Health Talk With Dr. Gross

The Difference Between Dental Implants and Bridges

Dental Implants and Bridges

Should I Get an Implant or a Bridge?

So the conversation went earlier this week.

On top of this patient’s questions is the fact that I am giving a lecture tomorrow to a group of dentists on the subject of dental implants in the front of the mouth. Yes, there can be differences between the front and the back of the mouth. At the lecture, I will be spending some time talking about which of the choices may be more appropriate in differing situations.

So I thought that since this subject of dental implants and bridges shows up no matter which direction I turn, I would spend some time sharing a few thoughts with you today.

To simplify things a bit, I will only be talking about permanent bridges in this column.

Defining Dental Implants and Bridges

First of all, let’s do some definitions.

Both dental implants and bridges are used to replace a missing tooth or teeth.

There is a fundamental difference between them.

When we utilize a dental implant, there is no focus on what is on either side of the implant. The only things that matter for the implant are quality and quantity of bone into which, the implant will be placed.

When we are dealing with a bridge, we need to shift our focus.

In a permanent bridge, it is all about the teeth on either side of the missing tooth or teeth. The bridge needs to anchor to those side teeth. Much like a bridge over water. The span is held up by the two or more vertical components of the bridge. In this regard, dentistry is no different.

So what influences which is the best treatment for that patient?

Factors that determine the best treatment option

The number of Missing Teeth

One factor is the number of missing teeth.

If a lot of teeth are missing then a bridge may be a challenge. Remember the span of the bridge has to stretch between 2 teeth. If the span is small, then the side teeth that support the bridge will not be overburdened. If we are replacing 3 or more teeth then we could overload those side teeth.

Before we used dental implants, we used to double connect the side teeth. That means that instead of 1 tooth holding the bridge on each side we would use 2 teeth on each side. So now our bridge is held in place by 4 teeth rather than 2 teeth.

Today, that option is still present, but adding implants to the missing tooth area might be a better choice. This way we don’t have to involve any adjacent teeth as we did in our bridge scenario.

The Condition of the Teeth

The other factor that we need to consider is the future.

If one of the teeth holding the bridge is weakened or its longevity is in question, then placing a bridge may not be prudent. Since if the anchor tooth of the permanent bridge is lost then the whole bridge is lost.

If one of the adjacent teeth has a root canal and post, the placement of the bridge could stress the post. This could lead to either fracture of the post or fracture of the root of the teeth.

Cosmetic Considerations

When it comes to cosmetics in the front of the mouth, many times a bridge, rather than implants, may be a better choice. This is due to how the gum and bone may reshape and behave after the implant is placed. When we do a bridge, we usually don’t get involved with the gum and certainly not the bone. This means that the guess of how the gum will look as it relates to the tooth will not be needed. The final position and shape of the gum will not vary and we can plan accordingly.

We Customize a Solution For You

I could go on and on discussing varying differences. However, my space is limited. These are some of the thoughts that go through my head when I am asked to come up with a solution.

This solution will have a tremendous effect on your present oral health and on the future of your teeth. As we all know, this can greatly impact your quality of life as the years go on.

If you want to learn more or have a specific question, please call Megan and schedule a consultation. There is no charge for this meeting as I enjoy talking about it and educating you. In fact, it is my passion! I can be reached at 440.951.7856 and look forward to hearing from you.


Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.


The Pitfalls of Private Dental Insurance

Are you wasting money on private dental insurance?

Summer is in full swing, and the phones are ringing off the hook with patients looking to get their smile to look as good as their tans. Unfortunately, to offset the costs, many people will fall prey to the pitfalls of private dental insurance. Don’t be one of them!

Many people have gone out of their way to scour the internet or burrow into the brain of their insurance agent to find the best private dental insurance policy.
More and more ads are aired on TV with promises of saving a bundle of money.

If it’s too good to be true…

Those of us who have been around the block a few times know that if it sounds too good to be true, then it is probably is.
In fact, I’ll go even further. If it sounds too good to be true, it could even be bad for you.

How many times are we approached in an attempt to lure us into outstanding investments or cures that no one has ever thought of?

We are inundated, even more, we are bullied into buying into the fear factor that if we do not have dental insurance, we will not be able to weather the costs of needed dental care.

In the end, and sadly enough, patients who buy private dental insurance find out that they lack in their coverage.

While we’ve discussed and touched on this topic before, I want to go over some of the pitfalls of private dental insurance and why it is not a wise choice.

What Do You Mean that I Do not Have Coverage for A Whole Year!?

Whatchu talkin' about Willis?One big loophole for insurance companies is the elimination or waiting period.
You are not eligible for a variety of services that are in your “coverage” until you wait 6-18 months. This period varies by policy and company.

Let’s think about this.

You pay a premium month after month. Even worse, you pay a whole year premium up front and have no coverage. You need to fulfill your waiting or elimination period until your coverage kicks in.

All the while, you are paying for coverage that you are not receiving when you need it.

That does not make any sense to me. It should not make any sense to you either.

Disappointment follows disappointment.

Okay so now we have paid our money and have fulfilled our waiting period. Our coverage begins. We plan our treatment plan together and find out another surprise. Your copay on more involved procedures can be as high as 80%. You have waited a year to find out that your coverage is only 20%.
Disappointment follows disappointment.

Private dental insurance is not as comprehensive as you think

Are you covered?

Wait! It gets better! Just keep reading.
When most of us think of insurance, we think comprehensive. It will handle anything that comes along.
While this is crucial, though not universal, in medical insurance, it is far from true in the dental field.

Every policy comes with a long list of exclusions. Sometimes an entire procedure or class of procedures is left out.

Crippled Coverage

Other times the procedure is crippled. What do I mean by crippled? Let me give you an example.

Let’s say that you need a filling on a back tooth. A vast majority of doctors will do a white filling. This is in demand by most patients and can help strengthen the tooth via its bonding mechanism. So we call the insurance company to find out rules and parameters. They tell us that a filling is covered, but white fillings are excluded. Silver fillings are part of the policy and nothing more.
If we need to step it up a bit for structural reasons and do an inlay, which is a solid filling, there is no coverage.

These are just a couple of examples of crippled coverage.
Insurance companies call it an “alternate benefit clause.” It is part of every insurance policy. It is loaded and quite common in privately purchased policies.

So now our 20% coverage that I mentioned above has been reduced even further by the crippling techniques,

So you tell me. Is it worth your money to become part of this system?

The premium that you pay may give you a cleaning or exam, but falls so short on the items that you may need or want.

Let us examine your policy before I examine your teeth

Dental Benefits claim formBefore you pay your premium, I recommend that my patients bring in the information about the policy.

I look it over, and Megan calls to get all of the details. I can then advise you on what may or may not make sense for your needs.

If it works, then I will encourage you to buy it. If it does not make financial sense, then I can provide you with a paper shredder for your hard earned money.

This is because you are just throwing your money after an elusive cloud that just floats away from you.
You can never grasp it or genuinely benefit from it.

Even if you are not a current patient, I will be more than happy to advise and help you avoid the pitfalls of private dental insurance.

Please call me at 440.951.7856 and ask to speak to me. I look forward to talking with you.


Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.


Good Oral Health Habits and the Life of Your Teeth

Good Oral Health Habits and the Life of Your Teeth

The health and life of our teeth are in our control. Nothing earth-shattering or profound in that statement. Our oral health habits directly impact the life and use of our teeth. Good habits will extend their life and bad habits will shorten it.

Simple right?

Unfortunately, despite its common sense nature, this is often overlooked and ignored by many people.

In this article, I’d like to explore 5 common sense oral health habits we can and should all adopt to extend the life of our teeth.

What Can I Chew With My New Teeth?

I get this question a lot from patients. This week it came from someone who actually received 3 new teeth. She had been missing them for a while. Having tried various solutions over the years, nothing really worked. She came to me to see if I could help. She was a perfect candidate for new teeth which were a great replacement for what she lost.

After we discussed that she could really eat whatever she desired, she asked me if there were any restrictions. At first, I said “no, you have no restrictions” but then I thought of a news story that I saw recently.

The article was about Hailey Baldwin, known for her modeling and television career, who appeared on late night TV.  Jimmy Fallon, the host of the Tonight Show was interviewing her.

During the interview, she opened two bottles of beer with her teeth. Any dentist hearing about this would cringe. To make matters even worse, the host then commented,”You are the coolest person I’ve ever met.”

I can’t imagine how many of her fans will try this.  The result will be a good number of broken teeth and trips to the dentist. In my world, this is an activity that will lead to many tooth problems. Teeth are for eating food. This is an example of a behavior that will negatively impact our health.

A common sense study with profound implications

In the same vein there, was a study just published by Dr. Frank Hu who is chair of nutrition at the Harvard School of Public Health. Right now the average 50 years old can expect to live approximately 30-33 years according to the US government statistics. However, Dr. Hu found that practicing 5 habits could add approximately a decade to that number.

The habits are not crazy. In fact, you could probably figure these out yourself.  

The 5 Lifestyle Habits to Extend Life:

  1. Not smoking.
  2. Eating in a healthy fashion.
  3. Exercising regularly.
  4. Maintaining a normal weight.
  5. Drinking only in moderation.

Nothing is really earth shattering on this list. What is of great interest to the medical and scientific community is that we have the power and the ability to extend our own lives. Put in another way, we can live out our full lives and not cut it short with bad behaviors. The more great news is that not only are these people living longer, but their quality of life has improved markedly.

I would like to suggest that we could extend the life of our teeth if we follow good oral habits also.

I have my own 5 habits to help our teeth.

The 5 Oral Health Habits to Extend the Life of Our Teeth:

  1. Use your teeth for what they were designed for – eating.
  2. Replace missing teeth.
  3. Fix broken teeth
  4. Get your teeth checked and cleaned regularly.
  5. Brush & floss daily


Using our teeth for things other than eating, like opening beer bottles with one’s teeth is akin to smoking.

Not fixing a broken tooth is akin to excessive drinking.

Not replacing missing teeth is akin to excessive weight.  

Not getting your teeth cleaned on a regular basis is akin to not exercising regularly.

Brushing and flossing are akin to eating in a healthful fashion.

These are all modifiable factors that will either extend or shorten the lifespan of our teeth. In many cases, they will allow us to keep our teeth throughout our entire lives. The health of our teeth is in our control.

If you are a regular reader of this column and have been considering putting emphasis on the care and health of your teeth, now is a great time to start.

Take my 5 Oral Health Habits to heart and call me. I can be reached at 400.951.7856. Talk to Megan and she will start you on the highway to better teeth. I look forward to hearing from you.

Jeffrey Gross, DDSFAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.


Are Permanent Teeth Right For Me?

Permanent teeth - natural and umplant

Well at first glance that should be an easy one.  Permanent teeth are the best choice for everyone. Isn’t that the way that we were created? We have arms, legs, fingers, and toes that do not come off.

Of course, due to trauma or disease, we could lose some of these permanent extensions of our being, but we know that we need to replace them. We strive for permanent fixes.

What does permanent mean?

Let’s take a moment and define permanent. We tend to think of permanent as being the same as forever.

First of all forever is not really forever. Forever, when used in a human context, usually means as long as I am around. Forever for a 20-year-old is not the same forever as a 75-year-old. So forever can have different meanings depending on the situation.  

So if permanent does not mean forever, what does permanent mean? It usually means that once something is in place, no one has any intention to remove it.

Is it possible to remove it?…yes. It is removed on a consistent basis?…no.

Permanent in the context of dentistry

For example, in dentistry, we refer to a filling as being permanent. There is also a temporary filling. What is the difference? The temporary filling will fall apart relatively quickly and replacement is planned. A permanent filling will last much longer and I have no intention to remove or replace it when I put it into functionality. So it really depends on my thoughts and plans at the outset. Even though permanent is not forever, it implies a long-term solution or a fix to an issue.

The less that I have to deal with a dental appliance, then the more it becomes part of me, so to speak. Framed in the context of what I just mentioned, it is more permanent.

Different types of teeth replacements

For a variety of reasons, we could be forced to lose all of our teeth. If we choose to have them replaced, we need to choose between different approaches.

Full Dentures

Full DenturesThe oldest and “simpler” choice is a full set of teeth that sit in the mouth.  We call this a full denture.

When I need to, I can take out my teeth. Why would I need to take them out? There are a number of reasons. Why do I take off my shoes?  There are a number of reasons. It feels better when they are removed, cleanliness, when in place pain is present, etc….

This is the easiest way to replace missing teeth. The kind that comes in and out at will. They are not permanent because they don’t stay in place all of the time.

Permanent Teeth

The other way to replace missing teeth is with permanent teeth. When we deal with just a few missing teeth, a permanent option can be very simple. We have different types of choices. They could be cemented bridges, bonded bridges or dental implants. They are all good solutions to the problem of replacing missing teeth with a permanent solution. When we are faced with losing all of our teeth, we only have one permanent solution. This is permanent teeth supported by multiple implants.

Dental Implants

There is not a day that goes by that I do not see a commercial talking about this. The approach has been around for a couple of decades but only in the last 10 years or so has it exploded. It is the closest thing that we have to turn back the hands of time for many patients.

The techniques keep on evolving and improving

It is not an invention. It is a technique. As with all techniques, improvement is the constant mantra.

I have done root canals for decades. The way that I do them now is so different than the way that I did them years ago. They are better and faster. The result is a happier patient coupled with great results.

The same is true with permanent teeth. The procedure keeps on evolving. Many times the teeth in a day procedure literally takes a day. There are so many variables and intricacies in the technique that predictability and repeatability have been a challenge.

Underside view of implant procedure

Underside view of implant procedure using Guided Smile Chrome

One of our local laboratories has pioneered a technique which makes the entire process modular. This technique is called Guided Smile Chrome and truly guides the smile. The result is less stress for all of those involved and a reduction in the total procedure time.

Teeth in a (half a) day

Permanent Teeth in half a day

Permanent Teeth in half a day – Next level full mouth teeth replacement with implants

Teeth in a day have now evolved into teeth in a half a day. The technique is computer driven and involves multiple modular pieces that fit together. The result was great and we corrected teeth that were spaced, decayed and broken. We even added teeth to places that were missing teeth for years. Best of all this patient did not have to learn to wear an upper denture. Learning to deal with a set of teeth that come in and out can be a challenge for us as we get older.

If you want to learn more about this breakthrough in permanent solutions to broken and decayed teeth, please call me at 440.951.7856 I look forward to speaking with you.


Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.


Missing a Tooth? You Have Options!

Missing a tooth?

Can I Have New Teeth on The Same Day That I Lose My Teeth?

This question may rank as one of the most sought after requests that I receive.
There are very few people to whom this point does not matter.
Going around missing a tooth is not something that most people want to do.

However, we have to qualify precisely in which situations this is relevant.
It is also true that most people do not mind walking around with a missing tooth.
Didn’t I just contradict myself?
First I said that patients do not want to be seen without a tooth, and then I followed with the opposite statement.

Let us look at these two comments and allow me to explain how they are not contradictory.

When people don’t mind missing a tooth

Let’s start and deal with the second statement.
What do I mean by “most people do not mind walking around with a missing tooth?”
With this latter statement, I am referring to our molars or chewing teeth.
In fact, I have found, not only do people not mind missing these teeth for a short period, but they don’t mind losing a tooth and not replacing it for years!

This is despite the fact that their chewing is either impaired or altered.
To chew food efficiently, they may need to favor one side. Alternatively, the person may spend a long time chewing their food before it is ready to be swallowed.

What’s the big deal? No one can tell!

The rationale for not replacing the tooth follows the thought that eating at some level can still be done. After all, there are still other teeth!
Imagine if we would apply that logic to a finger. One could say, “the loss of a finger would not be so bad as I have nine others.”
Of course, we would never say this but with teeth, since the function is not eliminated entirely and “nobody sees my space,” then what is the big deal?

When it comes to missing a tooth, many put appearance over function

I just touched upon the point which explains my first statement regarding people not wanting to walk around toothless.

Losing a tooth that is obvious to everyone around me is a big deal. In fact, this could affect chewing even less than a back tooth.

The deal breaker is the embarrassment. Walking around missing a tooth that everyone can see, bothers most people.

I remember walking into a store one time and seeing the regular employees walking around with a surgical mask on her face. I thought that she was ill and was contagious.

Being the friendly fellow that I am, I asked if she was okay. She replied that she felt well. Oh… the reason for the mask was that her front tooth broke and she was embarrassed about her appearance.

This is like the old real estate dictum.
As the saying goes, the three most important things in real estate are Location, Location, and Location.

Well, the same applies to losing a tooth in the minds of most people. Our appearance to our friends and neighbors is more important than the loss of chewing function.

With today’s modern dentistry, being toothless is a thing of the past.

I’m not going to focus on the two sides of this discussion.

I want to point out and say that with modern materials, computers and skill of the dentist, being toothless is a thing of the past.
I can either actually create a duplicate of a tooth, that is removed, at the same time that I remove it.
Today, I can also use digital impressions, photographs, and x-rays to convey information to my laboratory to allow them to create a
duplicate of our removed tooth.
This procedure applies to front teeth as well as it pertains to back teeth.
It is applicable when I am doing a permanent bridge to replace a tooth or teeth, or when I am making a removable bridge to replace a tooth or teeth.
This applies to when I remove all of your teeth and make a denture or when I may give you teeth supported on implants.

The point is, with today’s modern dental technologies and techniques, you don’t have to live with missing a tooth.

Whether your concern is appearance, functionality or both, you have options and we can help you!

My goal is to give you options and hope!

If you need to lose a tooth or teeth and are worried about the potential embarrassment, please call me and let’s talk.
My goal is to give you options, and as many people say to me, give you hope.
We can discuss various paths to follow. With your help and input, we can fine tune those options to deliver what you need and what you want.
I can be reached at 440.951.7856. Just call Megan and ask to speak to me or make an appointment for a complimentary consultation.
I look forward to hearing from you.


Jeffrey Gross, DDSFAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.


The Problem with Snacking with Invisalign Aligners

Snacking with Invisalign Aligners - banana smoothie

Is it wise to be snacking with Invisalign Aligners?

Continuing to chronicle and document my Invisalign® journey from a dentist’s perspective, this week we discuss the possibility and wisdom of snacking with Invisalign Aligners – even if it’s with soft food.

Weeks 4 and 5

These last two weeks continued to be less eventful.

Invisalign does a great job as long as you wear the aligners. This is why we instruct patients to wear them as much as possible except for brushing and eating.
I always get the question concerning the length of time that they really should be worn.
This usually ends up with a question of only wearing them at night. My answer is always “nighttime only is not long enough to create enough movement.”

To snack or not to snack – That is the question

With that in mind, I have the following dilemma. When presented with food and the chance to eat, I needed to decide as to whether to partake and remove the aligners or forgo the food.

I am not referring to meals. I am referring to the numerous opportunities for snacks during the day.
Many times it is easier to leave the aligners in.

This got me thinking as to whether or not I could be snacking with Invisalign® aligners in my mouth.
After all, I have seen patients without any teeth eating. They don’t eat well, but they do eat.
I learned that food that did not require much grinding was a perfect choice. I became adept at bananas, tangerines, yogurt and some other foods.
If you are currently wearing aligners, why don’t you gave it a try?

Its an issue of cleanliness

The only problem that I see is one of cleanliness.
For example, everyone can drink with the aligners in place.

If you head out to Starbucks and order your favorite latte, you will discover that coffee breath will linger longer than usual.
This is because once the liquid gets inside the aligners, the standard mechanical motion of the tongue and lips will not be present.
Saliva does not reach the area as readily as it does without the aligners. Food or liquid behind the aligners lingers.

If we take this concept to sugary foods, the sugar will stay in contact with your teeth much longer. That, of course, spells trouble.

So in the end, I actually ate less frequently than my new found idea allowed me, but still, more than, I had not come across this idea.

The bottom line is that I want to think like a patient, but I can’t get the dentist out of me.


Jeffrey Gross, DDSFAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.

For any questions about Invisalign®  or any of the other dental procedures performed at The Healthy Smile Dental Center please call Megan at 440.951.7856


How Often Should You Replace Your Dentures?

replace your dentures

If you have dentures, you may think that they should last forever.
The truth is, your face, jaw, and gums change over the years, but your prosthesis does not. Your dentures are made of a rigid material and can’t adapt to these physical changes.

In this article, let’s explore some issues that indicate it may be time to replace your dentures.

Will My Front Teeth Look Big?

I thought of this question as I met a new patient this week.
He had a set of dentures that were on their last legs. They had broken over the years and had a number of repairs to try and patch them together.

None of that phased me as I see that sort of thing a lot.

What made an impression on me was how much of his tooth showed when he smiled. The upper front teeth were enormous.

First of all the teeth were very long.

Secondly, when he smiled, the entire tooth was visible as well as a fair amount of pink denture base above the teeth.
This gentleman was in his 60’s, and that look was not at all natural.

We sometimes see that in a very young patient but time takes its toll on the height of teeth.

Dentures or crowns should look natural

Dentures or crowns on front teeth should reflect a natural look on a person.
They should be in consonance with their facial features and general appearance.
A person’s chronological age will affect the size of his teeth. Denture teeth that were made when someone was in their 40’s do not look natural for someone who is twenty or thirty years older.

Front teeth have definite shapes and sizes to create a “natural smile.” They are not all the same length..they are not all the same width..and of course, they are not bright white.

All of that just spells phony when one looks at it.

The makeup of a ‘natural’ smile

I strive to have a natural and comfortable look on the dentures that we make. The very front teeth are the largest and widest of the upper six teeth. They are taller than the tooth that is next to them and definitely wider than that tooth. They do not all line up in a row. The four front teeth as a group are relatively flat looking, whereas the cuspid, or “eye tooth” has a large mid-section. These subtle difference make our smiles look, for lack of a better
word, natural and pleasing.

When you need to replace your dentures

Dentures, like anything else, can be made to last for a long time. However, the larger question is whether or not they should be used for a long time.
First of all, a denture is porous and absorbs odors and bacteria to the point of saturation. This creates a very unsanitary situation in the mouth.
Second of all, the colors and size of teeth change as we get older. Bright white and large teeth are not appropriate for someone as they advance through middle age.
These are reasons that I recommend that your dentures be remade every 5-7 years.
This way our denture stays “in style”.

Just as our faces and bodies change, our artificial teeth should adapt and change. After all, this is the same thing that happens to people with natural teeth. They change in shape and color.

Customized dentures for each patient

During the denture making process in our office, we spend a lot of time getting the front teeth to look appropriate for that particular person.
Many times we use computers to aid us in picking the best size for our mouths.
These teeth are always viewed by the patient and me when the teeth are in wax. This allows me to move the teeth in any direction at will. We may move them up, or push them down, allowing us to see more or less of our teeth.
To create a natural appearance, I may recommend turning a tooth ever so slightly. I may suggest a small space between certain teeth.

All of this is done to duplicate the works of what we often call nature.

It is essential to see how the curve of the edges of your teeth looks against your upper and lower lip.
Do we have a harmonious smile line (a tracing of the teeth edges) or does it look out of place?

I compare pictures of your old teeth and try to make a change for the better, in a very subtle fashion. I use digital photos and videos to
help the patient see themselves as the rest of the world sees them.

The science and art of denture making

Denture making is a science blended into an art. It can’t be rushed and shouldn’t be hurried. After all, you will be wearing these dentures for years.
The least that should be done is spending an appropriate amount of time creating them.

If you think that it is time to make the move to a denture or to update your current denture, please call me. I will listen to you and do my best to help you.

I can be reached at 440.951.7856. Looking forward to meeting you.


Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.


The Added Perk With Invisalign® Treatment

The Invisalign® treatment aligners

The Invisalign® treatment aligners can serve as a tooth whitening tray too!

Continuing to chronicle my Invisalign® journey from a dentist’s perspective, this week we discuss an added benefit that Invisalign® treatment aligners provide that most people don’t realize!

Week 3

Invisalign® aligner trays can serve a second function

Okay, now let’s get to a fun topic.
Do you know that with the Invisalign treatment, there is an extra added perk that very few people discuss?
Please allow me to give you some insider information that many times is lost with all the emphasis, and rightly so, on the alignment and moving of teeth.
What is often forgotten is that the aligner trays can serve a second function. They can act as bleaching devices or trays too!

Two Different Approaches to Teeth Whitening

Bleaching or whitening of teeth has been around for a long time. There are two different approaches to brightening our smiles.

In-Office Laser Whitening

One approach is to sit under a high-intensity light in the dental office with your mouth packed with cotton and gauze while a caustic bleaching solution is put on our teeth. This method works well, though some people have developed a lot of sensitivity either during or after the visit.
These are sometimes hyped as “rapid whitening” or “laser whitening”.  They are all very similar as the manufacturer has come up with some method to accelerate the activity of the bleaching liquid. This kind of jump starts the bleaching process with follow-up care and more whitening done at home.

Take-Home Whitening

Whitening can also be accomplished without supercharging the solution. A unique solution is applied to the teeth and whitening proceeds in a steady, gentle fashion. You might ask, how does the whitening work? Doesn’t it run off the teeth? Dentists need a way to keep the solution on the teeth.

Usually, custom-made holders or trays are made for the patient to keep the liquid on the teeth while it does its magic.

Invisalign® treatment aligners can serve as bleaching trays

Interestingly enough, the trays or holders look like aligners that we use to straighten the teeth during the Invisalign treatment. So now with our aligners, we have the perfect fitting and accurate bleaching trays. This is a perfect opportunity to ask your dentist to provide you with a dentist-quality whitening solution for your teeth. This is something that I offer as a special perk to my patients.

Capitalize on the opportunity

For those of you considering straightening your teeth with the Invisalign treatment and its aligners, I encourage you to also whiten your teeth. Not only will they be straight, but they will sparkle when you are done with treatment.


Jeffrey Gross, DDSFAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.

For any questions about Invisalign®  or any of the other dental procedures performed at The Healthy Smile Dental Center please call Megan at 440.951.7856


Adjusting to Life With Invisalign® – Week 2

Invisalign Lower Aligner - Blue background

Continuing to chronicle my Invisalign journey from a dentist’s perspective, this week we discuss how I’m adjusting to life with Invisalign®

Week 2

Well, I just finished my second week, and it was a lot less eventful than my first.

Learning to place my aligners correctly

I learned how to set the aligners in my mouth without grabbing my lips or cheeks!

The lower set was more of an issue for me as the bottom lip always seemed to wrap forward and get caught in the aligner as I was snapping it into place.
At the same time, the back of the lower aligner would get close to my cheek on both sides. If I wasn’t careful, I would catch my lip and both cheeks at the same time creating a trifecta of sores.

Pro Tip! Using my fingers

I learned to use my fingers to hold back the lips and cheeks and still allow the aligner to seat in to place on my teeth. I needed all of my fingers to multitask.

Being a dentist, this was second nature to me. However, I see how my patients would fight and struggle to learn some of these skills. Some of them never learn those skills and tricks and come in with sores throughout their mouths.

I resolved to make an effort to teach some of these tricks and hacks when I notice sores that are present. Sharing my knowledge of holding back the lips while placing the aligners would really be a nice thing. I’m sure that my patients will appreciate it.

Inspecting the Invisalign® attachments

While I was placing an aligner, I decided to examine the attachments a little closer. One of my lower teeth, the lower right cuspid (eye tooth) had two attachments.
Remember the attachments are the little projections that are bonded to the teeth to help the aligners grip the teeth better and ultimately move the teeth properly.

The attachments are made of tooth-colored filling material and are relatively invisible. At least they are challenging to see.

Great! One of my Invisalign® attachments were missing

So when I looked a little closer, I noticed that only one of the projections was there. That tooth was missing the second attachment. I will assume that it was there and fell off.

The Importance of having two attachments

Whatever the reason the second attachment on that tooth was important. The cuspids have long roots and are difficult to move. This is probably why the Invisalign software that generated the plan placed two attachments. The better the grip, the more predictable the movement.

So I had to go back and have the second attachment replaced on the tooth. This wasn’t a big deal, except for the fact that the device that was used to holding my lips out of the way was really cutting into my upper lip.

After a reasonable amount of time grimacing and wincing, we decided that adding a cotton roll under my lip would help.
This reinforced to me that all retractors are not created equally.
I knew that from my end. Now I know it from the patients’ end as well.

Chronicling how I’m adjusting to life with Invisalign®

I just switched to the third aligner. I’ll see what develops this week.
In the meantime, I’ll just continue chronicling how I’m adjusting to life with Invisalign®.

Stay tuned for my thoughts on week 3 of this Invisalign Patient Experience – Through the Eyes of a Dentist!


Jeffrey Gross, DDSFAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.

For any questions about Invisalign®  or any of the other dental procedures performed at The Healthy Smile Dental Center please call Megan at 440.951.7856


The Invisalign Patient Experience – Through the Eyes of a Dentist

Invisalign Patient Experience

From The Doctor Chair to The Dental Chair – A Unique Perspective

As a dental practitioner administering Invisalign in my practice for nearly 20 years, I know it can be a terrific orthodontic approach to predictably straightening your teeth.
However, I never knew firsthand what an Invisalign patient experience was until now.
Now, as an Invisalign patient myself, I have the unique perspective of knowing what an Invisalign treatment entails from both sides of the equation.
I’m hoping this blog series will help give unique insight and perspective to anyone contemplating this procedure for themselves.

Welcome to The Invisalign Patient Experience – Through the Eyes of a Dentist!

Why Don’t You Practice What You Preach?

When I was in my last year of school, I listened to a physiology lecture from a practicing physician. He was morbidly obese and smoked during the address.
I kept on thinking and wondering. Why wasn’t he picking up and listening to what he was saying?
He knew that his lifestyle was heading him down the road to some serious health problems.
Why didn’t he take his own advice?

Well, some years later, I asked myself the same question.

I had developed a tooth issue which was the result of crowded teeth.
It was more than a tooth issue. It had ramifications to the gum and bone structure around my teeth.

Sure, I am a great brusher and flosser, and disease was less of an issue with me than with other non-dental people.

That being said, I was still beating up certain teeth. I knew that they would begin to chip and crack. The excessive wear was already there. I wanted to stop this.

Crowded lower front teeth

crowded teeth overhead shotI advise my patients all the time about crowded lower front teeth and what happens. I recommend fixing the issue before it becomes a severe problem. I needed to address this in my own mouth.

I finally made time for myself and began orthodontic treatment with Invisalign. As I mentioned earlier, I have used Invisalign treatment in my office for close to 20 years. Now I am on the other end of the treatment so to speak.

I now have aligners (that’s what those plastic things that move your teeth are called) on my top and bottom teeth.

I started to feel what it was like to be sitting in the dental chair, not in the doctor chair.

Sharing my Invisalign patient experience and perspective

So I thought that I would share some of those experiences, feelings, and issues that my patients have.
This time it is coming from a dentist perspective, and I hope to share what is going on and how I cope with those issues.
I hope that this may help some of you who are also going through orthodontic treatment.
For those of you contemplating this treatment, it will give you a glimpse into what lies ahead and how to successfully navigate the path.

Week 1

An appointment for Invisalign® attachments

I have just completed my first week of therapy. Let me tell you how it went for me.
It began last Monday with an appointment in which these little plastic projections were applied to my teeth.
These buttons are designed so the clear plastic aligners effect movement of the teeth.
The size and position of the attachments will control the movements and potentially their timing too.

I sat in the chair and had plastic retractors placed to hold my lips and cheeks away from my teeth.

The technician looked at my teeth and remarked as to how clean my teeth were. I rolled my eyes and thought, “what were you expecting.” Fortunately, I did not verbalize my thoughts.

Applying the Invisalign® attachments

The teeth that had the projections (officially called attachments) were cleaned. They were then dried and bonded in preparation for the attachments.
All of this was done with the cheek retractors in my mouth and cotton stuffed all over to prevent contamination of the teeth with my saliva.
The attachments were connected to the teeth, and I was given my first set of aligners. They snapped into place and really felt weird.

Two facts about wearing the Invisalign® aligners

Invisalign AlignerI knew two essential facts about wearing the aligners.

  1. First of all; wear them all the time except for eating and cleaning of the teeth.
    This should be 22-23 hours a day. They only work when you wear them. Night time wearing alone will not work.
  2. The second fact is never to put them down unless they are in some type of case. The Invisalign aligners are clear and easily lost.

Okay so far so good.

Eating with Invisalign® attachments

A few hours later, I wanted to eat something.

I needed to get these plastic things off of my teeth.

I washed my hands and put my fingers in my mouth trying to find an edge to lift them up.
It is really much easier at first when I am in the dentist role and trying to remove them.
I tried this way and that way until I finally found a spot to start pulling it off. I knew what it felt like to lift an aligner out of the mouth, so I pulled without uneasiness, and it came out.

I spent some time going through the discovery exercise on the other aligner with success.
I ran my tongue over my teeth, and the attachments felt like I found something stuck on my teeth.
I didn’t like that feeling as it was very strange to me.

I then began lunch.

Accidentally biting my lips and cheeks

As I started to chew, my lower left attachment pushed out my lip ever so slightly. This was just enough for me to catch my lip with my upper teeth and bite myself.
I did this once and then again.
I was forced to chew more slowly and deliberately.
This is probably not a bad thing in and of itself.

Of course, once you bite yourself and your lip or cheek swells just a little bit causes you to bite yourself some more.

I can’t tell you how many thousands of times that I have said that to my patients. Now it was more than words. It was a reality to me. I just needed to be more careful.

Putting the aligners back in

Okay, lunch is over.
Time to floss and brush and put the aligners back in.

Firstly I put in the upper set, and that was easy. Just line up the aligner with upper front teeth and snap into place.

The lower set was more of a challenge.
Just when I got it into position and pushed down firmly, my lip folded in and I nailed by the lip.
Of course, now I had a cut and was ready for a mouth sore to develop. Usually, trauma to the lips will result in a sore that takes a few days to heal.
I think that I just discovered a new diet.
Beat yourself up so that eating goes from a pleasure to a negative experience.

The crowning blow came from the inside edge of my lower aligner. I developed a canker sore (a small mouth sore) on the underside of my tongue. So now, not only was eating a pain(literally), so was the simple act of speaking. Every time my tongue moved it sent waves of pain through me.
How many more months do I have to do this?

Stay tuned for my thoughts on week 2 of this Invisalign Patient Experience – Through the Eyes of a Dentist!


Jeffrey Gross, DDSFAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.

For any questions about Invisalign®  or any of the other dental procedures performed at The Healthy Smile Dental Center please call Megan at 440.951.7856