Dr. Brian Saby's Dental Blog

The following article was published in the Boise Beauty Examiner:

A smile is the universal form of communication. With a smile we can portray happiness, excitement, approval, energy, and love. Smiling is sexy- and if we smile with confidence, it’s one of the most beautiful things we can do!

The color, shape, and alignment of the teeth all contribute to a beautiful smile. Tooth whitening or bleaching has become one of the most popular beauty treatments, and thanks to our Idaho cosmetic dentists, we can have straight teeth without even needing braces! The first step to getting the smile of your dreams is to consult a cosmetic dentist specializing in aesthetics.

Choosing the right cosmetic dentist, one with extensive training, substantial experience and a gentle approach that understands clients’ needs, is the key to achieving a successful outcome through whitening or bleaching your teeth, or for achieving straight teeth and a beautiful smile! Below are some guidelines for successfully choosing a cosmetic dentist.
Does the dentist have credentials in cosmetic dentistry?
Many dentists perform some sort of cosmetic work as part of their services, but how do you know if you are paying someone who is qualified to perform tooth whitening, bleaching, or give you straight teeth and a beautiful smile? In cosmetic dentistry, as in medicine, specialties exist that are indications of a high level of education and training. Presently, however, no specialty in cosmetic dentistry recognized by the American Dental Association exists. In 1984, however, the American Academy of Cosmetic Dentistry (AACD) was formed and has the filled the need for credentials in the area of cosmetic dentistry. The organization currently has 7,000 members in the U.S. and in 40 countries around the world. It is the largest international dental organization dedicated specifically to the art and science of cosmetic dentistry, and it administers the leading accreditation program for cosmetic dentists. This accreditation process requires dentists to attend many continuing education courses in cosmetic dentistry, to be tested and to submit a number of cosmetic cases to be judged by a panel of cosmetic dentistry experts.

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Have you ever wondered what dentists do to keep up and get ahead in the wonderful world of dental science?

When most dentists get out of dental school, they are ready to start practice and save the world’s teeth.  It seems almost universal that a new graduate feels that they are up to date on all there is to know about teeth and that everyone else is behind the times.  “You are better off seeing a new graduate, who knows everything, rather than one of those old timers who must be behind.” is a common thought often expressed by the new dentist.

Of course it only takes about a week or two in practice to realize that maybe you don’t know everything.  In a few more weeks, you quickly discover that your dental school education prepared you for private practice in only the very basic sense.  Actually, your dental school training gave you a very good foundation on which to grow, learn and eventually become a very good dentist.  What it cannot give a young dentist is experience.

To learn more and to keep current, dentists take continuing education courses.  Local dental societies and universities traditionally gave these courses. Over time there has evolved a large business of supplying dental courses to dentists and dental staff. These are either through private businesses or non-profit organizations.

Another way for a dentist to learn and improve is to pursue a fellowship or accreditation by a recognized organization.

An example is the American Academy of General Dentistry.  This organization is dedicated to dental continuing education and has set a standard for quality in this area.  The AGD has set up a system to track and record the courses taken by a dentist member.  When the dentist has taken 500 hours of course study, they are then eligible to write the fellowship exam.  After successfully writing and passing the 400-question examination the dentist would be awarded a Fellowship in the Academy of General Dentistry.

Another organization is the American Academy of Cosmetic Dentistry.  The AACD is an organization dedicated to appearance related dentistry.  This organization has a credentialing procedure that recognizes achievement in the art and science of esthetic dental care.  A written examination, clinical case presentation and an oral examination are required to achieve accreditation.  

While it is kind of cool to be awarded a fellowship or an accreditation status, the real benefit of pursuing these is the education and professional development that occurs in the process.  The true benefactor is the patient of dentists who go through these processes.

If you are in the process of choosing a dentist, be sure to ask your dentist about the continuing education he or she pursues.

If you were to take a survey of the “over 40” crowd.  You would find that the majority of people over 40 have had numerous fillings in their teeth, especially the back teeth.  You would also find that most of the old fillings are silver amalgam and likely quite large. (Feel free to try this at your next summer barbeque; it will make you the topic of conversation for months.)

The prevalence of dental restoration in that demographic group is largely due to the fact that this group missed some important dental developments during their formative years.  Fluoridation, dental sealants and the importance of flossing and brushing in the pre-teen years being the main advances in protection against tooth decay that were advanced shortly after this age group got their first cavities.

Fortunately, dentists have been very successful in the treatment of dental decay.  For many years now we have been proficient in placing fillings teeth that have been affected by decay.   Unfortunately, fillings have a limited life span and fail over time.  Each time a filling fails the next filling needs to be bigger.  At a certain point, there may be too much filling and not enough tooth to produce a good result.

Dental fillings were designed to fill a hole in the tooth using the remaining tooth to support the filling.  When the filling exceeds a certain size the remaining tooth structure is too brittle to hold the filling without fracturing under the strain of chewing.  This results in fracture of the remaining tooth.  To prevent tooth fracture or to repair a tooth that has fractured the dentist will recommend that the tooth have a crown.

A crown (also called a cap) is a restoration that covers the outside of the tooth.  The crown acts to hold the tooth together and replace the missing tooth material.  Think of it as a casing for the tooth.

To produce a crown, a thin veneer of tooth material is milled from the outside and the top of the tooth.  This produces enough space for the restorative material and allows for the crown to be shaped so it can function like a tooth.  Usually, 1 to 1.5 mm of tooth is removed around the tooth and 1 to 2mm removed from the biting surface.  A very accurate rubber-like impression is taken of the tooth and a plaster model is produced that is exactly like the prepared tooth.  A dental lab technician will then construct the crown that fits the model, and therefore the tooth precisely.  The crown is then cemented over the tooth preparation, any you are on your way to years of happy chewing.

Crowns can be made of a number of materials.  The most conservative, longest lasting material is still gold.  The malleable nature of gold allows for final finishing in the mouth that makes for best seal.  The main drawback of the gold crown is the colour. 

If esthetics is a concern, a veneer of porcelain can be made over the gold of a crown.  With modern, porcelain technology, these teeth can be made to be indistinguishable from natural teeth.  New technology even allows for all porcelain crowns that fit well, are strong and have the maximum esthetic potential.  This is especially helpful when the tooth to be crowned is near the front of the mouth.

Dr. Saby can help you decide if it is best for you to have crowns on some of your teeth and if so, what type you should have.