Ever have a dental problem, issue or concern and wonder what's a reasonable thing to do about it, or at least know? Those are the kinds of things we discuss on this blog.

September 30, 2020
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Is it important to avoid dark-colored foods and beverages during periods of performing teeth whitening treatments?

- Do you need to abstain from coffee, cola, tea, red wine and dark fruits (blueberries, blackberries, red and purple grapes, etc...) during your bleaching process? | What does research show?

Do you need to maintain a "white" diet when bleaching your teeth?

One common "rule" you'll encounter with having teeth whitening treatments (using either an at-home system or one involving your dentist) is that you must avoid foods and beverages that have a strong or dark coloration during the time frame (days, weeks) when you're treatments are being performed.

This warning typically includes beverages such as coffee, tea, red wine and cola. And foods such as dark fruits like blueberries, blackberries, and purple grapes. And avoiding these chromogenic (colored) foodstuffs is referred to as maintaining a "white" diet.

Not adhering to this type of diet is frequently cited by manufacturers, and dentists too, as a reason why the whitening results a person has achieved aren't as dramatic as initially suggested they would be.

But is this "white diet rule" based on science?

No. It might come as a surprise to you but there hasn't been a study published based on clinical trials that have evaluated this specific subject.

And that means, despite what you've been told, and no matter how earnestly, this rule is really just conjecture and unsubstantiated conventional wisdom.

What scientific evidence does exist, one way or the other?

While documenting sources for information found on other pages of our website, we unexpectedly ran across a paper titled: White diet: Is it necessary during tooth whitening? (Lead author: BA Matis)

And as soon as we noticed this title, we were quick to get a copy of the article so we could read through it.

▲ Section references - Matis

A before-and-after picture set of teeth whitening results.

Whitening results.

What does the paper say? Is maintaining a white diet during your treatment period really necessary?

A surprise.

Since we too had been influenced by the conventional wisdom published in dental literature and provided by whitener manufacturers, we found it surprising that the article concluded that the majority of evidence suggests that avoiding colored foodstuffs does not increase the level of whitening results a person's teeth achieve.

More specifically, and in more formal terms, the paper itself states ...

  • "Adhering to a white diet during the process of tooth whitening did not improve the esthetic outcome."

 

So, there you have it. Abstaining from coffee, tea, red wine and dark fruits, during your bleaching process (either at-home treatments or a series of professional ones), really isn't going to do anything in terms of enhancing your lightening results.

We'll also point out, and different from whitener manufacturers (and possibly even your dentist) who may be looking for a scapegoat to explain lackluster results, the authors of this paper were reporting "just the facts." They had no conflict of interest related to this subject.

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August 25, 2020
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Teeth straightening at home (Direct-to-consumer / DIY orthodontic kits and systems) - Does using this kind of approach make a good idea?

- Are there reasons why using a self-directed / on-your-own system can make a bad choice? | What specific concerns would your dentist have?

Using home teeth aligners is big business ... but does using this kind of DIY approach make a reasonable choice?

The possibility of making arrangements for straightening your teeth at-home, on-your-own has exploded into a myriad of options.

As proof, just do a quick web search for the keywords "home teeth aligners." When you do, you'll turn up a multitude of brand names (Smile Direct Club, SmileLove, Candid, SnapCorrect, AlignerCo, Byte aligners, etc...), with each company offering to guide you through the process of obtaining the perfect smile, on your own, at-home, seamlessly.

However, ...

Even though you do have a number of, evidently quite popular, options, the question then arises: Just because you can buy an at-home kit, does it make a good idea?

In an attempt to help you answer this question for yourself, we've looked through professional dental publications to create a list of arguments and talking points that are usually mentioned about direct-to-consumer aligner systems (admittedly, typically as negatives for choosing this method).

So, if asked ...

Here's what dentists tend to say about choosing at-home teeth straightening.

Picture showing a comparison of the appearance of clear teeth aligners vs. traditional braces.

A comparison of invisible vs. conventional dental braces.

1) Where's the experienced oversight?

Probably a dentist's biggest objection to a person choosing self orthodontic treatment is the lack of direct professional oversight throughout the duration of their case.

a) Who's at the company end of your case?

As the buyer of an at-home system, you may take comfort in the fact that at least someone at your aligner company has looked at your case and passed judgment on it. But what qualifications (technician vs. dentist) and motivations (case rejection means no sale for the company) do they have?

b) Is an orthodontist involved with your case? To what extent?

As a selling point, some do-it-yourself aligner companies proudly state that an orthodontist does play a role in case acceptance, planning, monitoring and/or support. The term that's frequently used to indicate this service is "orthodontist directed."

We see this feature implemented at varying levels with the Candid, SmileLove, Smile Direct Club, SnapCorrect and Byte systems. It's typically mentioned in conjunction with case acceptance/approval. Beyond that, the level of direct involvement with a patient's case seems to vary.

FYI: The orthodontist approving your case doesn't really have complete information.

While participating in the training program where any orthodontist has earned their credentials, they would have been required to do a complete patient workup before planning and treating anyone's case.

Yet with DIY at-home aligner systems, the same standard isn't met. The orthodontist doesn't have this same level of information that they were trained to require. Instead, they frequently just have some self-made (patient-made) photos and dental impressions (of varying quality), and from that make a diagnosis and treatment plan.

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August 6, 2020
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Does dental insurance cover crowns?

- Better plans usually do but it just depends on how your policy reads. | Here's how to tell. / What to look for. | How much in benefits can you expect? / Common limitations. | Example calculations: Crown cost with insurance.

Will your insurance plan cover your dental crowns?

How can you figure out the coverage you have?

Your dental plan very well may provide benefits for crown placement, although not usually at 100%. To know for certain, and to understand what level of coverage to expect, you'll simply have to check the wording of your policy or the promotional materials that you've been given or have access to online.

The first portion of this page explains how to do that. Then, once you've determined that this is in fact a covered procedure, the bottom section of this page gives sample calculations detailing how much crowns can cost with insurance. Jump ahead.

What details do you need to look for?

1) Are dental crowns mentioned as a covered item?

Insurance companies typically group dental procedures into general categories (usually Preventive, Basic and Major). The level of benefits paid for a particular procedure is then influenced by the category in which it's been placed.

What insurance classification do dental crowns fall under?

Crowns are usually classified as a "Major" dental service Defined.. So, check this section of the materials you have to see if crowns are included in the list of provided services.

What kinds of crowns does dental insurance cover?

If crowns are a covered procedure with your plan, take notice if there are any obvious limitations in what you see mentioned, like the case where only certain types are listed.

A list that includes all kinds of crowns Types of dental crowns. would be expected to include terms similar to the following three categories: 1) Full-cast/All-metal, 2) All-ceramic/Full-porcelain/Metal-free, and 3) Porcelain-fused-to-metal/PFM. (Other possible plan limitations for crowns are outlined below.)

2) If included, what level of benefits does the plan provide?

How much coverage does dental insurance usually provide for crowns?

As a Major service, dental plans usually cover crowns at 50% of what the company considers the "usual, customary and reasonable" (UCR) fee Calculation explained. for that kind of crown. Crown costs, by type.

Do any plans cover crowns at 100%?

Well yes, there must be some. But no, that's not the norm. The prevailing level of benefits provided by plans for dental crowns is 50%.

How a plan's UCR fee may affect the level of benefits you received.

It's important to understand that in some cases the benefits your insurance company pays out will be based on their UCR fee and NOT the actual fee you've been charged for your crown by your dentist.

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May 31, 2020
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How does using a rubber dam for dental procedures help to prevent the spread of the coronavirus?

As dental offices start to reopen following the initial peak of the COVID-19 epidemic, their dentists will need to implement a new set of "standard" protocols aimed at reducing their patients' in-office risk of exposure to the coronavirus.

One very effective step is the use of a dental dam (rubber dam) with patients when performing those procedures where its use is applicable.

This post explains how using a dam helps to reduce the potential spread of the coronavirus from infected patients into the dental office environment. And answers general questions about rubber dam usage/effectiveness that patients tend to have.

What is a dental dam?

A dental dam, frequently also referred to as a rubber dam, is a simple barrier device where a patient's teeth being work on poke through holes that have been punched in a sheet of "rubber" (in most cases, it's actually a sheet of latex that's used).

A tooth with a rubber dam in place.

A tooth with a rubber dam in place for its root canal treatment.

The basic goal of using a dam is to provide the dentist with a more controlled environment when performing a tooth's procedure. This is referred to as "isolating" the tooth.
[If you need further explanation about dam usage, the page linked here provides details (placement, use, removal, post-op considerations, etc...) about rubber dams when used in conjunction with performing root canal therapy.]

How does placing a rubber dam help to prevent the spread of the coronavirus?

The whole idea is very simple. The tooth isolation that a dam provides creates a working field where the level of viral particles that might be picked up from an infected patient's mouth during their dental procedure and spread into the dental office environment as a splash or aerosol is significantly reduced.

A tooth with a dental dam (rubber dam) in place.

Diagram of a tooth with rubber dam in place.

Our diagram illustrates how this works ...

The green line you see in our illustration represents the rubber dam (most commonly a sheet of latex). And also shows the metal clamp that grasps around the tooth to hold the sheet in place.
(In our real-life picture above, the sheet of latex is pink, and you can also see the rubber dam clamp that's been placed on the tooth.)

Notice that ...

With the dam in place, the patient's mouth has now been divided into two parts, a wet and dry side.
a) The portion of the mouth underneath the dam. | The wet side. -

Everything underneath the latex sheet is simply that part of your mouth that you see when you open it. It's your tongue, gums and most of your teeth, along with all of the saliva that bathes and covers over them.

Of course, if a patient has been infected with COVID-19, a fact they may or may not be aware of, it's this side of the dam where the bulk of the virus will lie (primarily in the patient's saliva).

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May 24, 2020
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Does a dentist really need an x-ray for every tooth extraction?

Consider this scenario ...

1) A dentist has a patient in their dental chair who has a tooth that has quite a bit of mobility.
2) Related to the tooth's looseness, it's pretty clear to both parties that the extraction process should be exceedingly easy.
3) The patient has no interest in the dentist investigating the tooth to see if it can be salvaged.
4) They just want it pulled, and as inexpensively as possible.

So with this type of case, is an x-ray really needed for the extraction?

Our premise.

What we've tried to portray above is a situation that involves the simplest scenario for an extraction. Not one where explicit knowledge about the tooth's root(s) anatomy will play a significant role in the act of removing it. (A situation where the benefit of taking an x-ray is clearly obvious.)

But instead, the case where the physics of the extraction process are so overwhelmingly in favor of the dentist that the patient could have probably even just pulled their tooth on their own, if they only had a way to numb it up.

So, even with this type of simple case, is an x-ray still always needed?

As you've probably already guessed, yes, in most cases you can anticipate that your dentist will still want one. The remainder of this page explains the various reasons why.

Reasons why a dentist will feel that they must take a pre-op x-ray, even for easy extractions.

1) Doing so adds another procedure they can bill for.

Just to get all cynicism out of the way first, yes, the requirement of taking a pretreatment radiograph will add to the cost of your bill for removing your tooth.

But despite the fact that your dentist may thank their lucky stars that they are in a profession where they can dictate what services are required, in reality, it's hard to imagine that this reason alone has much to do with the way they practice dentistry.

That's not to say that abuses with imaging don't occur.

The type of radiograph that's taken of your tooth can affect your bill substantially. And while it's not expected that a patient would have the expertise to know specifically what type is indicated for their case, you can ask questions.

Generally, in increasing order of expense, here are the types of imaging used.

A periapical dental x-ray.

A periapical dental radiograph.

a) Periapical x-rays (PA's).
This is the small type of dental x-ray you are probably most familiar with. The film or x-ray detector used to capture the image usually measures on the order of 1 by 1.5 inches.
  • By definition, this type of radiograph shows the entire tooth, root and all. (In dental usage, the word "periapical" equates with "around the root's tip.")

This is the least expensive type of dental x-ray (around $35). And in the vast majority of cases, this type of picture provides all of the information a dentist needs for the tooth's extraction procedure.

b) Panoramic films.

This type of radiography shows all of a patient's teeth and much of their associated jawbone structure. It's cost runs on the order of $130.

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May 22, 2020
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How likely are you to be exposed to COVID-19 at your dentist's office?

The website MarketWatch recently published this story, with the spin of the article being ... Which members of the workforce are at greatest risk of contracting COVID-19, ... for the least amount of pay.

What we took away from the article.

While the issue of money is important for any person and their family, what we found most interesting about the article's accompanying chart was simply which jobs/professions were considered those that placed their workers at greatest risk for COVID-19 exposure.

What they determined ...

As it turns out, the methodology the article used concluded that dentists, dental hygienists and dental assistants were some of the highest at-risk groups. And, specifically, 3 of the 4 most at-risk ones, meaning more at risk than doctors, nurses and most all other medical professionals.

What does that mean for you, the dental patient?

What are your risks for being exposed to the coronavirus when visiting your dentist's office?

It's a simple fact, there are multiple factors associated with the dental office environment that makes minimizing the patient's potential for exposure to the coronavirus a unique challenge. And much more difficult to manage than with essentially all other types of businesses you visit.

What follows below is an explanation of some of the primary risk factors involved, why they exist, and what can be done to help to mitigate them.

The idea of this page isn't to suggest that going to the dentist is unnecessarily risky. Instead, it's to explain why the nature of the dental office environment isn't as inherently benign as many others when it comes to the potential for virus spread. And therefore, your visit should be purposeful, and while there, you need to remain vigilant in following safe practices.

Dental office COVID-19 transmission issues and concerns.

1) Physical proximity to other people.

Having close, direct personal contact with other people, any of whom may unknowingly harbor the coronavirus, raises your potential for its transmission to you. And at different stages of your dental office visit, the nature of your contact with others will need to vary.

Here are some of the basic issues that should be considered with the different types of situations you'll encounter.

a) During your dental treatment.

Clearly, when dental work is performed, it's by a provider that's in close proximity to the patient. And for that very reason, it seems inconceivable that your dentist won't take steps to create as much of a barrier between you and them as possible.

It's not just a one-way street.

While much of the focus of wearing barrier devices may seem to just provide protection for the person donning the gear, it actually goes two ways. They also help to contain droplets that might be expelled by an infected person, like when coughing, sneezing, or even just talking.

What should you expect to see your dentist wearing?

A paper titled "Transmission routes of 2019-nCoV and controls in dental practice" (Peng) describes three tiers of protective wear recommended for dental professionals (the dentist and their clinical staff) under different circumstances.

The most basic one, categorized as "Primary protection" is considered suitable for general practice settings and includes wearing:

  • A disposable surgical mask. | Protective goggles or face shield. | Disposable gloves. | In-office-only work clothes. | A disposable work cap.

 

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May 13, 2020
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Can you recement your porcelain veneer back on with super glue?

Porcelain veneer emergencies will always happen. And in fact, we have an entire page that explains the kinds of things that can go wrong with veneers and why.

But beyond those general types of issues, from time to time we're asked specifically if it's OK for a person to recement their porcelain veneer that came off back on their tooth with super glue (cyanoacrylate, Krazy Glue®). This page address the various issues associated with that subject.

Our short answer.

Using super glue to put your veneer back on is a bad idea.

The basic goal of this page is to try to convince you that reattaching a lost veneer with super glue makes a poor choice. And while that notion may not surprise you entirely, the primary reasons we give to support that stance are probably different than the ones you may have expected.

What we were expecting to find ...

When doing the research for this page, we thought that it would be a simple matter to search through dental literature and find sources that stated that using super glue directly on tooth surfaces harms them. On the contrary, however, we didn't (we discuss this issue below).

So, we're not making the case against using cyanoacrylate products to reattach a lost veneer based on that argument.

Where the larger concern seems to lie ...

Instead, and as outlined on this page, in almost all cases a do-it-yourself job is almost certainly going to be deficient in several ways, due to both the DIY nature of your work and the properties of the material used (the cyanoacrylate).

And that means, despite having accomplished what you think looks like a great job, in reality, and unknown to you, it will have some serious shortcomings.

  • Some of these will place your tooth, its neighboring teeth and associated gums at risk for complications. (Especially over the long-term.)
  • And generally, your attempt will simply make your dentist's job of making a permanent repair just that much more difficult.

 

Here's an explanation of those points ...

1) The presence of voids under the veneer.

One of the biggest concerns with a do-it-yourself job is that when you recement the veneer, the super glue won't fully fill in 100% of the space between your tooth and restoration.

What's the concern?

Besides not being cemented as securely as it could be, if a void exists, several other potentially serious problems can occur.

a) Bacteria will find a home.

If an accessible nook or cranny exists in the mouth, like a minute void that opens at the edge of a porcelain veneer, it will be colonized by bacteria.

And since the space cannot be cleansed (which would be the case with this type of situation), that persistent accumulation of plaque will place the tooth and its associated gum tissue at increased risk for the formation of tooth decay and gum disease.

b) Voids may affect the appearance of your veneer.

Background - The color of a veneer, especially a porcelain one that's been designed with a lot of translucency (an important feature in helping it to look lifelike), is heavily influenced by the color of the cement that's used to bond it into place.

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April 26, 2020
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Can you pull your own tooth? Should you try?

We get this question every once in a while in our comments section. Most recently it was asked by a person whose dentist's office was closed due to the COVID-19/Coronavirus pandemic. And then just a few days ago, we saw this article about a man who actually did pull his own tooth, a molar.

So, is doing a DIY extraction possible?

Your dentist probably has at least one patient who has.

We expect that probably every dentist has been told by at least one of their patients that they've pulled one of their own teeth.

The usual details.

The classic scenario is one where the tooth involved was a lower front incisor that had extensive gum recession. And was so loose that it practically flapped in the breeze.

The story usually continues with ...
  • The tooth had been loosening up over the years (the person is often elderly). Sometimes, there's been a traumatic event (like biting into hard food) that's finally loosened it up severely.
  • The person tested the waters by wiggling and twisting on it, gradually more and more, and found that doing so didn't really hurt very much.
  • They then finally decided to just go for it, and twisted the tooth back and forth until it came out.

 

How a dentist would interpret this story.

When hearing their patient's narrative, any dentist who might have been alarmed initially about the level of pain that must have been endured soon begins to understand what took place and why they were able to get it out.

The situation that existed.
  • Their patient has simply described a lower front tooth that's been severely compromised by the effects of advanced gum disease.
  • The extensive gum recession that took place as a result was an indication that there was very little bone still encasing the tooth, meaning it was primarily just anchored in gum tissue.
  • Twisting the tooth back and forth stripped that attachment away from its root, with the tooth then coming out simply and quickly.

 

Every dentist knows how easy these (small, good access, single-rooted) teeth can be to take out. In fact, when removing multiple teeth, including some in this condition, a dentist may feel sheepish about charging full price for extracting them.

So, is it OK to pull your own tooth?

No, despite what can be or is sometimes done, we can't imagine a scenario where a dentist, carte blanche, would recommend to their patient that they should just go ahead and extract their own tooth. Here are some explanations why:

Reasons why pulling your tooth yourself makes a poor idea.

Some of the biggest concerns a dentist would have with condoning self-extraction have to do with all of the unknowns involved.

Some of these are issues that must be known before the process of extracting a tooth is even considered. Others are things a layperson won't know to do, or how to do, either as a part of the extraction process or post-operatively. Here are some details.

a) Do you understand your tooth's condition?

Being able to physically remove a tooth by yourself is one thing. Understanding why the tooth has developed the problem that it has, and understanding the ways that issue affects you, your oral health and the extraction process, is equally important.

A dentist's diagnosis of your situation is needed. (It's common that dental x-rays are necessary to be able to form that conclusion, something that no layperson can provide on their own.)

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