Ben and Gary Show Episodes

Can I Have Braces If I Have Crowns?

A patient has nine crowns on her front teeth. Over time, her teeth have moved forward giving her smile a buck teeth appearance.

She had braces before getting her crowns. She asks if she needs braces again.

Teeth can move

Often the first step in a cosmetic procedure is aligning the teeth. Although teeth can be just right when the crowns are placed, teeth can move, especially if a retainer is not being worn.

Depending on how the teeth move, the result can be displeasing and cause the patient to feel less confident.

Three possible fixes

There are three possible fixes for the rogue teeth. If the crowns were placed a long time ago, new crowns can be placed in a new position.

Another possibility is new traditional braces with brackets and wires. There is some risk. The brackets may scar crown surfaces and may require repair or new crowns.

If the crowns are not old, Invisalign, orthodontics using bracketless clear aligners, are a...

 My Tooth Turned Black!

What does it mean when a tooth turns black? Without seeing the person, we offer some possibilities.

If there is no pain, a likely possibility is the tooth was injured and the health of the nerve is compromised. The tooth may not actually be black but discolored. 

If there is discoloration at the gum line we also suspect trauma.

Another possibility is extreme decay, especially if the surface of the tooth is different from other teeth. In this case, there is probably an odor.

 Root canals without a crown

In a tooth that received a root canal but no crown, the root may discolor over time. In this case, an endodontist may try bleaching the tooth internally using the same process as bleaching teeth externally.

If this does not solve the issue, other repairs can be considered.

Root canals with a crown

A tooth with a root canal and a crown may also discolor if root discolors and the crown is thin. It could also be that the...

Gary Honored In San Francisco!

Big news! On 6 September, Gary was inducted into the International College of Dentists (ICD). This organization carries out good works worldwide.

He was sponsored for membership by Dr. Angela Culotta-Norton and Dr. Alan Singer. To be honored, Gary had to pass through peer review by twenty-six different regional groups.

The ICD honored him based on his 'outstanding professional achievements, meritorious service, and dedication to the continued progress of dentistry for the benefit of mankind.' But we knew that about him already, yes?

Gary also got to see his friend, Javier, from his missions to Nicaragua. Javier was the Colgate dental rep in Nicaragua when Gary was there. In the seven years since the two have seen each other, Javier married a dentist. They have a two-year-old daughter. Both Javier and his wife were also honored.

We're so proud of you, Gary!

And guess what? Ben was also inducted in the ICD earlier. Your turn Dan....

Do It Yourself (DIY) Dentistry

Wouldn't you know it? Your crown comes off, your filling comes out, or a tooth fractures. And you are nowhere near your dentist!

Time to learn a little DIY dentistry until you can get to see your dentist.

What to do if your crown falls off

You may be able to put back a loose crown using a little toothpaste to bond it in place. 

You may also use temporary dental cement that you can buy in a drug store. Make sure you read the directions. Make sure you align the crown with the tooth as this is a tight bond. No second chances!

You may also be able to reset the crown with denture adhesive.

Be sure not to overfill the crown no matter which DIY you choose. The excess will ooze out and irritate your gums.

No superglue, please. Even if you manage to place the crown without gluing it to your fingers, it will be hard for us to remove it without damaging the crown.

If the crown is broken or damaged, leave it out.

Time is of the essence. Teeth...

What Are Dental Ethics?

One of our viewers got two very different diagnoses from two dentists. She asks if there are ethical standards for dentists similar to the Hippocratic Oath for doctors.

There is not a Hippocratic oath. Local dental societies and licensing boards do protect the public by requiring continuing education in ethics as a condition of licensing.

The American Dental Society (ADA) promotes five ethics principles:

Nonmaleficence - do no harm

• This principle expresses the concept that professionals have a duty to protect the patient from harm. 
• To us, it means don't over-diagnose or over-treat.

Beneficence - do good

• The dentist has a duty to promote the patient's welfare. 
• We take people out of pain, restore their teeth, and create beautiful smiles.

 Justice - be fair and nondiscriminatory

• The dentist has a duty to treat all people fairly.

Patient Autonomy - self-governance

• The dentist has a duty to respect the patient's rights...

Got Dragon Breath? Here's What You Need To Know

We were asked "why do I have bad breath?"

There are many causes of bad breath. One of the most common causes is gum disease. Gum disease creates pockets around the teeth.

These pockets are hard to clean. As food and bacteria collect there, they cause odor. Gary comments that in a closed space such as an airplane he can smell gum disease.

Another common cause of bad breath is dry mouth. If you have dry mouth, exercise can make it worse. Do exercise. Just keep your mouth moist.

Do not ignore chronic bad breath. You should know that many diseases can be diagnosed from the gases in your breath. A physician or an ear, nose and throat specialist is the doctor to see. 

Mouth rinses are helpful in controlling bad breath. Mouth rinses containing alcohol can contribute to dry mouth. Many mouth rinses do not contain alcohol.

Don't ignore chronic bad breath. Get checked out.

Dan's First Week At Smiles International 

Dan chose Smiles International because of its commitment to quality dentistry, the friendly team, and the efficiency of the offices.

In his first week, he has practiced in all three offices and mastered navigating the area by Metro and car.

Ben warns that August traffic is not representative and teases about DC's weather. 

Dental School

Dan may be new to private practice but not to dental procedures. He began practicing on patients his third year of dental school, doing fillings and single crowns. In his fourth year, he move up to bidges and treatments affecting more teeth.

Prosthodontics Specialty

Dan took three more years of prosthodontics specialty training where he developed advanced skills including full mouth rehabilitation and a significant number of implant cases.

On Mondays, he presented patient cases to faculty. These included diagnosis and comprehensive treatment plans.

He also had to master lab work for more customized...

When Porcelain Crowns Show Metal 

We were asked:

What does it mean and what do I do if my porcelain crown has a black ring at the gum line or the porcelain is chipped and metal shows? The doc answers in this episode.

Chipped porcelain on crowns

Most of our crowns have been made of a glass-ceramic material that looks like a natural tooth fused to metal. In our mouths, this glass material is subject to the force of chewing, hot and cold, and acidic foods. It is vulnerable to chips.

Chips may or may not be a problem.

• If they occur between teeth, food can be trapped, gums irritated and subject to gum disease.
• If they create a rough surface, they can irritate your tongue
• If they are visible when you smile, they can make you self conscious

If you notice chips, see your dentist. He may smooth rough surfaces, monitor for problems, or recommend a cosmetic remedy.

Black metal showing at gum line of a crown

 Ceramic to metal fused crowns have a seam at the base. When the...

Gum Disease - Lasers to the Rescue

We were asked what is LANAP.  Joining us today is special guest and colleague, Dr. Justin Zalewsky, Periodontist, who will explain it.

LANAP (Laser Assisted New Attachment Procedure)

LANAP itself is not new. What is new and exciting is the technique is now FDA approved for true regeneration of bone, the surface layer of the tooth root, and periodontal ligaments.

With gum disease, gums

• become inflamed 
• small pockets of space form around the teeth and roots 
• bone destruction is evident

This condition was traditionally treated by cutting open the gum, cleaning out the infection and closing the gum wound. The gum closure with this procedure 

• exposes more of the root
• gives a picket fence appearance at the gum line
• makes one "longer in the tooth"

It works, however, quite well.

With LANAP, the patient feels like he is getting a cleaning but the laser

• causes the root bone to regenerate
• makes old teeth...

Keeping Contact

We are a bit neurotic about making sure contact between teeth is maintained in our patients' mouths. Good contact prevents food from getting stuck in between teeth making them easier to clean and less susceptible to decay.

The trouble is that teeth move. And when they do, spaces may open and contact between teeth is broken.

When this happens, food collects in the open spaces inviting decay, gum problems, and tooth loss. The affected person also finds it irritating and inconvenient.

Common causes of broken contacts

Spaces can occur where there are implants. Once placed, implants never move. If other teeth move, spaces may open and contact between them is lost.

Other causes:

• Teeth may drift forward causing spaces
• Grinding can separate teeth leaving spaces
• An adjacent tooth may be chipped opening a space

Closing spaces and keeping them closed can be perplexing

For example, consider the case of an 81 years old patient. Prior to seeing us, two...