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Home Services Our Approach Our Team Contact Us Preventive Dentistry  |  Whitening  |  Veneers  |  Crowns  |  Cracked Teeth  |  Implants  |  White Fillings  |  Gum Disease Science-Based Care The science of dentistry has advanced dramatically over the last decade. High speed tooth preparation, painless and very effective anesthetic techniques, tooth colored materials that match natural teeth, and superb preventive products, have all combined to make dentistry faster, easier and better. But how does a good dentist decide which products and procedures to offer? It starts and ends with a deep interest in the science of dentistry - the scientific method, critical reading of peer-reviewed journals, hours of continuing education and attendance at specialty workshops. It requires ignoring the ads and product salesmen. It requires study, and a skeptical scientific approach. Dr. Loshin will gladly explain the rationale behind any recommended treatment in non-technical language that you can understand. If something is controversial, such as the use of mercury or fluoride, he will explain both the known science and the controversy. He will never pressure you to buy elective cosmetic procedures or recommend any inappropriate or unproven treatments. » back to top Preventive Dentistry In the practice of Medicine there are hundreds of diseases and conditions afflicting people, which compete for the attention of doctors and researchers, who seek to treat, and occasionally prevent, these maladies of mankind. In the field of Dentistry we are very lucky to have only two primary disease entities, which account for almost all of dental disease. These are CAVITIES and GUM DISEASE. And these two diseases are PREVENTABLE! A large body of knowledge exists and revolutionary changes have occurred in our understanding of cavities and gum disease. With this knowledge, Preventive Dentistry can go far beyond simple "brushing and flossing." Dentists and hygienists rarely get cavities or gum disease. What do they know and do, that you do not? Which is the best toothbrush to use? When is the best time to brush? Electric vs. manual? What is the benefit of brushing in the shower? What is the downside to some "whitening" toothpastes? Which toothpaste is best? What is a simple technique to increase 20-fold the effectiveness of the fluoride when you brush? Are mouthrinses a waste of time? How can dental sealants benefit adults? What are "rechargeable" fluoride emitting fillings and how do they "turn off" the decay process? At Lasting Impressions Dentistry, we will tell you the answers to all these questions and more. Then we will tell you what we personally do to prevent dental disease. We want you to have every tip and trick available to keep your smile healthy for a lifetime. » back to top Whitening For over 20 years Dr. Loshin has offered teeth whitening to patients seeking a "brighter" smile. Whitening has become easier, quicker and a better value as methods improved and costs came down from "thousands" to "hundreds" of dollars. Although whitening may be new to you, we are very experienced with this at Lasting Impressions Dentistry. We have all the major techniques available, so that we can help you choose the best method for your particular teeth and budget. Laser Whitening Laser whitening is most appropriate for people "in a hurry" due to an upcoming event (like a wedding) or people who cannot tolerate wearing a bleaching tray to sleep, or those who simply "don't want to mess" with anything at home. Laser whitening is done in the dental office. The teeth to be bleached are isolated. Special gels are applied and "activated" by light energy. The experience resembles going to the "sunbooth" for your teeth. Although results vary, most people will attain several shades of lightening in a single treatment of about an hour. Take-home Tray Whitening During a 20 minute appointment, impressions (same as for braces) are taken. In our on-site lab, these impressions are used to make a personalized set of soft, pliable, clear plastic trays that precisely fit only your teeth and hold the bleaching gel in the right places. For 2-4 weeks you apply the gel in the trays and wear them to bed at night. This method is comfortable and easy to use. The trays are thin and soft and fit well. The material tastes good and stays in contact with the teeth for many hours. This LONG CONTACT TIME is the key to success! It enables the use of a material that causes almost no sensitivity and yet is very effective. Because whitening occurs over several days or weeks, it is easy to monitor and control the result. You can decide which teeth may need a little more whitening and then just bleach those teeth for a couple nights. You can stop and restart the process if necessary. You decide on the endpoint. There is no harm in bleaching longer than two weeks if you desire. Over-the-counter products There is a large variety of ill-fitting, self-fitting trays, swabs, gels and strips - These all suffer from the same pitfalls. They are messy and uncomfortable. They stimulate saliva overdrive. And they cannot be worn while sleeping, so the contact time with the teeth is insufficient. Some are effective, but harsh on the gum tissue. Others are mild, but ineffectual. Most of our whitening patients have tried over-the-counter products first and then turned to us for an effective, safe alternative. » back to top Veneers Dental veneers (sometimes called porcelain veneers or dental porcelain laminates) are wafer-thin, custom-made shells of semi translucent tooth-colored porcelain designed to cover the front surface of teeth. These shells are bonded to the front of the teeth changing their color, shape, size or length and resulting in an improved appearance. Porcelain veneers first appeared in the 1930's as temporary devices for film actors with bad teeth. In the early 1980's the development of dental microscopic etching and bonding allowed the creation of strongly attached, very life-like veneers that resist staining and can last many years. Dr. Loshin has placed hundreds of veneers since 1984 when he was one of the first dentists in Seattle to do these beautiful, yet technically challenging, restorations. Not all teeth are good candidates for veneers. Veneers are best placed on healthy teeth that can provide adequate support and are fairly well aligned. Some minor alignment problems can be corrected with veneers. This is sometimes called "instant orthodontics." Other likely candidates are teeth with gaps or spaces, dark colors or bad stains, chips or cracks. The procedure is done in two appointments. On the first, a small amount of surface enamel ( 1/50 inch) is buffed away, shaping each tooth which will receive a veneer. An impression of the teeth is made for use by our onsite dental laboratory where the veneer is fabricated. Digital photographs and computerized shade matching are used to achieve the best possible cosmetic result. We are unlike most dental offices that "send out" this laboratory work. Instead we have a state-of-the-art ceramic lab onsite, with a full-time dental ceramist who will personally work with you to correctly color your new teeth. On the second appointment the veneers are gently placed on the teeth for your approval. When (and only when) you, Dr. Loshin, and our ceramist, all agree that our veneers are fitting well, and properly colored, will we proceed to attach them to your teeth. This is a comfortable process wherein several liquids and gels are applied to your teeth, the veneers pressed on and cured by shining a laser-like curing light on the teeth. Veneers require no special upkeep beyond regular good preventive dental hygiene with toothbrushing and flossing. » back to top Crowns What are dental crowns and why are they so useful? A crown is a restoration that covers, or caps, a tooth, replacing the enamel layer, and creating an ideal size, shape and color. It strengthens the tooth so that it may function comfortably for many more years. Crowns are placed for a number of reasons: To rebuild a tooth when decay, old leaking fillings, or fractured parts have destroyed over 50% of the natural tooth structure. To protect weak teeth from fracture To restore cracked teeth To reduce hot, cold or chewing sensitivity To attach a bridge To cover badly shaped or discolored teeth When these problems occur, a well-constructed crown is the best, long-term remedy. There are three broad categories of crowns: 1. Metallic crowns, usually gold, are used mainly on the rearmost teeth where strength is very important. 2. Porcelain-Bonded-to-Metal crowns are used throughout the mouth where strength and cosmetics are equally important. 3. All-Ceramic crowns are for those teeth that show when you smile, where cosmetic appearance is of the utmost importance. Dr. Loshin's crowns involve a "system" of materials and techniques that all work together to provide a superior result. Old fillings or decay are replaced with a fluoride emitting foundation material. This material cross-links chemically with the special cement used to adhere the crown. In this way, a long-term decay-preventive feature is built into every crown, enhancing the likelihood of trouble-free service for many years. This attention to special preventive dentistry techniques is a hallmark of Dr. Loshin's practice. The experience of having a tooth prepared for a crown should be no more difficult than having routine fillings placed. Many patients watch a movie, TV or listen to music during the procedure. Digital photographs and computerized shade matching are used to achieve the best possible cosmetic result. We are unlike most dental offices that "send out" this laboratory work. Instead we have a state-of-the-art ceramic lab onsite, with a full-time dental ceramist on call to personally work with you to correctly color your new teeth. On the second appointment the crown is gently placed on the tooth for your approval. When (and only when) you, Dr. Loshin, and our ceramist, all agree that the new crown is fitting well, and properly colored, will we proceed to cement it to your tooth. Crowns require no special upkeep beyond regular good preventive dental hygiene with toothbrushing and flossing. In the photo to your left the broken tooth #6, plus teeth #7 and #8 were recently restored with cosmetic porcelain/metal crowns. Teeth #4 and #5 have old style crowns and are over 20 years old. They are less attractive than current state-of-the-art restorations. » back to top Cracked Teeth Fractured teeth are a very common dental problem. Cracks in teeth may occur for a variety of reasons such as trauma, teeth grinding (bruxism) or brittleness after root canal treatment. But, by far the most common cause for a cracked tooth is the expansion of an old silver filling in a tooth. Silver amalgam expands with age and like ice expanding in the sidewalk, causes the surrounding tooth to crack. Cracks may show up as fine fracture lines in the tooth enamel emanating from the edges of the old silver filling. They are generally not visible on x-rays. Sometimes they are not visible at all to the naked eye making the diagnosis of a "cracked tooth" dependent on the patient’s description of symptoms. Typical symptoms include sensitivity to cold or sometimes hot foods, sporadic pain when chewing that seems to come and go, or pain when direct pressure is applied. The treatment for a cracked tooth is removal of the old silver filling and construction of a crown ("cap") for the tooth. Although the crack or cracks may still remain in the tooth, the crown provides a rigid exterior shell which dissipates the chewing forces and eliminates the pain. The effect is like putting a picture frame around a puzzle. Pushing on the edge of the picture frame does not disturb the puzzle pieces inside. Sometimes the cracks propagate to the area between the roots of multi-rooted teeth. If this occurs pain will increase and the tooth must be removed. A crown will not relieve the pain. For this reason it is very important to treat cracked teeth before the fracture migrates and splits the tooth in half. » back to top Implants Dental implants are specially made posts that replace the roots of teeth that are missing. They are used to support a new crown, fixed bridge or denture. Implants are made of titanium, a strong precious metal, which has a long history of safe use in the body. When a tooth is lost, the conventional methods of replacement do not really "replace" the tooth, but rather "bridge" or "cover up" the gap with an artificial tooth that connects or rests upon the adjacent teeth. When this is done with a cemented bridge, it requires filing down the adjacent teeth for crowns, which connect to a false tooth crown. When this is done with a removable bridge or "partial plate," metal clasps grab the adjacent teeth for retention and support. In both cases, the teeth adjacent to the missing tooth are negatively affected. In contrast, with an implant-supported crown, there are no affects at all on the neighboring teeth. The "implant tooth" can be brushed and flossed normally and functions just like a real tooth. Though bridges and dentures have served us reasonably well for years, implants provide better support and usually result in more comfortable and stable replacement teeth. At Lasting Impressions Dentistry, our procedure to place implants and restore them properly for the best appearance and function, involves a team approach. We work closely with two of the top implant surgeons in the Seattle area. The initial preparation in our office includes x-rays, diagnosis, plaster modeling, digital photography and sometimes fabrication of a plastic surgical guide. The surgeon then places the implant in an office procedure that takes about an hour. We both monitor each patient post-operatively and during the healing process. Over the next 4-6 months bone grows into the implant, "integrating" it strongly into the jaw. Then the implant is "uncovered" and additional titanium parts are placed into the hollow center of the implant, which sticks through the gum like a real tooth. This becomes the foundation for a new tooth crown. From that point the process is like having a crown made on a real root. The experience should be no more difficult than having routine fillings placed. Many patients watch a movie, TV or listen to music during the procedure. Digital photographs and computerized shade matching may be used to achieve the best possible cosmetic result. We are unlike most dental offices that "send out" this laboratory work. Instead, we have a state-of-the-art implant lab onsite, with a full-time dental ceramist on call to personally work with you to correctly color your new teeth. On the second appointment the crown is gently placed on the implant for your approval. When (and only when) you, Dr. Loshin, and our ceramist, all agree that the new crown is fitting well, and properly colored, will we proceed to cement it to the implant. Implant crowns require no special upkeep beyond regular good preventive dental hygiene with tooth brushing and flossing. Implants are no longer a new or novel procedure in dentistry. In fact some have been monitored now for about 30 years. Using the latest technology and state-of-the-art materials we enjoy a success rate of 90% - 95%. » back to top White Fillings "I like the way the color matches my own teeth. When my five-year-old asked, 'Mommy, why are your teeth all black?', I knew it was time to replace my old silver amalgams." – Amy B. Dental amalgam, a metal alloy comprised of silver and mercury, was used to restore teeth 100 years ago! It has many problems such as its tendency to change shape with age, causing the tooth or filling to crack. It has a silver color that tarnishes, causing unsightly teeth that appear black in color. And finally, it does contain mercury, which many people would like to avoid. White porcelain fillings, also known as resin-bonded ceramic, are the modern day replacement for silver/mercury amalgam. For years dental materials scientists searched for an alternative to amalgam that is strong, white in color, long lasting and can adhere chemically to the natural tooth. We now have such a material! White Porcelain Filling consists of porcelain particles suspended in a plastic resin. It is as hard and strong as silver amalgam. And it is white! Formulations are now strong enough to use on "back" teeth. White fillings for "front" teeth have been successfully used for over 30 years. Dr. Loshin only uses the newest generation of white filling material that incorporates fluoride mineral for an added preventive benefit. Since white fillings are harder for the dentist to see, Dr. Loshin always uses high power magnification and a plasma arc laser when placing these beautiful, but technically more complex restorations. Advantages of white fillings- Bonds to tooth Strengthens tooth for long term stability White color matches tooth Less drilling needed due to bonding More conservative No mercury Modest additional cost » back to top Gum Disease Gum disease, known medically as periodontal disease is second only to the common cold on the list of most prevalent human ailments. At some point in life about 9 out of 10 people will be affected by it. Gum disease is the major cause of tooth loss in adults. The good news is that periodontal disease is mostly preventable, and easily treatable in the early stages. Unfortunately, the early signs are painless and often go unnoticed. As part of our complete care services, we always check for any signs of gum disease. Signs of Gum Disease: Gums that bleed when you brush or floss Red, swollen or tender gums Gums that have pulled away from your teeth Pus that appears between teeth and gums Teeth becoming loose or moving Sudden changes in the way the teeth come together Consistent bad breath Our treatment for gum disease emphasizes a non-surgical approach, and always starts with simple removal of the causative agents, plaque and tartar. This may take several appointments with our dental hygienist. Most of the time, that is all that is needed. The patient in the photo was first seen and treated in 1985. Even though her periodontal disease was severe, she was brought to a state of good health in about 6 months. She did loose some teeth, which were restored with crowns and bridges. In the 20 years since, she has maintained good dental health, and not spent any additional money on teeth problems. She has had preventive check-ups, fluoride, and teeth cleaning every 3-4 months for 20 years. » back to top