Spring Branch Family Dentistry
Services
(713) 461-8050 • (713) 461-4747
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Porcelain
Veneers 
Porcelain veneers, also called laminates, are ultra-thin, ceramic shells,
which are bonded to the front teeth in a virtually painless procedure
usually requiring no anesthesia. Porcelain veneers have become increasingly
popular over the last decade; tens of thousands of them have been placed
to mask discolorations, to brighten teeth, and to improve a smile. Highly
resistant to permanent staining from coffee, tea, or even cigarette smoking,
the wafer-thin porcelain veneers bond tenaciously to the teeth, resulting
in aesthetically pleasing, natural-looking teeth.
Veneers can serve as an alternative to minor orthodontics but are not recommended in cases of severe crowding or misalignment of teeth or in malocclusions. They are preferable to full crowns when adequate tooth structure is present to support the restoration; they require less reduction of healthy tooth structure than full crowns do and compromise neither periodontal nor gingival health.
Spring Branch Family Dentistry has placed hundreds of
porcelain veneers and considers the technique invaluable in improving
smiles. Porcelain veneers can be used to:
Close spaces
between the teeth (diastemas)
Rebuild broken
or chipped teeth
Replace unsightly,
stained, or washed out fillings
Lighten discolored
teeth
Reshape crooked
teeth
Whiten stained
or yellowed teeth
Porcelain veneers offer an advantage over bonding in that the porcelain
will not stain or discolor over time. The veneers are quite thin, only
0.3 to 0.5 mm thick, but are very strong once bonded to your teeth. They
have a natural appearance, with the strength, beauty, and durability only
porcelain restorations can afford. Veneers do not require the depth of
tooth structure removal that caps or crowns do, but they can accomplish
a natural-looking aesthetic result.
Some facts about porcelain veneers:
Since they
require approximately 0.5 mm of tooth reduction, porcelain veneers are
not considered a reversible form of treatment
The preparation
of a porcelain laminate veneer does not usually require the use of a local
anesthetic; for those patients who are particularly sensitive or anxious,
local anesthesia may be advisable.
Because of
the minimal amount of tooth reduction, fabrication of a temporary restoration
is usually not necessary. If one is needed, it can be made at the time
of the initial veneer preparation appointment.
Porcelain
veneer patients can expect some temperature sensitivity between the preparation
visit and the application visit. This is normal and is due to the removal
of a small portion of the enamel covering of the tooth. The sensitivity
should disappear after the placement of the porcelain laminate veneer.
Application
of the laminate (the second visit) can be accomplished, once again, with
or without local anesthetic. The laminates are applied using a light-sensitive
resin, which is hardened with a special light, and this visit may take
longer than the first.
Tooth
Colored Fillings
White fillings are made from composite resin, a tooth-colored plastic mixture filled with microscopic glass beads (silicon dioxide). Introduced in the 1960s, dental composites were initially used only on the front teeth because they were not strong enough to withstand the pressure and wear generated by the back teeth. Since then, composites have been significantly improved and can be successfully placed in the back teeth as well. They are used not only in the restoration of decayed teeth but also for cosmetic improvement of the smile by changing tooth color or reshaping disfigured teeth.
Composites offer an advantage over porcelain fillings because they can be placed in a single visit; they are not, however, as strong as porcelain. Composites may discolor over time. Dr. Patel or Dr. Khosla will make recommendations on filling type based on his knowledge of these materials and examination of your teeth.
Following preparation of the tooth to be filled, the composite in applied layers and uses a special light to harden each layer. The composite will then be shaped to fit the tooth, polishing the filling to prevent staining and early wear. Composite resin is also used to bond or cement veneers and porcelain inlays and onlays (porcelain fillings) and in other aesthetic restorations.
Dental crowns and bridges restore or replace natural teeth that have been damaged, decayed, or lost. A crown restores a decayed or fractured tooth to its original form and function, and a bridge is a replacement for one or more missing teeth. These restorations are cemented onto an existing tooth or teeth and are referred to as "fixed" dentistry as opposed to restoration of missing teeth with a removable appliance or partial denture.
Both crowning and bridging procedures require the use of local anesthetic and the grinding or preparation of the damaged tooth in the case of a crown or of the adjacent teeth if a bridge is needed. An impression is taken of the prepared area, and a temporary crown or bridge is placed. A badly decayed or broken tooth may require the use of a special restorative material to build the tooth up during the preparation phase. A fixed bridge prosthesis will span the area of a missing tooth, or pontic; the two or more adjacent supporting teeth are called abutments. Bridges are used to replace one or two missing teeth and require healthy adjacent teeth to support the replacement teeth.
The permanent crown or bridge will be ready to be fitted,
adjusted, and cemented in place approximately two weeks later. A new type
of all-porcelain crown offers the best blend of aesthetics and strength.
Teeth which have been filled and refilled with silver can often be made
to look untouched.
Some of the indications for a crown are:
A previously
filled tooth in which there is more filling than tooth. The existing tooth
structure may weaken so that it can no longer support the filling.
Extensive
damage from decay.
Discolorations
and compromised appearance of tooth or teeth.
Fractures.
Following
root canal. Teeth tend to become brittle after root canal and are more
apt to fracture. Such teeth can be protected by a crown.
Partials
and Dentures
The replacement of missing teeth is an important part of maintaining a
healthy smile. When teeth are missing, the remaining teeth can change
position, drifting into the empty surrounding space. Teeth that are out
of position can damage oral tissues. Cleaning thoroughly between crooked
teeth may be difficult, increasing the risk of tooth decay and periodontal
(gum) disease which can, in turn, lead to the loss of additional teeth.
A denture helps in the proper chewing of food, a difficult task when teeth
are missing. A denture may also improve speech and prevent sagging of
the face by providing support for lips and cheeks.
A removable partial denture, also called a removable bridge, can fill
the gap left by missing teeth and improve your smile. A partial denture
can be made of acrylic resin, metal, or a combination of the two.
Complete or full dentures replace all the teeth in the upper or lower
jaw and may be either "conventional" or "immediate."
A conventional denture is placed in the mouth four to eight weeks after
removal of all the teeth; this time span allows proper healing. A conventional
denture may also be made to replace an existing denture. An immediate
denture is placed as soon as the teeth are removed. The main disadvantage
to an immediate denture is that more adjustments of the appliance may
be required after the mouth has healed.
Oral
Surgery (Extractions, Including Wisdom Teeth)
One of the main goals of modern dentistry is the prevention
of tooth loss. All possible measures should be taken to preserve and maintain
teeth because the loss of a single tooth can affect dental health and
appearance in a major way. Tooth removal is, however, sometimes necessary.
Some of the reasons for tooth extraction as as follows:
Severe decay
Advanced periodontal
(gum) disease
Infection
or abscess
Orthodontic
correction
Malpositioned
teeth
Fractured
teeth or roots
Impacted teeth
(mainly wisdom teeth)
Wisdom teeth, or third molars, do not always erupt properly. The modern
human mouth is often too small to accommodate wisdom teeth which appear
in young adults aged 17 to 26. Consultation regarding the extraction of
wisdom teeth is wise before they cause pain, swelling, infection, caries,
and gum disease; the late teens to early twenties is the best time to
remove these teeth. Depending on the severity of a particular case, we
may recommend an oral surgeon for the procedure.
Any dental surgery carries certain risks, including pain, bleeding, infection, permanent numbness, and broken root tips and bone. Although we take every possible precaution to prevent or reduce these complications, they sometimes do occur. We will explain the risks in detail before any procedure. If you feel that you cannot accept the possibility that a complication may occur, you may elect not to undergo the procedure.
If you have just had a tooth extracted or if Dr. Patel or Dr. Khosla have recommended that a tooth be extracted, the following information will be helpful in getting you through the first few days after your extraction. Should anything occur that seems out of the ordinary, do not hesitate to call the office.
PREPARING FOR SURGERY
The following are tips to help you prepare for your surgical appointment.
1. Clothing - Wear loose, comfortable clothing with sleeves that are easily
rolled up.
2. Jewelry - Remove watches and bracelets.
3. Transportation - We will advise you if you should come alone or have
an escort bring you to the office
4. Diet - Eat a light meal 1-2 hours prior to appointment
5 . Medications - Patients should adhere to their normal medications prior
to surgery. All maintenance medications such as high blood pressure, diabetes
and thyroid medications must be taken on schedule. Take medicine with
a small amount of water or juice.
Wisdom Teeth - Post Operative Care
Do Not Disturb the Wound
In doing so you may invite irritation, infection, and/or bleeding. Be
sure to chew on the opposite side for 24 hours and keep anything sharp
from entering the wound (i.e., eating utensils). Try not to speak too
much if possible.
Do Not Smoke for 12 Hours
Smoking will promote bleeding and interfere with healing.
Do Not Spit or Suck Through a Straw
This will promote bleeding and may dislodge the blood clot, which could
result in a dry socket.
Do not brush the extraction area for the first 24 hours after surgery
After that, you may brush gently to keep the area clean.
Avoid all rinsing for 24 hours after extraction
This is to insure the formation of a blood clot which is essential to
proper wound healing. Disturbance of this clot can cause increased bleeding
or clot loss which may cause a painful condition called dry socket. Use
warm salt water rinses after 24 hours to keep the area clean.
Control of Bleeding
When you leave the office following the extraction, you will be given
verbal instructions regarding the control of post-operative bleeding.
We will place a rolled up gauze pad on the extraction site, and you will
be asked to change this dressing every 20 minutes or so depending on the
amount of bleeding that occurs. Some oozing is normal. We will give you
a package of gauze to take with you to use at home if the bleeding continues.
Should you need to use the gauze at home, roll it into a ball large enough
to cover the wound. Hold the gauze ball firmly in place by biting or with
finger pressure for 20 to 30 minutes. If bleeding still continues, you
may fold a wet tea bag in half and bite down on it. Tea contains tannic
acid, a natural styptic, which may help reduce the bleeding.
Control of Swelling
After surgery, some swelling is to be expected. This can be controlled
through the use of cold packs, which slow the circulation. A cold pack
is usually placed at the site of swelling during the first 24 hours in
a cycle of 20 minutes on and 20 minutes off.
After the first 24 hours, it is advisable to rinse with warm saltwater
every two hours to promote healing. (One teaspoon of salt to eight ounces
of warm water).
Medication for Pain Control
Some discomfort is normal after surgery. Anti-inflammatory medication
such as Aspirin or Ibuprofen are used to control minor discomfort following
oral surgery. We may prescribe stronger analgesics if the patient is in
extreme discomfort. Any prescribed medication should be taken as directed.
NEVER TAKE A PRESCRIPTION PAIN MEDICATION ON AN EMPTY STOMACH. Be certain
to drink at least 8 glasses of fluids during the day when taking the pain
tablets.
Nausea
The swallowing of blood, the taking of pain tablets, not eating or the
operation itself may cause you to feel nausea or upset to your stomach.
Diet and Nutrition
A soft diet may be prescribed for the patient for a few days following
surgery. Eat normal meals as soon as you are able after surgery. Cold,
soft food, such as ice cream or yogurt, may be the most comfortable on
the first day. Other foods include soups, soft-boiled eggs, fish, dairy
products, or well-cooked cereals. Drink all the liquids you desire (coffee,
tea, milk, etc.) at least 8 large glasses of water or fruit juices each
day.
Following the removal of your wisdom teeth it is important that you call
us if any unusual bleeding, swelling or pain occurs. The first 6-8 hours
after the extraction are typically the worst, but are manageable with
ice packs and non-prescription pain medication.
EXPLANATION OF SYMPTOMS THAT MAY OCCUR
1. SWELLING: Swelling of some extent follows nearly every tooth
extraction. This is Nature's way of beginning the healing process. It
does not mean infection has set in providing there is no prolonged fever,
pain, etc. After the removal of impacted teeth or trimming of the bone,
swelling is often quite severe. It is most marked on the 2nd or 3rd day,
and begins to disappear on the 4th day.
2. STIFFNESS: Stiffness of the jaws is also Nature's way of resting
the bone which needs to be repaired, and usually relaxes about the 4th
or 6th day. Warm mouth washes and heat (heating pad, hot water bottle,
warm wet towel applied to operated area for 10 to 15 minutes 4 to 6 times
a day will be comforting.
3. DISCOLORATION: Black and blue marks on the face are caused by
bleeding internally into the checks or chin. This may appear first as
a swelling but after the 2nd or 3rd day it may discolor the face yellow,
black or blue. It will gradually disappear in a week or ten days. Heat
applied to outside may be comforting, but will not greatly speed up the
fading process.
Root
Canals (Endodontics)
Inside your tooth's hard outer shell is a nourishing pulp of blood vessels,
lymph vessels, and nerves. The canal of the tooth root provides a conduit
for these vessels and nerves to connect to the rest of the body's systems.
Deep tooth decay or injury to the teeth can cause serious damage to and
infection of the nerves and vessels of the tooth pulp. Root canal, also
known as endodontic treatment, cleans out the infected pulp chamber and
canals and replaces the organic material with an inert filling.
Some indications of the need for root canal treatment
may be:
Spontaneous
pain or throbbing
Pain while
biting or chewing
Sensitivity
to hot and cold
Severe decay
or injury that causes an abscess (infection) in the bone surrounding the
tooth.
Damaged or infected nerves and vessels in the tooth pulp will not heal
by themselves. Infection will spread without treatment; the bone around
the affected tooth will begin to degenerate, and the tooth may fall out.
Pain usually increases, forcing the patient to seek emergency dental attention.
The only alternative to root canal in these circumstances is extraction
of the tooth, which may cause shifting of the surrounding teeth and eventual
malocclusion. Although extraction is less expensive than a root canal,
the space left by removal of the infected or damaged tooth will have to
be filled by an implant or a bridge, procedures which can be more costly
than root canal therapy. If you have the choice, it is always best to
keep your original teeth.
Root canal treatment at our office requires two visits. Initially, you will probably be given a local anesthetic to numb the area. A gap is drilled from the top of the tooth into the pulp chamber which, along with any infected portion of root canal, is cleaned of all diseased pulp and reshaped. The pulp chamber and canals are then filled with a rubber like substance called gutta percha. If the tooth is weak, a metal post may be inserted above the canal to reinforce the tooth. Finally, a porcelain crown is placed over the tooth to strengthen it and improve appearance.
More than 95% of root canal treatments are successful.
Occasionally, a patient may require retreatment, and, on rare occasions,
a surgical approach is necessary to seal the canals shut.
Gum
Treatment (Periodontics, including surgery)
Gum disease is the primary cause of tooth loss in adults. Our doctors
do an outstanding job of educating their patients about the causes and
prevention of gum disease. They are qualified not only to help prevent
gum disease but can also treat the disease with specialized procedures
for which they have years of training and experience.
Here are some questions and answers that will better help
you understand gum disease:
What is periodontal (gum) disease?
Periodontal or gum disease is a chronic inflammation and infection of
the gums and surrounding oral tissue. It is the cause of 70% of adult
tooth loss and affects three out of every four people.
What causes periodontal disease?
Bacterial plaque, a sticky, colorless film that constantly forms on the
teeth, is recognized as the primary cause of periodontal disease. If plaque
is not removed each day by brushing and flossing, it hardens into a rough,
porous substance called calculus (tartar). Toxins (poisons) produced and
released by the bacteria in plaque irritate the gums and cause the breakdown
of the fibers that hold the gums tightly to the teeth, creating periodontal
pockets which are vulnerable to even more toxins and bacteria. As the
disease progresses, the periodontal pockets extend deeper and the bacteria
move down until the bone that holds the tooth in place is destroyed. The
tooth will eventually fall out or require removal.
Are there other factors in the development of periodontal disease?
Yes. Genetics is a factor, as are lifestyle choices. Poor nutrition can
diminish the body's ability to fight infection, as can stress. Smokers
and users of spit tobacco are more prone to irritation of the gum tissues
than those who do not use these products. Diseases that interfere with
the immune system, such as leukemia and AIDS, may worsen the condition
of the gums. Gum disease tends to be more severe and more resistant to
treatment in patients with uncontrolled diabetes.
What are the warning signs of periodontal disease?
Signs include red, swollen, or tender gums; bleeding while brushing or
flossing; gums that pull away from the teeth; loose or separating teeth;
pus between the gum and tooth; persistent bad breath; change in the way
teeth fit together when the patient bites; and a change in the fit of
partial dentures. While patients are advised to check for the warning
signs, there might not be any discomfort until the disease has spread
to a point where the tooth is unsalvageable. Frequent dental examinations
are very important.
What does periodontal treatment involve?
In the early stages, most treatment involves scaling and root planning,
that is, removing plaque and calculus around the tooth and smoothing the
root surfaces. Antibiotics or antimicrobials may be used to supplement
the effects of these procedures. More advanced cases of gum disease may
require a surgical procedure which involves cutting the gums, removing
the hardened plaque build-up, and recontouring the damaged bone.This technique
is also designed to smooth root surfaces and reposition the gum tissue
so it will be easier to keep clean.
I've been told that they just cut the gums away in gum surgery, leaving
the teeth looking long. Is this true?
Gum disease often results in recession of the gums, causing the teeth
to look longer. In the past, the cutting away of the gums, called gingivectomy,
also made the teeth look longer. Newer techniques have been developed
that require removal of less tissue.
How do you prevent periodontal disease?
Removing plaque through daily brushing and flossing and having regular
professional cleanings are the best ways to minimize your risk of getting
periodontal disease.
What is the role of the general dentist in the treatment of gum disease?
The general dentist usually detects periodontal disease and treats it
in its early stages. If you suspect you have gum disease, your first visit
should be with a general dentist, not a periodontist (gum specialist).
Some general dental offices, ours included, have acquired the expertise
to treat more advanced stages of gum disease. If we feel that a patient’s
periodontal disease requires treatment by a specialist, we will not hesitate
to refer that patient to a periodontist.
Is maintenance important?
Patients should visit the dentist at least every three to four months
for spot scaling, root planning, and a general examination. Between visits,
patients should brush at least twice a day, floss daily, and brush their
tongues. Manual soft nylon bristle brushes are the most dependable and
least expensive.
T.M.D.
(temporomandibular disorder)
TMJ is an abbreviation for the anatomic structure that we call the temporomandibular joint (jaw joint). This joint is similar in many ways to the other joints in our body, and is therefore susceptible to many of the same problems that affect other joints. When we talk about a disorder of this joint or its surrounding structures we prefer to use the term TMD which stands for Temporomandibular Disorders.
The conditions that most often cause or aggravate a temporomandibular disorder can be broken down into several categories.
Macro-trauma
(direct trauma to the joint or surrounding structures) One of the most
common injuries of this type is the flexion-extension or "whiplash"
injury.
Occlusion (dental
bite)
Micro-trauma
(harmful or abnormal habits) This is most often caused by tooth grinding
or clenching
Diseases of
the joint
Psychological
factors
There are also
a number of less common factors which may include referred pain, medication
side effects, and systemic disorders such as fibromyalgia.
WHAT ARE THE MOST COMMON SYMPTOMS OF TMD?
Clicking
or grinding noises when opening or closing the mouth
Tightness or
restrictions when opening the mouth
Pain when opening
or chewing
A jaw that
"gets stuck" or "locks"
Headaches
Earaches, fullness
or clogged ears
Spasms or tightening
of the jaw or neck muscles
TMD patients may experience one or many of the above symptoms. If you
think that you may have a temporomandibular disorder feel free to call
us with your questions.
How do I know if I need braces?
There are many noticeable signs that point to braces - such as major gaps
between teeth, crowded teeth, and turned or protruding teeth. However,
the need for braces can manifest in the form of bone abnormalities, jaw
joint pain, and distortion of the formative teeth. Many times these signs
can only be detected by x-ray or involved testing.
What causes crooked teeth?
Unfortunately, most crooked teeth are inherited traits, like eye color
and hair color. Habits such as thumb sucking and jaw grinding can have
an effect on how teeth form. Accidental falls or undue pressure on the
teeth and gums may also play a part in the development of crooked teeth.
How do you put braces on?
The braces or orthodontic brackets are bonded to the front of the teeth
using an FDA approved adhesive. Although the adhesive is very strong,
hard and sticky foods may break the adhesive bond. The adhesive cannot
be too strong or it cannot be removed from the teeth following completion
of the orthodontic treatment. The entire painless procedure usually takes
between one to one and a half hours due to the drying time of the adhesives
and description of home care.
Do braces hurt?
Everything from getting them on to taking them off is a snap! The most
important thing to remember is that braces are designed to help you and
that following the orthodontist's home care directions will help you live
easily with braces. Discomfort or "tooth soreness" may occur
after adjustments, but that's just your teeth's way of getting used to
the braces. Slow chewing on soft foods will help alleviate any soreness.
Also, remember to keep your mouth clean at all times by brushing properly
after meals. A clean mouth is a happy mouth!
When will I get my braces off?
Depending on your individual factors, the Dr. Patel can only estimate
the length of time you will wear braces. Outside influences such as growth
rates and cooperation with home care can prolong or shorten treatment
times. Your orthodontist and you will discuss your projected time frame
(can be anywhere from 6 months to 30 months).
What are the benefits of braces?
Braces ultimately provide better appearance of teeth, a harmonious smile,
and well-balanced face. Improved self esteem and self confidence are wonderful
side effects of these results! Braces also promote cleaner, healthier
teeth, an even bite for improved jaw alignment and function, and less
strain on muscles and joints. Braces also help prevent future tooth decay
and gum disease. Speech and swallowing habits may also be improved. All
in all, braces help keep you mouth healthy and beautiful!
Can I afford treatment?
At Spring Branch Family Dentistry, we make sure that our braces are affordable
and our patients' needs can be met financially. We will gladly discuss
your financing options, insurance coverage, and length of payment plan.
We work with each patient's particular financial needs to allow the best
orthodontic care with low payments.
Your wedding is coming up, and you want your smile to be its brightest. Or maybe you have an important speaking engagement. Perhaps you just want to whiten your smile. While the expense of porcelain veneers may not be for you, bleaching is an affordable way to lighten the color of your teeth.
Generally, bleaching is successful in at least 90% of patients; its effect can last from one to five years depending on dental hygiene and exposure to staining substances. You might consider tooth bleaching if your teeth are darkened from age, coffee or tea stains, or smoking. Teeth with yellow, brown, or orange discolorations respond well to bleaching. Although the results are not as dramatic, teeth stained gray from fluorosis or tetracycline can be also be lightened.
If you have very sensitive teeth, periodontal disease, or teeth with worn enamel, you may not be a good candidate for bleaching. The bleaching process will not change the color of existing white fillings or crowns; these may need to replaced to match your teeth’s new lighter color.
Dr. Patel and Dr. Khosla recommend and offer at-home bleaching systems. With the at-home bleaching technique, an impression is taken of the teeth to be lightened during the first appointment; this is an easy and painless procedure. After you leave the office, a special plaster is poured into the impression to create a model of your teeth. A thin clear tray is made which fits exactly over the model with a special reservoir for the bleach your second visit, you will be shown how to place the bleach in the reservoir and how to wear the tray. The bleach is a specially buffered gel containing carbamide peroxide and an ingredient to reduce tooth sensitivity. The tray is worn thirty minutes twice a day for one week or until desired degree of lightening is achieved. If the teeth begin to discolor over time the use of the at-home bleaching tray for a day or two will usually restore brilliance to the teeth.
Over-the-counter, nondentist-supervised kits are available
at the drug store or through advertising on TV, but they cannot offer
the special customized tray. The over-the-counter bleaching kits use a
homemade "boil and bite" tray that lacks the special bleach
reservoir.
1111 Gessner Drive, Suite B • Houston, TX 77055
(713) 461-8050 • (713) 461-4747