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writeradmin writes blog posts on behalf of Dr. Kasia Lopez

Should I do Invisalign or Teeth Whitening First?

I’m doing some things to upgrade my smile. I’m very excited. I’m going to both whiten my teeth and do Invisalign. I wondered if it mattered which procedure I do first?  Eventually, I’ll get some dental bonding done to take care of all my chips.

Melissa A.

Dear Melissa,

Congratulations on getting to work toward the smile you’ve always wanted. It looks like you’re wanting to straighten your teeth as well as change their shape and color. I wanted to make sure you knew there’s a procedure that can do all of those things at once.

Porcelain veneers can give you a complete smile makeover. They can change virtually anything about your smile. In fact, a great cosmetic dentist can custom design a look for you depending on what your goals are. They can lengthen your teeth to give you a more youthful appearance or widen them slightly to give you more authority. There’s virtually no end to the variations possible.

However, it is a high-end procedure and will cost more than what you’ve currently planned. That may factor into your decision.

If you decide to stick with Invisalign, bonding, and whitening, that’s okay too. Most dentists will allow you to do both Invisalign and teeth whitening simultaneously. You can use your Invisalign aligners the same way you would whitening trays. You’ll just need to purchase the whitening gel. Make sure you get the professional gel your dentist can provide. Anything you buy over-the-counter will not be nearly as strong.

As far as the dental bonding goes, make sure you don’t bond anything to your teeth until you’ve achieved the level of whiteness you want on your teeth.  Once the bonding is done, there’s no way to change the color. You’ll want your dentist to match it to your final results.

One word of caution with porcelain veneers, if you decide to go that route, make sure you go to an expert cosmetic dentist to get the best results, preferably someone with a beautiful smile guarantee. You can find a listing of artistic cosmetic dentists who practice in your area on the mynewsmile.com website

Best of luck with your smile makeover.

This blog is brought to you by Dr. Kasia Lopez.

My Childhood Orthodontist Ruined My Smile

I’m distressed about my smile. When I was a child my mother took me to an orthodontist. He felt my teeth were crowded and removed the one right next to my front teeth. That put my pointy teeth close to my front teeth. It makes my smile look ridiculous. Now that I’m older they’ve shifted and I have a big gap between those and my front teeth now. Is there any way to fix this? I don’t just want to push the teeth together because that would look weird to have my pointy teeth so close, but I don’t know what to actually do about it.

Kerri R.

Dear Kerri,

I’m surprised at what your childhood orthodontist did. Removing your lateral incisors is a mistake. The canine teeth are needed where they are to help support your back teeth in the back and forth motion of chewing.

I’m glad you see the problem in just shifting the teeth closer.  That would never quite look right. You’re going to need to work with both an orthodontist and a great cosmetic dentist, preferably one with significant experience with dental implants.

Ideally, you’ll have enough space to place dental implants between your front teeth and your canines. That will get your smile back to normal. Just be sure they’re also an experienced cosmetic dentist, so the results look as beautiful and as natural as you’d like.

If there’s not enough space, you could do another round of Orthodontics, possibly even Invisalign, depending on your case. This will shift everything into position to place the implants.

I’m sorry you’ve found yourself in this dreadful position. Hopefully, this will help you move forward and feel confident when you smile.

This blog is brought to you by Dr. Kasia Lopez.

Can a Crown Make TMJ Worse?

My dentist told me I have TMJ.  I went in because my jaw aches. He felt my teeth grinding led to the problem and wants me to get a mouth guard. I was going to then it turned out I needed a crown. So,  I had to get that first. Ever since I received the crown, my jaw’s been killing me.  It hits the teeth above it before any of the other teeth do. I don’t know if that’s the problem. My dentist adjusted it, but nothing’s changed. He says I’ll get used to the crown and just get the mouthguard. But this pain is much worse than what I had before the crown.

Monica T.

Dear Monica,

How your teeth come together is quite important. It takes some additional training to understand the best way to put those together. If it’s not done well, then yes, an improperly placed crown can exacerbate TMJ that’s already present. In fact, it can even cause TMJ.

Some dentists will just adjust it over and over again without any real difference being made to wear out the patient from complaining. They start to feel like they’re the problem and give up.  Or, they just grind it down until it doesn’t hit the opposing teeth.

Because it’s worsened your TMJ pain, I’d like you to get a second opinion with a dentist who truly understands TMJ. You can look at Dr. Lopez’s TMJ qualifications to get an idea of what type of dentist you want to see.

Getting a mouthguard will help with your TMJ pain after the problem with your crown is fixed. Plus, if you grind your teeth and don’t get one, the pain will steadily get worse and could lead to cracked teeth.

This blog is brought to you by Dr. Kasia Lopez.

Horrible Pain With White Fillings

I had a cavity and told my dentist I wanted a white filling. He wasn’t too keen on it saying that I risked infection from my saliva. I didn’t want the mercury fillings so pretty much insisted. Now I’m in terrible pain. I wonder if he was right and I have a problem with the filling. What do I do?

Ben T.

Dear Ben,

While I understand your desire not to want mercury loaded fillings, there is a danger in pushing a dentist outside of their comfort zone. Most struggle with admitting when they’re out of their depth. They’re usually concerned you’ll lose confidence in them, which is dangerous for your long term care. Instead, they’ll suggest alternative treatments.

The best dentists, of course, will put their pride aside and explain why they’re not qualified to do the procedure. Then help you get to a dentist who can.

Composite fillings (white fillings) are a different procedure than the amalgam fillings. Your dentist didn’t know how to do the procedure but didn’t want to disappoint you.

You’ll need to get this removed and re-done. Based on what you’ve described, there’s not a good seal on your filling. It’s going to become a haven for bacteria, putting you at serious risk for decay.

You’re not stuck getting an amalgam filling. You’ll just have to have a composite filling done by someone with the skill to do it. Your best bet is to go to a mercury-free dentist. They do white fillings exclusively and will get you the right seal on your teeth.

This blog is brought to you by Holistic Dentist Dr. Kasia Lopez.

Invisalign with Crooked Gums

Can you get Invisalign if you have crooked gums? I had asked the hygienist if Invisalign would fix my smile. She just kind of laughed and said, “Not really”. I was a little embarrassed so I didn’t bother asking the dentist. But, that doesn’t fix the fact that I am embarrassed to smile. Is Invisalign impossible for me? I keep hearing they’re better than normal braces.  If I have to do regular braces, I will. I’d like to do something to help my appearance.

Lara S.

Dear Lara,

The hygienist was quite insensitive and partially wrong. If your teeth are crooked, Invisalign can help.  Some of the reasons people prefer them to traditional braces are you can straighten your teeth in secret, they’re more comfortable, they work faster than braces, and you can eat and brush more easily.

Regardless of what your hygienist says, you should always be comfortable asking your dentist anything. He or she should have the answers for any dental question you have. Even if the thing you inquire about isn’t the correct procedure, a good dentist would tell you what is, and not just leave you without answers.

While Invisalign can straighten your smile, it will not repair the crooked gums. There are procedures which will. There are two potential procedures which come to mind immediately. You’ll want something to reshape the tissue.  If the unevenness is from one tooth to the next, your dentist can do a gingivectomy, it removes extra gum tissue. If, however, the  gums are bulky, it would be called a gingivoplasty it involves reshaping them. Either procedure is fairly quick. It’s done in-office in a single visit and your gums will heal up fairly quickly after.

The dentist will know which procedure will help you. If there are other things such as the shape and color of your teeth bother you, the “Cadillac” of smile makeovers is to get porcelain veneers. That can completely change the appearance of your teeth and the character of your smile.

One word of caution. Almost any dentist can do the Invisalign procedure, but you’ll really need an expert cosmetic dentist to do a complete smile makeover. Something like porcelain veneers requires an artistic eye. Be sure they have some type of beautiful smile guarantee. You can look up expert cosmetic dentists in your area on the mynewsmile.com website.

I hope this helps. This blog is brought to you by Dr. Kasia Lopez.

Daughter’s Orthodontist Said Dentists Shouldn’t Place Invisalign

I was at my daughter’s orthodontic appointment and mentioned to him that I’m getting Invisalign. He said he hoped I wasn’t doing it through a dentist instead of an orthodontist. When I said I was, he told me it was a huge mistake because dentists can’t make adjustments and I’m putting my treatment at risk. Is this true? I don’t want to damage the teeth I’m trying to fix.

Melanie M.

Melanie,

It sounds to me like your orthodontist isn’t happy that so many patients go to their general or cosmetic dentist for Invisalign treatment. While orthodontists do receive some specialized training, many dentists are equally capable of placing braces and have even made the effort to train in their placement, adjustment, and care.

However, Invisalign is different from traditional braces and was designed with general dentists in mind. The treatment plan is computer designed and milled, so the time you have to wear orthodontics is significantly reduced.

If you’ve already been approved as a good candidate for Invisalign, then you shouldn’t have any issues. A dentist will do just fine. In fact, in some ways, a cosmetic dentist will be superior. For instance, if you also wanted to get your teeth whitened, a cosmetic dentist could oversee both procedures. In fact, your Invisalign aligners could be used to double as teeth whitening trays allowing you to do both simultaneously.

I’m sure your dentist would never have invested in becoming an Invisalign provider if he (or she) wasn’t serious about developing their qualifications to place them. Nor would they risk patient safety and care.

It wasn’t ethical of your daughter’s orthodontist to suggest it wasn’t safe for you to go to a dentist, especially without any evidence to the fact. All that does is cause a patient unnecessary worry and expense.

This blog is brought to you by Dr. Kasia Lopez.

Are Holistic Dentists Quacks?

My sister’s been going to something called a holistic dentist. She keeps talking about how important it is I do the same.  She gets a little weird about health sometimes and uses the oils for medicine, calling it natural. Now she’s saying this dentist is natural too. I’m worried she’s getting taken in by a quack. I don’t mind her using the oils, they won’t hurt her, but I’m concerned if she doesn’t get proper dental care it will have long term consequences. What do you think? Are they even really dentists? Will they take care of her teeth?

Hunter W. – Tennessee

Hunter,

I love that you’re looking out for your sister. It shows how much you love her. Let’s start by putting your mind at ease. If the dentist has a DDS or DMD by their name, they’re a dentist. A holistic dentist isn’t like a naturopathic doctor, which aren’t always doctors. Holistic dentistry is more a philosophy of treatment, but they’re actually dentists. They’ll clean and check her teeth, treat cavities, do root canals, extract and replace unsavable teeth, and do all the other things imperative for a healthy mouth.

It’s a belief that diseases of the mouth affect your overall bodily health and vice-versa. Recently, studies have shown a substantive link between gum disease and heart disease. Holistic dentists believe it’s important to avoid using harmful substances in dental care. Some dentists believe it’s all about the teeth, but if you’re using something that may help their teeth, but could negatively impact other aspects of their body it’s unacceptable.

You’ll mostly see this put into practice with dental fillings. A holistic dentist will not place an amalgam (ie. silver) filling. Why not? Because they’re made mostly of mercury. Sure they’ll fill the cavity and help your tooth, but mercury is a known toxic substance. Why introduce it into your body when we have a much safer, healthier, and I would add a more effective option with composite (white) fillings.

You may also find they are more determined to save natural tooth structure. While some dentists are perfectly fine with extracting and replacing teeth, a holistic dentist will strive to keep the natural tooth for as long as possible.

This blog is brought to you by Dr. Kasia Lopez.

Worried I Can’t Trust My Dentist

I’m confused and unsure of what to do. I’ve had orthodontics done. Over two years of braces AND I was the good girl who wore her retainer the whole time she was supposed to. My teeth look fine to me, but my dentist says my bite isn’t right. He wants me to get crowns on ALL my teeth to fix it. In all fairness, I’ve already had a couple of cavities, and I think we got on this because I said I wanted my teeth whiter, but getting crowns everywhere seems excessive to me. Should I get a second opinion from a TMJ specialist or is what he’s telling me on the up and up?

Stephanie – Boston

Dear Stephanie,

We need to reign this in very quickly. And, yes, a second opinion from a TMJ specialist would be a good idea. I haven’t the slightest idea why your dentist is recommending a full-mouth reconstruction. You haven’t indicated any TMJ symptoms. Usually, patient’s mention jaw pain, popping, grinding, clicking, or generalized mouth pain. Even migraines can be a symptom of a TMJ problem. If you have these kinds of severe symptoms, you should have a consultation with a TMJ specialist.

As for having the crowns done, this is one way to go about correcting bite issues, but there are also less invasive and less expensive ways to go about doing it, too. In fact, the simpler solutions should always be checked first. Crowns aren’t the solution for whiter teeth either.  The simplest solution would be teeth whitening.  It will do the job beautifully while preserving your healthy tooth structure. Like a full-mouth reconstruction, it’s way too large an overtreatment. Unless you’ve already got crowns on your front teeth, you can have whitening done.

If you were suffering from TMJ issues, it doesn’t necessarily mean it’s because of your bite. Like I said earlier, there are many other TMJ treatments (and causes). However, let’s say for arguments sake you have TMJ and your bite is the problem. It would require someone with serious expertise in TMJ. Someone who has undergone additional training and routinely performs full mouth reconstructions. It’s an advanced procedure. When done incorrectly can cause more problems than it solves.

My bottom line on this is ALWAYS try to preserve healthy tooth structure and get a second a second opinion.

This blog is brought to you by Dr. Kasia Lopez.

Why Can’t Children Have Mercury Free Fillings?

I took my son to the dentist and discovered he has a cavity. I told the dentist I didn’t want a filling that contained mercury and preferred he do a white filling. He told me children can’t have white fillings. Is that true? Why?

Danielle – Idaho

Danielle,

No, it’s not true. Though, I wouldn’t push this dentist to do the white filling. It would likely fail. It takes a special skill to do composite (mercury-free) fillings. It’s a different technique than the old amalgam fillings. He may not know the new techniques. Or, he may know how to do it, but doesn’t like doing it on children.

It is more challenging to do young children. It requires them to be very still and keep their mouth open. The composite material needs to remain dry throughout the procedure for the bonding to stay secure.

Some children have trouble doing that. However, there are ways around that. Sedation dentistry is a good option for children who struggle with following directions or are afraid in the dental chair. It is safe and gives them a calm, cheerful feeling.

You’re more likely to find a dentist to do what you want by looking for a mercury-free dentist or a holistic dentist.

I’m glad you’re looking out for your child and doing some research before caving to your dentist.

This blog is brought to you by Dr. Kasia Lopez.

Did the Dryer Destroy My Invisalign?

I mistakenly put my Invisalign aligners in the washer/dryer. It went all the way through the washer cycle and got about 15 minutes into the dryer cycle before I realized my mistake.  I had them in the pocket of my PJs during breakfast. I’d tossed them in the washer. It wasn’t until after I brushed my teeth that I noticed they weren’t with me.  I grabbed them out of the dryer as soon as I could. They still fit, but feel different on my teeth. Did I ruin them?

Cyndy M. – Tennessee

Cyndy,

We’ve all accidentally watched something, so I wouldn’t feel too bad about it. However, I wouldn’t continue wearing them. Your Invisalign aligners are likely warped. Wearing them will set your treatment back.

If you’re close to the end of this two-week cycle, you could just go on to your next set of aligners. You don’t want to switch early very often, because it puts the roots of your teeth at risk of coming loose. But, just this once should be okay.

If you’re at the beginning of your two-week cycle, you’ll need to have the aligners re-made. Your dentist can do that without too much trouble. But, call the office as soon as possible so they can get it made quickly for you. If you’re without aligners for even just a few days your teeth with start to shift. That will be disastrous for your treatment.

Hopefully, you still have your last set of aligners handy and can wear them until the new ones are ready. That will prevent any shifting.

This blog is brought to you by Dr. Kasia Lopez.