Smile Designing - Part 2

The importance of good planning and preparation

As discussed in the first part of this blog - What is Smile Designing?, the key to Smile Designing is in the planning. 

Evaluation and Assessment

Your dentist will first make a full assessment of all components which contribute to your smile. It is important to consider how, not only your teeth, but also your facial features and gums contribute to your overall smile. 

While your dentist will discuss and seek to address aspects of your smile which you dislike and want to change it is important to make a full assessment so that the end result will be in harmony with your facial features, age, gender and personality. 

You can think of it in terms of the way architects design and plan a building. They will not consider the more cosmetic features first, such as the windows and balconies. First importance should be given to the overall structure and foundation. In the same way, in Smile Designing, the aim is to create a smile which will be functional and lasting, not only nice to look at. 

Any underlying dental or gum problems will also need to be diagnosed and treated first. There is no point designing beautiful crowns or veneers and placing them on teeth which have hidden decay or will become loose in future due to gum problems.

Several diagnostic aids may be used in evaluation and assessment:

• Before and after photographs
• X-rays - to assess the jaw bones and teeth
• Facial measurements - to assess proportions and alignment
• Study models - made after taking impressions of your teeth
• Wax-ups - the planned changes to teeth can first be demonstrated in wax on the study model

Facial Assessment

If the are discrepancies in the proportions, alignment or symmetry of the face this will affect the smile. 


For example, some people have a discrepancy between the size of the upper and lower jaws in relation to each another. In more severe cases adjustments to the teeth alone may not be sufficient. Surgery to correct the position of the jaw bones may be required.





In cases where the chin, cheeks or lips appear out of proportion cosmetic surgery may be used to give a better appearance.

Orthodontic Assessment

It is important to evaluate the position of your teeth in relation to your jaw bones and each other, especially when you bite together. A poor bite can affect not only appearance but also normal chewing and speech. The way your teeth meet will also determine how much space there is for placing crowns (caps) or replacing missing teeth with either implants or bridges.

Inman Aligner

If there is a significant bite problem, orthodontic treatment with braces may be required before other treatment can be carried out. Even smaller problems, such as crooked front teeth, are often best corrected with modern types of braces either instead of or prior to placing crowns or veneers.

Periodontal (Gum) Assessment 

Healthy gums are  a major part of your smile. Not only do healthy gums look good they are also important in providing support for your teeth. 

If gum disease is left unchecked the gums will recede so that the roots of the teeth become visible. Also, the problem can spread to the bone surrounding the teeth, causing teeth to become loose. As well as professional cleaning, thorough brushing and flossing of your teeth at home is vital to maintain healthy gums. 

Your dentist will assess the gum level in relation to the teeth and the amount of gum which shows when you smile. Where more complex gum problems are found referral to a periodontist (gum specialist) may be required.

Dental Assessment

There are many potential dental issues which may need resolving. 

Here are some examples:

• Tooth decay
• Staining or discolouration of teeth
• Unsightly fillings, crowns etc.
• Missing teeth
• Gaps between teeth
• Crowded teeth
• Poor alignment of teeth
• Tooth wear
• Mis-shaped teeth
• Too little or too much tooth displayed when smiling
• Tooth dimensions out of proportion

The planning stage is vital in developing the correct plan for treatment. Your dentist will guide you through the process to create a long-lasting, beautiful smile.

In the next part we will discuss some of the techniques and treatments which may be a part of the Smile Design process.

Smile Designing -Part 1

What is Smile Designing?

A smile is one of your most noticeable features. A cheerful face makes you instantly more attractive and approachable. 

But what if you are self-conscious about your teeth or gums? 

Many people cover their mouths or do not smile fully for fear of showing features in their mouth that they do not like. 

Do you long to have a smile you are proud to show the world? 

This is where smile designing comes into play.

Smile Designing is the process of pre-visualizing the ideal smile and planning to predictably achieve the desired end result. 

In the past, dentists tended to deal with different problems in the mouth separately. Smile Designing is a comprehensive approach, taking into consideration the way the mouth is used in eating and speaking, as well as smiling. All the factors which contribute to your smile are evaluated -this includes not just your teeth and gums but also your lips, bones, muscles and skin. 

The aim is to create a balanced and harmonious smile which looks natural. The end result should match the facial features, personality and age of the individual. With careful planning and good maintenance the result will also be long lasting. 

It is important to find a dentist with the right training and experience in Smile Designing. To achieve the desired result a cosmetic dentist may need to work closely with other specialists such as orthodontists, periodontists and implantologists and oral surgeons. A great lab technician who uses the best materials is also vital.


At Smile Station in Bangalore Dr. Gurudev and his team use their training and expertise to give their clients smiles which they are proud to show to the world. 


In the following parts of this blog we will discuss the planning process and some of the techniques used in Smile Designing. 

Sensitive Teeth?

Why are my teeth sensitive?

Are your teeth sensitive?

Do you avoid cold food and drinks?

How do you know if it’s just sensitivity or a more serious problem?

                                                          

How common is sensitivity?

It is very common to experience some pain with extremely cold food and drinks. Teeth may also be sensitive to sweet, acidic or hot food and drinks. It is more common in young adults and women report more sensitivity than men. More often dental sensitivity is mild but for some people it can have a significant impact on their daily life.

What causes tooth sensitivity? 

The most common cause of sensitive teeth is exposure of the dentine layer of the tooth. In comparison to the outer enamel layer of the tooth, which is the hardest tissue in the human body, dentine is softer and more porous. Changes in temperature or pressure cause movement of fluid within dentine and this stimulates pain receptors, causing sensitivity.

How does dentine become exposed?

In a normal, healthy tooth dentine is covered by enamel above the gum level and cementum on the root surface. The most common cause of dentine exposure is gum recession leading to exposure of the root surface. The cementum layer on the root surface is softer and thinner than dentine and is prone to wear away leaving the dentine exposed.

What causes gum recession?

• The most common cause is gum disease caused by plaque build-up due to inadequate brushing and flossing.

•  Brushing too aggressively with a wrong technique or a toothbrush that is too hard can wear down the enamel at the gum level as well as damage the gums. (For more information on brushing technique, click this link.)

• Excessive clenching and grinding of the teeth can cause enamel at the neck of the tooth to become worn away and worsen pre-existing gum disease.

• Using smokeless or chewing tobacco can lead to gum recession and more serious problems such as mouth cancer. Smoking also increases the risk of gum disease.

Dentine can also become exposed when enamel is worn away. 

This may be due to:

·         Long term tooth wear due to a heavy bite or tooth-grinding habit.

·         

     Frequent exposure of tooth enamel to acidic food and drinks.  

·         Stomach acid due to reflux or frequent vomiting.

·         Tooth decay

A cracked tooth of filling may also lead to sensitivity or pain.

Teeth may also be temporarily sensitive after placement of fillings or tooth whitening procedures.

How can I tell if sensitivity is a sign of a more serious problem?

It’s not always easy to tell. It’s always best to see your dentist if sensitivity is an issue so that they can investigate the cause and find the correct treatment.

If you experience pain for some time after the trigger has been removed, or if your teeth are sensitive to hot this is could be a sign of inflammation within the tooth pulp which contains the nerve.  This needs to be dealt with as soon as possible, to avoid losing the tooth.

How can sensitivity be treated?

This really depends on the cause. The following chart covers some of the most common causes:

Gum disease and recession	Improvement in brushing and flossing techniques. Regular professional cleaning. More complex periodontal treatment required for severe gum disease.
Tooth wear and toothbrush abrasion	Correct brushing technique using soft bristled brush. Fluoride varnish. Fillings or sealants may be required to replace lost tooth surface and protect exposed dentine.
Tooth grinding habit	Mouth guard can be made to be worn at night to prevent tooth grinding.
Acid erosion of tooth enamel	Change in diet, reducing consumption of acidic and sweet food and drinks. Treatment of cause in case of reflux or vomiting. Wait 20 minutes before brushing teeth after acid in mouth. Fluoride gel or varnish. Fillings, crowns or veneers may be required to replace lost tooth surface and protect exposed dentine.
Tooth decay	Fillings. Root canal treatment may be required if decay is very deep and the nerve is infected. Prevention of further decay.

How can I prevent tooth sensitivity at home?

Of course, if there are certain foods and drinks which trigger sensitivity, these are best avoided.

As mentioned above, good diet and oral hygiene will decrease your risk of dental decay and gum disease.

Fluoride helps to reduce sensitivity and decay, it can be found in toothpastes and mouthwashes.

Toothpastes made specifically for sensitive teeth also contain other mineral compounds which can help to numb the tooth nerve or create a protective barrier preventing stimuli, such as cold and heat, from causing pain sensations. You need to use these toothpastes regularly, twice a day. If particular teeth are sensitive, you can use your finger to rub a small amount of paste onto the sensitive tooth surface after brushing.

If you have any questions or concerns, please contact Smile Station (click for link), where we will be happy to help you.

Straight Front Teeth Fast!

Are you embarrassed about your smile?

Maybe you have crooked front teeth and have considered seeing an orthodontist but feel it is too late to wear braces as an adult?

Are you worried about the cost and length of treatment involved?



Thanks to a recent innovation in orthodontics, treatment may be easier, faster and less expensive than you expect.

The Inman Aligner uses 3D technology to safely straighten front teeth faster than other appliances.

How does the Inman Aligner work?

The appliance has nickel-titanium coil springs which power aligner bow wires which rest on the inner and outer aspects of the front teeth. This produces gentle forces which act over a long range of movement to guide the teeth into their new position. 

What does it look like?

The metal springs towards the back of your mouth may be visible when you smile. The part the brace on the front teeth is made from clear acrylic.

It looks much better than conventional "train-track type" braces but is slightly more noticeable than "invisible" braces which are completely clear.

The appliance can be removed for short periods of time for special occasions or taking photographs, as well as for daily cleaning.

What is the difference between the Inman Aligner and other types of braces?

Due its unique design, the Inman Aligner can safely straighten teeth faster than others appliances. Treatment is usually completed within 6-18 weeks.

"Invisible" aligners take at least 6 months and traditional fixed braces between 1 to 2 years to complete treatment. 

Faster results and fewer visits also means that treatment is less expensive.

Before treatment

After treatment

Which problems are suitable for treatment with the Inman Aligner?

• Mild to moderate crowding or protrusion of front teeth.
• Rotated front teeth.
• Cross bites - upper incisor teeth behind lower teeth in bite.
• Where front teeth have become crooked after finishing traditional orthodontic treatment.
• Pre-alignment of front teeth before cosmetic treatment, such as veneers or whitening. In fact, the Inman Aligner has been called the "missing link" between cosmetic dentistry and orthodontics.

Before treatment

After treatment

What is involved in the treatment?

• The appliance is removable, but in order to get the fastest results it must be worn at least 20 hours per day. 
• A mould of your teeth will be taken so that the appliance can be custom made in a dental laboratory.
• As with all braces, there may be some discomfort and speech may be affected when the appliance is initially fitted, but this should only last for up to a few days.
• You would need to see the dentist for checks every 2 or 3 weeks whilst wearing the appliance.
• After any orthodontic treatment, a retainer is advised to prevent the teeth moving back. This could either be a removable retainer, or a thin wire bonded to the backs of the teeth (where it cannot be seen).

Find a certified user

It is important to find an dentist who is trained and certified in using the Inman Aligner and uses genuine appliances. 

If you are in Bangalore, you are welcome to visit us at Smile Station in Indiranagar and discuss if the Inman Aligner may be the right solution for you.

Medical and Dental Tourism in India - Part 4

Part 4 - Dental Tourism

In the previous posts we have discussed the pros and cons of medical tourism as well as practical advice for those considering travelling for medical treatment.

In the section we will look specifically at dental tourism, drawing on our experience at Smile Station in Bangalore, India.

What is Dental Tourism?

Dental tourism is a subset of medical tourism. Sometimes also called a "dental vacation" when people combine a foreign holiday with seeking dental treatment.

Why is dental tourism becoming more popular?

Many people who have private, or government provided, medical insurance do not have dental coverage and therefore have to pay the full cost of treatment. Even those who have dental insurance are not covered for many treatments, such as implants and cosmetic dentistry. Extensive reconstructive or cosmetic treatment can be expensive. In the USA and Europe, comprehensive dental treatment has become unaffordable for many.

Travelling for dental treatment is popular, largely due to wide variations in treatment costs between countries.In some cases treatment may be much more affordable in a neighbouring country, such as in Mexico compared to the USA. People from the UK may travel to Hungary or Poland in Eastern Europe where treatment costs are considerably lower.

India is popular with individuals who have family in India and are living abroad as they may seek dental treatment whilst visiting relatives. Others visit for work, vacation or a spiritual retreat and take advantage of quality, affordable dental care whilst in India.

India offers a rich cultural experience and a full range of options, from budget to 5 star hotels, for those looking to combine dental treatment with an unforgettable vacation. 

Depending on the procedure, it is possible to make savings of 50-90% compared to the cost of treatment in the USA or Europe. Even after adding travel and accommodation costs, big savings can be made. 

Developing countries are able to offer more affordable care due to lower overhead expenses, such as the cost of labour, insurance and less bureaucratic red tape. However, there is also generally less regulation of the dental profession.  There is currently no independent, international inspection committee for dentistry, unlike the Joint Commission International (JCI) which accredits hospital and medical care providers. Therefore, it is vital to do your research well in order to find a well qualified, experienced and ethical dentist.

Which procedures are suitable for dental tourism?

The most popular procedures for dental tourists are:

• Dental Implants
  
• Tooth coloured filllings
• Crowns and bridges
• Veneers
• Dentures
• Implant retained dentures
• Root canal treatment
• Periodontal (gum) treatment
• Tooth whitening
• Smile design and makeover

Procedures are usually elective (planned in advance) although emergency treatment may also be sought by those travelling for business or pleasure.

What do I need to consider if I am planning dental treatment abroad?

The tips and advice for those considering medical tourism in the previous part of this blog (click for link) also apply to dental tourism.

In addition:

• Do your research and get recommendations and reviews from verified patients.
• Check your dentist's training and experience and whether they have international qualifications or certification.
• Make sure that the clinic is clean and sterilization protocols are followed.
• Find out about the treatment and how many visits will be required.
• Discuss the best treatment option for you and any risks or precautions.
• For complex restorative treatment, such as implants, crowns and bridges, the timing of multiple visits will need to be carefully planned.
• Find out what travel and activities may be advised or avoided in the post treatment phase.
• Enquire about treatment costs and any guarantees for implants, crowns and bridges etc.
• Consider whether you will be able to return for follow-up or maintenance, or whether you will require follow-up treatment in your home country.

The Smile Station Experience

At Smile Station, in Bangalore, we are regularly welcome international clients, as well as those from other parts of India. Our team of internationally trained and certified consultants are able to provide a full range of dental treatment under one roof. Treatment options, along with their risks and benefits are fully explained so that you can make an informed choice. We have a proven track record in providing high quality, professional and ethical care. 

The clinic environment is relaxed and welcoming and we specialize in helping those who are anxious about dental treatment. The practice is well equipped with the latest technology and materials and a strict sterilization protocol is followed. We used internationally acclaimed dental laboratories to provide world class restorative treatment at an affordable cost. We are also able to arrange airport transfers and travel and accommodation in India.

We have received great feedback from our international clients, many of whom return to Smile Station whenever they are in India.

Here are just two testimonials:

“What an incredible experience! I needed four crowns Dr. Gurudev & his staff went out of their way to accommodate me in the short time I was in Bangalore. Friendly and Professional service at a fraction of the cost in the US.” 

Linda Busi, Santa Fe, New Mexico, USA

Dr. Guru Dev is one of the best dentist I have ever been to....and I've had a lot of excellent dentistry in my life....with having 26 gold porcelain crowns in my 20's. While in India for a long time I had some serious dental problems that I saw 2 dentist for...both of whom said that the tooth needed to be pulled. Being extremely emotionally sensitive to dentistry and feeling no trust in either of them a friend suggested I go see Dr. Guru Dev. He took charge right away with calmness, and gentleness through every procedure. He saved that tooth through a very complicated root canal, and then came the crown. He became my dentist from that point on ....through an extraction, and eventually to an implant which I was very scared to have done. Now back in the US every dentist I see asks who did it and how well done it is. I have had no problems since. I only wish Dr. Guru Dev had a dental practice on the West Coast of the US! Thank you Dr. Guru Dev for all your care and professionalism. Lucky people in Bangalore! 

Christinea Johnson, California, USA


If you would like to know more, please check the Smile Station website (click for link)

Medical and Dental Tourism in India - Part 3

Part 3 - Tips and Advice

In the previous section we looked at the pros and cons of medical tourism. 

If you are considering travelling for medical treatment it is important to know your options and prepare well.

 

Do your homework

Find out about the proposed procedure, the benefits and risks.  Research which destinations and treatment centres have a proven track record and good reputation for the specialty. The Patients Beyond Borders website has a lot of good information (click for link). 

You can also check the Joint Commision International's service World Hospital Search to find JCI accredited health care organizations (click for link).





If possible, get reviews or talk to others who have had the same procedure or been to the same clinic or hospital. Find out if the medical staff speak your language or whether you will require an interpreter.

Finding the best doctor or physician

If possible, get personal recommendations of doctors from those who have been treated by them. Do not rely on reviews on the internet as there is no way to check if they are genuine.

You can check a doctor's qualifications, licence to practice and membership of professional associations. Find out where a doctor did their training and how many years they have been in practice. Check if the doctor is board certified (USA), or on the specialist list (in other countries) for the area they are working in. For example, if a doctor or surgeon trained in the USA, they may be American Board Certified and working in another country.

Doctors who are well known in their field have often published research papers, which you can search for on-line.

Find out which hospitals or clinics the doctor or surgeon practices in, and whether these are internationally accredited.

Ask questions

You should be able to speak to the doctor or surgeon before you travel, either by phone or on-line consultation.

Here are some questions to ask:

• How many of this type of procedure have you performed and what is your success rate?
• Where and how will you perform my procedure?
• Is the surgical facility accredited?
• What are the risks associated with the procedure and how can these be minimised?
• What is the cost of treatment?
• What is the expected recovery time, what kind of help would I need in the recovery phase and when would I be able to return home?
• How do you deal with any complications, if they arise?

  

Know your rights

Find out how the medical profession is regulated in the country you are travelling to and who you could contact in case of any concerns or complaints. Check your doctor's qualifications and membership of professional and licencing associations. Find out about travel insurance for your trip and what it will, and will not, cover.

 

Have realistic expectations

A good doctor will advise on various options for treatment as well as expected recovery time and possible side effects. Beware of those who offer miracle cures.

 

Consult with local physician or surgeon and arrange follow-up care upon your return

It is important to inform your local physician of your intention to travel. They may be able to give you valuable advice in addition to arranging any follow up care you may require.

Medical records

You will need to take records of your complete medical history, or have these transferred to the doctor who will be treating you. It is also important to obtain the medical records of your treatment for your physician in your home country.

 

Travel with a friend or relative

It can help to have moral support and someone to help you, especially in the recovery phase.

 

Find out about visa regulations

If you need a visa you need to allow sufficient time for the application process. Some countries allow for visa on arrival at the airport.

 

Budget for all associated costs

Whilst calculating savings for your medical care, don't forget to budget for all costs such as flights and transfers, visas, food and accommodation and vacation activities.

 

Pre-travel health advice

Consult a travel health provider at least 6 weeks prior travel to arrange any necessary vaccinations and any other precautions, e.g. antimalarial measures, which may be required for your destination. You should also discuss the risks of travelling, and especially flying after surgery. Air travel is not recommended for at least 7-10 days following many types of surgery.

 

Plan timing of any travel and vacation activities

Depending on the planned treatment, you will need to allow enough time for rest and recovery. It may be better to plan sightseeing and other activities before, rather than after surgery.

 

Consider using a medical tourism facilitator

A medical tourism facilitator can help in all the arrangements, from the planning stage right up until follow-up care in your home country. Be aware that there is no standard regulation for medical tourism facilitators. Choose a facilitator who is highly recommended by previous clients and has international accreditation.

In the last section, we will look more specifically at Dental Tourism

Medical and Dental Tourism in India - Part 2

Part 2 - Pros and Cons of Medical Tourism 

and India as a destination

Benefits of Travelling for Medical Care

• Cost Savings
• Less Waiting 

(both discussed in part 1 of this blog)

• Availability of world class health care

Many countries have hospitals and health care centres which are internationally recognised for clinical excellence and high quality care. Joint Commission International (JCI) is a not-for-profit organization, based in the USA, who assess organizations according to exacting standards on patient safety and high quality practices and procedures. Currently, 659 health care organizations around the world have achieved JCI accreditation, which is viewed as the gold standard in the global health care community.

• Combining medical treatment with a vacation

As an added bonus to travelling for medical care, many people use the opportunity to take a break from their every day routine whilst seeing a new place and experiencing the local food and culture. Many destinations also offer alternative therapies at a lower cost which can be beneficial in the healing process and rejuvenation. 

• Discretion

Some people may prefer the anonymity of having a procedure done whilst abroad and therefore not having to reveal details to family, friends and colleagues. 

Some difficulties to consider

• Need to do research

The decision to go abroad for treatment should never be taken lightly. It is important to do your research on the physician and hospital or clinic you are planning to visit and prepare properly. Medical tourism facilitators can help with planning but the medical and practical aspects of your trip. This will be discussed in the next section.

• Lack of Regulation 

There are currently no distinct laws or guidelines to regulate international medical tourism. 

The Medical Tourism Association is a non-profit, membership based association for the medical tourism industry which seeks to work with providers and consumers around the world to promote high quality, transparent healthcare. However, membership is purely voluntary. 

• Language and cultural differences

There is the possibility of misunderstandings due to language and cultural differences. These can be minimised by using a good interpreter where required and making sure any questions or concerns are addressed, especially when giving consent for a procedure.

• Travelling 

Depending on the destination visas and vaccinations may be required. You will need to check advice on how soon you are able to fly after surgery and plan accordingly.

• Follow up care and post-treatment complications

It is important to consider follow up care after you return to your home country and discuss this with your physician before you travel. Individuals should be aware that physicians in other countries do not practice under the same laws as in their home country and therefore seeking legal remedies would be much more difficult and complex should medical negligence occur. 

Medical Tourism in India

India is one of the worlds top destinations for medical travel. Whilst other destinations tend to specialise in one or two areas, India offers the comprehensive solution for the full range of medical and dental needs. Due to India's growing economy and private health care sector there are many world-class hospitals with highly skilled staff and the latest technology and facilities. In the large cities, such as Bangalore, Mumbai, Chennai, New Delhi and Hyderabad, there are many centres which specialise in various types of surgeries, such as joint and heart surgery. These hospitals have excellent pre- and post- surgical care as well as international patient services who can help with arrangements, such as travel and accommodation.

The number of internationally accredited (JCI) medical centres in India has increased rapidly and currently stands at 21, from only 2 in 2005. Unlike other Asian medical tourism destinations, who aggressively recruit specialist physicians from other countries, India produces some of the world's finest physicians and surgeons in it's own excellent teaching hospitals and research centres. Also, whereas in the past, many Indian doctors have emigrated looking for better opportunities, more recently there is a trend for foreign based and trained doctors returning to India.

Potential cost savings, especially for more complex surgeries, are also the greatest in India. Patients can save between 65-90% for many procedures, compared to the cost in the USA.

Even after taking into account associated costs, such as travel, accommodation and visas, patients can still make big savings. The recent fall in the value of the rupee against international currencies has resulted in relatively lower cost for those from abroad. Many patients will also choose India to avoid long waiting times for surgeries in their home countries.

Another advantage for English speaking patients, is that English is widely spoken in India. All doctors and most nurses and other health professionals are trained in English. Those travelling to large cities, where most of the world-class facilities are located, will be able to get around easily using English.

Although the visa process for visiting India has at times been complicated, India will soon be extending visa on arrival to all, barring eight "prior reference" countries including Pakistan, Iran and China.

India is also a popular destination due to its rich cultural heritage, natural beauty and interesting places to visit.

In the next section we will discuss tips and advice for those considering or planning health care overseas.