On Тhe Way To Happiness | Rouge Magazine | September 2010

Dr. Petar Duchev – private practice in Sofia, directed exclusively towards aesthetic restorations, interdisciplinary approach in cases of total rehabilitation, implantology. The clinic is a member of the American Academy of Cosmetic Dentistry.

The first law of happiness states: “Smile as often as you can every day!”

Today, however, we don’t seem to have enough time for this. We are so rushed in the rhythm of the modern routine that we pass by the small things that can make us happy. What about the most ordinary ones? In order to save a couple of minutes, we don’t even think about what we eat and at the end of the day, the only thing left in our minds, is а strange feeling of tension. When for a moment the smile finds its way back to our faces, it seems to have lost its charm. This may actually be a very real problem which also has a medical explanation and a special term – tooth wear. Dr. Petar Duchev – Chief Doctor of DENTAL CLINIC PETAR DUCHEV is telling us how to handle it, how to protect ourselves from it and why it is so typical of the way we live today.

What is tooth wear?

I would like to emphasize that this is a disease which is typical for the contemporary urbanized society. In general this problem results from the high acidity in the mouth, associated with the excessive consumption of fizzy drinks, foods with artificial color additives and preservatives, as well as with our desire to have snow-white teeth. All of these factors inevitably affect the enamel which gradually wears off and the dentin underneath begins to appear. The dentin is even more sensitive to the factors listed above. Generally, tooth wear is a natural and physiological process, which, however, becomes pathological more and more often. The disturbing fact is that those affected by it are mostly teenagers or people around 45 years old.

Are these the most common factors associated with this problem?

In fact, stress is also among the main factors. When a person is stressed, s/he tends to clench his/her teeth that leads to grinding at night, pains in the joints of the jaw and the head, as well as neck stiffness. The result is a vicious circle and the tooth wear deteriorates. Besides, this problem often accompanies certain disorders such as anorexia and bulimia.

What are the first symptoms that tell us that something is wrong?

One of the main symptoms is that the teeth look very even, but at the more advanced stages of tooth wear, the smile looks old. If one observes closely enough, the appearance of brown lines on the surface of the upper and lower incisors can be seen. This is one of the first indicators that the enamel is worn off and the dentin is visible. As I mentioned, the latter is extremely sensitive to the artificial color additives in the different drinks and foods, and changes its shade very fast.
Besides, the cuspids which are typically spear-shaped, look as if their tops have been cut off. In addition, if we wish to have a beautiful smile, the two front incisors should be slightly longer than the other teeth.

What measures can be taken to avoid this problem?

When it comes to this, the right prevention is most important, and it is, since one of the greatest problems is that sometimes even the dentist cannot evaluate when the natural process of tooth wear has become pathological. Therefore it is best to avoid fizzy drinks and pay special attention to the highly aggressive cleaning with special pastes. Tooth whitening and particularly the tooth whitening that is done during a visit to the dental clinic, is very stressful for the enamel.

Still, today many people wish to have snow-white teeth. What would you advise them?

Tooth whitening should be done only when needed, and its purpose should most of all be to make the dentin lighter, because the enamel which covers it is transparent. The patient is advised to select a whitening system for home use and perform the procedure under the supervision of his/her dentist. The latter is most able to decide which the most suitable and least aggressive shade for every patient is. This option is more time-consuming, but at the same time it is much more gentle to the teeth.

What are the treatment methods?

There are two main options. The first one represents restoration of the height of the teeth by placing crowns. When the latter are placed, however, the tooth should be considerably filed down and the tooth nerve is at risk of getting affected. This is why our team prefers the second method, called biomimetic restoration. A tooth treated like this will be brought back to its normal anatomic shape. In order to achieve this, a specific group of composites is used. These are special materials that possess the characteristics of natural teeth, and most importantly, are just as elastic. It is this quality, added to the advanced technologies in the modern systems, that ensure the longer life of the restored teeth. These materials are divided into two groups, one of which is used to replace the missing dentin and the other one replaces the enamel. One of the advantages of this method is that the patients get used to their new smile considerably faster than they would with crowns.

Is the restoration painful?

It is not, because we always work with anesthesia, but the whole process takes long, as it follows a separate protocol. Besides, in 80% of the cases the tooth wear affects almost all teeth and thorough restoration is needed – and only the restoration of the upper jaw takes two days.

What are the treatment stages?

Before the treatment starts, the patient must wear a special silicone brace for a month. The goal is to increase the distance between the two jaws in order to make the joint used to the change in their location. Then we proceed to restore the upper chewing and front teeth. When this stage is complete, the patient must once again wear the silicon brace for a month, and only then can we start work on the other teeth. Afterwards we place a new brace which should not be taken off for a minimum of six months.

This is quite a long period.

It is, but the result is worth it. The advantage of this method is that after we apply it, the smile looks in exactly the same way that it did in the patient’s youth. Plus, it allows for a slight change of the color of the teeth, as well as for harmonization of their positions. We also do our best to provide maximum comfort to our patients. While the procedure in the clinic lasts, they wear special video glasses and can watch movies. If they wish, they can enjoy their favorite music played on an MP3 player. In this way, the work of the team does not disturb them and the time they spend in the dentist’s chair, goes fast. Besides, the isolation system used keeps the mouth of the patient open without him/her making an effort to do so, while excellent visibility is provided to the dentist. The result is an ideal bond between the material and the tooth itself, and a really good and long-lasting result is achieved.

Is special care after the treatment necessary?

The patients should know that even though such restoration is made, they cannot avoid the visits to the dentist afterwards. It is just the opposite – the recommendation is for dental check-ups every eight months so that the tartar is removed from the teeth and they are polished.

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