The first step in deciding whether you might be a candidate for Botox is an evaluation to assess your facial movements, lines and wrinkles. Botox has been used to treat thousands of patients. The decision to start treatment with Botox is an important one.

What Benefits can I expect from Botox?

Botox can decrease the strength of the underlying facial muscles. By relaxing these muscles frown lines, squint lines, nasal crunch lines and horizontal forehead wrinkles become less deep. Your muscle strength and action will be minimized. We don’t use Botox around the mouth, as we don’t want to weaken your smile. Botox works on the muscles underneath the skin. If the creases are very deep in the skin then laser resurfacing or facial fillers may be a better option.

What is Botox?

Botox Cosmetic is a natural purified protein extracted from a bacterium and refined into a medicine. It has the unique properties to relax the wrinkle-causing muscles creating a smooth, natural look. It is a simple and quick non-surgical treatment that delivers great natural-looking results! Completely safe, it has been thoroughly researched and tested (more than 3,000 studies).  and used in clinical practice for 20 years with no incidence, approved by FD and Health Protection Branch of Canada).  More than 13 million procedures have been performed since 2002.

Q How do I know if I am a good candidate?

A Botox works best on dynamic wrinkles (those you can see when making movements), if you have a static wrinkles (those that are there all the time) Botox will soften yet won’t eliminate them. And if you want to lift Botox can life the mid-face and brow. Many younger women are starting with Botox to prevent the formation of lines and wrinkles and it’s ideal for women and men from 40 +.

Q Do all practioners use the same method of delivering Botox ?

A NO!!! We use the method as taught by Warren Roberts DMD (one the world’s leading experts on Botox) and practiced by dentists exclusively. We only inject at an angle just under the skin unlike the typical method of injecting straight on thus increasing your discomfort and chance of hitting the bone and bruising. And we inject into the muscle that causes the wrinkle not the typical method of injecting into the wrinkle, which can lead to droop in brow area.

Q How long will treatment last?

A Effects generally wear off after 3-4 months

 Q What is the treatment experience like

A  Procedures are typically 15-20 min , results take up to 14 days after treatment (but many see results within four days).

Q Does the injection hurt?

A No- it feels like a mild insect bite, we use tiny needles (same as used by diabetics).

Q What are the possible side effects?

A Side effects are very rare and are not permanent. You may experience tenderness at injection and redness at injection site, small bruising, short term headache.

Q Is it safe to use Botox and Juvaderm together?

A Yes they work well together

Q How do I know my doctor won’t give me too much Botox?

A The production of Botox is carefully controlled at every stage to ensure that it’s safe for medical use.  Your doctor has been trained to administer it safely and manage any issues that may occur. We plan your Botox plan very carefully and administer the amount in order for you to reach your aesthetic goals. We use averages then adjust according to your goals, age, skin quality and level of strength training.

Q How will my doctor determine how too much Botox to use?

A  This will depend on your goals and how deep your wrinkles are and if you work-out. For each area i.e. the forehead there are general guidelines as to how much to administer but this number can vary depending on your age, condition of skin and if you strength train (patients who strength train have stronger facial muscles and typically require more Botox).

Q  Are there any patients who should not receive Botox?

A  Botox is not recommended for women who are pregnant, nursing or people with myasthenia gravis or other muscle diseases.

Q What does Botox look like?

A Botox comes in a glass vial containing small amounts of crystals. A special solution containing water and small amount of salt is added when the doctor prepares it for injection. A freshly made solution is injected into the specific muscles with a disposable syringe using a very fine gauge needle.

Q Does your face feel different afterwards?

A No the skin and facial movements feel just the same as before –you won’t notice that it’s in your face except by looking in the mirror.

Q Does Botox interact with other drugs?

A  It is always important to let your doctor know if you’re taking other medications specifically amino glycoside antibiotics (these inhibit the effect of Botox).

Q How long does it take to work?

A The effects are usually first noticed in 72 hours and may take up to ten to 14 days to see the full effects.

Q How long do the effects of Botox last?

A A recent study showed that Botox lasts from 3 to 6 months.

Q Does this mean I will need to continue treatment?

A Yes 3 -4 times a year is common to maintain the benefits.

Q How much does it cost?

A Botox is sold by the unit, your fee is determined on how many units you are given. It is typically $12 per unit (though it can be found for less based on the provider’s discretion). We charge $12 a unit (this includes your photographic documentation).

 I tell my patients that in addition to rejuvenating their smile by building up their teeth with either porcelain or ceramic veneers or crowns we can add more volume and youthful dimension to their face. And by lengthening worn down front teeth that will then support the upper lip, lips will look plumper. ”A youthful face has a three-dimensional quality and this can help maintain it,” says Miami-and New York-based dermatologist Fredric Brandt.

Shed your concerns that adding to your teeth will make them look bulky or horsey. These restorations are sculpted individually so they look beautiful, natural and harmonious with your existing teeth. Properly done, all any one will notice is how great you look-rejuvenate your smile, rejuvenate your face!

Your Smile says it all!!

We’ve all seen people with a gorgeous smile; some are born with it yet most need a little help from their cosmetic dentist. We watched Lindsay Lohan go from drab to fab by simply whitening her teeth. Others may desire more profound change such as changing shape or contours of the teeth (straightening, shortening, lengthening), closing spaces or replacing amalgam with natural looking composite. Done right, the improvements can be breath taking and life changing, results should like natural only more beautiful. Cosmetic dentists have specialty training in smile design and incorporate the newest technology, materials and partner with ceramic artists to get the ideal look and luminescence of natural teeth. These changes can take years off; brighten skin tone, plump out lips etc.; in coordination with great skin care it’s a total approach to facial rejuvenation.

Q and A with Dr Bloom

I just want to whiten my teeth, what do you recommend?

There are two methods we use; at-home tray whitening or light activated, both systems can whiten your teeth up to 8 shades. For tray bleaching we give you the custom trays that you wear overnight-you should see results in 1-2 weeks. For faster results we offer the Zoom system-this is light activated and in one office visit your teeth will be up to 8 shades whiter. Both systems can cause sensitivity so it’s imperative to have an evaluation prior to any treatment.

What if I don’t like the shape of my teeth?

You may be a perfect candidate for porcelain veneers that only cover the front surface of the teeth. We use two systems; standard porcelain veneers or Durathin veneers. Both will give you a luminous look but the Durathin system is no-prep and doesn’t require any tooth structure to be taken away. It’s simpler and non-invasive. Done right, veneers look completely natural, reflect the light and strengthen the teeth. We only use the Durathin no-prep veneers crafted by ceramic artists.

What if I learn (after an evaluation) that I’m not a candidate for veneers?

No worries, we can do porcelain crowns, these will look as beautiful and natural, but as they are a more profound restoration we need to take away more tooth structure. Just know that you will not compromise any of the beauty by going with a crown instead of a veneer.

I’ve heard about composite bonding, what is this?

Yes!! This is where we apply one or more composite materials directly to your teeth then paint (much like an artist) to achieve the ideal blend of color and luminosity. I trained with Newton Fahl Dmd currently the world’s foremost expert in this exciting technique.

 Is it true that I can consider cosmetic dentistry instead of orthodontics to straighten my teeth?

Absolutely! We call it instant orthodontics and if you’re the right candidate we consider porcelain veneers or crowns. Many of my patients have gone this route.

Does it really matter what dental laboratory you use?

Yes Absolutely!! I hand picked my lab given their expertise, training and quality of their work. As I am meticulous in my work I expect the same from my lab, the restorations they make for you must not only look gorgeous but they must be an ideal fit for your bite. Anything I place in your mouth should feel like it’s part of you and completely harmonious with your bite.

I hear about ceramic artists, what do they do?

A ceramic artist is a highly trained laboratory technician who takes their skill to level of artist. The ceramic artist takes more time in planning, design and uses only the best materials to create gorgeous dental restorations. I only work with ceramic artists.

*Before considering cosmetic dentistry please see David for an evaluation, together you can decide what’s best for you.

Why is this so exciting? Before, in all of our veneer cases David had to take away tooth structure in order to get the proper fit and luminescent quality that is vital for a beautiful, natural result. Although patients never complained it has always bothered him to cut healthy teeth. With the DURAthin veneers he can place the veneers directly on your teeth non-invasively. And as your natural teeth are still in tact the veneers can be removed (although this never happens).

 The key to success is the partnership with the ceramic artisans who design and create these ultra thin veneers that emulate natural teeth. They have to be just the perfect degree of thickness to have strength and reflect light that gives that natural (only better) quality. For the right candidate these are a fabulous option for a smile make-over.

Our understanding of the disease has increased greatly over the last few years. We now know that it is a bacterial infection of the pockets around the teeth. Frequent deep cleaning/scaling keeps tissues clean of plaque/tarter etc but we can take this one step further by eliminating the bacteria by 99% for six weeks with the laser. We’re recommending this treatment to most of our patients prior to their cleaning appointment to;

a) Reduce or eliminate bacteriamias-during the normal cleaning process most patients will have some areas that may bleed which allows bacteria in the mouth to enter the bloodstream. Having this treatment prior to your hygiene appointment eliminates the need to pre-medicate and oral pathogens that may be damaging to your health 

b) Prevent cross contamination- eliminates the issues of an infection in one area of the mouth spreading to another.

c) Kill bacteria in pockets around the teeth- stops infections before they cause physical destruction of loss of attachment around the teeth.

This is one of the most exciting preventive measures we’ve ever seen.

1. Healthier gums-By passing the laser around the gum tissue of each tooth we can eliminate 99% of the bacteria (less bacteria means fewer problems short and long term), best of all your bacteria levels will stay this way for six weeks. And it’s quick, our hygienist can treat your mouth in ten minutes (all you feel is a slight warmth). We recommend this to all patients with periodontal issues.

2. Tooth sensitivity, a pass of this painless laser takes away tooth sensitivity.

3. Replaces some surgical procedures- if gum tissue needs to reduced (for aesthetics or to restore the tooth properly), the laser is ideal. It’s quick, easy, very effective and means less chair time for you.

4.  If you suffer from cold sores caused by herpes simplex one a quick pass of the laser on the area will create instant healing and can stop the virus completely in the initial stage. As I’ve had this simplex since childhood I find this very exciting!

Welcome to the new millennium in dentistry.

 Bruxing can be a stress behavior or due to an imbalance in your bite or completely involuntary (you may do this in your sleep which I why you wake up with a headache). This is shocking news to most of my patients yet I can tell easily, by looking at your facial muscles (think of it like body building), work a muscle and it builds, and by wear patterns on your teeth. These are developments I look for in all initial exams in addition to the secondary signs of bruxing such as TMJ pain, cracked or sore teeth and gum recession.

 If this is you, there are several things we can do to get you comfortable. If you brux in your sleep (thus can’t control the behavior) then I will make you a custom fit bite splint/mandibular orthotic to wear when you sleep. This way if you brux you won’t hype-activate the muscles because your bite splint allows your jaw to go back to its resting position and move freely without interlocking (unlike 99.9% of the nightguards made). If you brux due to an imbalance in your bite (many do as it’s the body’s way of equalizing your bite), I will balance your bite by equilibrating, bringing your bite back into harmony. As life is busy enough (no room for downtime), properly diagnosing and treating your headaches is life changing!

Just as important to the clinical expertise I gained is the philosophy of L.D. Pankey (founder), showing me the joy in practice. L. D. was a bit of a philosopher, enjoyed connecting with his patients (not just their dental issues). He found the doctor/patient relationship is more vital by  opening his ears  and really listening. He practiced empathetically, supportive of every patient but empowering them to make their own decisions following his clinical recommendations. Inspired by his philosophy I always reach for excellence, have pride and joy in my work and enjoy the rapport I have with every patient (as we partners in your health). I will design an optimal health plan to keep you looking and feeling great but following my recommendations next steps are up to you.

Now 21 years as a Pankey dentist I’m happy to commit to weeks of hands-on advanced training outside the office  (sometimes out of the country), next stop is Brazil to work with Newton Fhal (leading expert in cosmetic bonding). I’ve taken one of his hands-on courses when he was teaching in California and now I would like to continue my training at his  facility an hour outside Rio. 

 I practice according to three credos in accord with the Pankey philosophy;

“A restorative dentist must have and cultivate the creative mind of an artist and accuracy of an engineer”

“knowing your work is number one then comes treating people right and being honest with them”.

” It’s the moral obligation of the dentist to bring his ability up as close to his capability as possible in accord with his talent”

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