More Smiles Dental Spa Dentistry Blog | James A. Moreau, Jr., D.D.S.

Saturday, May 31, 2008

Why Replace a Missing Tooth

When my grandparents grew up in rural Mississippi 100 years ago, their concept of dental care was that when a tooth got rotten enough and caused enough pain, you pulled it. When they were all gone, you got dentures. They had no idea that the loss of even a single tooth begins a succession of decline and probably hastened the loss of other teeth.

Today, while some people are still naive about tooth replacement, many more people understand and are educated about the importance of taking care of and keeping your teeth for as long as possible. And when one is lost, a wise consumer will not delay in seeking help to replace the tooth.

When a tooth is missing, the underlying bone begins to shrink and recede since there is no live nerve and root structure to be supporteed. The blood supply to that area is diminished. Loss of bone is easily visible on dental x-rays.

Also, the tooth that was opposite (above or below) the lost tooth, will begin to extrude itself into the newly opened space, putting it at risk also. And, as if that were not enough, the teeth in front of and behind the missing tooth will begin to drift into the open space. As they move into the space, a chain reaction begins as all the teeth begin to shift to fill in the open space. As a result, they no longer come together properly when biting down, causing excessive wear and tear on the surfaces of the teeth. Ever noticed someone who had really flat teeth that were straight all across the bottoms?

There are a number of ways to replace that missing tooth and prevent all this resulting mayhem in the mouth. Dental implants are a very good solution in most cases to replace a missing tooth, restore the aesthetics of your smile and hang onto the bone structure to prevent the bone from resorbing and shrinking away. Permanent bridges are also still used, and removable appliances are also an option though sometimes awkward and less than ideal.

Delaying tooth replacement too long can allow so much bone loss that an implant is no longer a good option and delaying can allow problems to compound themselves, creating a more complex and more expensive set of issues.

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posted by MoreSmiles at 8:45 PM 1 comments

Living in Pain

I mentioned previously that there are people who live in pain every day and never realize that this isn't normal and they don't have to live this way. Dr. Moreau would attest that he, himself, had TMJ symptoms for years...dibilitating headaches he attributed to allergies or high school football injuries. Over time, his body had accommodated and he just assumed this was the way he had to live. UNTIL...he went to Las Vegas Institute for Advanced Dental Studies (LVI) and began to explore the importance of functional aesthetics. Cosmetic dentistry can be expected to last longer when it is functioning the way it was intended. That leads back to the proper alignment of jaw joints and occlusion of the teeth, which leads to ensuring a healthy, comfortable bite and TMjoint, which leads to relief of many aggravating symptoms. Anyway...he discovered that he didn't have to live with that kind of pain...and neither do our patients.

posted by MoreSmiles at 6:13 PM 0 comments

Friday, May 30, 2008

Signs and Symptoms of TMJ

Thousands and thousands of people live their lives every single day with uncomfortable symptoms of TMD, Temporomandibular Disorder, yet don't realize that this isn't "normal" and would certainly never think to report this to their dentist.

One of our own family members, who had previously worn an NTItss device for jaw joint symptoms, was in the office today for her periodic exam and professional cleaning. She casually mentioned that she had experienced some numbness in her face and that she was going to see an ENT for an ear infection. Dr. Moreau asked her if she had still been wearing her NTItss, and the answer was no. He did a few preliminary palpitations and screening and suspects that the symptoms she is assigning to ear infection are actually radiating from her TMJ. TENSing and EMG in our office next week will confirm or rule that out.

The point is that someone even this close to dentistry can easily misdiagnose, or BE misdiagnosed because they simply didn't think to tell their dentist what they were feeling.

Some Signs and Symptoms that you should definitely report to your dentist, if he or she is trained in neuromuscular dentistry (NM dentistry), are:

Neck, shoulder or upper back pain
Jaw Joint pain or clicking/popping noises
Facial pain or numbness
Ear pain or congestion
Sensitive teeth
Clenching or grinding of the teeth, habitually
Ringing in the ears
Limited opening of the jaws

If you've experienced these symptoms, and HAVE mentioned this to your dentist or physician, without proactive response on his or her part, you should consider finding a dentist who has some background in neuromuscular dentistry and ask for evaluation and screening for TMD. An NM dentist won't hesitate to apply the proper protocol for accurate diagnosis and treatment.

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posted by MoreSmiles at 5:47 AM 1 comments

Thursday, May 29, 2008

What is TMJ? What is TMD?

Just a quick post to clarify the difference between TMJ and TMD. Pretty basic stuff, but you may hear people say, "I have TMJ." The truth is that EVERYONE has a TMJ; usually what they mean is that they have TMD.

TMJ stands for Temporomandibular Joint (jaw joint). TMD is Temporomandibular Joint Disorder. TMD occurs when, through malocclusion (bad bite), injury or habitual clenching, for instance, the jaw joint becomes inflamed and causes discomfort. Can be difficult to diagnose largely because patients who suffer from TMD either don't know where to go for help or get mixed signals from medical professionals about how to treat. Used to be that when all else failed, doctors would recommend surgery. A better understanding of the role that muscles play in the comfort of TMJ has led to better diagnosis, treatment and resolution. And more and more patients and medical professionals alike are recognizing that treatment by a properly trained and educated dentist is the best course.

posted by MoreSmiles at 5:25 PM 0 comments

Monday, May 26, 2008

Cosmetic Veneers--Do You Want to Go Down the Bucchal Corridor?

My previous post ended with a teaser about the importance of the bucchal corridor in considering cosmetic changes for your smile.

The bucchal (say buckle) corridor is the space between your cheek and the outsides of your upper back teeth that is visible when you smile. We always ask patients to look in a mirror, smile and then count how many teeth they can actually see in their natural smile line. Usually, that is the number of teeth that would need to be veneered, or treated cosmetically, for a satisfying and natural-looking result.

Some people may figure if they can see 10 teeth in their upper arch smile, then maybe we can just get by with doing 6 or 8 teeth and save some money. The problem is that the resulting effect is that you "lose" the bucchal corridor. The front, veneered teeth will stand out, but then the smile drops off behind those and you just don't see the rest of your smile. The best way to convey the impact of a lost bucchal corridor (a long dark hallway if you will) is to show you. Though this photo is NOT our patient, in the picture above (you'll recognize the adorable Matthew Perry), you can see the effect of only veneering the front six teeth. The result is that the "improvements" appear unaesthetic, unnatural, and unappealing. The actor has since had his smile redone to eliminate this problem and create a more natural smile with a full bucchal corridor. So now you know. :-)

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posted by MoreSmiles at 4:05 AM 2 comments

Sunday, May 25, 2008

Try On a New Smile

There are a couple of really effective ways for a patient to get an idea of what their smile would look like if they made certain cosmetic improvements to their teeth.

A resin "mock-up" can be achieved by placing resin filling material directly to the teeth to simulate what the changes would look like. The teeth are not prepped/etched to allow for permanent attachment of the resin, so once it's light-cured to harden, it can be simply popped off. The mock-up is not particularly artistic or color-matched, but it does pretty accurately represent the potential for the smile.

Computer digital imaging is another resource for previewing cosmetic changes. We take a digital photograph of your full face, download it into the imaging program, use a "paint" type software to simulate changes such as whitening, gum recontouring, shorter or longer teeth, veneers, etc.

And another resource is similar to the mock-up mentioned above but is a bit more flexible...literally and figuratively. An "off-the-shelf" strip of pliable, rubbery "veneers" can be temporarily adhered to the fronts of the upper arch of teeth. They'll stay on long enough to make it home and show them to your spouse or your mom, but will peel off easily. Unlike the mock-up, the strip will come off in one piece and then can be quickly reapplied for an instant before/after comparison.

Another advantage is that sometimes a question may arise as to how many teeth will need to be veneered for a natural-looking result. The strip can be trimmed, or shortened down to 4, 6, or 8 teeth to allow a realistic idea of how many veneers will render the best result throughout the bucchal corridor.

Next post: Looking down a dark hallway...or...exploring the bucchal corridor.

posted by MoreSmiles at 3:41 AM 1 comments

Saturday, May 24, 2008

Orthotic Used to Relieve TMJ Pain

In the presence of TMJ pain, once we've documented signs and symptoms, we use special technology to help the teeth, jaw and muscles find their most comfortable, relaxed position. Then an orthotic device, a one-piece prosthesis, is temporarily bonded to the natural teeth surfaces, creating a new biting surface for the patient to try for several months. Symptoms should be relieved and then options are considered for the best long-term solution. This patient is wearing an orthotic in this photo. The upper teeth have already been restored by Dr. Moreau after establishing her new, pain-free "bite" with crowns and veneers. The orthotic proved that her new bite was comfortable and helped guide us in restoring the lower teeth as well. Look closely on the lower teeth and you'll be able to detect a line of shade variation between the top half and lower half of the teeth. The upper half is a bonded orthotic which this patient wore for a period of several months.
As a TMJ doctor, we can focus on the neuromuscular aspects that contribute to painful jaw, muscle and teeth pain, including headaches, and apply principles of neuromuscular dentistry to get rid of pain and restore comfort for the patient.

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posted by MoreSmiles at 6:38 PM 1 comments

Snap-On Smile on The Today Show

I saw a quick segment on The Today Show last week which featured a removable aesthetic dental mouthpiece called Snap-On Smile. The case shown on the segment was a young person who had some spacing or pointy teeth if I remember correctly. With literally a "snap" the dental device was placed over the teeth, totally changing the appearance of the smile--for the better, obviously.

For a quick, temporary transformation - for short-term wear - a Snap-On Smile may satisfy an immediate need for some patients. Or if a patient is considering having some veneers or other permanent cosmetic dentistry done, but would like to "try-on" a sample to see how they would look with certain changes to their smile, a Snap-On Smile is one of several options allowing a sneak preview.

The drawback would be Snap-On Smile in the hands of a dentist who doesn't fully understand proper occlusion (yes, that happens) or a patient who treats the device as a long-term solution to their aesthetic ailments. Just like with no-prep veneers such as Dura-Thins or Lumineers, case selection is important. Since the device adds to the occlusion of the teeth, it can change the bite and create some discomfort for the patient. Prolonged wear could lead to more troubling symptoms. Snap-on Smile is also better used in a situation where your smile won't come under close scrutiny but may be viewed rather from a distance or in fleeting moments.

Snap-On Smile certainly has it's usefulness, but in the hands of a knowledgeable, progressive dentist is but one tool in a hefty toolbox that offers multiple options for multiple dilemmas and must be deployed only in the right situation for which it is best suited.

My next post will discuss another option for allowing patients to preview cosmetic improvements they may be considering.


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posted by MoreSmiles at 3:08 AM 3 comments

Monday, May 12, 2008

After a busy week at the American Academy of Cosmetic Dentistry scientific session in New Orleans, Dr. Moreau was off this morning, bright and early, to join the American Dental Association legislative leadership team in Washington, D.C., for a round of visits with Louisiana legislators. Except for a bomb threat at the airport which delayed boarding his flight (turned out to be unfounded), all is well in the capital city tonight.

Organized dentistry (the American Dental Association - ADA) is approaching universal health care by looking to expand access in ways that will not affect taxpayer money. For instance, the leadership is coming up with a variety of ideas, through legislation, to encourage dentists to see medicaid children and to provide care for the poor and under-served.

Your dentist is in a leadership role in trying to make these changes in Congress. Things are changing in the U.S.--easily twenty cents of every dollar spent on health care is caused by government taxation and regulations. It's important to find a balance between what's necessary and what's in the way of Americans having reasonable access to the best health care in the world. These are complicated issues, but the ADA - and your dentist, as an Action Team Leader for the ADA initiative - are all over it.

Over the course of two days, Dr. Moreau and his grassroots team of Louisiana dentists will be meeting with 6 of 9 legislators from Louisiana to initiate the discussions. Nothing will get done in Congress this year because of the lame duck presidency, but the group is working to set up ideas and bills for the next Congress. Four bills are being proposed through this ADA initiative.

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posted by MoreSmiles at 8:06 PM 0 comments

Out of the Office--ADA Leadership Role

I apologize to anyone who may be calling our office over the last several days and have not been able to reach us. It is very unusual for us to be closed more than a couple of days at a time, but it just so happened that there are two back-to-back events requiring Dr. Moreau to be away this week.

As you've probably read in previous posts, we were attending the annual scientific session of the American Academy of Cosmetic Dentistry (AACD) Tuesday through Friday of last week.

Monday and Tuesday of this week (5/12, 13) Dr. Moreau is in Washington, D.C. meeting with congressmen and senators on behalf of the American Dental Association. Dr. Moreau has been involved for a number of years with this facet of the ADA's legislative grassroots initiative. He is very comfortable and effective in this role, and this year was asked by the Louisiana Dental Association to take on the role as Action Team Leader for the whole state. As such, he coordinates other dentists throughout the state who then contact their congressmen and senators in their home districts to establish rapport and be available to communicate the ADA's position on various issues that are important to dentistry...such as funding for children's dental programs and fluoridation of water supplies.

Each spring, the ADA brings dentists from throughout the country to Washington for a few days of leadership training, reviews of pertinent issues and speakers from Capital Hill. The dentists arrange ahead of time to meet in the Senate and House offices with the legislators and/or their staffs.

You should be happy to know that dentistry has organized this grassroots effort to ensure, through legislation, the safety of patients, promotion of good health initiatives and provision for advances in dental care. You, the patient, are the ultimate beneficiary of these efforts.

So, I apologize again if we failed to answer the phone when you called this week. Cindi and Jessica are trying to man the phones as much as possible, and I am monitoring email from my remote location and responding to your appointment confirmation messages and requests for information as quickly as I can. Your continued patience is appreciated.

We will be in the office with our hygiene team seeing patients on Monday and Tuesday and will be happy to hear from you then.

posted by MoreSmiles at 6:32 PM 1 comments

Sunday, May 11, 2008

Changing Lives Daily

I mentioned in a previous post on this blog the power of transforming a person's life through cosmetic or advanced reconstruction dentistry. You may be sceptacle and wonder how that is possible. A few examples come to mind.

Several years ago, a middle-aged, single lady came in for a smile makeover. We placed some porcelain veneers proportioned for her face and shaded for her particular coloring. The result was stunning. When she returned several months later for her periodic exam and professional cleaning, she looked absolutely beautiful. Not only was she quick to flash her lovely new smile, but she had complemented that look with a new hairstyle and contact lenses instead of glasses. Her long-time boyfriend had proposed marriage and she was literally starting a new life. While results such as this may not be typical in every case (as they say on TV ;-), we do see this type of overall change in a patient's life once they have the renewed self-confidence that comes with a renewed smile.

Another case is a beautiful young college student who had a laser gum lift to allow her smile to present longer teeth framed by her lips instead of her gums, followed by porcelain veneers. I recently saw a friend of hers who told me what a beautiful job we had done on her smile and he told me (and I quote), "Ya'll have transformed that girl!" Coincidentally, she was featured in a magazine ad with a group of other people. She told us that at the time of the photo shoot, the photographer was arranging his subjects for the shots. He looked at her and said, "You, with the teeth, over here." He promptly placed her in a prominent position at the forefront of the group.

Another young lady had extensive decay on nearly every tooth. Over the course of several appointments, we restored her smile with a combination of porcelain crowns, veneers, onlays and tooth colored fillings. She barely smiled when we first began seeing her as a patient, and spoke very little and softly, without eye contact. By the time we completed her restorations, she was bounding into the office, once again, as with the aforementioned patient, with a new hairstyle, and a completely outgoing personality.

We are so grateful to these patients, and scores more, who have allowed us the absolute privilege and joy of being able to do this for them. We love what we do, and we're having the time of our lives...helping people change theirs.

posted by MoreSmiles at 6:16 PM 0 comments

Saturday, May 10, 2008

Financing Larger Cases in Dentistry

The level of dentistry that we do in our advanced restorative and laser-assisted dental practice sometimes leads to very complex, full-mouth dentistry cases. It is possible that in order to restore someone's mouth to ideal health, function and beauty, the total cost of treatment could be in tens of thousands of dollars. Monthly payment plans make this type of dentistry more accessible to a greater number of people who may not necessarily be able to pull that sum of money easily out of the family's ready financial resources.

For these larger cases, we can now offer lower rates on financing for 72 and 84 months. Depending on credit history and amount financed, rates as low as 7.99% or 8.99% may be available. This is a great deal considering that the average credit card rate, according to (4/18/08), is 11.9%, and an installment loan can run around 13.6% .

We believe that everyone should be able to have the level of dentistry that we provide, and that is why we are so happy that we have been able to assist so many patients over the years with payment plans such as this which allow them to comfortably afford the dentistry that they need or want. Achieving a level of excellence in providing dental care is very costly for a dentist as it involves years and years of expensive, additional continuing education study beyond dental school, as well as utilization of the very best materials and laboratories to produce predictable, natural-looking results that satisfy a patient's expectations. Dr. Moreau would not be able to take on challenging full-mouth reconstruction and smile makeovers if he had not commited a large chuck of our practice's profits back into the extra training required to perform at this level.

Likewise, pursuing a smile makeover can often be, for the cosmetic dental patient, a big investment, but there is no better investment you can make in yourself than one that can transform your life through increased self-esteem and self-confidence, ideal health and function that allow you to eat well, nourish your body and support your overall health, and by all means, enjoy eating all the glorious foods you love.

posted by MoreSmiles at 5:53 PM 1 comments

Friday, May 09, 2008

Online Access to Your Account

Our patients have become accustomed over the last year to confirming dental appointments in our office through email and text messages. This service is provided as a convenience through our partner, Smile Reminders. I visited with the folks from Smile Reminders today at the Academy of Cosmetic Dentistry annual scientific session, and I was told that a new release will be available to us soon that will allow our patients to have several options for online access to your family's account in our office. You'll be able to view your charges, payments and a record of insurance activity. As a convenience, you will also have the option of being able to securely make payments to your account. Invisalign patients will also be able to view their ClinCheck records and see the progress of their invisible orthodontics. We'll keep you posted and let you know through our email newsletter when these options are available.

posted by MoreSmiles at 7:30 AM 0 comments

Thursday, May 08, 2008

Las Vegas Institute Friends Meet in New Orleans

We had a great opportunity last night at the AACD meeting to get together with fellow alums from the Las Vegas Institute for Advanced Dental Studies. The AACD draws cosmetic dentists from around the world, and it's always a pleasure to renew acquaintance with an invaluable network of colleagues with whom we blog and email throughout the year on various dental and non-dental topics.

A group of about 20 Las Vegas Institute graduate doctors and spouses gathered at "Herbsaint", one of our many wonderful New Orleans restaurants, last night. The Las Vegas Institute represents a unique, advanced perspective on complex cosmetic and functional dentistry. So those who have studied this neuromuscular dentistry share a comraderie, and it's always an instant bond between these like-minded dentists. Those at the table last night came to the Crescent City (aka NOLA, aka Nawlins) from as far as Southern California; Calgary, Alberta, Canada; and Manhattan, New York.

posted by MoreSmiles at 5:39 PM 0 comments

Saturday, May 03, 2008

Cosmetic Dental Meeting Coming Up

Next week is the Annual Scientific Session of the American Academy of Cosmetic Dentistry. For almost 10 years now, we have made a commitment to attend this meeting annually because of the tremendous value it has to our patients. Yes, the destinations are nice (Puerto Rico, Vancouver, San Antonio, Hawaii, to name a few), but the content and atmosphere of the meeting are largely responsible for the enthusiasm we have for dentistry. The attendees are the "cream of the crop" dentists from throughout the world who recognize the benefit of staying abreast of the very latest technologies, philosophies and techniques in dentistry. They are a vibrant group, eager to share amongst themselves a wealth of knowledge and experience. Typically, the learning and growing process at this meeting spills out into the hallways with animated conversations between colleagues. We look forward to renewed fellowship and friendship each year with dentists we've met from throughout the country. New Orleans is the host city this year, so we are particularly proud to assist in hospitality duties as we welcome these thousands of colleagues to our home. The benefit of the meeting to our patients is that you can be assured that your dentist stays on the cutting edge of every thought that passes through the collective minds of modern dentistry. He sifts the vast wealth of information and comes back with not only renewed energy but reinforced ideas for making dentistry more comfortable, more durable, more affordable, and more beautiful for all the patients at MoreSmiles! Seriously.

posted by MoreSmiles at 7:30 AM 1 comments

Friday, May 02, 2008

Britesmile Special Extended

We had a really good response to the newsletter we sent via email that highlighted the $299 special fee offered for one-hour whitening through the BriteSmile company. BriteSmile has extended that special a bit longer. So there's still time to take advantage of the special fee and enjoy having whiter teeth for the summer.

posted by MoreSmiles at 9:56 AM 0 comments

Disclaimer: Covington Cosmetic Dentist, Dr. Moreau, has provided this website for informational purposes only. It is not intended to provide advice nor does the use of this site create a doctor-patient relationship. It is only to provide information on a qualified Cosmetic Dentist in Covington, Mandeville, Metairie, New Orleans, Slidell and the surrounding Louisiana areas.

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