consultation with a cosmetic dentist

consultation with a cosmetic

Your initial consultation with a cosmetic dentist is an opportunity for you to learn about the practice that you've narrowed down your search to, as well as discuss what you like and don't like about your smile. It's also an opportunity for you and the cosmetic dentist to establish realistic expectations for your cosmetic dental treatment.

Consultations for cosmetic dentistry treatments typically include records gathering. Because these records are important for developing a unique and precise cosmetic dental treatment plan that will satisfy your needs, a significant amount of time may be spent for this purpose. Records gathering involves, but is not limited to:

* A comprehensive intraoral examination and inspection of any existing dental work.
* Intraoral photographs
* Radiographs (x-rays)
* Impressions of your upper and lower teeth (models and study casts will be made later).
* Looking through smile design books that show an assortment of before and after photographs of different cosmetic dental procedures.
* Reviewing different tooth shapes and sizes to see what appeals to you.
* Discussing tooth color
* Using a computer monitor, reviewing your smile tooth by tooth with the cosmetic dentist so you can thoroughly understand what can be changed and how.

Your consultation may also include a meeting with a patient coordinator. The patient coordinator's role in the cosmetic dental practice is to help you with scheduling appointments and follow-up care.

You may also meet with the practice's office manager to discuss the types of financing or payment options available to help you manage the cost of your cosmetic dentistry treatment – dental insurance does not typically provide coverage for cosmetic treatment. If not, remember to ask about what the financing options are. While payment plans are available through a number of dental loan providers, your cosmetic dentist may offer in-house payment options as well.


Considerations for the Consultation

Cosmetic dentistry results may vary and are dependent on the skill of your dentist. Finding a qualified cosmetic dentist therefore requires careful consideration, even during the consultation stages of treatment.

During your consultation, make note of how you feel about the practice's ambiance. Specifically, are you comfortable with the cosmetic dentist's chair-side manner? Is the staff friendly, welcoming and quick to address your concerns? Since cosmetic dentistry treatment can take time, it is important to establish a rapport with all individuals involved.

If the cosmetic dentist provides you with a diagnosis and treatment plan during the consultation, it is important that he or she share that information with you in detail. Make sure that you understand your diagnosis and any viable treatment alternatives. Make sure that you feel completely comfortable with the level of detail and thoroughness of the explanations you are given so that you can make an educated decision about your cosmetic dental treatment.

Likewise, when providing you with a treatment plan, the cosmetic dentist should be able to tell you about the type of materials that will be used in the fabrication of your restorations. Be sure to ask about how long the results are expected to last and the type of maintenance required in order to sustain the benefit of the procedures. For example, teeth whitening must be repeated every three to six months – depending upon the procedure you choose – in order to maintain the benefits. Similarly, you may be required to wear a protective mouth guard at night to help maintain your veneers.
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Since most cosmetic dentistry procedures include restorations made in a dental laboratory, ask about the dental laboratory technician your dentist plans to involve in your treatment plan. Is the laboratory technician or ceramist a Certified Dental Technician or an accredited member of the AACD? Has the dentist worked with this laboratory technician for many years and/or on similar cases in the past?

When you select a cosmetic dentist, you are selecting a dental professional who will help you change your appearance by changing the look of your teeth and your smile. It is a very personal and important choice. Most procedures are not reversible, so you will want to take your time, ensure that you feel comfortable with the dentist, and that you feel confident with his/her skills and capabilities. When you do, you will likely be happy and completely satisfied with the results that are achieved with the cosmetic dentistry treatment you receive

Problems with complete dentures

Problems with complete dentures

Problems with dentures include the fact that patients are not used to having something in their mouth that is not food. The brain senses this appliance as "food" and sends messages to the salivary glands to produce more saliva and to secrete it at a higher rate. This will only happen in the first 12 to 24 hours, after which, the salivary glands return to their normal output. New dentures can also be the cause of sore spots as they compress the soft tissues mucosa (denture bearing soft tissue). A few denture adjustments for the days following insertion of the dentures can take care of this issue. Gagging is another problem encountered by a minority of patients. At times, this may be due to a denture that is too loose, too thick or extended too far posteriorly onto the soft palate. At times, gagging may also be attributed to psychological denial of the denture. (Psychological gagging is the most difficult to treat since it is out of the dentist's control. In such cases, an implant supported palateless denture may have to be constructed or a hypnotist may need to be consulted). Sometimes there could be a gingivitis under the full dentures, which is caused by accumulation of dental plaque.

One of the most common problems for new full upper denture wearers is the loss of taste.

Another problem with dentures is keeping them in place. There are three rules governing the existence of removable oral appliances: support, stability and retention.

Prosthodontic principles of dentures

Support
Support is the principle that describes how well the underlying mucosa (oral tissues, including gums and the vestibules) keeps the denture from moving vertically towards the arch in question, and thus being excessively depressed and moving deeper into the arch. For the mandibular arch, this function is provided by the gingiva (gums) and the buccal shelf (region extending laterally (beside) from the posterior (back) ridges), whereas in the maxillary arch, the palate joins in to help support the denture. The larger the denture flanges (part of the denture that extends into the vestibule), the better the support.

Stability
Stability is the principle that describes how well the denture base is prevented from moving in the horizontal plane, and thus from sliding side to side or front and back. The more the denture base (pink material) runs in smooth and continuous contact with the edentulous ridge (the hill upon which the teeth used to reside, but now consists of only residual alveolar bone with overlying mucosa), the better the stability. Of course, the higher and broader the ridge, the better the stability will be, but this is usually just a result of patient anatomy, barring surgical intervention (bone grafts, etc.).

Retention
Retention is the principle that describes how well the denture is prevented from moving vertically in the opposite direction of insertion. The better the topographical mimicry of the intaglio (interior) surface of the denture base to the surface of the underlying mucosa, the better the retention will be (in removable partial dentures, the clasps are a major provider of retention), as surface tension, suction and just plain old friction will aid in keeping the denture base from breaking intimate contact with the mucosal surface. It is important to note that the most critical element in the retentive design of a full maxillary denture is a complete and total border seal (complete peripheral seal) in order to achieve 'suction'. The border seal is composed of the edges of the anterior and lateral aspects AND the posterior palatal seal. The posterior palatal seal design is accomplished by covering the entire hard palate and extending not beyond the soft palate and ending 1–2 mm from the vibrating line.

As mentioned above, implant technology can vastly improve the patient's denture-wearing experience by increasing stability and saving his or her bone from wearing away. Implant can also help with the retention factor. Instead of merely placing the implants to serve as blocking mechanism against the denture pushing on the alveolar bone, small retentive appliances can be attached to the implants that can then snap into a modified denture base to allow for tremendously increased retention. Options available include a metal Hader bar or precision balls attachments, among other things.


Complications and recommendations

The fabrication of a set of complete dentures is a challenge for any denturist, including those who are experienced. There are many axioms in the production of dentures that must be understood, of which ignorance of one axiom can lead to failure of the denture case. In the vast majority of cases, complete dentures should be comfortable soon after insertion, although almost always at least two adjustment visits will be necessary to remove sore spots. One of the most critical aspects of dentures is that the impression of the denture must be perfectly made and used with perfect technique to make a model of the patient's edentulous (toothless) gums. The denturist must use a process called border molding to ensure that the denture flanges are properly extended. An endless array of never-ending problems with denture may occur if the final impression of the denture is not made properly. It takes considerable patience and experience for a denturist to know how to make a denture, and for this reason it may be in the patient's best interest to seek a specialist, either a Denturist or a Prosthodontist, to make the denture. A general dentist may do a good job, but only if he or she is meticulous and usually he or she must be experienced.

The maxillary denture (the top denture) is usually relatively straightforward to manufacture so that it is stable without slippage. The lower full denture tends to be the most

-_ lower full denture should or must be supported by 2-4 implants placed in the lower jaw for support. A lower denture supported by 2-4 implants is a far superior product than a lower denture without implants, held in place with weak lower mouth muscles. It is routine to be able to bite into an apple or corn-on-the-cob with a lower denture anchored by implants. Without implants, it is quite difficult or even impossible to do so.

Some patients who believe they have "bad teeth" may think it is in their best interests to have all their teeth extracted and full dentures placed. However, statistics show that the majority of patients who actually receive this treatment wind up regretting they did so. This is because full dentures have only 10% of the chewing power of natural teeth, and it is difficult to get them fitted satisfactorily, particularly in the mandibular arch. Even if a patient retains one tooth, that will contribute to the denture's stability. However, retention of just one or two teeth in the upper jaw does not contribute much to the overall stability of a denture, since a full upper denture tends to be very stable, in contrast to a full lower denture. It is thus advised that patients keep their natural teeth as long as possible, especially their lower teeth.