Tooth Whitening

Treatment options in the management of cancer of the floor of the mouth (FOM) consists of radiotherapy alone, surgery alone, or a combination of these two modalities.1 and 2 Presently, the role of chemotherapy remains investigational. Early tumors are equally amenable to treatment by surgical resection or radiotherapy; therefore, a single modality is preferred as the definitive treatment in T1 and T2 tumors. Other factors such as potential complications, cost, convenience, compliance, long-term sequelae of treatment, and willingness of the patient must be considered for selection of the initial treatment. On the other hand, advanced-stage tumors require combined therapy with radical surgery and adjuvant radiotherapy for a successful outcome. In these cases, the factors that influence the choice of surgical approach for the primary tumor are the size of the primary tumor, its depth of infiltration, its location in the oral cavity (anterior versus lateral/posterior), and its proximity to the mandible. Both tumor growth and treatment significantly compromise speech and deglutition, particularly when the tumor involves FOM and the mandible. Newer concepts of immediate reconstruction and use of microvascular techniques have dramatically improved the results of treatment for this group of patients.

Selection of treatment modality (more…)

In the past decade, there has been a remarkable upswing in interdisciplinary collaboration between dentists, orthodontists, and periodontists in smile enhancement, and now an entire field of “cosmetic periodontics” has evolved in collaboration with cosmetic dentistry. Contemporary orthodontic smile analysis is generally defined in terms of (1) vertical placement of the anterior teeth to the upper lip at rest and on smile (adequate incisor display but not too gummy), (2) transverse smile dimension (buccal corridors), (3) smile arc characteristics, and (4) the vertical relationship of gingival margins to each other. Through the interaction with these other disciplines and the knowledge gained, we have expanded our diagnosis of the smile to further refine the finishing of anterior esthetics for our patients.

As our interaction with cosmetic dentistry has increased, we have become very aware of what standards guide the dentist who strives for an excellent smile. Through cosmetic bonding and laminate veneers, the dentist can control tooth shape by adding or taking away from the tooth, crown, or laminate. As orthodontists, we have generally limited our tooth-reshaping efforts to incisal edge “dressing.” The purpose of this article is to examine some cosmetic ideas and present new ways in which we can improve the smiles of our patients. In Part 1, I will define and illustrate how these principles are applied to improve the cosmetics of orthodontic patients. In Part 2, my coauthor and I will review the new laser technology available for reshaping soft tissues, and, in Part 3, we will discuss the clinical use of those lasers. (more…)