Dr. Noah's Dentistry Blog

Questions About Dentistry Answered

Worried About Maryland Bridge Before Dental Implant

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I have a 13 year old daughter who needed orthodontics and has a congenitally missing tooth. We’re finished with her braces and our long term plan is to get a dental implant for her missing tooth. We just need to keep that space open until she is old enough for the procedure, in the meantime.

Our dentist has suggested that we use a Maryland Bridge. He’s been doing one with a ceramic back, but it keeps falling off. He is talking about doing a metal one, but I’m not crazy about that. I worry it will stain her teeth. What do you think? Would a different cement on the ceramic one work better?

Abigail

Dear Abigail,

Two illustrations of a Maryland Bridge

I’m glad you wrote. The good news is that your choice of a dental implant is perfect. It is the best tooth replacement you can give her once she is older. I don’t think this dentist is serving your daughter (or your bank account) well. I am sure he has the best of intentions, but I don’t like his choice of a temporary tooth replacement. A Maryland Bridge isn’t really a temporary tooth replacement. That is because in order for it to really stay in place, the dentist has to cut a notch into the tooth, such as in the image above. Anything that changes the structure of your teeth is not a temporary tooth replacement. Once she is ready for her dental implant, she will need dental bonding in order to fill in the notch needed for the bridge.

The fact that your dentist cannot keep the Maryland Bridge on makes me wonder if he did that notch. If he didn’t, don’t have him do it. Instead, I want you to get a real temporary tooth replacement— a dental flipper. In fact, get one either way and get a refund on the Maryland Bridge. As an additional benefit, not only will the dental flipper not change any of her tooth structure, but it is significantly cheaper than the Maryland Bridge your dentist suggested.

I hope this helps.
This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.
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Teeth Whitening and Tooth Mousse for White Spots

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I have some white spots on my teeth ever since I had my braces off. I was a bit late getting my teeth straightened as I didn’t have the money until recently. My dentist is suggesting I do tooth mousse for a couple of months and then follow it up with teeth whitening. Is this the right plan for me? I don’t have any reason not to trust the dentist, it is more I have an off feeling about things and have learned to trust my gut. So, I’m seeking another opinion before moving forward.

Avery

Dear Avery,

Teeth whitening trays in a blue case

I am glad you wrote. Your gut serves you well. White spots, especially after braces are signs of decalcification. This takes place because your braces made it a bit tricky to really get in there and brush. Bacteria got trapped and decalcified those spots. These are precursors to decay and can do some serious damage to your teeth.

While your dentist is giving it the “old college try”, I would say that he is about 50% correct in how he is handling this. Tooth mousse is designed to help remineralize teeth, but does not always work. It would not hurt to try this.

As for teeth whitening, in this case he is completely wrong. While teeth whitening does wonderful things for making your teeth look whiter, brighter, and even younger, it will whiten your teeth evenly. This means that your white spots will get whiter along with the remainder of your teeth. That is not the solution you are looking for.

The best way to deal with white spots is with microabrasion and dental bonding. However, this will require an expert cosmetic dentist. If you want whiter teeth, go ahead and do that, but afterward you’ll need to have the dental bonding done. Do not do the bonding first, because it will not whiten along with your teeth.

I hope this helps.
This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Braces Causing Enamel Damage To My Teeth!

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I am 13 years old and just got my braces off. Right after they were removed I am seeing chalky white spots on my front eight teeth. I had my teeth cleaned four times a year, and my orthodontist never mentioned this possibility for tooth destruction to me. My dentist wants to do porcelain veneers; is this what you would recommend? Also, I am a teeth grinder, if that makes a difference.

-Ashley in Texas

Ashley,

I wouldn’t recommend porcelain veneers for someone your age for your 8 front teeth. The problem with doing veneers at your age is that your teeth could erupt a little further as you get older, which will reveal the margin of the veneers instead of keeping that margin at the gumline. Plus, the fact that your dentist is suggesting that at your age makes me worry that he or she isn’t expert in placing porcelain veneers. There is a more conservative option for you, which would be direct dental bonding, and I would go to an expert cosmetic dentist for that.

The white spots are decalcification. What happens when you have braces is that the braces catch food every time you eat anything. If you don’t brush it off right away, it sits there and bacteria grow in the food debris and put out acid that attacks your teeth. I’m disappointed that your orthodontist didn’t talk to you about that. When you have braces, you need to be very careful about eating, and your orthodontist should tell you how to avoid this problem. One thing is that when you’re wearing braces you should avoid snacking. Just confine yourself mostly to eating at meals with only occasional snacks, and that will greatly reduce the damage. And then, after you eat, you need to brush right away. When I had my braces, I carried a toothbrush with me so I could do that, and after lunch or a snack I would excuse myself to the bathroom and take care of this. If you’re not able to brush, at least swish vigorously with water to get as much of that food debris off your teeth. Not only does it decalcify your teeth, but it smells bad.

Getting your teeth cleaned four times a year is okay, but it’s no substitute for getting the food out from around your brackets right away.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Fixing a Black Triangle

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I’ve just finished my braces and am starting my retainer. My orthodontist ended up shaving off about 2mm of space on the teeth. This ended up creating a black triangle at the gums. Will this go away or will I need to have another procedure done? Would grafting gum tissue to the space fix it?

Emma

Dear Emma,

example of black triangles at bottom teeth

Black Triangles

My guess would be your orthodontist is planning on fixing this by closing the space and just has it this way at the start of your retainer treatment. The first thing I would do is talk to him about it. If he doesn’t plan on doing anything about it and the gums don’t adjust when you’re done wearing a retainer, then you’ll need to take steps.

Gum grafting won’t be a useful procedure for you in this case. Your gums position themselves based on both the positions and shapes of your teeth. Even if you grafted gum tissue there, it would shift to a position based on the teeth in the area.

If your dentist doesn’t close this space and it bothers you, the procedure to fix it would be dental bonding. However, you don’t want to have just any dentist do this. It’s a tricky procedure to get right. You’ll need an expert cosmetic dentist to work on this.

One thing to be aware of with braces is to make sure you’re really getting in there when you brush your teeth. The areas surrounding the brackets gather bacteria. If you aren’t super careful, you’ll end up with white spots on your teeth. You haven’t mentioned this as an issue for you. I’m only bringing it up for the benefit of others who may still be wearing braces.

The Modern Alternative to Braces

These days, there are been tremendous advancements in orthodontics. The best of these advancements is Invisalign. These are sometimes called invisible braces because they use clear aligners to straighten your teeth instead of metal wires and brackets. They are completely invisible even at a conversational distance.

They have another, mostly unknown, benefit as well. The aligners can also double as teeth whitening trays. This will allow you to straighten and whiten your teeth at the same time.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Orthodontist Shaved My Son’s Teeth

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I’m fuming after a visit to the orthodontist. I took my 12-year-old son in to get started with orthodontic treatment. The doctor said it would be a longer visit because they were getting everything set up, but didn’t really elaborate on everything they’d be doing. It may be on me, but I didn’t clarify. I just thought he was getting braces put on. Come to find out, AFTER the appointment no less, that the dentist shaved his teeth. I had to hear about the procedure from my son. I thought he was mistaken when he came out and told me what they’d done, so I corrected him, and the assistant then told me what my son was saying was accurate. She said it was normal for treatment and that they do it with all their patients. Now, on top of everything else, I’m worried about the long-term damage the orthodontist may have caused. Why did he do this and can it be fixed?

Signed,

Not Ok in OK

Dear Not Ok,

Smiling young woman with braces

Why Did the Orthodontist “Shave Teeth?”

This is done to make space. Once the dentist measures out how much space is there and how much space is necessary for all the teeth once they’re in alignment, it becomes apparent if more space needs to be made. There are several ways to make space, such as palatal expanders and tooth extractions, but reducing the width of teeth is common as well. In short, if the dentist removes just the tiniest amount of structure on the sides of each tooth, it adds up to a fair amount of space overall. This may have been the easiest and least invasive method for your son. It’s referred to as “interproximal reduction.”

Interproximal Reduction is Safe

Although each dentist has his own toolkit he draws upon for various cases, interproximal reduction often earns a place in the toolkit because it is a safe and fast choice. True, some of your son’s enamel is gone now. Nothing will bring it back. However, if the reduction was such that your son would be at an increased risk for decay now, the dentist would have protected the surface with dental bonding. You can confirm if this was necessary with the dentist.

The Dentist Should Have Spoken with You

Despite the fact that this is a safe and trusted procedure, the dentist should have explained it to you in advance. He’s required to get “informed consent” before procedures are carried out, and if he didn’t fully inform you, then you didn’t give consent. That’s not ok. It’s possible he glossed over it or the detail was lost amid all the new information you were being given at the time, but if you’re 100% certain he didn’t discuss it, or even think he should have been more direct about it, then you should mention it to him. Again, it doesn’t sound like his practice was off, but if he’s missing the mark in communication, he needs to address that.

This post was sponsored by Dr. Ryan Noah, a Tulsa orthodontic treatment provider.

Splotchy Teeth After Braces

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My daughter had braces done. They did straighten her teeth but now several of the teeth are splotchy from being two different colors. She does have thin enamel and I’m wondering if the orthodontist took this into consideration before giving her braces. Are they permanently damaged? Will insurance help me fix them? Would teeth whitening help?

Amelia

Dear Amelia,

Smiling young woman with braces

White spots are a sign of decalcification. This means your daughter wasn’t brushing quite enough where she needed to during her orthodontic treatment. Braces catch food which will sit there and start the decay process until it is cleaned off. It’s very important to brush your braces right after every time you eat. Snacking should be severely limited, and it would be smart to keep a toothbrush with you at all times in order to brush after each meal.

Your daughter was particularly susceptible because of her thin enamel. Your daughter’s spots will turn into decay if they’re not dealt with.

Dealing with White Spots After Braces

One thing you could try is Tooth Mousse. This sometimes helps re-mineralize teeth. However, it usually has better success when the cause is from something else. Either way, it’s worth a try.

Unfortunately, teeth whitening won’t work. This will whiten your teeth evenly which will just make the splotchy color more obvious.

Usually, the best solution is for a skilled cosmetic dentist to grind down the soft enamel down to solid tooth structure and then to do dental bonding over it to restore the tooth. This isn’t an easy procedure, so make sure the dentist who does it has the skills necessary.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Gum Recession During Braces

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I had a problem with gum recession during my braces. This created a black triangle at my gums. Is there a solution for this?

Dave

Dear Dave,

images of teeth with black triangles

Unfortunately, quite a few patients develop this problem with traditional braces. Many patients find it harder to keep up with their oral hygiene as well. Yes, gum recession can lead to black triangles. I’m sorry you’re dealing with this. The first thing I’d do is find out the cause of the gum recession, making sure it’s not a result of gum disease. If gum disease is the cause, that will need to be dealt with first.

There are orthodontic treatments that make it easier to brush and floss properly. For instance, with Invisalign, you simply remove your aligners then brush and floss as you normally would.

Treating Black Triangle After Orthodontics

Sometimes orthodontics can correctly repair a black triangle, but if this happened during your treatment that’s not going to happen. Instead, you’ll need a cosmetic solution.

I’ll be honest with you, not many dentists can do this repair. It’s treated with dental bonding, but because of the placement of the spaces, it requires some real expertise in cosmetics to make this look natural.

Unless your dentist is among the top cosmetic dentists in the country, I’d have him recommend someone for you.

This blog is brought to you by Glenpool Dentist Dr. Ryan Noah

Solution for a Huge Tooth Gap

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I have a tooth gap big enough to almost fit another tooth in. My dentist suggested Lumineers. I can’t imagine that scenario turning out well. What would I have? A center tooth like a cyclops? Eeww! I do want a solution though. What do you recommend? Please don’t say Lumineers. I might cry.

Luna

Dear Luna,

A woman placing her Invisaliagn aligners

Orthodontics no longer has to mean metal braces

I’m glad you have more sense than your dentist. You’re right that Lumineers would end up a disaster. With such a large gap you’d need one of the top cosmetic dentists in the world to make that look natural. I have a much better solution for you.

Commonly, a tooth gap is repaired using dental bonding. This closes the gap with a composite resin. However, again, the size of the gap you’re dealing with would make this challenging.

In your particular case, I’d suggest orthodontics. As an adult, you won’t want a mouth full of metal even if it means closing your tooth gap naturally. Instead, Invisalign will be a fantastic solution, but without being uncomfortable and unsightly. They have one of the highest patient satisfaction rates too.

Getting a Mini Smile Makeover with Invisalign

Many people find that by combining teeth whitening with Invisalign, they get a mini smile makeover of sorts. The Invisalign gives them beautiful straight teeth, while the teeth whitening takes years off their appearance and makes them a brilliant white color.

One thing to be aware of with teeth whitening is it will only whiten natural tooth structure. If you have other dental work, such as crowns or fillings, those won’t whiten from the solution. Instead, they’ll have to be redone in order to get them to match your new white color.

I hope this helps you. Again, I’m glad you sought out advice instead of just listening to your dentist’s disastrously bad suggestion.

This blog is brought to you by Dr. Ryan Noah.

Dentist Told Me to Go to Orthodontist Not Cosmetic Dentist

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I have a gap between my teeth I want to fix with cosmetic dentistry. I’d asked my dentist for a referral but he says that’s a waste of money and I should see an orthodontist. I’m too old for a mouth full of metal. Besides, it’s my money, if it’s more expensive but works I’ll be happy. I don’t want to be a metal mouth at 42.

Lara M.

Dear Lara,

A woman placing her Invisaliagn aligners

Orthodontics no longer mean metal braces

The only time cosmetic dentistry is a waste of money is if you go to a bad cosmetic dentist. It sounds to me like your family dentist is feeling a little salty about you asking to see a cosmetic dentist, probably because he hasn’t developed his skill set to include cosmetic work.

Cosmetic dentistry isn’t a recognized specialty with the American Dental Association (ADA). Instead, it’s general dentists who’ve invested time in learning the cosmetic procedures. Obviously, some dentists will be better than others, so you have to be careful.

Are Orthodontics the Only Solution for a Tooth Gap?

There are several solutions for a tooth gap, but let’s look at the orthodontic ones first. Obviously, you already know about the traditional metal braces. But, there have been significant advances in orthodontics since you were a child. We now have braces that you can’t even see.

If you look at the image above you see a woman placing clear aligners onto her teeth in the first picture. The second picture beneath that is her with the aligners on. As you see, there’s no way to tell she’s wearing anything on her teeth. This is Invisalign. It uses sets of clear aligners to straighten your teeth which are not visible even at a conversational distance.

But, let’s say you still don’t want orthodontics. That’s okay. The most common solution for a tooth gap is dental bonding. It uses a composite resin to fill in the gap. A good cosmetic dentist will make it blend seamlessly in with your natural tooth structure.

If there are more things about your teeth you’d like to change than just a gap, you might consider porcelain veneers. Porcelain veneers completely remake a smile. They can change the shape, size, and color of your teeth.

This blog is brought to you by Dr. Ryan Noah.

Is It Possible My Tooth Gap Will Close?

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I’m seventeen years old. My teeth are completely straight and healthy except for a small gap between my front teeth. I know that I’ve kind of lucked out in the teeth department but the small gap between the two front teeth really bugs me. My wisdom teeth still haven’t come in. Is there a possibility when they do come in it will push the gap closed? If not, is there something I can do to close it that doesn’t include a mouth full of metal?

Amanda P.

Dear Amanda,

While it is possible that the eruption of your wisdom teeth could shift your top arch and close the gap, there are also a few things that could keep that from happening.

First, the gap could be too large. That may mean that your teeth shift, but not enough to close the gap completely.

Second, there is a small piece of tissue in between your two front teeth which is known as a frenum. Most people who have a gap between their teeth, the frenum is the cause. In some patients, the frenum is so large they need to have it removed so that the gap can be closed with orthodontics.

impacted wisdom teeth

Third, not everyone’s wisdom teeth come in straight. If they do, great. But, many patients have to have their wisdom teeth removed because they end up impacted. If that’s the case with your wisdom teeth, they won’t be available to push your diastema (tooth gap) closed. The above image shows you what impacted wisdom teeth can look like.

If it happens that you aren’t able to use your wisdom teeth to shift everything, there’s still hope. And, it won’t require a mouth full of metal.

You could use Invisalign. These are invisible aligners that can close the gap for you in a more effective and comfortable way than traditional braces.

If you don’t want to use orthodontics at all, you can go the cosmetic route. The simplest procedure is to have dental bonding done by a good cosmetic dentist. It uses composite material, similar to what you’d find with white fillings to fill in the gap. You want an experienced cosmetic dentist in order to ensure they’ll be able to make it look natural.

I hope this helps.
This blog is brought to you by Dr. Ryan Noah.