All posts in Dental procedures

Yes! Straight Teeth Are Possible – Even Now!

Straight Teeth -Senior Woman with new straight teeth

Wow, I Never Had Straight Teeth!

It was almost like a staged reaction that one sees on a TV show. After removing 10 teeth and placing a denture in the mouth of the patient, her eyes lit up in delight with an astonished expression appearing on her face. I thought to myself, this is why I love the practice of dentistry.

Let me explain what was going on with this patient. I started seeing her a little while ago with a complaint of a loose tooth.  Whenever someone gives me a history such as that, I think immediately of infection. Although trauma could also be involved, infection is usually the underlying reason.

A Foundation Analogy

Everyone needs to understand that teeth are held firmly in place by a strong foundation. Just like a building is built with cement or steel anchors into the ground so too are teeth firmly anchored in our heads. More specifically in our upper and lower jaw.

In our analogy, if the foundation, starts to become compromised and erode away the building will become unstable. It will no longer be safe to live in. Either we fix the foundation or we knock down the house and start over.

So too in the case of teeth once the foundation is compromised we strive to fix it.

Fixing the deterioration early

The beginning of a compromised foundation in the mouth is what we call gingivitis or in more general terms, periodontal disease. We try to catch the problem early and stop the deterioration.

This is usually relatively easy to do. It takes some time and effort on our part and on the patients part. It is not costly or uncomfortable to fix the problem at this point.

If we don’t deal with the problem when it is first discovered, then there are more sophisticated solutions that are available.

Obviously, since the problem is worse and more involved then the solution takes more effort on everyone’s part. However, we still have a solution.

We don’t have to condemn the house and bring it down.

When Gum Disease is Ignored

If we persist and ignore the problem, then condemnation by the local authorities is the only answer to this dangerous and unsafe situation.

In the case of our mouth’s the teeth are so bad that they are very loose. The mouth is filled with unsightly gum disease. Sometimes the gums bleed easily and other times they don’t. The common denominator is loose teeth and really unpleasant breath. A professional in the dental field picks up immediately on the smell that emanates from someone with bad gum disease.

Once Past the Point of No Return

In our patient’s case, she had no hope except to remove the teeth that were hopeless.

Hopeless means that I have no other method or technique to stop the gum disease around a tooth except for removal.

Once a tooth is gone then the disease process goes away. It feeds off the teeth. Without them, the disease is gone. So I had a fix for the disease in her mouth.

Fixing the Cosmetics After Removal of The Teeth

However, her cosmetics were a challenge. Her natural teeth were long and protruded a great deal outside of her mouth. Within reason, whenever we kind of start over and remove teeth, we have a fresh opportunity to fix the cosmetic problem.

This is what we did in this case. The upper front teeth we lined up in a very pleasing pattern and position. We needed to make them harmonious with bottom teeth and sometimes that can be a challenge. We were fortunate and created an outstanding result. She now has new straight teeth!

New Straight Teeth – An Emotional High for Everyone

As I said at the beginning, the good feeling from helping someone such as this can not be measured by any means. In fact, words can do justice to describe the feeling.  It was an emotional high for everyone in the office that day. My staff and the patient were all elated beyond words.

If any of this sounds like your situation or a situation of a loved one or friend, tell them that a solution is available for them. Whether the solution is a permanent teeth or great looking denture, there are answers to their problem. They are not alone.

Megan is available to schedule you for an evaluation and provide you with some answers to your questions. Please call her at 440.951.7856 and take advantage of this opportunity.

Wishing everyone a great week!

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


Why Are My Front Teeth Sticking Out?

flaring front teeth

We don’t notice the subtle changes over time

We look at ourselves or at familiar objects many times during a day. It gets to the point that we don’t even notice them anymore. This is the way our brains sort out all the details that we encounter and put those that we are familiar with on the back burner.

Our brains have to deal with the matters at hand and everything extraneous that is not pressing at the moment is filed away, so to speak.

A great example of this is watching someone or something grow and develop. On a daily basis we don’t see the slight incremental changes that occur, but if we are presented with a snapshot of the past, the difference becomes obvious and at times is rather striking.

This happens in the mouth also. We brush our teeth on a daily basis, but how many of us notice the subtle changes that occur in the mouth.

What Causes Flaring Front Teeth?

Today, I will focus on the flaring front teeth. Why does this occur? Does it occur to everyone over time? Is there a way to stop or correct it? That’s a lot to talk about, so let’s get right to it.

The Relationship Between the Bottom and the Top Teeth

A very common statement that I hear from patients is one involving the relationship between the bottom teeth and the top teeth. We know that teeth are there for chewing. To effectively chew, the top and bottom teeth must grind against each other.

When talking about the front teeth, and asking someone to bite down, oftentimes they throw their jaw forward so the lower front teeth touch the upper front teeth and meet perfectly.

People say to me “see, they come together really good.”

I then ask them to relax their jaw and gently close their mouth. Now the lower front teeth move back behind the upper front teeth and are no longer meeting perfectly.

Go ahead and take a moment to stand in front of a mirror and try it. I can wait for you to come back.

The Normal Position of the Lower Front Teeth

Now that you have tried that little exercise yourself, you see that the normal position of the lower front teeth is behind the upper front teeth. This is because the front teeth are really not chewing teeth.

The back teeth are the chewing teeth and they come together to grind and chew the food. The front teeth are the ripping and cutting teeth. They slide over each other like a pair of scissors.

The Forces put on the Upper Front Teeth

So now that we know that the proper position of the lower front teeth is behind the upper front teeth to create our personal set of teeth scissors, we can understand the forces put on the upper front teeth. The lower teeth push the front teeth up and out. These teeth will be stable if we have back teeth.

However, if we have lost our back teeth, and not replaced them. In fact, even if we wear partial dentures that are old, their result is the same. Excessive upward and outward forces on our front teeth.

The result is the upper front teeth flaring or sticking outward.

A Strong and Stable Chewing Platform

As I stated at the beginning of this column, the changes are subtle and take place over time. However, the flaring front teeth is a universal phenomenon. Our teeth don’t look like they used to and our faces start to become sunken. This is why having a strong and stable chewing apparatus in the back of our mouths is so important.

If you think you are having an issue with flaring front teeth, please call Megan at 440.951.7856 to schedule a consultation.  I look forward to helping you out!

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



There’s No One Size Fits All in Dentistry

one size does not fit all in dentistry

In this article, let’s discuss how a recent study on aspirin dosage mirrors my philosophy and approach to my dental practice. Since each patient and their situation is unique, there is no One Size Fits All in dentistry. We will tailor a solution that fits the patient best because I take a personalized approach to dentistry.

Doctor, I Take A Baby Aspirin Every Day

I hear this statement quite frequently in the office. Depending on the patient and the procedures that are planned, this fact may or may not have an impact as to how I proceed. Other patients tell me that they take a full aspirin tablet is part of their regimen. Does this make a difference? Are these people iller or at more risk than the baby aspirin group? Why is anyone even taking an aspirin?

Like aspirin dosages, there is no one size fits all in dentistryWhy People Take Aspirin Daily

Let’s talk about this for a moment.

Cardiovascular disease, including heart disease and stroke, affects millions of people in the United States. Many times this is due to blood clots that form and occlude or block a vital pathway. This could be to the heart or the brain. When this happens people suffer a heart attack or stroke.

If we can thin the blood and make the ability to clot less likely then in theory, we can help a person avoid these problems.

Sometimes people who have never had a problem, take aspirin. Others take it only after having some type of health issue. The former is called Primary Prevention and the latter is Secondary Prevention.

The difference between these two approaches has been studied and debated for years. Sometimes even countries have different recommendations as to what and how much to take.

Like anything in life, aspirin has benefits but it also has the potential for creating bleeding issues. So how do we decide how much to take if our doctor makes this recommendation?

A Recent Study on Aspirin Dosages

In an article and study published very recently, a Professor Peter Rothwell in the Department of Clinical Neuroscience in Oxford University in the United Kingdom the following conclusion was reached.

There is not one dose of aspirin that is universal for all people.

Low doses of aspirin (75–100 mg) were only effective in preventing vascular events in patients weighing less than approximately 150 lbs and had no benefit in the 80% of men and nearly 50% of all women weighing more than that.

On the flip side, higher doses of aspirin were only effective in patients weighing more than the first group of people.

So yes, a 200 lb man will need more than a 100 lb woman.  

The correct amount of aspirin to help keep the blood flowing freely is weight dependent.

So a baby aspirin may be appropriate for that slender lady whereas that muscular man will need a full adult aspirin.

A Personalized Approach to Dentistrypersonalized dentistry

This concept of applying the correct dose to the individual is an example of creating a personalized approach to medicine.

In my world, this means a personalized approach to a dental problem. We need to look at the entire mouth and the entire patient to come up with the correct treatment and sequence of procedures.

Your thoughts, desires, and goals all go into the decision-making process.

In fact, we make this decision together through a process called co-diagnosis.

Some examples

For example, this week a patient just finished the special “get a new set of teeth in one day” procedure.

These teeth are permanent and she will never take them out. She never wanted to wear a denture and this was the solution for her.

Another patient could deal with a denture but only if it locked in on implants. This one comes in and out but solves the need to use adhesive paste.

A third patient is also losing many teeth. She also wants an instant solution. In her case, a permanent same day bridge is in her cards. Similar situations but a variety of choices are available.

Just as Dr. Rothwell in England found that one dose of aspirin is not appropriate for everyone, so too one size fits all in dentistry will also not be a correct approach.

If you would like to hear options for a variety of procedures in one office, please pick up the phone and call Megan.

She can be reached at 440.951.7856 and she will get you in for a discussion in the most expedient manner. I look forward to meeting you!


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


The Time is Now to Get Your Spare Denture Made

senior with spare denture

What Is Involved In Making A Spare Denture?

I could not believe my ears when I met this patient yesterday. He was actually planning ahead. He was getting prepared for the possibility of not having his denture because of _______________. You get to fill in the blank.

Possibilities are dropping it and it breaks into two pieces, letting the dog get a hold of it, biting down on a nut and cracking it, losing it in Lake Erie. (Yes, you read that correctly. I had a patient who lost his upper denture while swimming in the lake.)

Whatever the reason may be, if you can not be seen in public without your teeth, then you need a spare denture.

I have recommended this for years to my patients. In the past two weeks, this subject came up with and is being acted on by two totally different patients.

So let’s talk about how we do this. Let’s talk about costs. Let’s talk about the time involved.

Making A Spare Denture Used to be a Time Consuming and Expensive Process

In the not too distant past making a spare denture involved all the same things that were involved when the denture was originally made.

Impressions were taken, the bite was verified, teeth were chosen and tried in, etc. Essentially we were doing the whole process all over again.

If we decided to skip any steps or appointments, we were taking a chance of having a problem.

Okay, this was only supposed to be a spare. That is all well and good if the spare is truly a spare.

Some people want the spare to be their new all the time, every day denture.

There is no room for skipping steps or taking shortcuts.

The denture has to be made with the same precision and care as the existing denture hopefully was made. Multiple appointments and fees commensurate with that level of work were the guidelines that need to be followed in that case.

Today the Task is Simplified and Inexpensive

What if the spare is truly a spare. Its purpose was to be worn in an emergency. It was a backup, to use computer lingo, in case something went awry. It was to be used if a reline needed to done at the laboratory.

In 2018, we have technology that makes the process of making a spare denture simple. With modern computers and scanning devices, my lab can make a duplicate of any denture.

The inside and outside are an exact copy of the original denture.

Less Time

From a time standpoint, all that is involved is 2 appointments. The teeth are an exact copy of the size and shape of the original denture. The inside is an exact copy. This saves the lab some time.

We also employ technology makes it impossible to have a single tooth pop out of the denture.

More Affordable

This streamlined process has another benefit.

The cost is better than the term affordable would indicate. This process is downright inexpensive.  

In fact, my patients are in general disbelief when I tell them the fee.

The usual response is why didn’t I do this sooner. When you think about it. It makes sense. We don’t need all the appointments and verification steps of a traditional denture. We are copying the inside and outside of what you have.

Proactively Planning for Future Possibilities

Planning for future possibilities takes a lot of stress out of our lives. I saw another patient earlier this week who knew that his tooth was on its last legs. In cases like that, I always advise the patient to be proactive and deal with the issue on his or her terms.

What does that mean?  Allow me to explain.

When a tooth breaks or causes discomfort, both you and I have to scramble to fix or short circuit the problem. In other words, we are working with the tooth calling the shots. This may mean a greater cost, lost time from work or other events in life and a general inconvenience as it disrupts our daily routine.

When we are proactive, we are in control as to the how and when a treatment will proceed. We are now in charge, not the tooth. Those patients who follow this advice are so much further ahead than those who decide to not deal with the issue.

If you know that an issue is pending or have been advised by someone to take care of some health issue, now is a great time to set the wheels in motion to deal with it.

If you only have one denture, then maybe now is the time for that spare.

Getting out and about is easy in the glorious sunny weather that we are experiencing. There is no need for boots and heavy coats as bone-chilling cold is a distant memory.

Give Megan a call at 440.951.7856 and set up a visit to meet us and discuss your concerns. I 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 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.


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.


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


Dental Anesthesia: Its Not Just Shots Anymore!

 dentist with dental anesthesia needle

I Hate Shots. I Wish That You Would Have Something Else!

Many years ago, just the opposite was stated. Dental anesthesia simply didn’t exist! There was really nothing to numb or deaden a tooth so it could be treated. The first local anesthetic used was actually cocaine. It worked but of course, it was addictive and toxic. It wasn’t until the beginning of the last century that our famous Novocaine came on the scene. In fact, it was so popular that many people today use the word to mean a local anesthetic.

Pain-free dentistry is now a reality!

We really don’t use Novocaine anymore in dentistry as it has been replaced by better anesthetics with fewer side issues. These newer products give better numbing, which we call “anesthesia” and work quicker. It would be an understatement to say that local anesthetic has revolutionized dental care. We can now perform a variety of procedures, whether simple or sophisticated with the patient being totally pain-free.

Before local anesthetic, the only treatment available was the removal of a troublesome tooth and of course was not a pleasant experience for any one. The ability to numb a tooth has led to more people keeping teeth for their entire lives, rather than being toothless in their twenties. So that’s great! We can do a dental procedure in a pain-free environment using a local anesthetic. The problem with this from the patient perspective is how we have to administer it. Of course, I am referring to the dreaded shot.

What is dental anesthetics?

Let’s talk a little about this. The method of action of a local anesthetic is to bathe the nerves that transmit sensation from the tooth to the brain in this numbing liquid. When the nerves come in contact with the solution they shut down and no longer do their job of sending a pain signal. This closed for lunch sign is effective until the anesthetic leaves the area of the nerve and sensation comes back to the tooth.

Different locations of the mouth have different requirements for giving the anesthetic. For the upper teeth, it is given one way. For the lower teeth, it is given another way. The upper jaw is much more porous than the lower jaw. Therefore, simply placing the anesthetic under the gum next to an upper tooth will cause the tooth to numb. The lower jaw is much denser and if you put anesthetic next to a tooth it will not penetrate the jaw and reach the nerves of the tooth. To numb a lower tooth, you have to find the nerve that supplies the entire side of the mouth and numb that. That is why we numb the back of the mouth when we work on lower teeth even though we may be working more towards the front of the mouth.

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Did you know? There is now a nasal spray dental anesthetic!

The human body is a marvel of complication, sophistication, and crossovers when it comes to its various parts. Because of this, we now can actually numb many upper teeth without a shot. Yes, that is not a typo! We DO NOT need a shot for a number of upper teeth. Just last year the FDA approved a product called Kovanaze for use in dentistry for upper teeth. The product is a nasal spray that is given prior to performing dental work. It can numb the upper front teeth without the side effect of numbing the lips and cheeks. It is not for all teeth, but one of the most sensitive injections is in the front of the mouth. With this nasal spray anesthetic, those days are history.

Topical dental anesthetic for pain-free cleanings

Many people are sensitive to having their teeth cleaned. Because of this, they skip their very important dental cleanings and checkups and only come when it is too late. I use another product which can be squirted around a tooth without the use of a needle to numb the area. This can make your cleaning totally pain free.

Unlike the nasal spray, I can use this any place in the mouth. It doesn’t make a difference if it is an upper tooth with its porous jaw or a lower tooth with a dense jaw. This product simply works without having to use a shot. This product is called Oraqix (pronounced Ora-Kicks) and I have used it for a number of years to make routine procedures more comfortable and easier. When you are at ease, our work goes faster and is done much better. It is a win-win for all involved.

Today, Dental Anesthesia does not have to mean shots

So although needles have not left medicine, and dentistry, in particular, there are a number of innovations that work towards my goal in interacting with my patients. That goal is providing the best care with the most comfort. Needle free anesthesia is an example of that approach and desire. If these or other dental topics are intriguing and you want to learn more about new techniques and products, please call me. I can be reached at 440.951.7856 and look forward to hearing from you.

One of the best ways to learn about the latest in dental care is to register and attend my next educational seminar which is open to the public. It will take place on Thursday, August 24, 2017. It will be at my office on Lakeshore Boulevard at 6:00 PM. Call our office to register.


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