Author: Adam R. Pershing, DMD

If you are concerned about excess gum tissue or an uneven gum line, crown lengthening and gum contouring are minimally invasive periodontal procedures that can improve the balance of your gums and teeth, creating a well-proportioned and symmetrical smile.

Crown lengthening, also known as a gum lift, is a procedure frequently used to treat a “gummy smile.” When excess gum tissue covers more of the teeth than is typical, teeth appear shorter and smaller. During a gum lift, small areas of excess tissue are removed to reveal more of the tooth’s structure, making teeth look longer and more proportional.

Like crown lengthening, gum contouring is a common cosmetic surgical procedure. An uneven gum line can cause one or more teeth to appear misshapen or shorter than the rest, producing a “crooked smile.” Gum contouring aesthetically reshapes the gum tissue for a natural-looking, even gum line.

These procedures are also used in dental restorations. If needed, crown lengthening can provide sufficient tooth surface for the application of veneers. When teeth have suffered injuries or serious decay near the gum line, a gum lift, or gum contouring can expose enough of the remaining tooth to support a crown. Contouring can be used with gum grafting to restore a gum line damaged by periodontal disease.

Both crown lengthening and gum contouring are common outpatient procedures performed in your dentist’s office.

• Your dentist will take a health history and assess your teeth, gums, and bone health, since gum disease or decay need to be treated before the procedure. You’ll discuss the outcome you desire and what to expect during and after surgery.
• Before the dentist begins your procedure, local anesthetic will be used to numb the area. Sedation is also an option.
• Your dentist will use hand-held tools or a laser to remove excess gum tissue. If necessary, a small amount of bone tissue around the tooth might be reshaped as well.
• The gum tissue will be shaped, or contoured, around the base of the tooth or teeth to create an even, attractive gum line. Some small sutures might be needed to close, and a dressing applied.
• You’ll be given directions for follow-up care to reduce swelling and bleeding, as well as instructions for how to brush, what to eat, and what to avoid as you heal. Your dentist might also prescribe antibiotics, an oral rinse, or pain medication.
• Complete healing will take several months. You’ll have follow-up appointments with your dentist to monitor your recovery.

If you’re unhappy with your smile’s appearance because of excess or uneven gum tissue, talk to your dentist. Learn how crown lengthening and gum contouring can create an attractive gum line that works in harmony with your teeth and lips for a beautifully proportioned smile.

Over time, stain-causing foods and beverages, smoking, and thinning enamel can dim the brightest smile. If you are feeling self-conscious about your teeth, your dentist can help you discover the whitening treatment that is best for you.

At-home Whitening

Home treatments can be helpful in reducing surface stains. These methods are less expensive than in-office whitening, but, because they can’t offer the strength of professional whiteners, they aren’t as effective, and they usually require several weeks of daily application.

Whitening Toothpastes and Rinses

Whitening toothpastes and rinses use mild abrasives and bleaching agents, most often peroxides, to remove surface stains caused by foods, beverages, and smoking. They can also help keep teeth their brightest after a professional whitening. While toothpastes and rinses can’t do much to affect tooth color or deep staining, surface stains can show some improvement after several weeks.

Whitening Strips

These flexible plastic strips come in two sizes, to fit both upper and lower teeth, and are coated on one side with a thin film of peroxide-based gel. The gel-side of each strip is positioned on the front of the teeth and gently pressed into place. The strip needs to adhere to each tooth completely to ensure even whitening, and shouldn’t touch sensitive gum tissue to avoid irritation. The strips are usually recommended for use twice a day, for 30 minutes each time. Total treatment time can vary from several days to several weeks.

Stock Gel Trays

Gel tray whitening systems provide a mouthguard-like appliance that is filled with whitening gel and placed over the teeth. Trays can come pre-filled with gel or with individual gel applications in syringes. Stock trays aren’t always a perfect fit, and it’s important to make sure the whitening gel doesn’t contact the gums and other soft tissue in the mouth. Use time will vary with different manufacturers.

While all these whitening methods can brighten your smile, there are some circumstances which make a professional whitening your best option. Professional whitening agents are more powerful and can help eliminate darker stains which over the counter (OTC) products can’t remove. For those with deeper or darker staining, or for those who would like to see immediate results, in-office whitening is the best choice.

In-Office Treatment

An office whitening treatment is generally faster, more effective, and lasts longer because dentists use gels with a higher concentration of peroxide than those gels found in OTC products. Your dentist will examine you first to make sure your teeth and gums are healthy, protect your surrounding gum tissue and mouth during the procedure, and monitor treatment throughout. Office whitening usually takes from 30-90 minutes.

Light-Activated Whitening

Some office whitening treatments make use of halogen, LED, or UV lighting as part of the procedure. Light doesn’t whiten teeth itself. Instead, it works with the gel solution, activating the molecules in the whitening gel and speeding up the chemical reaction which eliminates stains.

Custom Gel Trays

Custom trays created in the dentist’s office are an option for those who want to use a whitening gel at home. Professionally crafted trays will fit your teeth perfectly and allow a more precise application of the peroxide gel, which will also be provided. Custom trays can require about two weeks of use for maximum whitening.

Some teeth are not good candidates for typical whitening procedures at home or in-office. If you have deeper discoloration caused by trauma or medications taken during tooth formation, or if you have dental bonding, veneers, crowns, or bridges which are darker than your natural enamel, talk to your dentist to decide which whitening treatment or cosmetic procedure is the best option to achieve your brightest smile.

Dental bonding is a conservative cosmetic treatment that improves the appearance of chipped, discolored, or misshapen teeth using composite resin to repair and restore the tooth surface.

Bonding can transform the appearance of a smile. The procedure is commonly used for:

• Repairing chips and minor cracks
• Covering stained or discolored enamel
• Closing small gaps between teeth
• Remodeling the contours of teeth which are undersized, crooked, or misshapen
• Rebuilding areas where enamel erosion has taken place
• Creating inconspicuous, tooth-colored fillings

The procedure begins with an exam to make sure the tooth is healthy and a good candidate for bonding. The tooth surface is prepared, and a specially formulated dental adhesive is applied which enables the composite resin to “bond” to the tooth structure.

The composite resin is put in place and molded to the desired shape. The resin material is carefully color-matched so the bonding is indistinguishable from natural tooth enamel. Once in place, the resin is hardened with a curing light. The bonding is given a final check for fit and shape, then smoothed and polished.

Bonding is a popular choice in cosmetic dentistry because it is convenient, cost-effective, and minimally invasive.

• Bonding can frequently be completed in one visit, and often without the use of anesthetic.
• Bonding is less expensive than veneers or crowns.
• While veneers and crowns last longer and are less vulnerable to chipping or staining, these procedures require the removal of more tooth structure.

Dental bonding is not an option for every tooth. Major chips and cracks, deep decay, or serious misalignment might require alternative treatment. Talk to your dentist to discover whether bonding is the right choice to enhance the natural beauty of your smile.

Bruxism is the medical term for excessive tooth grinding and/or jaw clenching. Because our jaw muscles are capable of producing hundreds of pounds of force, continuous grinding and clenching can cause significant damage to teeth and jaws without dental intervention.

Unconscious grinding or clenching during waking hours is referred to as “awake bruxism.” Awake bruxing frequently occurs during times of focused concentration, stress, frustration, or anxiety. Simply being aware of clenching and grinding is often all that’s necessary to stop. Further possible treatments include jaw relaxation and stress-reduction techniques, mouthguards, and medication.

More commonly, bruxism takes place while sleeping. Because sleeping bruxers are unaware that repetitive grinding or clenching is taking place, sleep bruxism may lead to serious dental complications over time.

Bruxing can cause fractured and chipped teeth, worn tooth surfaces, and lost enamel. Major damage might require a crown or an extraction. Bruxing pressure can crack veneers, fillings, and crowns, and is linked to dental implant failure. Persistent bruxing can injure the temporomandibular joint, the complex joint which allows us to move our jaws in all directions.

What causes Sleep Bruxsim?

Sleep bruxism has been linked to a variety of possible triggers, among them:

• Stress and anxiety
• Personality type
• Cigarette smoking
• Alcohol and caffeine consumption
• Sleep apnea
• Problems with bite or tooth alignment
• Certain medications and medical conditions
• A hereditary tendency in families

While there is no cure for sleep bruxism, your dentist can help you manage the condition. Relaxation techniques, lifestyle adjustments, medication, sleep disorder treatment, dental or medical care, for example, can help address the triggers for your bruxism.

And you can prevent further damage to your teeth and jaws with the use of a custom-fabricated nightguard. Nightguards fit over the teeth, preventing tooth injuries caused by grinding and reducing stress on your jaw.

Your dental team will take an impression of your teeth and a dental lab will create an appliance tailored to your specific needs. Because these nightguards are custom fitted by your dentist, they are more effective, more comfortable, and more durable than over the counter options.

Symptoms of Sleep Bruxing

There are symptoms which may indicate that you’re sleep bruxing before serious dental damage appears. These include:

• Tooth pain or sensitivity
• Enamel which appears flattened or worn
• Chipped or cracked teeth and cusps
• Loose teeth
• Frequent headaches or facial pain
• A sore jaw or clicking and popping noises when you move your jaw
• Earaches or ringing in your ears
• Waking up with tongue, mouth, or cheek injuries
• Fatigue due to sleep disruption
• Being overheard grinding your teeth

If you have any of these symptoms and suspect you might be grinding or clenching your teeth, consult your dentist right away. Prompt treatment can help maintain and protect your dental health.

Fillings can be used to restore teeth with small to mid-sized cavities as well as minor chips, fractures, and wear. Tooth-colored fillings are a popular choice for restorations because they complement the natural beauty of a smile. Unlike traditional gold or silver fillings, tooth-colored fillings blend in with tooth enamel to restore decayed or damaged teeth almost invisibly.

While composite resin fillings are the most well-known option, porcelain and glass ionomer fillings are also unobtrusive choices for a dental restoration. The filling you choose will depend, in part, on the filling’s size and location and the kind of filling you need.

• Direct fillings are completed in one appointment. The filling is bonded to the tooth immediately after any decay is removed and the tooth is cleaned and prepped.
• Indirect fillings take one of two forms: an inlay, which covers the surface of a molar inside the cusps, or an onlay, which covers the surface and at least one cusp.

After the tooth is free of decay, cleaned and prepped, an impression is taken of the tooth. The filling is created from this impression, and then bonded to the tooth during a second visit. Indirect fillings might also be used to repair small chips, fractures, and worn teeth.

Common Tooth-colored Restorations

Composite Resin Fillings

Made of acrylic resin mixed with powdered quartz, glass, or other ceramic particles, composite fillings can be used for both direct and indirect fillings. These are the most popular tooth-colored restorations.

• Can be applied to the tooth immediately after preparation
• Can be closely matched in color to tooth enamel
• Harden quickly under a special curing light
• Less expensive than porcelain fillings
• Preserve more tooth structure than metal amalgams
• Durable, but may not be as durable as porcelain or amalgam fillings for chewing surfaces
• Insurance coverage can vary depending on the location of the filling

Porcelain/Ceramic Fillings

These indirect fillings are made of advanced ceramic materials, fabricated using an impression of the prepared tooth for a precise fit.

• Most realistic looking because they are translucent as well as matched for color
• Typically last longer than composite fillings, and less likely to chip or crack
• More stain resistant than composite fillings
• Usually require at least two appointments
• More expensive than composite fillings

Glass Ionomer Fillings

Glass ionomer is a flexible paste made with silicate glass powder. Commonly used as a sealant or a cement for orthodontic brackets, glass ionomers can also be used in fillings.

• The material bonds directly to the tooth itself
• The glass powder can be formulated with fluoride, which is released over time for added anti-cavity protection
• Resin-modified ionomers are available that harden more quickly
• Don’t always blend as well with natural tooth color
• Less durable than other filling materials, so these fillings are better used in temporary fillings, to fill cavities along the gum line or other non-biting surfaces, or to fill baby teeth.

The size of a cavity, its location, cost considerations—these factors will all affect your choice of filling. Talk to your dentist to discover which tooth-colored option is best to protect the health and enhance the appearance of your smile.

Inlays and onlays are indirect restorations used to repair molars and premolars damaged by decay or trauma. Inlays and onlays fit more securely and last longer than fillings, strengthen compromised teeth, and preserve more natural tooth structure than crowns.

Inlay Dental Restorations

An inlay is used to restore the center of the tooth inside the cusps. Cavities, small cracks and fractures, and other damage are treated with an inlay when a large filling would weaken the structure of the tooth.

Onlay Dental Restorations

An onlay typically covers the center of the tooth and one or more cusps. An onlay prevents further cusp and tooth damage when a cusp is cracked, broken, or decayed. Because an onlay is place only on the damaged part of the tooth, it is a less extensive procedure than a crown and preserves more of the natural tooth.

Direct restorations like dental fillings can be completed in a single appointment. Indirect restorations require at least two appointments, because the inlay or onlay is fabricated outside the office.

• At the first appointment, the area is numbed, and the tooth treated for decay or injury. The tooth is then cleaned and shaped for the restoration.
• An impression is taken of the tooth.
• The tooth is given a temporary inlay or onlay to seal and protect it.
• The impression is sent to a lab. Using this model, a restoration is carefully fabricated to fit the exact dimensions of the tooth.
• Once the fabrication is complete, the temporary filling is removed, the permanent inlay or onlay is positioned for an ideal fit, and the restoration is bonded to the tooth surface.

In the past, gold was used for both inlays and onlays. Today, there are several options available to suit different aesthetic concerns and price points.

• Gold restorations are fabricated from gold alloyed with other metals. While they are the most durable option, they are more expensive, and they can be conspicuous.
• Ceramic and porcelain restorations are tinted to blend with tooth enamel and are both durable and stain resistant. They are roughly similar in cost to gold restorations.
• Composite restorations are the most cost-effective option and are also tinted to match the tooth’s natural color. They aren’t as stain resistant as ceramic and porcelain and are slightly less malleable than other options.

When a tooth is too damaged for a filling, but doesn’t need the complete coverage a crown provides, an inlay or an onlay can be the ideal restoration. Talk to your dentist to discover the best option to restore both the appearance and the function of your injured tooth.

The temporomandibular joints (TMJ) connect the temporal bones on each side of the skull to the mandible, or lower jawbone. These complex, hinge-like joints allow the mouth to open and close, move back and forth, and slide from side to side. Muscle, bone, and cartilage work together for easy and comfortable facial movement so we can speak, eat, swallow, yawn, and smile.

When the joint doesn’t function as smoothly as it should, the limited movement and discomfort which result could be caused by Temporomandibular Joint Disorder, or TMD.

What Causes Temporomandibular Joint Disorder?

Temporomandibular Joint Disorder can develop due to arthritis, bruxism (tooth grinding), genetics, an injury or infection near the jaw, a misaligned bite, or a combination of factors. Sometimes the cause is unclear. TMD could be indicated if you suffer from any of these symptoms:

• Painful chewing
• Persistent pain and discomfort around the TMJ or in the face or neck
• Earaches or ringing in the ears
• Changes in bite alignment
• Muscle spasms near the jaw
• Clicking, popping, or grating noises when the jaw moves
• Jaws that are limited in movement or lock open or shut

If you suspect you might have TMD, your dentist or doctor will conduct a careful examination of your temporomandibular joints, their range of movement, and your head and neck. When needed, imaging studies can be used for further examination of the joint.

TMD Treatments

Often, conservative treatment is effective in treating TMD. Your dentist or doctor will tailor treatment to the cause and symptoms of your TMD:

• Use of over-the-counter pain relievers, ice packs, and moist heat compresses
• Behavior modification for habits which can cause jaw pain (gum chewing, jaw clenching, nail biting, poor posture)
• Techniques for relaxation and stress relief
• Muscle relaxants, corticosteroids, or anti-inflammatory medication
• Physical therapy
• A custom-fitted mouthguard, bite plate, or bite splint to protect teeth and jaw from the pressures of tooth grinding
• Dental treatment to improve minor bite misalignment
• Orthodontic treatment to treat more serious bite misalignment

If necessary, surgical procedures can provide more extensive examinations and treatment. These include:

• Arthroscopy: A minimally invasive procedure performed under anesthesia, which uses a thin tube with a video lens and light inserted through a small incision in front of the ear. This technology allows the surgeon to get a close look at the joint and the area surrounding it. Arthroscopic surgery can repair some types of TMJ damage.
• Arthroplasty: Surgery performed under anesthesia, can repair, replace, or reposition damaged parts of the joint. Arthroplasty can be used to remove bony growths, repair or replace the articular disc that cushions your joint, and access areas that an arthroscopy can’t.

Jaw pain isn’t always due to TMD, and many cases of TMD are temporary. But frequent discomfort, limited movement, or any other persistent symptoms are a good reason to see your dentist or doctor for a thorough examination and diagnosis. Prompt treatment will help prevent further damage to the joint and make facial and jaw movement comfortable once again.

When you’re happy with your smile, you’re able to greet the world confidently, both personally and professionally. Concerns about your smile can undermine that confidence. If you’d like to correct imperfections in your smile, cosmetic dentistry can transform your look and your outlook with innovative treatments designed to create the smile you’ve always wanted.

Some of the reasons people are unhappy with their smiles include stained teeth, gaps, irregular gum lines, damaged or missing teeth, and misalignments. Your dentist can help you achieve a healthy, aesthetically pleasing smile with a range of treatment options, including:

Teeth Whitening

Surface staining can be caused by external factors such as diet, tobacco use, or inadequate oral hygiene. Brighten your smile with a whitening treatment in your dentist’s office. Professional whitening is generally faster, more effective, and longer-lasting than at-home products. If deep stains make whitening treatments impractical, you might consider bonding or veneers.

Tooth Contouring

Small chips, minor size and shape irregularities, slight overlaps—teeth which need minimal cosmetic restoration can benefit from tooth contouring. Your dentist will remove a small amount of enamel to reshape tooth and then polish it for a smooth, even appearance. Contouring is cost-effective and generally requires no anesthetic, but cannot be used to treat more seriously damaged or misaligned teeth.

Bonding

In this procedure, composite resin is shaped and bonded to the tooth’s surface to repair minor chips and cracks, cover discolored enamel, close small gaps between teeth, reshape undersized, crooked, or misshapen teeth, and rebuild areas where enamel erosion has taken place. Bonding is convenient, cost-effective, and minimally invasive.

Veneers

A dental veneer is a thin, translucent, durable porcelain shell which is custom-made to cover the front of a damaged tooth. Like bonding, veneers can restore the appearance of teeth with chips, cracks, and stains, can close small gaps between the teeth, and can reshape misshapen or slightly misaligned teeth.

Crowns

Crowns cover the entire tooth above the gumline. Porcelain and ceramic crowns look like natural teeth and can be used to restore the appearance of teeth with more serious fractures, cracks, and shape irregularities.

Implants

Implants are natural-looking and functional replacements for lost teeth. A screw-like post is implanted in the jawbone, where it fuses with the bone over several months to act as the tooth’s “root.” Once the post is secure in the jaw, a replacement tooth, usually in the form of a crown, is fixed in place. Implants do more than make your smile complete again; they help prevent the jawbone underneath the lost tooth from shrinking and stop nearby teeth from shifting out of place.

Crown Lengthening

Also known as a gum lift, this procedure is frequently used to treat a “gummy smile.” When excess gum tissue covers the tooth surface, teeth appear shorter and smaller. During a gum lift, small areas of excess gum tissue are removed to reveal more of the tooth’s structure, making teeth look longer and more proportional.

Gum Contouring

Gum contouring is another common periodontal procedure. An uneven gum line can make one or more teeth appear misshapen or shorter than the rest, causing a “crooked smile.” Gum contouring aesthetically reshapes the gum tissue for a natural-looking, even gum line.

Gum Grafts

When gum recession exposes the roots of the teeth, teeth appear longer and the roots are more vulnerable to decay. Gum grafting replaces missing gum tissue with your own or donor tissue to create an attractive, healthy gum line that protects your roots while enhancing your smile.

Aligners

Clear aligners are a discreet way to treat tooth and bite misalignment. Today’s aligners can treat a variety of orthodontic conditions, and are inconspicuous, efficient, and convenient. Your dentist can let you know if aligners will work for you.

Don’t let cosmetic imperfections make you hesitant to share your smile with the world. Talk to your dentist to discover how cosmetic dentistry can enable you to realize your goal of a beautiful, healthy, and confident smile.