When it comes to restoring both the beauty and functionality of a smile, two of the most commonly used techniques are porcelain crowns and veneers. Why? They consistently deliver beautiful, natural-looking results that are permanent and require very little maintenance. And while they have many things in common, they also have just as many differences.

The Similarities

Here are some facts that apply to both porcelain veneers and crowns:

• Both enable changes to a tooth's color and shape.
• Dental laboratory technicians use precise molds made by our office to hand-craft porcelain veneers and crowns.
• Both are made using high-quality dental porcelain.
• Neither respond to tooth whitening products — the color of the veneer or crown remains the same color as the day it was placed.
• Neither procedure is reversible once completed.

The Differences

Here are some of their differences:

• Crowns are used to replace a larger amount of tooth structure while veneers are thin shells that are placed over the front surface of teeth.
• Veneers require much less tooth preparation (reduction by drilling) than crowns.
• Crowns allow for greater change of tooth shape, while veneers allow for more minor changes.
• Crowns are generally used to restore teeth that have lost tooth structure from decay or trauma.
• Veneers are generally used where teeth are structurally healthy and intact, but color and shape change are required.
• Veneers are used mostly for teeth that are visible when smiling, while crowns can be used to restore virtually any tooth.

Want To Learn More?

To learn more, read the Dear Doctor article, “Porcelain Crowns & Veneers.” Or, you can contact us to discuss your questions or to schedule a consultation.

Periodontal (gum) disease, though it may be invisible to everyone but your dentist, can have a powerful effect on your entire body. Not only is it dangerous to your teeth and jaws, but it can increase your risk of heart attack and stroke, cause preterm births in pregnant women, and affect blood sugar control in diabetics.

Diabetics are our subject for today. Symptoms of diabetes include abnormally high levels of glucose (a form of sugar) in the blood, leading to frequent urination, excessive thirst, blurred vision, unexplained weight loss, and loss of energy. The disease can also cause severe complications in various parts of the body.

Normally, glucose, your body's main energy source, is kept under control by a hormone called insulin, which is made by an organ called the pancreas. In type 1 diabetes, a person's pancreas does not produce enough insulin to deal with all the glucose in his or her blood. In type 2 diabetes — a condition related to increased age, physical inactivity, overweight, and heredity — the pancreas may produce enough insulin, but the body is not able to use it effectively. This condition is called insulin resistance.

People with type 1 diabetes need insulin to survive. Type 2 may be treated with exercise, diet, medications, and insulin supplements.

Serious complications of diabetes range from kidney failure, blindness, and nerve damage to infections that do not heal, gangrene and amputation of limbs.

Diabetes and periodontal disease seem to have reciprocal effects on each other. Diabetics are more likely to have periodontal disease than non-diabetics; and those with periodontal disease are likely to face worsening blood sugar control over time.

Periodontal disease (from “peri”, meaning around and “odont”, meaning tooth), is caused by dental plaque — a film of bacteria that settles on your teeth and gums every day. It's what you remove with daily brushing and flossing. Any bacteria that remain cause inflammation, which can lead in the worst cases to loss of bone and eventual loss of teeth.

The close relationship of diabetes and periodontal disease probably results from changes in the function of immune cells responsible for healing. Inflammation is a part of normal wound healing — but chronic or prolonged inflammation can destroy the tissues it was meant to heal. This may be a major factor in the destructive complications of diabetes.

Many of these complications begin in the blood vessels. Like the eyes and the kidneys, gum tissues are rich in blood vessels. Gum tissues are also under constant attack from bacteria. If you are a diabetic, effective plaque control, along with regular professional dental cleaning, can have positive effects not only on periodontal disease, but also on control of your blood glucose level.

Contact us today to schedule an appointment to discuss your questions about periodontal disease and its connections with diabetes. You can also learn more by reading the Dear Doctor magazine article “Diabetes & Periodontal Disease.”

If you have a tooth that just doesn't look good because of decay or injury, a porcelain laminate veneer is probably a good way to make it look as good as it ever did — and maybe even better! Dental veneers are composed of thin layers of dental ceramic material. They essentially replace the original tooth enamel and require preparation of the tooth by removing a small amount of enamel to allow room for the placement of the veneer.

Recently, more and more dentists have been using minimal prep or prepless techniques that do not require this preparation. In such cases, the porcelain is bonded directly to the outer layer of the tooth's enamel. Highly skilled dental technicians can design a custom-fit veneer that feathers into the tooth just short of the gum line.

Prepless techniques cannot be used in all situations, but when they are used appropriately the results are beautiful and very stable. Should you get prepless veneers? The following is a list of advantages and disadvantages of prepless veneers.

Advantages of prepless veneers include:

• Tooth preparation or reduction is not needed, leaving the original tooth whole.
• They are not placed under the gum tissue, eliminating the possibility that the restorations negatively impact the gum tissue.
• They can be used to change the appearance of teeth that are too small or misshapen making the teeth look larger and eliminate unwanted spacing.
• They can be used to “lengthen” teeth that have been worn down by grinding.
• Since the underlying tooth has not been reduced, prepless veneers are reversible and practically risk-free.

Disadvantages include:

• There are many cosmetic situations in which they cannot be used, and traditional veneers (requiring preparation) must be used instead.
• Prepless veneers cannot be used in cases in which orthodontic treatment is recommended to move the teeth, such as improper tooth position, poor bite, or a poor facial profile.
• Since they are added on to existing tooth structure, they do not work for teeth that are relatively large or in a forward position in a smile.
• They do not usually work for lower teeth because of space restrictions.
• They cannot replace lost or damaged enamel.

Working with prepless veneers requires special skills and training. Please discuss our credentials and experience with us when you inquire about this technique. We can assess your specific situation and let you know whether restoration without the drill is appropriate for you.

Contact us today to schedule an appointment to discuss your questions about prepless veneers. You can also learn more by reading the Dear Doctor magazine article “Porcelain Veneers Without the Drill.”

If your teeth have a worn appearance, it's possible you have a habit you're not even aware of: clenching or grinding your teeth. Also called “bruxism,” this destructive action causes your top and bottom teeth to come together or scrape past each other with a force that's many times what is normal for biting and chewing.

So what's normal? This can be expressed in terms of pounds. An adult usually exerts a force of 13-23 pounds to bite or chew food. But we have the potential to generate as much as 230 pounds of force, or 10 times what's normal. A “parafunctional” force of this magnitude applied repeatedly is bound to stress your teeth and other areas of your oral system. Besides wearing away the enamel of your teeth — and maybe even some of the softer dentin layer underneath — you may experience muscle spasms or pain in your jaw joints. Serious cases of wear can lead to “bite collapse” in which your face actually changes shape as your cheeks and lips lose support. This can make you look prematurely aged.

What can be done? To prevent further wear, we can fabricate for you a thin, plastic mouthguard that will protect your teeth at night or during times of intense stress. We can also recommend ways to temporarily relieve the discomfort that your grinding/clenching habits can cause. Heat and/or anti-inflammatory medication, for example, can be helpful.

If your tooth wear is minor (raggedness along the biting edge of a tooth or teeth) you may not need any restorative work. However, if tooth wear has already caused changes to your teeth and bite that you find aesthetically or functionally unacceptable, we can restore lost tooth structure in a variety of ways. Veneers and crowns are two examples.

If you have any questions about tooth wear or grinding habits, please contact us today to schedule an appointment for a consultation. You can learn more about this topic by reading the Dear Doctor magazine article “How And Why Teeth Wear.”

If you fear a visit to the dentist, you are not alone. Studies have shown that up to 75% of people surveyed have some fear of dental visits, and 10 to 15% fear the dentist so much that they avoid any dental treatment. This can have serious repercussions, leading to toothaches, infections, and loss of teeth. Poor oral health can even negatively affect your general state of health.

Here's the good news. Even people who are the most afraid of the dentist can learn to reduce their fear and feel calm and safe during a dental visit.

Dental fears develop when people have bad dental experiences. For many, the problem is a sense of loss of control. Sometimes, fears are based on stories people have heard or even movies they have seen.

The feeling of being afraid reinforces your fear. If you experience the rapid heartbeat, sweaty palms, tensed muscles, and other symptoms of fear while in the dentist chair, you are likely to remember these unpleasant feelings afterward and become even more fearful. In order to reverse this process, you need to begin to associate dental visits with good experiences and a sense of control. Here's how we can help you do this:

• Know that you are not alone and we are here to help you.
• Talk to us about your fears. We are sure to listen and not be judgmental. If you don't talk about it, you can't get over it.
• We will start by doing things that cause only mild or no anxiety. We want each visit to be a good experience, so you are able to leave our office with a feeling that it was okay, and you can do it again.
• Our goal is for you to overcome your fear. We will make this a priority and that priority is as important as “fixing your teeth.” We will be happy to talk about the time and fees associated with your treatment so that you can overcome your fear and gain a sense of control of the situation.
• It took a while for your fears to develop, so you should realize that it will also take a while to get over them. We will spend as much time as you need to get over your fears and will not rush you into doing anything for which you are not ready.

Contact us today to schedule an appointment to discuss your questions about any fears you may have. You can also learn more by reading the Dear Doctor magazine article “Overcoming Dental Fear & Anxiety.”