YEHIA MASSOUD DDS | Oral Implantology

Q. What are my choices for filling materials?
A.There are four choices:
Plastic or composite, Porcelain, Gold, Mercury...Each has advantages and disadvantages.

Q. What is the advantage of porcelain vs gold vs plastic?
A. Plastic requires only one visit, is esthetic and least costly. However, It does shrink the most, resulting in leakage or decay under the filling and more frequent remakes. Also, it abrades easily against the opposing tooth, causing it to have the shortest life span of all filling materials. Porcelain is a stronger material than plastic, bonds the tooth together to reinforce it, looks like a natural tooth and lasts longer than plastic. The only disadvantage is it is more costly than plastic. Gold is the strongest and longest lasting material available. It is also the most gentle on the tooth. The disadvantages are cost, being about the same as porcelain, and appearance. It is most suitable for areas of the mouth where it is not visible, such as back upper teeth. Mercury fillings are not performed in my office due to health concerns.

Q. How significant is the advantage of one material over the other?
A. The correct choice of materials is crucial for the health and longevity of the tooth. Generally, if cost is a concern, then plastic is used, where possible. If cosmetics are a concern and one seeks a more durable material, then porcelain is the choice. If one seeks the most durable and proven material that is gentlest on the tooth, and is located in an area that does not show, then gold is still regarded as the finest material there is.

Q. What is so special about gold fillings and would you use it where it shows?
A. Gold is the standard by which all other materials are judged. A filling usually fails by fracturing or leaking. Gold does not fracture and, if done well, will not leak. I use a microscope for my fillings, thus ensuring the most precise fit. Gold is also gentle on the opposing teeth, having similar hardness as enamel. Therefore, it will not wear down or fracture the opposing tooth. It is not unusual for a gold filling to last 50 years or more. This cannot be said of the other materials. If one is looking for the finest material to have as a filling, then gold is the obvious choice. Of course, I am very conscious of people’s concerns for esthetics. Thus, if cosmetics is a major concern, I would suggest gold only in areas of the mouth that are not visible.

Q. What is the advantage of using gold under a crown?
A. Using a metal under a crown that is to be placed on a back tooth where biting forces are greatest helps to make it stronger, thus reducing the risk of fracture of the porcelain. I use gold and platinum (unlike most crowns which are fabricated with nickel and other base metals in them) for several reasons. First, the fit obtained by gold/platinum is the best fit possible. The quality of a crown is judged by how intimate the fit is between the crown and the tooth. A well fitting crown will not leak and bacteria will not seep under the crown, causing decay and infections. Also, a crown placed in the mouth becomes a part of your body. It is important to have a noble material that is biocompatible with your body rather than the cheaper metals mentioned above. The gum tissues react favorably with gold rather than the cheaper, base metals which often lead to inflammation.

Q. Why do you use such materials such as gold and platinum?
A. As mentioned in the previous question, these noble metals become part of your body. Therefore, it is important to place the healthiest materials that have withstood the test of time and against which all others are judged.

Q. Why do you use a microscope?
A. To be able to visualize the fit of my crowns under such high magnification has significantly improved the precision and quality of my work. This results in a longer lasting restoration.

Q. How long does Chairside Whitening take?
A. The procedure takes about one hour. It begins with a preparation period followed by the actual whitening process. It is recommended to have a cleaning prior to the whitening session.

Q. Is whitening safe?
A. Yes, extensive research has shown the safety of whitening performed under the supervision of a dentist. As a matter of fact, it is considered one of the safest cosmetic procedures available.

Q. Does it hurt?
A. During the procedure and for the rest of the day there is some intermittent discomfort, which usually is gone by the next morning. To minimize this, we place a desensitizer on the teeth.

Q. Will my teeth eventually go back to their old color? How often do I need to redo it?
A. By following some simple post whitening care instructions, your teeth will always be lighter than they were before. Occasional touch-ups with touch up gel may be necessary. These are professional formula products designed specifically to keep your teeth their brightest and are available through our office.

Q. Will it work for me?
A. Whitening works for most people. Of course, only your dentist can tell you if it is appropriate for you. Feel free to discuss it with Dr. Massoud next time you are in the office.

Q. Does Invisalign interfere with my speech?
A. Not at all. After a few minutes of reading out loud, the tongue quickly adapts.

Q. Do I have to wear it all the time?
A. Yes, otherwise it does not work. The only time you remove the aligners is while eating or cleaning your teeth.

Q. Is it uncomfortable?
A. When the aligners are first placed, they are tight. This is a sign that they are working to move your teeth to their final position. But after several days this gives way.

Q. Can people notice it?
A. The advantage of Invisalign is that the retainers are clear, making them virtually invisible. This is the reason so many adults have embraced this technology, as it does not interfere with you daily lifestyle.

Q. Do I have to wear a retainer afterwards?
A. Yes, a retainer is necessary in order to hold the teeth in their final position while they are consolidating. The length of time necessary varies from patient to patient.

Q. Is it just for looks?
A. While straightening your teeth, of course makes them look natural, healthy and pretty, there is another very important benefit as well. Straight teeth are easier to clean, leaving them healthier. Also, your bite and function is usually improved with straight teeth. Many TMD problems are a result of crooked or malpositioned teeth. So there are significant health benefits to straightening your teeth as well.

Q. How long does it take?
A. Treatment time varies from patient to patient and is based on the severity of the case. The average case takes about 12 months.

Q. Is it expensive?
Q. The cost of Invisalign is reasonable when one considers the benefits obtained in terms of health, esthetics and your sense of self. There are various financing options which make it very affordable. Feel free to inquire next time you are in the office.

Q. What are porcelain veneers?
A. Porcelain veneers are thin porcelain facings about .3-.7mm thin. They cover the front of the tooth and are designed to improve the shape and brighten the color of your teeth. They can be used to close gaps, straighten crooked teeth and greatly improve your smile.

Q. Could I visualize the results before we start?
A. Yes. A trial set of veneers can be placed over your existing teeth to give you a close visualization of how the final result will look like. This way you can see your most optimal smile before deciding on treatment.

Q. How many visits does it take and do I wear temporaries in between visits?
A. It is a 2 visit procedure with one week between visits. If necessary, we can shorten the gap between visits. Yes, you do wear temporaries that closely resemble what the final veneers will look like. This is in order for you to try out your final smile before we finish it. This also allows you to make any changes to the veneers before they are finished.

Q. What is an implant?
A. A dental implant is a replacement of the root of the tooth on which a crown, or artificial tooth can be attached. This replacement root is in the form of a screw and is made of titanium.

Q. How does an implant work?
A. The implant screw is placed in the jawbone in the area where the missing tooth exists. During the period of osseointegration (4-6 months) the jawbone is growing on the surface of the titanium implant, actually fusing to the surface and incorporating the implant as a solid part of the jaw. Subsequent to this osseointegration, a crown, or artificial tooth is fabricated to restore the esthetics and function of the missing tooth.

Q. Does it hurt?
A. The placement of the implant is a surgical procedure which is usually performed under local anesthesia. Normally, there is no pain associated with this step. Subsequent to the procedure, there might be some minor discomfort that is remedied with pain medication for the initial period of healing.

Q. What can go wrong?
A. A properly planned and placed implant will have a very low risk of failure. However, there are unforeseen circumstances, such as infection or failure for the bone to osseointegrate, or fuse to the implant. In the event of such rare occurrences, the implant is removed and the area reevaluated for retreatment. Every year millions of implants are placed worldwide with a very predictable and very high success rate.

Q. How does it feel after it is finished?
A. Implants are intended to restore function. Therefore, your new teeth will look and feel natural and comfortable. You should be able to chew, smile and speak with confidence. Most people who receive implants are much happier than with other treatments.

Q. What is TMD Syndrome?
A. TMD (or TMJ) Syndrome is a series of disorders associated with the jaw joint, muscles and teeth, usually as a result of an imbalance in the way the patient's teeth close together. More specifically, it results from an orthopedic instability in the alignment of the jaws.

Q. What are the symptoms of TMD?
A. The symptoms of TMD can vary from patient to patient. Generally, those who suffer from TMD will experience one or more of the following: pain in the jaw muscles, headaches, clicking of the joints, locking of the jaw, worn or fractured teeth, ringing in the ears, dizzy spells.

Q. What causes TMD?
A. Usually, the cause of TMD is an incorrect bite, or malocclusion. This misalignment of the upper and lower jaws causes stress on the muscles that function in biting. Eventually this stress could wear down the jaw joints or lead to tooth fracture.

Q. How do you treat TMD?
A. The treatment of TMD is tailored individually for each person. The goal is to relieve the symptoms and stabilize the bite. Usually, an orthotic device is fabricated to stabilize the bite by making it harmonious in order for the muscles to heal and symptoms to improve. Once this is achieved, other therapies to permanently realign the bite can be undertaken.

Q. How does an orthotic improve my symptoms?
A. An orthotic improves your symptoms by gently realigning your jaw position so there is no strain on the muscles, joints and teeth. This correct, relaxed jaw position allows the muscles to rest and heal, therefore reducing the pain and other symptoms. Over the course of wearing the orthotic, you should begin to feel more comfortable and be able to chew swallow and speak with the pain greatly diminished.

Q. If left untreated, can it cause damage?
A. The reason you have symptoms is because something is not correct. If left untreated, this could lead to further breakdown of the muscles, joints or teeth. The muscles might become very painful, the joints worn and the teeth worn or fractured.

Q. How is snoring a health risk?
A. Sleep apnea, or snoring, leads to resistance to airflow through the airway. This can reduce the amount of air reaching the lungs and reduce oxygen concentration in the blood. The body senses the lowered oxygen level and the heart works harder to get more oxygen to the body. This chronic strain on the heart has been associated with hypertension, congestive heart failure, stroke and heart disease. In addition, the lack of deep REM sleep leads to fatigue/cognitive dysfunction, depression, sexual dysfunction, gastric reflux as well as other health problems.

Q. What can be done to treat it?
A. The OASYS oral /nasal airway system is the first FDA approved device that is designed to maintain the airway in order to increase the air reaching the lungs. Dr. Massoud is a certified OASYS provider, having been trained in its fabrication and treatment.

Q. Is the appliance uncomfortable?
A. The appliance allows patients to breathe more easily, therefore they receive a more restful sleep. In addition, it is not bulky or obtrusive like airway machines, so it is easier to wear and sleep with. It also has the added benefit of being easily transported during travel, as it is a small appliance. Initially, there might be some jaw or teeth discomfort. However, this disappears within a few days of sleeping with the appliance.

Q. How many visits for a root canal?
A. Usually, it takes only one visit for most root canals.

Q. Does it hurt?
A. No, we ensure that you are quite numb before we start. Afterwards, the most you can expect is some discomfort that is easily alleviated with Motrin. Rarely, is there more than just mild discomfort. Why do I need a crown afterwards? Because a tooth treated with root canal becomes weaker and can fracture if not covered by a crown.