Frequently Asked Dental Questions by Patients of Dr. Sellinger

Ryan Sellinger, DMD
Article by
Manhattan Cosmetic Dentist

When should old silver fillings be removed?

This is a question I am asked pretty much every time I encounter a new patient with amalgm or silver fillings. There are many controversies surrounding silver fillings and the fact that they contain mercury. My own opinion is that I wouldn’t want them in my mouth so I am certainly not placing them in my patients’ mouth! That being said this does not mean that all silver filling need to be removed immediately.

Here is the good news! Amalgam fillings are never used in our practice. In fact they are pretty much obsolete throughout the profession. Most silver fillings have a shelf life of about ten years. The determination to remove them is made if there is evidence that leakage is occurring or there is a fracture in the material. To determine if leakage is occurring we use digital x-ray to help us see if there is recurrent decay under the filling. However, decay is not always visible with an x-ray alone due to the silver filling masking the decay when viewed on the x-ray. A clinical determination is also necessary. We look at the filling at the interface where the filling meets the natural tooth; if the filling is leaking you will see a dark line or a grayish hue on the tooth.

Here is the bad news! Leaking fillings don’t cause pain until it is often too late! This means that early detection and maintenance of your mouth is critical to prevent the need for root canals and extensive dentistry.

When I drink or eat something hot or cold I feel sensitivity on a particular tooth. What may be causing this?

It is possible that the particular tooth may have a cavity. If the sensitivity is severe and lasts a prolonged period of time it is possible that root canal therapy may be necessary. If there is an existing filling in the tooth the sensitivity may be caused by a leaking filling.

Candy and very sweet foods cause a particular tooth to be sensitive. What may be causing this?

It is possible that the particular tooth may have a cavity. If the sensitivity is severe and lasts a prolonged period of time it is possible that root canal therapy may be necessary. If there is an existing filling in the tooth the sensitivity may be caused by a leaking filling.

Crowns vs. Veneers what is the difference?

Typically the determination of whether a patient should have veneers or a crowns is based on what the patient and dentist are looking to achieve.
While both procedures can be highly aesthetic the two treatments have different uses. Typically, veneers are used when a patient would like to improve the shape and color of their teeth. Crowding and excess space issues can also be alleviated. Veneers are thin (approximately finger nail thickness) beautifully shaped porcelain that is customized for each individual patient.

Frequently, crowns are used in cases in which there is less tooth structure due to tooth decay or in cases in which a tooth has undergone root canal therapy or trauma. Crowns can achieve all of the aesthetic advantages of veneers and should only be used when necessary.

Is veneer therapy painful?

The placement of veneers should not me painful. During the procedure, typically the patient is anesthetized and in some cases patients may request nitrous oxide. While the teeth are being prepared for veneers there should be no pain or discomfort at all.

Shortly after the procedure patients are given a non-steroid anti-inflammatory (NSAID) such as Advil. This is all that should be needed to prevent the breakthrough of any pain associated with the preparation of veneers.

The next part of the procedure involves the cementation of the veneers. Again the patient is anesthetized. Anesthetic is need here because the temporaries are removed and the teeth may be sensitive due to the exposure of the teeth after the removal of the temporaries.

After the veneers have been cemented teeth are sometimes sensitive due to the procedure. Again Advil or another NSAID is used to prevent the breakthrough of pain.

Plenty of water is needed to keep teeth cool. Teeth need to be properly disinfected to ensure longevity and health of the restorations.

Veneers will enable you to Smile Smile Smile.

What is the solution for tetracycline or internal stain?

Horizontal grayish lines are often from antibiotic use while your teeth were developing and as such are what is referred to as internal or inherent stains. Other nternal staining may be a result of anomalies or illness during the development of teeth.

These stains ofter present a challenge for any of the whitening products. However you may see some results with in office whitening products such as zoom whitening or GC Ion followed by an in home regiment with at home whitening products such as Night White.

If you are unable to acquire the results you desire from in office whitening, veneers will certainly get you the results you are looking for. Veneers are thin beautifully shaped ceramic shells that are placed over teeth and will mask the horizontal lines or any other internal stains. As an added benefit the shape of your teeth can be enhanced giving you that dazzling smile you are looking for.

Why floss?

Flossing helps to clean plaque in hard to reach places on the tooth surface specifically in between the teeth where the tooth brush can not reach. Accumulation of plaque left on the tooth surface can lead to the formation of tartar which is a hard structure that contains bacteria. Tartar can only be removed professionally by your dentist or hygienist. Build up of tartar can lead to inflammation of the gums also called gingivitis.

What are the benefits of mouth wash?

Mouthwash or specifically antibacterial mouthwash helps to reduce the amount of bacteria in the mouth. This is important because these bacteria produce sulfur compounds which are the actual cause of bad breath or halitosis.

Other mouth washes contain fluoride which helps to harden the outer surface of tooth structure and prevent bacteria build up and tooth decay.

Is whitening safe?

Based on clinical studies tooth whitening products are not harmful when used as directed. These studies demonstrate that there is no concern about harm to the dental enamel or any tooth structure.

Will my teeth continue to whiten with continued use of whitening products?

Every individual patient will have different whitening results. Additionally, each individual has their own saturation point or point in which their teeth will longer whiten. This is why it is important to use these products under the supervision of your dentist. The dentist can identify this saturation point and determine if additional whitening is necessary and will be effective.

How do I maintain veneers?

One wonderful characteristic about porcelain veneers is their resistance to staining. However they are not completely impervious to stain. We often see staining with patients who frequent coffee, red whines, or food with high chromatic value.

Daily maintenance should include brushing with a soft bristle tooth brush and non-abrasive toothpaste (ie. Non-whitening) and flossing.

If the staining progresses and cannot be handled with daily maintenance, in-office whitening can be used to help eliminate some stain.

In some cases recession occurs around the veneer and may appear as stain. In this case the veneers can be replaced or a gum tissue graft can be done to cover the recession.

Lastly, if the staining is more than whitening can handle the veneers can be replaced in the same manner they were placed the first time.


How does invisalign work?

Invisalign is a series of aligners that incrementally moves teeth as prescribed by the dentist based on the required results of the patient and dentist.

The aligners are replaced every two weeks. Each aligner moves the teeth a little more towards the goal of straightening the teeth.

Once all the information is gathered patients can view the final results of their alignment on the computer imaging program before committing to treatment.

What are different options for whitening?

In-office whitening or professional whitening is the most predictable and effective way to whiten your teeth when followed by an at-home whitener for 7-14 days. The whitening results from the in-office procedure needs to be stabilized by an at-home technique where the real whitening takes place. The in-office whitening procedure starts with the isolation and protection of the gum tissue and lips. The whitening material is applied to the teeth after which a high intensity light is focused on the teeth. Typically, 3 passes are done to achieve the greatest whitening results, and with each pass new whitening material is placed. The doctor can control the concentration of the material as well as how long the material is applied to achieve the most effective whitening results.

At-home whitening uses whitening trays that are made from molds of our patients’ teeth. Whitening material of different strengths is placed in the trays to apply the material to the teeth. The trays are worn for only 1 to 2 hours at a time to reduce any patient sensitivity. With these procedures an improvement of anywhere from 4 to 8 shades can be expected depending on various factors including the starting shade and extrinsic staining from foods that have a high “chromagenic” index, i.e. stains caused by foods such as soy sauce, tea, coffee, red wine or cigarette smoking.

How does whitening work?

The outer surfaces of our teeth are made of enamel rods which are porous. These tiny pores have a tendency to collect non-harmful stains that brushing alone can not reach. Tooth color comes from within, below the enamel surface and the color pigments called chromaphores are oxidized when the whitening gel is on the teeth for the correct amount of time. Whitening products and procedures use either carbamide peroxide or hydrogen peroxide to breakdown these stains and internal colors from the enamel pores to the surface below called the dentin. The chemical reaction is an oxidation process in which stain is broken down. High intensity light is used in in-office procedures and serves to accelerate the oxidation reaction.

How does professional whitening differ from at-home whitening?

The most important difference and advantage of in-office or professional whitening is the ability to have your dentist determine if in fact you are a good candidate for the procedure. In addition it is important that the teeth and gums are healthy, free from tooth decay and the teeth are clean. In office procedures can be monitored by the dentist, gum tissue and lips can be isolated and the proper concentration and length of treatment can be determined. Typically the concentration of peroxide is great when administered by the dentist.

What is your in home whitening recommendation?

This depends on the starting shade of the tooth, since some shades are more difficult to whiten. For difficult shades, the tray and gel system fabricated by the dentist is highly effective. The tray and gel systems use carbamide peroxide. This system should be monitored careful by the patient and dentist and if sensitivity arises a shortened cycle may be necessary.

How should I care for my teeth after whitening?

After whitening treatments specifically in-office treatments the teeth are more susceptible to taking on stain within 48 hours after the procedure. During this time, it is recommended that patients do not eat or drink anything that may stain a white t-shirt. As far as maintenance goes whitening trays which can be used to touch up you teeth after the procedure work great but the proper concentration of material is critical here. With any of the procedures, at-home or professional, it is very important to be supervised by a dentist, there is a point of saturation in which teeth will no longer whiten and your dentist can determine if you are at that point.

Composite vs. porcelain veneers?
Both treatments involve full or partial facings of teeth that when properly done can enhance the beauty of your smile. Today’s composite materials can provide a life like beautiful appearance that is conservative of tooth structure and can last for a long time. Veneer therapy is used in cases in which more is needed to be done to accomplish natural esthetics. Veneers can be used in more severe misalignment, form, color and spacing issues.

With composite veneers the resin is applied in layers to the tooth and sculpted directly in the mouth to achieve the desired esthetic the patient is looking for. Composite veneers are used in situations in which there is chipping or discoloration of natural teeth. They are also used where there are minor misalignments of teeth to give teeth the appearance of more aligned teeth.

The greatest advantage of composite veneers is that it is an additive process that is reversible and can be removed and replaced as needed. Beautiful natural esthetics can be achieved in the right hands. Composite veneer therapy is an art. Aesthetic dentistry is not for all dentists and involves extreme attention to detail. When accomplished properly no one should know you had the treatment.
Porcelain veneer therapy involves removal of a thin approximately finger nail thickness layer of the tooth’s enamel followed by the bonding of a thin sculpted porcelain veneer. This procedure is used when there is more severe discoloration, malformation or misalignment of teeth.

Advantages of porcelain veneers are their extreme resistance to stain and chipping as compared to composite veneers.

In general both procedures can produce beautiful natural aesthetic results. Your doctor can help you decide which procedure or combination of procedures is right for you.

Sensitivity and whitening procedures

Sensitivity is sometimes a result of either in-office or at-home whitening systems. The sensitivity ranges from no sensitivity at all, to very sensitive. Typically sensitivity does not last longer than 24 to 48 hours. If sensitivity persists past that time there could have been underlying conditions that may have been triggered and it is recommended that you see your dentist promptly.

The best remedy is an NSAID (non-steroidal anti-inflammatory drug) such as Advil or Alieve. Typically, our patients are given an NSAID before they leave and are instructed to take it before bed time. If symptoms do occur they typically do not occur directly after the procedure. Rather they occur multiple hours after the procedure. Taking the NSAID ahead of time may prevent the sensitivity from surfacing.

What are alternatives to dentures?

There are many treatment alternatives for dentures. The most frequent complaint about dentures is the retention and stability of the lower denture.

Treatments can range from as little as two implants to support the lower denture to a full mouth of implants to replace each individual tooth.

Typically implants are strategically placed so that bridges can be placed to replace the missing teeth.

Smile makeover categories

There are 5 general categories that patients fall into which prompts them come to the office to attain the most fabulous smile. Our patients can have any combination of these contributing factors that may need to be improved:


1. Discolored teeth:

  • Patients can have extrinsic stains like stains from food such as wine or coffee. In this case, whitening may be the treatment of choice.
  • patients can have intrinsic stains like stains caused from antibiotics during development or calcifications or hypo calcifications. In this case, the treatment can consist of bonding veneers or a combination of both.

 2. Misaligned teeth:

  • patients can have small arch discrepancies.
  • twisted teeth
  • crowded teeth or have spaces
  • in this case, invisalign may be a treatment option as well as in some cases bonding and veneers to correct these malalignments

3. Chipped or missing teeth:

  • small chips can be repaired with bonding or veneers
  • larger chips can be repaired with veneers or crowns
  • missing teeth can be replaced with bridges or implants

4. Narrow arches:

  • some patients present with narrow smiles giving the appearance of a small or short.
  • In this case, veneers bonding, Invisalign, or any combination of these procedures can be used to create a more full beautiful smile.

5. Unhealthy or inflamed gums

  • in this case periodontal therapy or a deep cleaning is needed to ge the gums back to health
  • the gums are the foundation to healthy smile. healthy gums are necessary to ensure healthy beautiful teeth for the long haul.