Friday, June 15, 2018

Black band on tooth

Black band on an extracted tooth?

A black band on an extracted tooth is most often seen from tetracycline staining. Typically we see it on a wisdom tooth of a young adult or late teen that took acne medication.

What causes the black staining on the extracted tooth?

The primary cause is tetracycline or similar antibiotic taken when the tooth was being formed in the jaw. Other possibilities could be exposure to high levels of lead, although the cases I have seen where they claim lead also had tetracycline so one must wonder which is causative.

Image of black staining on extracted tooth

See on some facebook thread. Others that people see look similar.

Acne medication turns teeth black

The most common time dentists will see this black banding is when we extract a wisdom tooth on a kid that took acne medication. Acne medication is often in the tetracycline family and if they take it at the time when the roots of a wisdom tooth are developing you will see a black line on the wisdom tooth. If they take it at a very young age or take tetracycline medication at a younger age then it can be on the crown of the tooth. I don’t think medical doctors give tetracycline to children anymore because they know it will cause teeth that we see to turn black.

Image of a black band on an extracted tooth

This patient took tetracycline for acne at age 15. This is what his wisdom tooth looks like at 19.

Black staining on an extracted wisdom tooth?

This stain is from an intrinsic cause and is usually tetracycline medication. There is also extrinsic staining from primarily gram positive bacterial plaque. This extrinsic staining is more common on the primary dentition and is usually found in low caries children. The stain appears to be a ferric salt. You also see this under temporary and permanent crowns, especially if you use a ferric blood clotting agent.

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Thursday, June 7, 2018

Protected: Dental video review

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Friday, June 1, 2018

Internal bleaching

Interested in internal bleaching after a root canal?

Internal bleaching is a procedure your dentist does to whiten a dark tooth after doing a root canal. The root canal may have been years ago or may be done at the same time as the bleaching.

What are the internal bleaching steps?

Internal whitening is a two visit dental procedure. First of all we access the inside of the tooth and place the whitening agent. Finally, we remove the whitening agent and place a post or filling.

Step 1 of the internal bleaching procedure

  1. We take a photo to document pre-op shade of tooth.
  2. Next we remove any filling and or any post in the tooth.
  3. If the tooth has not had a root canal then one is done.
  4. Remove some gutta percha to several mm below the crestal bone.
  5. Mix a solution of EDTA with an endoactivator.
  6. Place small layer of Vitrebond base over the gutta percha with a small syringe and a blue tip.
  7. Place the bleaching agent.
  8. Next place the bond and red flowable over the acess.
  9. Check bite and smooth

Step 2 of the internal bleaching protocol

  1. Check with he patient on the level of “whiteness”.
  2. Post op photo if everyone is happy.
  3. Remove filling covering the bleach and rinse it all out.
  4. See step 1 above if not white enough.
  5. Prepare post space
  6. Seat post with Rely x unicem 2 or parapost cement
  7. Cure
  8. Etch
  9. Bisco All Bond
  10. Bleach Filtek composite
  11. Check bite and smooth

What does internal bleaching cost?

The fee will vary depending on where you live and who you see, therefore the answer depends! Our internal bleaching cost in 2018 is $576 and that number does not include the filling or post that we place after we are done. A fair fee for your zip code can be found by typing in the dental code below in the fee site fair health consumer. org, the number will probably be close to ours though.

Some internal bleaching before and after photos.

Below is a normal example of a before and after result. There are more dramatic examples that you can see by clicking our before and after internal whitening link as well.

Before and after photo of internal bleaching

From dark tooth to white tooth!

What are the internal bleaching side effects?

A whiter tooth is a major side effect of this procedure, obviously! Real side effects are pain, and if you have ever whitened your teeth and gotten this pain then expect more. Another serious potential side effect is internal resorption. This is a possible but debatable side effect. Resorption comes from trauma, and teeth that need internal bleaching have always had trauma as well so may be a case of correlation and not causation.

What is the internal bleaching dental code?

The dental code to use is D9974 and the code is a per tooth dental code. Therefore, if you have two teeth next to each other that need this then you code for both teeth individually.

Internal bleaching products and materials.

Probably one of the biggest debates is what material to whiten with and many people prefer sodium perborate to hydrogen peroxide. I have no strong feelings on the issue. I really do not have any strong opinions on products to use other than be sure to use a glass ionomer liner at the base.



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Wednesday, May 30, 2018

Little blue bump on lip

Little blue bump on lip? What is that little blue bump on your lip?

Little blue bump on lip is a term some will use to search when they have a venous lake.

People often describe their venous lake as a little blue bump on lip.

So, what is a venous lake? A venous lake is a blood lesion that is typically found on the lip. They are fairly common and easy for use to treat. However, there are few locations that treat these lesions so we end up seeing patients from all over the country.

How do I remove the little blue bump on lip?

To remove a little blue bump from your lip you need to see your dentist or a dermatologist. It is our experience that very few are willing to treat these lesions, simply because they don’t have experience with them. Most dermatologists want to remove surgically and cutting these lesions out has a very poor success rate. We treat the venous lake lesion with one of our dental lasers.

What does a venous lake look like?

The venous lake looks like a little blue bump on your lip! Some are not so little but the majority are smaller than a quarter. Below you can see a fairly small venous lake and the post photo after treatment. This photo was taken two weeks after the laser treatment from the patient’s home. As you can see there is no evidence of anything ever being there! The patient is very happy with her treatment!


Image of little blue bump on lip treatment.

Before and after of a little blue bump treatment or more accurately a venous lake treatment.


Want to know more about venous lake treatment?

If you want to know more about our venous lake laser treatment check out our page that is all about venous lake treatment. The procedure is quick and predictable. We see patients from all across the country so no matter where you are we have a plan for your treatment.

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Tuesday, May 29, 2018

Cheap all on 4

How to get a cheap all on 4 or how to get a cheaper all on 4

Cheap all on 4 is not really something that can happen in the US but there are ways to get a cheaper all on 4. To learn more about our all on 4 process click the link.

Cheap all on 4 tips to reduce your cost.

There are several things you can do to make getting an all on 4 cheaper. All of them have downsides.

  1. Go without a fixed temporary.
  2. Go without any temporary.
  3. Use cheap materials.
  4. Find a dental school that provides the service.
  5. Use cheap doctors and labs.
  6. Go overseas.

Go without a fixed all on 4 temporary and or go without any temporary.

If you currently have a denture, then that is a great opportunity to not get a new temporary while the dental implants are healing.

Downside of no temporary or no fixed all on 4 temporary.

The downside of this is simply that you are still wearing a removable for another 6 months.

Use cheaper materials for your all on 4 final prosthesis.

The cheapest all on 4 framework material for you to get is a metal or polymer, resin, or fiberglass framework. The non-metal option is cheaper to make but currently (2018) the only doctors using it are cutting edge and will not be cheap so metal is the way to go. Depending on lab the cheapest metal will be CrCo or titanium.

The cheapest option for the rest of the all on 4, the part you will see, is acrylic. The acrylic denture teeth come at different price points as well.

Downside of using cheaper materials.

You will have more complications and it will not look as nice. The cheap teeth, look cheap and unnatural. They look like a denture, that may not bother you though. The cheaper acrylic materials break and wear down more often. If you grind or clench your teeth, you will have problems like teeth breaking out.

Image of a cheap all on 4

Acrylic teeth will break out for a lot of all on 4 patients

Go overseas, find a dental school, or used cheap doctors for your all on 4.

All of these involve finding someone to do it cheaper. There are countless ways to provide this service at a cheaper price. You can go overseas and have the whole thing done. You can go to a dental school and have it done. Furthermore, you can find a dentist doing it very cheap as well.

Image of a cheaper all on 4

Cheaper all on 4 will often have design issues making them inferior. These are all custom built so what you get is never the same from office to office.

Downside of going to the cheaper all on 4 place.

You tend to get what you pay for and for a major expense like this it is often regretted later. Going overseas for a multiple appointment service like this means travel costs start to eat away at your savings. Plus you have no recourse if and when things go south. In addition few US dentists will help you when things go south because we have liability issues that the provider, being outside the country does not. You are basically forming a life long relationship with whoever does this.

Going to the cheapest doctor might be a good method for you if cost is your only concern. We are not the cheapest so if that is your main concern do not bother calling us. Beware there are often things left out when you see cheap prices advertised. You can find the whole process for under $20,000 and even under $15,000 in the US if you really look hard.

Finally, going to a dental school is the safest route in this group. The downside is it will take more time and you may have different doctors at different points as students leave. Also the price may be a little more than the cheap US doctors but often you are getting an excellent doctor overseeing the case at a dental school.



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Thursday, May 24, 2018

Diabetic screening dental code

What is the diabetic screening dental code?

Diabetic screening dental code is D0411. It is new for 2018.

Diabetic screening dental code use.

We do not have an HbA1c monitor in the office but are considering getting one. From what I have read some plans pay for this but most do not. The cost is minimal though and we are considering using it for surgical patients as a screening tool, especially for dental implants.

The criteria we are setting up is to use it for patients over 40 years old who have not been see a medical doctor in over a year.

What does the diabetic screening dental code say?

D0411 says “HbA1c in-office point of service testing.”

Insurance payments for dental code D0411.

If anyone is submitting this dental code, please share what fee is being paid. Also how many plans are paying this. Thanks!

What devices test HbA1c?

The are many cheap options for testing HbA1c these days.

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Tuesday, May 8, 2018

Baby bottle decay and white crowns

How we fix baby bottle decay with white baby crowns

Baby bottle decay is a fairly common issue we see in very young children that drink juice from a baby bottle. It impacts the front four teeth the worst and can cause the the teeth be need a lot of dental work at a very young age.

So how to we fix baby bottle decay when it occurs?

When we see baby bottle decay on such young children we need quick action! It does not take long for these cavities to result in pain or even the need for removal! Besides the risk of pain and infection there is also the psycho-social aspects of not having any front teeth for many years. In the past metal crowns were the only option available. This lead to some kids being teased and picked on at school by others. Today we can use a completely ceramic crown that looks very real!

This stainless steel crown alternative is a zirconia pediatric white dental crown!

Sally’s story…

Sally was brought in by her mother when she saw brown stains on her daughter’s front teeth. Unfortunately these were not stain and we all decay. Sally was very young and Dr. Briney and her parents knew she needed something that looked like real teeth. They knew that young kids need to feel confident about their smile therefore they choose our white kids crowns for her treatment.

Baby bottle decay was fixed with white kids crowns.

White kids crowns on the front four teeth.


Sally is really happy and thinks her teeth look “pretty” furthermore her parents are very happy with the natural looking result.

Have baby bottle decay and need some kids white crowns?

If your child has baby bottle decay, we can help! Do you now want something that will look natural for the next phase of your child’s life? We will help you the same as we help many families in the same situation. Dr. Briney is our pediatric dentist and offers sedation for children too young to complete the work while awake. To learn more about Dr. Briney check out her bio! Finally, just give us a call if you have any questions or check out our pediatric white dental crown page or our youtube channel!

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