Cosmetic Dentistry
Q 1: If my teeth are crooked, what are my options?
Answer: There are many options for straightening teeth. These include orthodontic treatment, veneers, crowns and bridges.
Q 2: What are the different options for teeth whitening and how do I know what is best for me?
Answer: There are a few options for teeth whitening. Some teeth whitening procedures are done in the dental office with a special machine however there are other take-home kits that can be provided by your dentist. To find out the option best for you, visit with your cosmetic dentist and have them review with you all of the options in order to find the product that will best fit your needs.
Q 3: What are the kinds of problems that Cosmetic Dentistry can help correct?
Answer: The main advantage of cosmetic dentistry is the improvement of esthetics. Cosmetic dentistry can improve your smile, lip contour, and function.
Q 4: Do you accept insurance for cosmetic procedures?
Answer: We accept insurance for dental procedures to the limits of your individual policy. Our insurance experts will work with you to provide you with the best dentistry, and alternatives in payment, for procedures not covered by your policy.
Q 5: What are the most common reasons teeth get discolored?
Answer: The most common reason teeth get discolored is from drinking coffee or tea and smoking. To a lesser extent, age may make teeth less translucent and a darker color.
Q 6: What are dental veneers and how do I know if they are right for me?
Answer: Dental veneers are a thin material that fit over your natural teeth. They require a minimum of tooth reduction and preparation. The general dentist that cares for your routine needs is the best person to ask questions about dental veneers.
Q 7: Does tooth whitening hurt?
Answer: In most cases teeth whitening does not hurt, however the teeth may be temporarily sensitive to hot, and especially cold, after the procedure.
Q 8: If I have my teeth whitened, are there foods or drinks that I need to avoid?
Answer: After you have had your teeth whitened, you may want to avoid coffee, tea and smoking, as they will continue to stain your teeth. It may be necessary to repeat the tooth whitening procedure periodically to keep the fresh smile look.
Q 9: Are there any home treatments for whitening that you would recommend?
Answer: Although over-the-counter teeth whitening kits that can be purchased at any grocery or drug store can improve the whiteness of your smile, we recommend a home treatment gel that is used for teeth whitening. The gel has greater whitening ability and may help you keep your white smile longer. Ask your dentist about the home treatment gel and see if it is right for you.
Q 10: What can I do at home to help with sensitivity after whitening?
Answer: Teeth can often be sensitive after undergoing a whitening treatment. We recommend that after teeth whitening, you avoid drinking cold fluids or eating spicy foods.
Dental Implants
Q 1: What are Dental Implants?

Dental Implants are a safe and clean way to repair or replace damaged or missing teeth.† The Smiler Center for Dental Excellence, Encinoís premier Oral Surgery and Dental office, uses state-of-the-art technology and treatments to ensure our patients have a safe, clean, and comfortable experience when undergoing an implant procedure.

What are Dental Implants?† Dental implants are biocompatible substitutes for lost natural teeth. They are devices for attaching artificial replacement teeth firmly to the bone. Implants can be used to support a single crown, replace many teeth, or as anchors for fixed bridges and fixed or removable partial or complete dentures.

If you have questions about Dental Implants, Implant Supported Crowns or Bridges, or Implant Supported Dentures, please donít hesitate to give us a call (818) 995-8601.

Q 2: What are the types of Dental Implants?

There are basically two types of implants.

One type fits on top of the bone. This is called a subperiosteal implant and is custom designed for the patient's jaw. This is usually for patients with extreme bone loss.

The second type of implant is placed in the bone. This is called an endosteal implant. There are different sizes and shapes of endosteal implants. They may be shaped like cylinders, screws, or hollow baskets. Some are long and thin. The choice of the implant that is used depends on the quality and amount of available bone, and the type of prosthesis or denture, which will be supported by the implants. In some patients one or more implants might be used to replace a single tooth, act as an anchor for a bridge, or as support for a full denture.

Q 3: What is the history of Dental Implantology?

Dental implantology goes back to the time of the early Egyptians. Modern oral implantology, as we know it today, dates back more than 30 - 40 years. Various teeth implants have been used on or in the bone for over 50 years. The newer bone-integrated and biointegrated implants have been used with good success.

Implant academies and associations around the world have conducted long term studies. In addition, participants at the Harvard School of Dental Medicine Conference on Dental Implants have endorsed dental implant techniques as safe and effective cosmetic dental work.

Recently, the American Dental Association has assigned insurance code numbers for implants and some insurance companies reimburse patients for dental implant cost and/or related procedures and prostheses. All of this activity stems from one central fact DENTAL IMPLANTS WORK.

Q 4: How can Dental Implants help me?

Dental Implants may offer solutions to you if:

  • You cannot chew comfortably and efficiently with conventional dentures
  • You have lost teeth and don't want removable partial dentures
  • You have lost a single tooth and want a single tooth implant rather than a bridge appliance
  • You are now wearing a partial denture or full denture, and would prefer a fixed bridge or fixed-removable appliance
Q 5: Am I a candidate for Dental Implants?
Answer: Most patients who are healthy enough to undergo normal dental treatment and maintain good oral hygiene can have dental implants. Since general health conditions or structures of the mouth may prevent the use of an implant, individual evaluation is necessary.
Q 6: Who makes up the Implant Team?

The implant team is made up of the Oral and Maxillofacial Surgeon, the Restorative Dentist and the Laboratory Specialist.

The Oral and Maxillofacial Surgeon is a highly trained specialist who has completed four comprehensive years of dental school plus at least three years of in-hospital surgical residency.

At The Smiler Center for Dental Excellence, Dr. Smiler is out head Oral and Maxillofacial Surgeon.† In addition to the training mentioned above, Dr. Smiler has also taken and passed rigorous examinations to become a Board Certified Diplomat of the American Board of Oral and Maxillofacial Surgery, a Diplomat of the International Congress of Oral Implantologists, and the Academy of Osseointegration. He is also a member of numerous implant organizations and academies.

The Restorative Dentist has the special skills required for the design and fabrication of the final crown, bridgework or denture. It is the restorative dentist's training that will provide you with a functioning and esthetic dental appliance.

The Laboratory Specialist has special knowledge about dental materials, dentures, and crown and bridge construction. His job is to fabricate in the laboratory what your dentist has designed for you.

Q 7: Will my Implants function as well as my original teeth?
Answer: Nothing will function as well as natural teeth. However, implants function better than removable teeth. In most cases patients can eat without being aware of the implants. Most patients are happier with fixed teeth, a single tooth, or dentures that are supported by implants.
Q 8: What are the risks of surgery for Dental Implants?

Most of the possible complications associated with implant surgery are not serious. Other than the unlikely situation of a severe infection or fracture of the bone, medication, surgical intervention or removal of the implant, easily reverses most problems. If the implant must be removed, it is often possible to replace it with another implant. Sometimes the implant can be placed in the same location, or it can be placed in another location.

All surgical procedures have certain risks. Although complications are unlikely, you should be aware of the following:

  • Surgery on the lower jaw may incur a risk of damaging the nerve that controls the sensation of the lower lip. If this nerve is damaged, there could be a loss, or change, of feeling in the lower lip and chin. This change in feeling might involve tingling, itching, burning, feeling cold, feeling hot, or feeling partially or completely numb. Damage to the nerve is not likely. If it does occur, the feeling will usually return gradually to its normal state within a few weeks to a few months. However, it is possible that the resulting numbness could last for years or be permanent.
  • Similar damage can occur to the nerve of the tongue.
  • Surgery on the upper jaw could result in nerve damage to the corner of the nose. The placement of implants on or in the upper jaw can result in perforations into, infections of, or problems with the nasal passages or the sinuses. Fortunately, such damage is rare. If it does occur, it will usually heal uneventfully, although treatment might require antibiotic therapy or surgical correction. If problems are allowed to develop around upper implants and are ignored by the patient, they may progress into the sinus and result in a condition requiring surgery, treatment and correction.††
  • When an implant is placed near a tooth, it is possible that the tooth root may be damaged during bone preparation for the Implant. Such damage is extremely unlikely. If it should occur it is likely to heal, although it is possible that the damaged tooth would be lost or need root canal treatment.
Other surgical risks are bleeding, bruising, infections and swelling.
Q 9: What are the risks of Dental Implants?
Answer: Infection is a concern with dental Implants. Good oral hygiene can greatly reduce this risk. Some implants can cause additional stress on the bones in the jaw that can lead to loosening of the implant, failure and subsequent removal of the implant. If the implant fails due to bone deterioration and must be replaced with a conventional appliance, the patient may experience problems with retention because of associated bone loss. Additional possible complications include discomfort, cosmetic problems, Implant breakdown, and damage to adjacent teeth in the mouth. Fortunately, these problems are rare, especially with regular checkups.
Q 10: What are the chances of rejection of the Implant?

The body does not reject a dental implant as it might a heart, lung or kidney. Although implants are more stable than removable dental appliances, bone and gum tissues do not attach to the implant as they normally do to a natural tooth root. Therefore, a dental Implant will not be as stable as a naturally healthy tooth.

Q 11: How long will my Implant last?

Some implants are still functioning successfully after 25 years. For patients who have a history of trouble with their mouths and whose bone physiology around their roots have been a problem, the prognosis would be less optimistic than for patients who have had fewer dental health problems. Also, if there are many natural teeth remaining, the expected longevity of an implant is greater than if all the teeth are missing. As with any artificial replacement in the human body, no promises or guarantees can be made as to longevity of the implant, or of the implant-supported appliance.

It is impossible to know how long any particular implant will last, and therefore itís impossible to predict or guarantee success.

Q 12: What causes failure of Dental Implants?

Circumstances that may result in the failure of implants and the appliances they support are: local conditions, systemic conditions, and structural overload.

  • Local Problems: Bacteria can accumulate around a dental implant just as it can around a tooth. Bacteria can cause inflammation and infection of the gum and bone tissue. This can proceed to bone loss and loss of the implant. For long term success, implants must be kept meticulously clean. Other local damage can result from improper use of cleaning Instruments, grinding of the teeth, smoking, and/or excess use of alcohol.
  • Systemic Problems: Diabetes, metabolic bone disease, steroid therapy, HIV, and problems with absorption of nutrients are but a few of the medical problems that may influence the success of implants. Any condition which prevents the body from repairing bone or other supporting tissue can result in the eventual loss of bone and gum support for the implant. Conditions such as osteoporosis, collagen diseases, drug use and addiction, or any debilitating disease can prevent the body from repairing itself. This does not necessarily mean that implants should not be used. Discussion with your physician is sometimes needed to determine whether any medical problems would prohibit implant treatment.
  • Structural Overload: When an implant supported fixed or removable dental appliance, such as a single crown, a bridge, or a denture, is overloaded by chewing forces, something has to give. Most chewing forces are within the physiologic and/or mechanical tolerances of bone tissue that support teeth or implants. When the chewing forces are such that they exceed physiologic tolerances, as when the teeth are tightly clenched together or if not enough implant support anchors are placed to absorb chewing forces, bone tissue can be lost from around the implant.
Q 13: What are the problems associated with smoking?

Smoking is extremely harmful to all oral tissues, especially when implants are present.
Smoking can cause the following problems:

  • Heat from smoking is retained in the metal.
  • Irritants from smoking also effect the normal healing of the gum and bone tissues of the mouth.
  • Smoking robs the bone and other tissues of vital nutrients and minerals needed for healing and maintaining the healthy bone connection to the implant.
  • Smoking also decreases blood supply and oxygen to the gums and bone tissues that are next to the implant.

To help keep the supporting bone and gum tissues healthy and able to resist infection, the implant patient should not smoke.
We are always concerned about the prognosis of dental implants and their restorations on patients who continue to smoke cigarettes, cigars or pipes. It is well documented in our professional literature that smoking contributes to damage of the gums and bone around natural teeth as well as implants. This can result in:

  • Failure of the graft to heal
  • Failure of the implants to heal within the bone
  • Infection of the bone and/or gum tissue
  • Bone loss
  • Lower immune resistance requiring removal of teeth, graft and implants.
If you can eliminate smoking, maintain good home care, and have maintenance hygiene appointments on a regular three-month basis with your dentist, your prognosis can be expected to be very good.
Q 14: Can an Implant be replaced?
Answer: Depending on the reason for its removal, an implant can often be replaced. After healing, if adequate bone is present and the gum tissue is adequate, a new implant can be inserted.
Q 15: How long does treatment take?

A basic requirement of implant surgery is enough time for adequate healing. This is usually from three to six months. During this time the implants are usually under the gum tissue (occasionally they are above the gums). During this time the implant is healing in contact with the surrounding bone. A temporary appliance can usually be made which will be functional, comfortable and esthetic. This appliance may be used during the healing period.

After healing of the implant in the bone, the prosthetic phase of treatment can be continued. In some cases this can take from a few weeks to a few months.

Q 16: What kind of follow-up care is needed?

Good oral hygiene.

Your implants can fail for the same reasons that your natural teeth are lost. Poor oral hygiene is the greatest cause of implant failure. The build-up of dental plaque and debris around teeth and implants cause an increased concentration of bacteria and the destructive consequences of inflammation and infection. This will lead to swollen gums and loss of bone that is needed to support the implant. Excellent oral hygiene is necessary and vital to long-term success of the implant-supported crown, bridge, and fixed or removable dental appliances.

Frequent visits to your dentist are an important part of your commitment to success of your implant procedure. Your dentist and his staff will instruct you in the proper use of toothbrush and other oral hygiene aids. In the morning and before bedtime, you must brush and clean around the implants and the supported appliance. The dentist may also need to clean around the implant(s) and also check the health of the supporting bone tissues by examination and x-rays.

Q 17: What is a realistic approach to “my” treatment?

It is important to have a sense of realism when approaching implant placement surgery and the prosthetic phase of treatment. The following facts should be understood and accepted before proceeding with treatment:

First, I may not be a good candidate for implant surgery.

Second, the goals of dental implants are to help improve the chewing function, make dentures more stable, help improve esthetics, and possibly permit the placing of crowns or bridges instead of a removable full or partial denture. Implants can never be as good as my natural teeth.

Third, my motives in seeking dental implants should be realistic. The placement of dental implants and the associated prosthetic coverage are not "cure-alls." The degree of success with implants depends on many factors including my age, health and other specific problems.

Fourth, every surgical procedure and prosthetic reconstruction entails some degree of risk.  Results may not match my expectations. I recognize and am willing to accept these risks.

Fifth, no implant will last forever. It is possible for an implant to be functional, without problems, for many years. However, this cannot be predicted. It is possible that my implant will be functional for many years. It is also possible that my implant will be functional for a much shorter time.

Sixth, it would be unethical, as well as impossible, for any surgeon/dentist to guarantee the results of implant or prosthetic treatment. The result of treatment however, is almost always an improvement over the previous dental condition.

Seventh, the decision to begin treatment is a shared responsibility between me and my doctors. It is important for me to discuss the benefits, risks, questions, and alternative treatment with Dr. Smiler and my dentist.

General Dentistry
Q 1: How often should I have my teeth cleaned?
Answer: It is recommended that you have your teeth cleaned every 3-6 months. If you have Dental Implants, it is recommended you visit your dentist for a cleaning every 3 months.
Q 2: How often should I use dental floss?
Answer: Flossing your teeth is essential to maintain clean and healthy teeth and gums. Flossing should be part of your daily teeth brushing routine.
Q 3: What kind of toothpaste and toothbrush should I use?
Answer: The kind of toothpaste you choose to use is an individual one. However, the tooth brush you use should have sufficient stiffness to remove debris and get in between teeth.
Q 4: Are electric toothbrushes better than regular toothbrushes?
Answer: Electric toothbrushes are a mechanical convenience and are a great option for cleaning your teeth. However, just like an old fashioned hand-held toothbrush, you should still take at least 2 minutes to brush your teeth.
Q 5: Do you accept insurance?
Answer: The Smiler Center for Dental Excellence accepts many kinds of insurance, including Medicare. However, please remember that the benefits supplied by individual insurance policies vary and may not cover all of your dental needs. Our insurance experts are happy to work with you to provide you with the most care covered by your policy.
Q 6: Do you treat children?
Answer: Although we can work with children, in most cases dental treatment for children is best done with a pedodontist (childrenís dentist). We are happy to refer patients to pedodontists in our dental referral network.
Q 7: What products should I use if I have sensitive teeth?
Answer: The cause of tooth sensitivity is at the root of this issue. It is suggested you have a complete dental examination by your dentist so they can make suggestions of how to best treat your sensitive teeth.
Q 8: What can I do if I grind my teeth or clench when I sleep?
Answer: Clenching and teeth grinding is a common issue. In most cases a night-guard is the best, easiest, and most cost effective way to treat grinding or clenching of teeth. In some cases, more extensive and individualized treatment may be needed. It is suggested you visit your dentist and have a complete dental examination so you and your dentist can make the treatment decision that will be the most effective for you.
Q 9: What are the different types of fillings?
Answer: There have been many advances in filling materials. These include ceramic and composite materials, composition of gold alloys, and porcelain fused to metal crowns. Your dentist will be able to answer the type of filling material needed for your specific case.
Q 10: Should I have my old Mercury fillings replaced?
Answer: No! Older fillings should be removed only if there are leaky margins, decay under the fillings, or if there is additional loss of tooth structure.

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Dental Implants
TMJ Treatment/Jaw Pain
Oral Pathology (Oral Cancer)
Tooth Extraction/Impacted Canines
Wisdom Teeth Removal
Bone Marrow Aspiration
Bone Grafting
IV Sedation
General Anesthesia
Nerve Repositioning
Ridge Expansion
Sinus Lift Bone Augmentation
Nitrous Oxide
Oral Sedation
Clinical study
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