Are all Crowns the same?

As a Orlando Dentist I receive many calls each week about crowns and the price of crowns. First, the reason you need a crown is usually due to a cavity you had when your dentist placed a filling in your tooth years ago. As a young adult, the filling material starts to wear out; you then need another filling or if the size of the area that requires a filling is to big you then need a crown. Crowns are needed when the loss of tooth structure is large that the tooth can not support a filling any longer. There is to much unsupported area that you need a crown to protect your tooth when you are chewing, to prevent the tooth from breaking. You also need a crown if you ever have had a root canal or endodontics on the tooth. Root canals take the nerve and blood supply out of the inside of the tooth and now you have to have a crown the tooth, to protect the tooth from fracturing.

Now that you know a little about why we need a crown, we have to mention the different types of crowns. Perspective patients will call my office price shopping but unaware that not all crowns are the same or of the same quality. So when you get a price on the phone you need to know what you are getting. For example in my office I offer the best quality. I do not give my patients a choice of the cheaper ones. They will not last and there really is not much difference in price for the quality you are getting. The important factor is how much gold is in the crown. The higher the quality of gold the longer the crown will last you. The higher gold content the closer the gold is fired when making it, which means to you longer lasting. So remember you want a crown that is High Nobel metal. High Nobel metal means more gold. If you are getting semi precious or non precious this means no gold or half gold and your missing out on quality and last.

Another type of crown is the all porcelain crown. These crowns are for the more aesthetic areas. They have no metal in them because you do not want the metal showing. These are good for the front areas of your mouth. I do not recommend these for the posterior areas do to my experience they break and fracture. I can place a nice white crown in the posterior area but will always have high Nobel gold underneath where you can not see, giving the patient more strength. In the anterior area I do use the all porcelain restorations and these are getting stronger. Don't let anyone fool you, what you give up in strength you gain in aesthetics and vice verse. So you do have choices. Many people are hearing about the one day crown.

They are called Cerec and in my opinion I do not do them. I have replaced many of these from other dentists that have failed. I only have the best laboratories make my crowns. It might take a week to get the crown, but your having a technician make your crown that has been doing crowns for 30 years is much superior. Do you really want a machine you program the characteristics of how the crown should look. This excellence is based on the doctors assistant dictating how it should look. They have minimal training not a ceramist who has been stacking Porcelain for 30 years. I use these cerec crowns as temporaries and then have the real one made by my laboratory. Sales associates are always trying to give me these Cerec crowns and I do not want them. The technology is improving but it is not there yet. Some doctors, to tell you the truth, do like this because they do not have to pay a lab bill and they cut chair time down to only one visit. I believe in quality and this is not my cup of tea.

Thanks Again,
Dr. Aschacher

Teeth Whitening

I am most frequently asked when I am at work or just out having dinner about teeth whitening. There are so many new things on the market that can help with teeth whitening. I am sure you have heard on the radio and TV about Zoom Bleaching. The way this is done you come into the dental office for a couple hours and have your teeth isolated with a rubber dam protecting your gums and then the bleach is applied to your teeth. The bleach sits on your teeth while we move a special light that activates the bleach and shines on your teeth for a period of time. Some people need a couple of treatments and some just one.

As an Orlando Dentist I don't recommend this to many of my patients even though it can be profitable for your practice. I have found many of the patients have extreme cold sensitivity after this procedure. There are products you can use before and after this treatment to help but they can still stay sensitive to cold. I have found in my practice I like making my patients professional laboratory custom trays. In all the research you can get the teeth as white as with the zoom Bleaching without the sensitivity. I start the patient at a lower concentration and make sure they use the fluoride I recommend. I will work them up to stronger bleach as long as we do not get sensitivity. This is my favorite way. Also in the future if they want to touch up they have the trays and just add the bleach. This is ideal if you are going to a Wedding and want a little extra white. My patients when they follow this regimen have minimal to no post op sensitivity.
A simple way to get started is to buy Crest White strips which are not real strong but you do still get results. Follow the directions and if you like what you see you can go to the next level of bleaching with the trays. There are other ways to get the quick boost, but with those your risk is sensitivity.

There also are many brands of bleach out there and some can cause more sensitivity than others. My favorite bleach is by American Hygienics and I have minimal sensitivity with my technique. I also recommend when you are going to have new crowns made to bleach first, this will get you to the color you want so you can now have the crowns made whiter to match.
Please feel free to email me with any of your more specific questions.

Thanks Dr. Aschacher

Orlando Dentists and the Economy

As an Orlando Dentist, I wanted to talk a little today about the economy which is on every ones mind; and how it relates to treatment. I have been noticing in my practice a 30% lowering in case acceptance due to the economy. This is troubling to me, because the patients I do see are more emergencies lately. Patients are putting off standard of care maintenance issues and are finding out by waiting there are more emergencies. Emergent care is quite more costly to do than getting your regular check ups and taking care of the small things so the dental fillings that are needed don't end up becoming endodontic problems. Root canals are quite more costly. Also there has been a drop with getting the prophylaxis (cleanings) done. It has been show that plaque has been linked to heart problems. This is the bacteria in plaque that is the culprit. If we stay on are normal cleaning schedule you will reduce the chance of heart problems as well. Preventive care is a lot less expensive when compared to emergent care. Please as a Orlando dentist stay on your recall with your hygienist and if you have things that need treatment try to make arrangements like we do with are patients to get it done to avoid costlier procedures like root canals. We have a financing company call "Care Credit" that we can do 6 months or longer with no interest. This has been helping a lot of my patients avoid the big costly bill by waiting.

I have two offices in Orlando. I have one office in Ocoee/Windermere/Orlando area that is great for serviceing my Clermont patients and it also takes care of my downtown patients because it is right off the 408 highway and Good homes road. Real easy and quick access.

My other location is on South Orange Blossom trail and it takes care of my Orlando patients and Kissimmee patients. I even have patients from all the way to Cocoa Beach who come down the Beach line and get off on Orange Blossom Trail. With these two locations access to care is quite easy and availble.

The month of April 2009 I am offering a Economy helper with a dental special. A lot of my patients want whiter teeth and teeth whitening. With a new patient exam and xrays we are offering Professional Made Bleach trays for 50% off the standard price of $600. A $300 dollar value. These are the ones made at the laboratory and can get your teeth as white and whiter than Zoom Bleaching.

Dental Veneers, Porcelain Veneers the latest and greatest

Welcome all you dental enthusiast to my new blog. Today I will be discussing all the types of Porcelain Veneers (Dental Veneers), that are available and the pros's and con's. I have been getting a lot of phone calls due to the interest in the new dental veneers. A type of dental veneer that I get a lot of call's about are the Lumineers. This is just a brand along with Empress, procera, Hera Ceram, Divinci, and all the ones made the same day with the Cad/Cam machine. Lumineers claim to fame is that you do not have to prepare them. This means the dentist does not have to cut the patients tooth. The dentist takes a impression and sends it to the lab and when the veneers come back they are custom fit to the patent's tooth and they are bonded into place. These are nice but to me they look to bulky. When you place a tooth over a tooth it is too bulky. I prefer to prepare the tooth for the patient by cutting the tooth just a little, like 0.5mm. This is so small but allows for the veneer to be exactly seated and you have made room for the dental veneer so it will not be to bulky. The only time I do not prepare the teeth is when the teeth are set way back and you need to bring them out. All my patients who listen to me and let me lightly prepare the teeth are so happy with the natural and good looking result.

My favorite brand of Veneer is Empress when I need a lot of translucency in the tooth. These can be made so life like. If I have to make a dental Veneer on a patient that has dark teeth I use Procera Veneers. These have a coping or cover that blocks out the dark color of underneath and lets you make a nice real light shade on top. All in all I use many types of veneers to customize my care for my patients. You want to make the veneer that best fits the patient. Lumineers are just a brand like Pepsi and Coca Cola that was made popular by the make over TV show(Extreme Make Over.) It was just the brand the cosmetic dentist used.

As of recently dentists are advertising for a one day make over. They are using Cad/cam technology that can make veneers in a day. There are many advantages to saving time and all done in one day. My take on this and with all the ones I have seen and evaluated I don't like the aesthetic results. With my veneers for instance I have a technician that has been doing Porcelain veneers and stacking porcelain for 30 years. It is a real art. With the one day veneers the computer makes the veneer cad /cam generated, but it is up to the assistant or doctor to do the anatomy, color, and design. We do not have the training like my technician with layering porcelain and color. I am a perfectionist with my veneers and want the very best. They are OK, but for my money stay with the brands I previously recommended.

Another trick with dental veneers is teeth Whitening. You want to have trays made and have your patient have there teeth whitening done before the veneers are made. You want to get the rest of the teeth in the same shade zone as you want your veneers.
Look for my next Blog on Teeth Whitening.

Dr. Aschacher