You should have a complete Periodontal Implant evaluation once per year and sometime twice per year if you are more suceptible to periodontal disease. Your cleanings (SPT's) should be provided as needed and this will depend upon your pocket depths and Oral Hygiene  of proper brushing and flossing. We will tailor this to your individual needs and we would recommend SPT's every 3-4 months to prevent any further breakdown. 

We do not cure Periodontal Disease!  We stop or arrest it and you must continue your excellent brushing and flossing daily to prevent further breakdown.  You have a great investment in your natural teeth and or implants and we want you to maintain them for a lifetime.  We want you to have a BEAUTIFUL SMILE !

Regular periodontal implant  exams and SPT visits are essential in preventing further peridontal implant breakdown.   At these visits, your teeth are cleaned and checked for increase of pocket depths or loss of tissue and or bone.   Additionally, there are many other things that are checked and monitored to help detect, prevent, and maintain your periodontal implant health.  These include:

• Medical history review:  We will update your medical history at each and every visit as well as your blood pressure, pulse rate and your OHI level. Knowing the status of any current medical conditions, new medications, and illnesses, gives us insight to your overall health and also your  periodontal implant  health.
• Examination of diagnostic x-rays (radiographs): Essential for detection of further bone loss, tumors, cysts, and cavities.  X-rays also help determine tooth and root positions.  Radiographs should be taken of your dental implants annually to assses their status.
• Oral cancer screening: Check the face, neck, lips, tongue, throat, tissues, and gums for any signs of oral cancer.  We provide an oral cancer evaluation at each and every visit.
• Gum disease evaluation: Check the gums and bone around the teeth for any signs of periodontal disease.  A periodontal probing will be  provided as needed.
• Oral Hygiene Instructions (OHI): Review and recommend oral hygiene aids as needed (toothbrushes, end tuft brush, interdental brushes, rubber tip stimulator, dental floss and any special cleaning aids, fluorides, rinses, etc.).  We will check your OHI levels at each visity and show you how to do a more effective job.  Your hands are 90% of the success of your periodontal implant health.
• Removal of plaque: Plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (poisons) that inflame the gums.  This inflammation is the start of periodontal disease! We will monitor your OHI levels at each and every visit.  Please bring your oral hygiene aides of brushes, floss, Plaque Control Record at each and every visit.  If you remove the Bacterial Plaque daily you will have minimal calculus formation.  We want your OHI scores to be below 10%. 
• Removal of calculus (tartar): Calculus is hardened bacterial plaque that has been left on the tooth for sometime and is now firmly attached to the tooth surface.  Calculus forms above and below the gum line, and can only be removed with special dental instruments.  We will use ultrasonic scalers and curretes to remove all the deposit on the root surfaces.
  Teeth polishing:  Stain does not cause disease and it is removed by polishing to whiten your teeth. Stain or discolored teeth may be bleached by your general dentist to enhance your smile. We want you to have a BEAUTIFUL SMILE !
Review dietary habits:  "You are what you eat!" Your eating habits play a very important role in your periodontal and systemic health.  We want your entire body and mind to be healthy.
• Examination of tooth decay and restorations: All tooth surfaces will be checked for decay and we will provide this information to your general dentist.  They will be responsible for your restorative needs.
• As you can see, a good periodontal implant  exam and SPT involves quite a lot more than just checking for cavities and polishing your teeth.  We are committed to providing you with the best possible care, and to do so will require regular check-ups and cleanings.  We want to be Proactive and prevent further breakdown and take care of it very early.

Our intitial examination and consultation takes approximately 1 and 1/2 hours.  The fee for the intitial examination is $150.00 which is due an payable at the time of the examination. 

 At that time we will discuss the causative factor of your disease problems, recommended treatment options and all of the fees involved to create a beautiful smile.

Four out of five people have periodontal disease and don’t know it!  Most people are not aware of it because the disease is usually painless in the early stages.  Unlike tooth decay, which often causes discomfort, it is possible to have periodontal disease without noticeable symptoms.  Having regular dental check-ups and periodontal implant examinations are very important and will help detect if periodontal implant problems exist.

Periodontal disease begins when bacterial plaque, a sticky, colorless, film of bacteria, food debris, and saliva, is left on the teeth and gums.  The bacteria produce toxins (acids) that inflame the gums and slowly destroy the bone.  Brushing and flossing regularly and properly will ensure that plaque is not left behind to do its damage.  We want you to brush 4-5 times per day and dental floss 2 times per day. "Cleanliness is next to Godliness."

Other than poor oral hygiene, there are several other factors that may increase the risk of developing periodontal disease:

• Smoking or chewing tobacco – Tobacco users are more likely than nonusers to form bacterial plaque and tartar on their teeth.  They will have a greater severity of periodontal disease and the possibilty of oral cancer as well.

• Certain tooth or appliance conditions – Bridges that no longer fit properly, crowded teeth, or defective fillings that may trap bacterial plaque.

• Many medications – Steroids, cancer therapy drugs, blood pressure meds, oral contraceptives.  Some medications have side affects that reduce saliva, making the mouth dry and bacterial plaque easier to adhere to the teeth and gums.

• Pregnancy, oral contraceptives, and puberty – Can cause changes in hormone levels, causing gum tissue to become more sensitive to bacterial toxins.

• Systemic diseases – Diabetes, blood cell disorders, HIV / AIDS, immunocompromised patients, etc.  We will suggest good medical examinations and test from your mediical doctor.

• Genetics may play role – Some patients may be predisposed to a more aggressive type of periodontitis.  Patients with a family history of tooth loss should pay particular attention to their gums.  All family members should be evaluated early in life.  These cases can be diagnosed in youngsters. We may recommend genetic testing.

Signs and Symptoms of Periodontal Disease

• Red and puffy gums – Gums should never be red or swollen.

• Bleeding gums – "Gums should never bleed", even when you brush vigorously or use dental floss.   If you were washing your hands and they were bleeding you would immediately seek medical care.

• Persistent bad breath – Caused by excessive amounts of bacterial plaque in the mouth.

• New spacing between teeth – Caused by bone loss.

• Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone).

• Pus around the teeth and gums – Sign that there is an infection present.  Pus are dead, dying and waste products of bacteria and breakdown of tissues.

• Receding gums – Loss of gum around a tooth.

• Tenderness or Discomfort – Bacterial plaque, calculus, and bacteria irritate the gums and teeth.

Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease and premature loss of teeth.

Brushing and flossing help control the plaque and bacteria that cause dental disease.  "Cleanliness is next to Godliness."

Bacterial plaque is a film of food debris, bacteria, and saliva that sticks to the teeth and gums.  The bacteria in bacterial plaque convert certain food particles into acids that cause tooth decay.  Also, if bacterial plaque is not removed, it turns into calculus (tartar).  If plaque and calculus are not removed, they begin to destroy the gums and bone, causing periodontal (gum) disease.

Bacterial plaque formation and growth is continuous and can only be controlled by regular brushing, flossing, and the use of other dental aids.

Toothbrushing – Brush your teeth at least four to five times per  day (especially before going to bed at night) with an ADA approved soft bristle brush and toothpaste.

• Brush at a 45 degree angle to the gums, gently using a  six small circular motions, and then rolling down three times ensuring that you always feel the bristles on the gums.
• Brush the outer, inner, and biting surfaces of each tooth.
• Use the tip of the brush head to clean the inside front teeth.
• Brush your tongue and roof of your mouth to remove bacteria and freshen your breath.

You should have multiple tooth brushes and floss available at home, work, purse, etc.

Electric toothbrushes are also recommended.  They are easy to use and can remove bacterial plaque efficiently.  Simply place the bristles of the electric brush on your gums and teeth and allow the brush to do its job, one tooth at a time.  We would recommend the manual brush in most cases.

Flossing – Daily flossing twice a day!  is the best way to clean between the teeth and under the gumline.  Flossing not only helps clean these spaces, it disrupts bacterial plaque colonies from building up, preventing damage to the gums, teeth, and bone.

• Take 24-30 inches (60-76cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the thumbs and index fingers.
• Using your thumbs and indexfingers to guide the floss, gently insert the floss between teeth using a sawing motion.
• Curve the floss into a “C” shape around each tooth and under the gumline.  Gently move the floss up and down, cleaning the side of each tooth.  You want it to be "squeaky clean."

Floss holders are recommended if you have difficulty using conventional floss.

Rinsing – It is important to rinse your mouth with water after brushing, and also after meals if you are unable to brush.  If you are using an over-the-counter product for rinsing, it’s a good idea to consult with your dentist or dental hygienist on its appropriateness for you.

Brushing our teeth removes food particles, bacterial plaque, and bacteria from all tooth surfaces, except in between the teeth.  Unfortunately, our toothbrush can’t reach these areas that are highly susceptible to decay and periodontal (gum) disease.

Flossing two times per day is the best way to clean between the teeth and under the gumline.  Flossing not only helps clean these spaces, it disrupts bacterial plaque colonies from building up, preventing damage to the gums, teeth, and bone.

Bacterial plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (acids) that cause cavities and irritate and inflame the gums.  Also, when bacterial plaque is not removed above and below the gumline, it hardens and turns into calculus (tartar).  This will further irritate and inflame the gums and also slowly destroy the bone.  This is the beginning of periodontal disease.

How to floss properly:

• Take 24-30 inches (60-76cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
• Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
• Curve the floss into a “C” shape around each tooth and under the gumline.  Gently move the floss up and down, cleaning the side of each tooth.

Floss holders are recommended if you have difficulty using conventional floss.

Flossing two times per day will help you keep a healthy, beautiful smile for life!

With the appropriate soft tissue procedures we can cover the exposed roots and enhance your smile.

If you teeth appear to be short of stubby when you smile, we can crown lenghten them and create a BEAUTIFUL SMILE FOR YOU!!

This is being touted in the media: "get your implants and crown in a day."

Implants in a day ????  How about implants for a lifteme!!!!  Why do we want to take shortcuts when it comes to your smile and health!

YES and NO!

YES:  A single rooted tooth can be removed and the implant placed the same day.  For molars, ideally the tooth should be removed and a bone graft is placed and allowed to heal 4-6 month and then the dental implant is placed.  Then this is allowed to heal for 4 months and the final crown will be place.

YES:  A temporary crown can be placed on it the same day but a final crown will be placed after healing for a period of time.

NO:  We do not recommend this in most cases.  "If  I cut myself shaving: how long does it take to heal?"  How long have you been missing the tooth?  We do provide this service.

YES:  Our greatest concerns is the ESTHETICS and a temporary crown or appliance will be provided for you to fill in the missing space(s).  This will be provided by your general dentist.

Dr. Dennis Nishimine has been placing dental implants since 1990.  Our team of doctors,  Dee C. Nishimine, Dennis Nishimine, and Sophia Tseng all have completed surgical specialty training in university settings of 2-3 years.

No  your periodontal implant therapy should not be uncomfortable or painful.  If we utilize the appropriate medications for you you should be comfortable. 

We will provide the appropriate anesthetics and can sedate you for your comfort.  Please look at the SEDATION page.

Yes after the corrective procedures(surgical) you will be prescribed appropriate antibiotics and pain medications and these should make your comfortable. 

In some cases we will utilize sedation either orally or intravenous to make you more comfortable with your therapy in conjunction with local anesthetics.

If at any time you feel that you are uncomfortable please let us know and we will ensure that you area as comfortable as possible.

You may respond differently to the medications and if they do not seem to be adequate we can easily change your prescription to something more effective for you.  Your COMFORT is our greatest concern and you can reach the doctors 24 hours a day.

Please call:  YOU CAN REACH US 24 HOURS A DAY!!!

Fresno Office: (559) 229-6557                        Merced Office: (209) 383-2196

Dr. Dennis Nishimine: (559) 259-3077             Dr. Dee Nishimine: (559) 709-8684 

Dr. Sophia Tseng: (415)786-7515

This depends upon the complexity of the case.

Generally cases take 4-6 months to complete and this can be expedited if needed.

With many state-of-the-art dental treatments and prevention options available in dentistry today, there are fewer reasons for having to extract (remove) teeth.  When something does go wrong with a tooth, we try to do everything possible to restore the tooth and maintain your natural tooth.  If the tooth is non restorable, badly infected or fractured you have no alterantive but having it removed.

Losing a tooth can be a very traumatic experience and it’s very unfortunate when it does happen.  Injury, accident, fracture, severe dental decay, and gum disease are the major reasons for having to remove a tooth.  If teeth are lost due to injury or have to be removed, it is imperative that they be replaced to avoid cosmetic and dental problems in the future.

When a tooth is lost, the jaw bone that helped to support that tooth begins to atrophy, causing the teeth on either side to shift or tip into the open space of the lost tooth.  Also, the tooth above or below the open space will start to move towards the open space because there is no opposing tooth to bite on.  These movements may create problems such as decay, gum disease, excessive wear on certain teeth, and TMJ (jaw joint) problems.  These problems and movements do not result immediately, but will eventually appear, compromising your chewing abilities, the health of your bite, and the beauty of your smile.

Options for replacement of missing teeth:

"Standard of Care"  Today the "Standard of Care" of care is that all missing teeth may be replaced.  Ideally we want a full complement of teeth for chewing function, phoenetics and a BEAUTIFUL SMILE ! These will be discussed from the most ideal to the least desirable.

Implants - Are a great way to replace one or more missing teeth. They may also be great to support ill fitting dentures. A dental implant is an artificial root that is surgically placed into the jaw bone to replace a missing tooth. An artificial tooth is placed on the implant, giving the appearance and feel of a natural tooth. Implants are very stable, durable, and are the most aesthetically pleasing tooth replacement option.  The greatest advantage is that you don't have to "cut down adjacent teeth or have anything come in and out of your mouth."  This is just like your natural tooth.

Fixed bridges - This type of bridge is generally made of porcelain or composite material and is anchored (cemented) permanently to a natural teeth adjacent to the missing tooth site. The benefit of this type of bridge is that it is fixed (not removable) and it is very sturdy. The disadvantage is that in order to create a fixed appliance, two healthy, natural teeth will have to be crowned (capped or cut down) to hold the bridge in place.

Removable bridges - This type of bridge is a fair solution for replacing one or more missing teeth. They are usually made of tooth-colored plastic, artificial teeth combined with metal clasps that hook onto adjacent natural teeth. Removable bridges are the most economical option for replacing missing teeth, but may be the least aesthetically pleasing. This is because the metal clasps on the appliances are often impossible to completely conceal.

Dentures - This type of tooth replacement is used when all of the natural teeth are missing in one dental arch. Dentures are removable artificial teeth that are made to closely resemble the patients’ original teeth.  Today dentures and partial dentures should  be totally eliminated with the proper utilization of dental implants.   No matter how long you have been in dentures we can eliminate them with proper bone grafting and dental implants.  We can restore your teeth and your personal being and eliminate dentures today!

If you are missing teeth, ask us how we can replace them with dental implants. Together we will select the best replacement option for your particular case. Prevention and early treatment is always less involved and less costly than delaying treatment and allowing a serious problem to develop.  "Brush and Floss"

Many people are unaware that having periodontal disease (the destruction of gum tissue and bone that hold our teeth in place) can affect your overall health.  Periodontal disease is one of the most common infections; often more prevalent than the common cold!  Periodontal disease is not only the number one reason people lose teeth; it can also affect the health of your body!

Periodontal disease is a bacterial infection, and in its earliest stages, it’s called gingivitis.  It starts when an accumulation of plaque (a colony of bacteria, food debris, and saliva) is NOT regularly removed from the gums and teeth.  The bacteria in plaque produce toxins/acids that irritate and infect the gums and eventually destroy the jaw bone that supports the teeth.  When periodontal disease is not treated it can eventually lead to tooth loss!

There are numerous studies that have looked into the correlation between gum disease and major medical conditions.  These studies suggest people with periodontal disease are at a greater risk of systemic disease and indicate that periodontal disease may cause oral bacteria to enter the bloodstream and travel to major organs and begin new infections.  Research suggests that periodontal bacteria in the blood stream may:

• Contribute to the development of heart disease
• Increase the risk of stroke
• Compromise the health of those that have diabetes or respiratory diseases
• Increase a woman’s risk of having a preterm, low-birth weight baby

Researchers conclude there is still much research to be done to understand the link between periodontal disease and systemic diseases, but enough research has been done to support that infections in the mouth can play havoc elsewhere in the body.

To ensure a healthy, disease-free mouth, we recommend the importance of regular dental check-ups and cleanings, which include a periodontal evaluation.  Also, diligent home care and a proper diet can help reduce the plaque and bacteria in the mouth.

Remember….the mouth body connection!  Taking care of your oral health may contribute to your overall medical health!

Bad breath (halitosis) can be an unpleasant and embarrassing condition.  Many of us may not realize that we have bad breath, but everyone has it from time to time, especially in the morning.

There are various reasons one may have bad breath, but in healthy people, the major reason is due to microbial deposits on the tongue, especially the back of the tongue.  Some studies have shown that simply brushing the tongue reduced bad breath by as much as 70 percent.

What may cause bad breath?

• Morning time – Saliva flow almost stops during sleep and its reduced cleansing action allows bacteria to grow, causing bad breath.
• Certain foods – Garlic, onions, etc.  Foods containing odor-causing compounds enter the blood stream; they are transferred to the lungs, where they are exhaled.
• Poor oral hygiene habits – Food particles remaining in the mouth promote bacterial growth.
• Periodontal (gum) disease – Colonies of bacteria and food debris residing under inflamed gums.
• Dental cavities and improperly fitted dental appliances – May also contribute to bad breath.
• Dry mouth (Xerostomia) – May be caused by certain medications, salivary gland problems, or continuous mouth breathing.
• Tobacco products – Dry the mouth, causing bad breath.
• Dieting – Certain chemicals called ketones are released in the breath as the body burns fat.
• Dehydration, hunger, and missed meals – Drinking water and chewing food increases saliva flow and washes bacteria away.
• Certain medical conditions and illnesses – Diabetes, liver and kidney problems, chronic sinus infections, bronchitis, and pneumonia are several conditions that may contribute to bad breath.

Keeping a record of what you eat may help identify the cause of bad breath.  Also, review your current medications, recent surgeries, or illnesses with your dentist.

What can I do to prevent bad breath?

• Practice good oral hygiene – Brush at least twice a day with an ADA approved fluoride toothpaste and toothbrush.  Floss daily to remove food debris and plaque from in between the teeth and under the gumline.  Brush or use a tongue scraper to clean the tongue and reach the back areas.  Replace your toothbrush every 2 to 3 months.  If you wear dentures or removable bridges, clean them thoroughly and place them back in your mouth in the morning.
• See your dentist regularly – Get a check-up and cleaning at least twice a year.  If you have or have had periodontal disease, your dentist will recommend more frequent visits.
• Stop smoking/chewing tobacco – Ask your dentist what they recommend to help break the habit.
• Drink water frequently – Water will help keep your mouth moist and wash away bacteria.
• Use mouthwash/rinses – Some over-the-counter products only provide a temporary solution to mask unpleasant mouth odor.  Ask your dentist about antiseptic rinses that not only alleviate bad breath, but also kill the germs that cause the problem.

In most cases, your dentist can treat the cause of bad breath.  If it is determined that your mouth is healthy, but bad breath is persistent, your dentist may refer you to your physician to determine the cause of the odor and an appropriate treatment plan.

Over the years there has been some concern as to the safety of amalgam (silver) fillings.  An amalgam is a blend of copper, silver, tin and zinc, bound by elemental mercury.  Dentists have used this blended metal to fill teeth for more than 100 years.  The controversy is due to claims that the exposure to the vapor and minute particles from the mercury can cause a variety of health problems.

According to the American Dental Association (ADA), up to 76% of dentists use silver containing mercury to fill teeth.  The ADA also states that silver fillings are safe and that studies have failed to find any link between silver containing mercury and any medical disorder.

The general consensus is that amalgam (silver) fillings are safe.  Along with the ADA’s position, the Center for Disease Control (CDC), the World Health Organization, the FDA, and others support the use of silver fillings as safe, durable, and cost effective.  The U.S. Public Health Service says that the only reason not to use silver fillings is when a patient has an allergy to any component of this type of filling.  The ADA has had fewer than 100 reported incidents of an allergy to components of silver fillings, and this is out of countless millions of silver fillings over the decades.

Although studies indicate that there are no measurable health risks to patients who have silver fillings, we do know that mercury is a toxic material when we are exposed at high, unsafe levels.  For instance, we have been warned to limit the consumption of certain types of fish that carry high levels of mercury in them.  However, with respect to amalgam fillings, the ADA maintains that when the mercury combines with the other components of the filling, it becomes an inactive substance that is safe.

There are numerous options to silver fillings, including composite (tooth-colored), porcelain, and gold fillings.  We encourage you to discuss these options with your dentist so you can determine which is the best option for you.

If you’re feeling somewhat self-conscious about your teeth, or just want to improve your smile, cosmetic dental treatments may be the answer to a more beautiful, confident smile.

Cosmetic dentistry has become very popular in the last several years, not only due to the many advances in cosmetic dental procedures and materials available today, but also because patients are becoming more and more focused on improving their overall health.  This includes dental prevention and having a healthier, whiter, more radiant smile.

There are many cosmetic dental procedures available to improve your teeth and enhance your smile.  Depending on your particular needs, cosmetic dental treatments can change your smile dramatically, from restoring a single tooth to having a full mouth make-over.  Ask your dentist how you can improve the health and beauty of your smile with cosmetic dentistry.

Cosmetic Procedures:

Teeth Whitening: Bleaching lightens teeth that have been stained or discolored by age, food, drink, and smoking.  Teeth darkened as a result of injury or taking certain medications can also be bleached, but the effectiveness depends on the degree of staining present.

Composite (tooth-colored) Fillings: Also known as “bonding”, composite fillings are now widely used instead of amalgam (silver) fillings to repair teeth with cavities, and also to replace old defective fillings.  Tooth-colored fillings are also used to repair chipped, broken, or discolored teeth.  This type of filling is also very useful to fill in gaps and to protect sensitive, exposed root surfaces caused by gum recession.

Porcelain Veneers: Veneers are thin custom-made, tooth-colored shells that are bonded onto the fronts of teeth to create a beautiful individual smile.  They can help restore or camouflage damaged, discolored, poorly shaped, or misaligned teeth.  Unlike crowns, veneers require minimal tooth structure to be removed from the surface of the tooth.

Porcelain Crowns (caps): A crown is a tooth-colored, custom-made covering that encases the entire tooth surface restoring it to its original shape and size.  Crowns protect and strengthen teeth that cannot be restored with fillings or other types of restorations.  They are ideal for teeth that have large, fractured or broken fillings and also for those that are badly decayed.

Dental Implants: Dental implants are artificial roots that are surgically placed into the jaw to replace one or more missing teeth.  Porcelain crowns, bridges, and dentures can be made specifically to fit and attach to implants, giving a patient a strong, stable, and durable solution to removable dental appliances.

Orthodontics: Less visible and more effective brackets and wires are making straightening teeth with orthodontics much more appealing to adult patients.  Also, in some cases, teeth may be straightened with custom-made, clear, removable aligners that require no braces.

Thanks to the advances in modern dentistry, cosmetic treatments can make a difference in making your smile shine!

Since teeth whitening has now become the number one aesthetic concern of many patients, there are many products and methods available to achieve a brighter smile.

Professional teeth whitening (or bleaching) is a simple, non-invasive dental treatment used to change the color of natural tooth enamel, and is an ideal way to enhance the beauty of your smile.  Over-the-counter products are also available, but they are much less effective than professional treatments and may not be approved by the American Dental Association (ADA).

As we age, the outer layer of tooth enamel wears away, eventually revealing a darker or yellow shade.  The color of our teeth also comes from the inside of the tooth, which may become darker over time.  Smoking, drinking coffee, tea, and wine may also contribute to tooth discoloration, making our teeth yellow and dull.  Sometimes, teeth can become discolored from taking certain medications as a child, such as tetracycline.  Excessive fluoridation (fluorosis) during tooth development can also cause teeth to become discolored.

It’s important to have your teeth evaluated by your dentist to determine if you’re a good candidate for bleaching.  Occasionally, tetracycline and fluorosis stains are difficult to bleach and your dentist may offer other options, such as veneers or crowns to cover up such stains.  Since teeth whitening only works on natural tooth enamel, it is also important to evaluate replacement of any old fillings, crowns, etc. before bleaching begins.  Once the bleaching is done, your dentist can match the new restorations to the shade of the newly whitened teeth.

Since teeth whitening is not permanent, a touch-up may be needed every several years to keep your smile looking bright.

The most widely used professional teeth whitening systems:

Home teeth whitening systems: At-home products usually come in a gel form that is placed in a custom-fitted mouthguard (tray), created from a mold of your teeth.  The trays are worn either twice a day for approximately 30 minutes, or overnight while you sleep.  It usually takes several weeks to achieve the desired results depending on the degree of staining and the desired level of whitening.

In office teeth whitening: This treatment is done in the dental office and you will see results immediately.  It may require more than one visit, with each visit lasting 30 to 60 minutes.  While your gums are protected, a bleaching solution is applied to the teeth.  A special light may be used to enhance the action of the agent while the teeth are whitened.

Some patients may experience tooth sensitivity after having their teeth whitened.  This sensation is temporary and subsides shortly after you complete the bleaching process, usually within a few days to one week.

JAW NECROSIS is a very serious side effect with patients that are on bisphophanates eg. fossamax, boniva, actonel, etc.  Patient's on and oral regimen seldom have problems.

If you have or on I.V. Bisphosphanates this should be evaluated very carefully by you and your oncologist.  Dr. Dennis Nishimine, Dee Nishimine, & Sophia Tseng feel that being proactive is the most important aspect of care.  If you are going to undergo I.V. therapy of Bisphosphanates we would want your periodontal implant condition to be as healthy as possible prior to commencing with this form of therapy.   We have cases of Jaw Necrosis with patients that have I.V thearpy.  We feel that this can be minimized with proper periodontal therapy and little to no infection in your mouth prior to therapy.