http://www.stephenkristdds.com/

Stephen M. Krist DDS, 33 Davis Boulevard, Tampa, FL (2025)

04/20/2023

YOU MADE THE DIFFERENCE!
https://loveinctampa.org/donate

We are so thankful for all of those who came to support Love INC of Metro Tampa and learn more about Our Defining Difference.

Love INC is a collective with a calling to walk alongside motivated guests, and a mission to help others live out their God-given potential. By developing this potential, we are disrupting a toxic, transactional system that cripples a community and imprisons them in a cycle of need.

We are incredibly grateful for those who could attend and give to our mission.

If you have not yet had a chance to give, please follow the link below to make a contribution.

https://loveinctampa.org/donate

Your donation makes a difference. Gifts of your time, talent and treasure continue to transform lives and communities In the Name of Christ!

Pictured here left to right:

Thaddeus Bereday, Love INC Board Chair

Dr. Stephen Krist, dental ministry founder and recipient of the Ven. Dr. Kathleen Moore Volunteer Service Award

Dr. John Obeck, dental ministry leader and Love INC board member

Chalette Davis, Love INC Executive Director

10/07/2022

Dr. Obeck’s Dental Newsletter – The Complete Guide to Flossing Technique and Flossing Tools

Dr. Krist and I have continued to receive great feedback and support from our patients regarding the monthly patient education newsletter. To all of those who read this newsletter, thank you. I hope you find this monthly newsletter educational and interesting; perhaps it may even answer some questions about oral health that you may have been pondering. If you have any dental questions or topics you would like me to write about, please let me know! This newsletter will be a deep dive on flossing techniques and tools to help keep the interproximal surfaces of your teeth free from decay and your gums as healthy as possible.

“What you do at home is more important than what we do here.” Although regular professional cleanings and check-ups are important to debride tartar and calculus (calcified plaque buildup) above and below the gumline, it is the patient’s primary responsibility to prevent gum disease by taking care of their teeth at home. This includes brushing twice a day with a soft bristled toothbrush angled toward the gumline to remove any plaque buildup that forms at the base of the teeth and using floss or an interproximal aid once a day to remove the plaque biofilm that forms below the gumline in the pocket known as the “sulcus”. Plaque is a sticky biofilm made of bacteria, salivary proteins, and food particles that can only be removed by mechanical debridement (brushing, flossing, professional cleaning). If left unattended, the minerals in our saliva calcify this plaque and turn it into hard chunky white buildup known as tartar or calculus. Flossing should be completed in a “C-shaped” fashion by adapting the floss to the contour of both the mesial and distal surfaces of every tooth and gently sliding the floss up and down above and below the gumline into the sulcus to remove all plaque. It is ineffective to floss by quickly sticking floss between the teeth just to remove trapped food.

“Healthy gums shouldn’t bleed.” Whenever there is bleeding while flossing it’s because there is some degree of gum disease: either gingivitis (inflammation of the gums without bone loss caused by bacteria) or periodontitis (chronic bacterial infection of the gums causing irreversible bone loss around the gums). I want to point out that gingivitis is a reversible condition, meaning that the gums can be restored to a healthier state preventing irreversible damage. Periodontitis is irreversible in the sense that the gums and bone supporting the teeth can never be restored once they have been eroded by chronic inflammation. Severe, uncontrolled periodontitis can result in mobility of teeth and bone loss. However, periodontitis can be stabilized and maintained so that future bone loss does not occur.

“Use whatever tools you can to increase compliance with gum care.” Although well-adapted string floss is the gold standard for removing plaque, I am a firm believer that something is better than nothing. I encourage the use of any tool that motivates you to consistently clean your gums. I will make a quick list of interproximal aids and their pros and cons to help you figure out what works best.

String floss
Pros: gives the best adaptation to the tooth structure and can be guided below the gumline to remove plaque
Cons: can be challenging use on yourself especially for those with poor dexterity, can also shred (although shredding can be beneficial to give clues about tight or rough restorations)

Floss Picks
Pros: very easy to use even with one hand, typically increases compliance in patients
Cons: poor adaptation to tooth structure, can cause flossing clefts, not effective for cleaning implants or deep pockets, creates a lot of plastic waste and litter (throw them away not on the ground!)

Interproximal Brushes (or teepees)
Pros: great for cleaning food traps or open contacts
Contacts: does not replace flossing, used more as adjunctive aid, need to be replaced regularly

Water Flossers/Water Picks
Pros: excellent for cleaning around implants, patients can add mouthwash (1:1 ratio) or a tablespoon of bleach to increase antibacterial effects
Cons: does not always fully debride plaque especially in deep pockets, not as portable as floss or floss picks

08/17/2022

Dr. Obeck's Dental Newsletter - Practice History

Dr. Krist and I have continued to receive great feedback and support from our patients regarding the monthly patient education newsletter. To all of those who read this newsletter, thank you. I hope you find this monthly newsletter educational and interesting; perhaps it may even answer some questions about oral health that you may have been pondering. If you have any dental questions or topics you would like me to write about, please let me know! This newsletter will be a guest column from Dr. Krist on the history of our practice.

“As a child, my first dentist was my uncle Dr. John Torres. In 1945 after World War II, he came back to Tampa and limited his practice to children as a pedodontist. My mother Esther was his receptionist and dental assistant and she would work until noon every day so she could be home when my sister and I got home from school.

My other uncle Dr. Ed Van Epoel, who was married to my mother’s sister, returned to Tampa in 1953 and joined in practice with a man named Dr. Gus Perdigon. They built a building on Davis Island and practiced together until 1965. In 1965, Dr. Van Epoel built our current building and my uncle Dr. John Torres and my mother joined the Van Epoel practice. Unfortunately, Dr. Torres died the following year, so my mother Esther became Dr. Van Epoel’s front office receptionist.

During my high school and college days, I would clean the windows and worked in the dental lab at Dr. Van Epoel’s practice. After graduating dental school, I joined my uncle Dr. Van Epoel in practice in 1979 and we were partners until he retired in 1989. As a young dentist, I saw children as well as adults.

I first saw Dr. John Obeck as a patient when he was four years old. Now it is such an honor to have him as my partner and the future owner of this practice. Today, I am still treating patients of my uncles, Dr. John Torres and Dr. Ed Van Epoel. I am so proud to keep the 78 year old practice of Torres, Van Epoel, and Krist going strong. Furthermore, I am so excited to be able to pass the baton to Dr. John Obeck next year. We will continue to be a fee-for-service, referral based dental practice and we welcome and appreciate all new patients.”

Hopefully this letter provides you a nice snapshot of the history and the ethos of our practice. We strive to “do the right thing, and do the thing right” for every single patient every single day. Because our practice is largely dependent on referrals, it means so much to us and helps our business stay strong when our patients refer their friends and family to see us for their dental needs. Thank you so much for reading! If you have any dental questions or concerns you can always reach out to me or Dr. Krist!

Sincerely,
John Obeck, DDS

06/15/2022

Dr. Obeck’s Dental Newsletter – Tips for Preventing Tooth Decay

Dr. Krist and I have continued to receive great feedback and support from our patients regarding the monthly patient education newsletter. To all of those who read this newsletter, thank you. I hope you find this monthly newsletter educational and interesting; perhaps it may even answer some questions about oral health that you may have been pondering. If you have any dental questions or topics you would like me to write about, please let me know! This newsletter will be a “deep dive” on preventing tooth decay.

Most tooth decay is a direct result of the effect of acid on your teeth. The bacteria in our mouths consume sugar from foods we eat and produce acid as a byproduct. This acid is what wears down enamel and dentin and allows the bacteria to pe*****te and spread inside our teeth like termites in wood. The more acid you have in your mouth the lower the pH becomes and the more likely you are to have decay. Decay can begin at any time of your life when the conditions are right. Here are some tips that will reduce the amount of acid in your mouth, the chance for decay and the need for repair:

1. Limit or eliminate all sources of sugar. Sugar comes in many forms such as table sugar, sodas (which are very acidic as well), natural sugar found in fruit (dried fruit is worse), honey, maple syrup, high fructose corn syrup. Sticky sugar is worst because it adheres to your teeth. Sugar is added to processed foods and is often hidden. Read labels and look for it. There are 4 grams of sugar in 1 teaspoon which equates to 16 calories. Limit total sugar intake to· 5 to 10% of your total daily calories.

2. Be very aware of the acid content in the foods you eat and the beverages you drink. Adding acid to your mouth from your diet will create an environment that will promote decay. Read labels and look for any acid such as citric, phosphoric, malic, tartaric, acetic, tannic, fumaric, and lactic, to name a few. These can be found in citric juices, wines, tea, coffee, beer, sport drinks, vinegar, and enhanced water beverages. If you consume these, remember to swish with plain water to dilute the negative effects on your teeth.

3. Medical conditions that lead to vomiting or acid reflux are devastating to teeth in general and promote decay by allowing the acidity of your stomach to affect the acidity of your mouth. See your medical doctor for treatment and follow the advice prescribed. A dry mouth will also create an acid environment and lead to decay. This is because our saliva, which has a basic pH, cannot neutralize the acids present in our mouth. Some medications such as antidepressants and blood pressure medications cause dry mouth.

4. Maintain excellent oral hygiene by brushing your teeth with a soft or ultra-soft bristled brush and fluoride tooth paste minimally two times per day for two minutes, about twenty minutes after meals. We recommend a powered brush with a timer and a pressure sensor to make sure you are not brushing too hard. Flossing once daily before bed time is advised. Use products designed to reduce the acid in your mouth; we recommend Arm & Hammer Dental Care toothpaste and Crest Denisfy with stannous fluoride for all our patients unless a more aggressive approach is required. Some patients should use a prescription strength fluoride toothpaste.

5. Daily use of mints or gum sweetened with only Xylitol is highly recommended. Xylitol is a safe sugar substitute which cannot be broken down by bacteria into acid. New research has shown that xylitol can actually kill harmful bacteria in the mouth and aid in remineralization of teeth. Do not let your dog eat xylitol because it is toxic to them.

6. Consider an oral probiotic if you have gum disease or history of cavities. Much like yogurt or sauerkraut for our gut health, oral probiotics flood our mouths with “good guy bacteria” which outcompete and kill the “bad guy bacteria” that cause destruction to our teeth and gums. We recommend ProBiora as it is the most well studied oral probiotic and have seen it cause improvement for both gum disease and tooth decay in our patients taking it. Do not use mouthwash if you use an oral probiotic because it will kill the “good guy bacteria” too.

Being aware of the factors that influence tooth decay and taking steps to reduce your risk of developing decay will go a long way toward preserving your teeth and your restorations. If you have any questions or concerns please do not hesitate to reach out to me or Dr. Krist!

Thanks,
John Obeck DDS

03/24/2022

Dr. Obeck’s Monthly Newsletter – What is a Root Canal?

Dr. Krist and I have continued to receive great feedback and support from our patients regarding the monthly patient education newsletter. To all of those who read this newsletter, thank you. I hope you find this monthly newsletter educational and interesting; perhaps it may even answer some questions about oral health that you may have been pondering. If you have any dental questions or topics you would like me to write about, please let me know!

A root canal is a common dental procedure in which the pulp of a tooth is removed. Pulp is the nerve and blood vessel in the center of a tooth that extends down the root and allows the tooth to feel sensations such as heat, cold, and pain. A tooth may need a root canal because a deep cavity has reached the pulp, a crack may have propagated into the pulp and irritated the nerve, or an abscess may have formed on the root of the tooth. Once the pulp is removed, the tooth is then irrigated with an antiseptic rinse and the root space is filled with a rubbery biocompatible sealer called gutta percha.

There are several symptoms exhibited by teeth that need a root canal. These symptoms may include: severe pain that wakes the patient up in their sleep, intense and long lasting pain to either heat or cold on a specific tooth, pulsing or throbbing constant pain, or pain when chewing on a specific tooth. In addition to x-rays, thermal and percussion tests can be performed by your dentist to determine if the pulp of a tooth is compromised enough for the tooth needs a root canal.

It is a common misconception that root canals are always a painful procedure, and they are falsely portrayed in pop culture as a torturous event. At the start of the procedure the tooth is numbed with local anesthetic and the procedure is not much different from a filling. Root canals may need to be completed in two visits if an abscess is present. At the first visit, the canals are filled with a medicine that kills the bacteria present in the abscess. At the second visit, the medicine is cleaned out and the root is filled with biocompatible sealer.

Peer-reviewed meta-analysis of hundreds of studies has shown that root canals are a safe and effective way to treat infected teeth and no systemic complications have been proven to be caused by root canals. However, it is worth noting that root canal treated teeth are not without their own set of complications. The main complication with root canal treated teeth is that they make teeth more fragile and susceptible to root fractures. For this reason, all premolars and molars with a root canal must be covered with a crown to prevent a catastrophic fracture of the tooth. In addition, root canal treated teeth may develop a recurring abscess and the root canal may need to be retreated.

If you or your loved ones are experiencing any tooth pain, please do not hesitate to contact Dr. Krist or I and we will get you in as soon as possible. Due to the acute nature of tooth pain, it is typical to have a root canal completed the same day the problem is diagnosed and patients typically experience immediate pain relief. Although we do not complete root canals in our office, we diagnose the need for them every week and have a great referral network of highly trained endodontists in Tampa.

Sincerely,
Dr. John Obeck

01/27/2022

Dr. Obeck’s Monthly Newsletter – Teeth Whitening 101

I hope everyone is having a great start to the 2022 and I am excited to present my first newsletter of the year! This month I will be presenting a fact sheet on teeth whitening and it will be in a bullet point format. To all of those who read this newsletter, thank you. I hope you find this monthly newsletter educational and interesting; perhaps it may even answer some questions about oral health that you may have been pondering. If you have any dental questions or topics you would like me to write about, please let me know!

• The active ingredients that cause teeth to whiten are carbadmide peroxide and hydrogen peroxide (which is a byproduct of carbamide peroxide).
• Peroxides whiten teeth through a chemical reaction that oxides the organic component of teeth.
• Whitening gel does not break down tooth structure.
• Whitening often makes teeth sensitive. Although the exact mechanism causing this sensitivity is unknown, it is typically temporary.
• Composite tooth-colored fillings, porcelain crowns/veneers, and cosmetic bonding cannot be whitened. If you are considering cosmetic dentistry to change the shape or appearance of some of your teeth, you should whiten the other teeth to your desired shade before having the cosmetic work done.
• “Whitening toothpastes” and “charcoal toothpastes” are typically very abrasive because they are designed to abrade away extrinsic staining on teeth. Often, these abrasive toothpastes can wear away enamel, especially when used with a hard bristled toothbrush and a vigorous scrubbing technique.
• Whitening toothpastes do not chemically whiten teeth unless they contain a peroxide. If they do contain a peroxide, it is at a low dosage and does not typically yield a significant whitening effect.
• Custom fit whitening trays are considered the “gold standard” for whitening teeth because they expose the largest surface area of teeth to the highest concentration of hydrogen peroxide for the longest amount of time.
• Putting Sensodyne or stannous fluoride toothpaste in your whitening trays once you are done bleaching can help mitigate sensitivity.
• If you are going to use whitening trays, make sure you brush your teeth and floss before you put them on to remove any plaque buildup.
• Make sure to wipe whitening gel off your gums when bleaching because it can irritate and inflame them.
• Whitening strips are a viable option to whiten teeth but yield the best results on teeth that are uniform and straight.
• Whitening trays and strips should be worn for different lengths of time depending on the strength of the gel. If 15% peroxide gel is used, patients can sleep with their whitening trays in overnight. If 35% peroxide gel is used, patients should only use them for 30 minutes at a time.
• The greatest whitening result is seen when patients stick to a daily regimen for a couple of weeks as opposed to sporadic one-time uses.

Thank you so much for reading! If you have any dental questions or concerns you can always reach out to me or Dr. Krist!
Sincerely,
John Obeck, DDS

12/07/2021

Dr. Obeck’s Monthly Newsletter – Part Two: A Guide to Treating Grinding, Clenching, and Tooth Wear

Dr. Krist and I have continued to receive great feedback and support from our patients regarding the monthly patient education newsletter. To make up for the lack of a newsletter last month, I will be writing a two-part double feature this month. To all of those who read this newsletter, thank you. I hope you find this monthly newsletter educational and interesting; perhaps it may even answer some questions about oral health that you may have been pondering. If you have any dental questions or topics you would like me to write about, please let me know!

This month I am presenting a two-part guide that helps patients understand the various factors that cause tooth grinding (aka “bruxism”) and how this impacts the teeth, muscles, and jaw joint. In part one, I broke down the main reasons people clench their jaws and grind their teeth. In part two, I will now discuss strategies to help patients manage bruxism and prevent unnecessary damage to the teeth and temporomandibular joint (“TMJ”). It is important to note that bruxism is an involuntary neuromuscular activity that typically cannot be completely “cured”; so patients must diligently focus on managing their bruxism and minimizing the risks associated with bruxing.

Nightguards: Patients who brux their teeth often do so at night without realizing it. They may wake up with headaches, tightness in their jaw, and sore teeth, jaw joints, and jaw muscles. At our practice we make two different types of night guards depending on the presence of temporomandibular joint (“TMJ”) symptoms. The first style of nightguard is for patients without TMJ symptoms only allows patients to contact the nightguard with their two front teeth. These small nightguards “trick” our brains in our sleep by deprogramming the jaw muscles into using less of their biteforce. These nightguards protect the teeth and relieve muscle soreness and tightness; I wear one every night. The second style of nightguard is for patients with TMJ symptoms and cover every tooth. These nightguards provide ideal, balanced contacts for all teeth and ease jaw joint pain and protect the teeth wear and attrition. It is important to note that “soft” nightguards should be avoided because they actually cause patients to clench and chew on them in their sleep, much like a chew toy for a dog. This usually exacerbates muscle soreness and TMJ symptoms.

Botox Injections: A new and exciting treatment for bruxism involves injecting the masseter and temporalis muscles with Botox to relax the muscles. While many associate Botox with its cosmetic applications, this is a non-cosmetic intramuscular treatment for therapeutic use. Although Botox is not permanent, it greatly reduces the amount of bite force that patients are able to exert while bruxing. This treatment is a great option for chronic bruxism patients who also clench during the day and often break their teeth or dental restorations.

“Lips together, teeth apart”: Many patients are surprised to hear that our upper and lower teeth should not be touching each other throughout the day. Our teeth should only contact each other lightly when swallowing or chewing our food. Some people clamp their teeth together without grinding them during the day and at night. If you find that you constantly touch your teeth together throughout the day, always remember the phrase “Lips together, teeth apart, tongue up to the roof of your mouth” and try to break the habit. You may be able to reduce muscle soreness and clenching during the day with this constant reminder. Unfortunately, this phrase has conscious limitations and cannot stop involuntary bruxism that could be related to medications, stress, or sleep disordered breathing.

Stopping Parafunctional Habits: Some patients do not brux their teeth but rather have “parafunctional habits”. Parafunctional habits are abnormal behaviors that can chip or split teeth. Sometimes parafunctional habits can cause irreparable damage and tooth loss. Some common examples include nail biting, chewing pencils, biting fishing line, opening containers with teeth, or holding objects with teeth. Teeth are not tools. If you have parafunctional habits, try to consciously remind yourself of the risks that these behaviors pose to your dental health and stop them.

Hopefully, this guide serves you well as an educational primer to understand the various treatments for bruxism. Bruxism cannot be truly “cured”; but it can be successfully managed and treated with cooperative efforts from both the patient and the treating dentist. If you have any questions or concerns about bruxism or other oral health topics, please do not hesitate to reach out to Dr. Krist or me. Thank you so much for reading!

Sincerely,
Dr. John Obeck

12/07/2021

Dr. Obeck’s Monthly Newsletter – Part One: A Guide to the Causes of Grinding, Clenching, and Tooth Wear

Dr. Krist and I have continued to receive great feedback and support from our patients regarding the monthly patient education newsletter. To make up for the lack of a newsletter last month, I will be writing a two-part double feature this month. To all of those who read this newsletter, thank you. I hope you find this monthly newsletter educational and interesting; perhaps it may even answer some questions about oral health that you may have been pondering. If you have any dental questions or topics you would like me to write about, please let me know!

This month I want to present a two-part guide that helps patients understand the various factors that cause tooth grinding (aka “bruxism”) and how this impacts the teeth, muscles, and jaw joint. In part one, I will break down the main reasons people clench their jaws and grind their teeth. In part two, I will discuss strategies to help treat patients’ bruxism and prevent unnecessary damage to the teeth and temporomandibular joint (“TMJ”).

First, it is important to understand that there are many different reasons that people clench their jaws and grind their teeth. Some people simply clench their jaws together without grinding their teeth and experience sore jaw muscles and TMJ symptoms without any wear on their teeth. Other people clench and grind their teeth together in their sleep or during the day and experience tooth wear, loose teeth, and TMJ symptoms. Bruxism is typically an involuntary, neuromuscular habit that patients do not consciously choose to do. Bruxism and clenching can be episodic or chronic. Finally, some people have parafunctional habits like nail biting or opening containers with their teeth that cause tooth wear. Unlike unconscious bruxism, some parafunctional habits can be broken.

Stress and Anxiety: Some people go through temporary periods of grinding when they are acutely stressed out about life events like studying for exams in college, transitioning between jobs, taking care of a sick loved one, or moving to a new state. Some people who suffer from anxiety disorders chronically clench and grind. There is not a clear scientific reason why people clench their jaws and grinding their teeth during periods of stress. Dr. Krist and I believe that stress related clenching and grinding is a neuromuscular physiologic response to the body being constantly in a “fight or flight” response, similar to a rapid heart rate and dilated pupils.

Medications: Some patients are surprised to find out that medications can cause people to brux their teeth. The two main classifications of drugs that are associated with bruxism are antidepressants and stimulants. The common antidepressants associated with bruxism are Selective Serotonin Re-uptake Inhibitors (SSRIs) which include Prozac, Zoloft, Celexa, Paxil, and Lexapro. The common stimulants associated with bruxism are amphetamines which include Adderall, Dexedrine, Evekeo, and Concerta. If you think that your medications may be causing you to clench and grind, please talk to your primary care physician or psychiatrist about possibly trying a new medication or cognitive behavior therapy. Finally, ni****ne and alcohol, especially if consumed before bed, have been shown to disrupt our sleep cycles which can cause night time bruxism.

Sleep Apnea and Sleep Disordered Breathing: People suffering from sleep apnea and sleep disordered breathing (upper airway resistance) often brux their teeth. For more information on sleep apnea, please refer to my previous newsletter about “Sleep Apnea and the Dental Connection”. The body unconsciously bruxes in episodes of sleep apnea as a compensation mechanism to tighten up the neck muscles which open up the airway for easier breathing. If Dr. Krist or I see some of the oral clues and signs of sleep in our patients, we often suggest the patient have a sleep study to diagnose or rule out potential sleep apnea.

Misaligned Teeth (aka “Malocclusion): Some studies have shown that people with crooked or misaligned teeth unconsciously grind their teeth. This is a controversial topic among dentists, however, because not every person with misaligned teeth grinds or clenches their teeth. The predominant theory is that people with unstable bites grind their teeth as a means of wearing their teeth into a place of better stability. In general, people with misaligned teeth and unstable bites have a higher incidence of bruxism, jaw muscle pain, and TMJ symptoms.

Dr. Krist and I primarily focus on identify causes of bruxism in our patients, managing symptoms, and preventing unnecessary damage to the teeth and jaw joint. Hopefully, this guide serves you well as an educational primer to understand the various factors that contribute to the complicated topic of bruxism. Bruxism cannot be truly “cured”; but it can be successfully managed and treated with cooperative efforts from both the patient and the treating dentist. If you have any questions or concerns about bruxism or other oral health topics, please do not hesitate to reach out to Dr. Krist or I. Thank you so much for reading!

Sincerely,
Dr. John Obeck

10/25/2021

Dr. Obeck is going to be a vampire for Halloween so he and Elena made some vampire fang veneers for his costume! This involved taking an impression of his mouth and making a stone model, sculpting some fangs on the model, and then making acrylic veneers from the sculpted model. Cool stuff!

09/28/2021

Dr. Obeck’s Monthly Newsletter – Understanding Various Cosmetic Dental Procedures

Dr. Krist and I have continued to receive great feedback and support from our patients regarding the monthly patient education newsletter. To all of those who read this newsletter, thank you. I hope you find this monthly newsletter educational and interesting; perhaps it may even answer some questions about oral health that you may have been pondering. If you have any dental questions or topics you would like me to write about, please let me know! This month I will explain the rationale and techniques behind several different cosmetic dental procedures that can change the size, shape, color, and shape of teeth so that patients can enjoy a more confident and joyful smile.

Cosmetic bonding: This is a procedure that involves using tooth colored composite resin to make minor adjustments to the size and shape of teeth. Cosmetic bonding is often the appropriate procedure for restoring undersized and chipped teeth or closing small gaps between anterior teeth in one simple appointment.

First, the tooth is lightly beveled with a bur to create a fresh, uncontaminated surface area of tooth to bond the composite resin. Very little tooth structure is actually removed in this process and patients rarely need to be numbed for it. Next, the tooth is prepared with two solutions called “etch” and “bonding agent” which are then cured with an ultraviolet light to create a microscopic, chemically bonded layer on the tooth structure which the composite resin attaches to. Finally, the composite resin is placed and sculpted by the doctor and then light cured to chemically bond the resin to the tooth structure.

The resin is then adjusted and polished to ensure it is comfortable within the confines of the patient’s normal bite and looking beautiful and natural. The pros to cosmetic bonding is that it is relatively inexpensive and can be done in one quick appointment. The cons to cosmetic bonding is that it sometimes needs to be replaced or polished because it can be easily damaged and pick up stains. Furthermore, composite resin cannot be bleached so it can stand out if a patient’s teeth change in color over time.

Porcelain Veneers: Veneers are the gold standard for changing the size and shape of patient’s anterior teeth. These beautiful ceramic restorations are indicated when a patients wants to make major changes to the size, shape, color, and alignment of their anterior teeth. Porcelain veneers are a lot like the tooth equivalent of fingernail coverings that people use to lengthen and color their nails.

First, photographs are taken and a diagnostic wax up of is made from models of the patient’s teeth to show the patient what is possible and what the finished smile design will look like. Once the patient and doctor are in agreement on the size and shape of the teeth and share the same expectations, the veneering process begins. Initially, the patient is numbed and some tooth structure needs to be removed in order to make room for veneers. Typically 0.3 - 1.0 millimeters of enamel is removed on all of the teeth being veneered. Temporary veneers are then made chair-side from the diagnostic wax up and fitted on the patient who gets to demo their new smile for several weeks. In this time, adjustments can be made to ensure the final product will mimic the temporary veneers. Then, an impression and photos are taken and sent to a dental laboratory where a dental technician communicates with the doctor and makes the porcelain veneers. The patient then returns for another appointment to have the veneers chemically cemented to their teeth.

The pros about veneers is that they are quite durable and last for many years if properly taken care of. They are very esthetic and can truly change someone’s confidence and appreciation of their smile. The downside veneers is that they are expensive and the process takes several appointments and often involves 2 to 10 teeth per arch to achieve the proper proportions and results. It is important to note that orthodontics (braces or Invisalign) is sometimes needed BEFORE veneers in order to ensure optimal alignment and results. Furthermore, they cannot be whitened once they are cemented.

Resin Infiltration: This process is very similar to cosmetic bonding because it uses bonding agents and flowable composite resin to change the color of teeth. This procedure is appropriate for patients who have white splotches on their teeth. These “white spot lesions” can be caused by congenital defects, orthodontic brackets, and exposure to either too much or not enough minerals like calcium and fluoride during childhood. Resin infiltration requires no numbing and involves etching the splotchy areas of the tooth with a low grade acid to create microscopic porosities which are then filled in with flowable tooth colored resin and cured. This changes the color of teeth but does not change the size or shape.

Teeth Whitening/Bleaching: The main idea behind whitening is that peroxide gel is used to chemically alter the intrinsic color of teeth. I am going to write a separate issue all about whitening because there is a lot to talk about.

I have included pictures below of some “before” and “after” results from patients at our practice for all of these procedures.

Both Dr. Krist and I are properly trained and educated with advanced courses to carry out any of these cosmetic procedures. These cosmetic procedures can be life changing for patients and are often our favorite appointments to experience because the result is usually very joyful. Dr. Krist and I do not like to “sell” these procedures to patients; we prefer when patients ask us directly about changing the size, shape, and color of their teeth so we can educate them about the possibilities. If any of these procedures sound intriguing or applicable to you, please reach out to either Dr. Krist or myself so we can help you improve the confidence in your smile!

Sincerely,
Dr. John Obeck

Stephen M. Krist DDS

04/20/2023

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03/24/2022

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