and placed beautiful porcelain veneers on her upper front teeth. In just a couple of weeks, she had the smile she wanted just in time for the holidays.
Porcelain veneers take the concept of bonding to its pinnacle. Their delicate and fragile appearance is what makes them so elegant and natural looking. Essentially, porcelain veneers are porcelain and ceramic enamel facings, which are placed on teeth that have had light surface preparation. Porcelain veneers are secured in place with a bonding and the results are nothing short of stunning.
Since they involve at least two visits and are crafted at a commercial dental laboratory, the cost of porcelain veneers is considerably higher than direct bonding, but the results are superb. And, although porcelain veneers are like very fine pieces of Murano glass, once bonded into place they are extremely strong and usually last for many, many years. However, old habits die-hard sometimes, which brings me to my next holiday emergency encounter:
About seven years ago I placed six porcelain veneers on the teeth of my wonderful patient, Noelle. But, despite my warnings and periodic remonstrations, Noelle is an unrepentant ice chewer. She arrived at my office this past week after suffering an ice cube mishap. She had bitten into an extra hard cube and cracked one of her precious front veneers – and a good portion of the remaining tooth structure, too. Noelle did a real number on that front tooth!
The Solution: A Ceramic Crown
A ceramic crown is often referred to as a cap, but this is not your grandfather’s old cap. There is no black line at the gum-line and they are totally free of metal. Ceramic crowns are often the cosmetic restoration of choice when there’s not enough tooth structure to support a porcelain veneer. Rather than being a facing, a ceramic crown encompasses the entire tooth. However, it is virtually identical to a porcelain veneer in appearance.
The beauty and elegance of fine porcelain and its unique interaction with light is the cornerstone of modern cosmetic dentistry. The combination of the craftsmanship of a truly gifted dental ceramist working in a state of the art dental lab facility, combined with the skill of an experienced cosmetic dentist results in extraordinary results.
The process requires at least two visits with the patient wearing a temporary crown until the permanent one is perfected. Ceramic crowns are very strong and can be expected to last a very long time.
I prepared Noelle’s tooth for the porcelain restoration, digitally scanned it (versus a conventional gooey impression), and sent her on her way, smile intact ready to greet the holidays.
A broken tooth can be very distressing, but a broken front tooth can really put a damper on your holiday. This season brought an unusual number of cosmetic casualties that needed immediate attention and at the same time offers up to the interested, a glimpse of some of the various options available in the world of cosmetic dentistry.
I am gratified to have had the opportunity to bolster the Christmas and holiday spirit of patients in need, by restoring and improving their smiles.
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