New but old news at Elevated Dental

Much like the technology world, Dentistry is constantly changing and improving.  One of the newest advancements is actually old news to the rest of the world.  In October 2016, the FDA cleared the use of a product called Silver Diamine Fluoride (SDF) for use in the United States.  Why is this old news to the rest of the world?  Well because they have been using it for a hundred years.  We are excited to discover its benefits here in Telluride!


So what is this new but old product?  Silver Diamine Fluoride is exactly what its name implies, a mixture of Silver ions with a high concentration of Fluoride.   The FDA has cleared this product to decrease tooth sensitivity, but what really makes this product exciting for us, is it’s off label use, to prevent and arrest cavities!  Which means it can stop a cavity in its tracks!!  The silver acts as an antimicrobial agent and the Fluoride hardens the softened parts of the tooth caused by the bacteria.  

SDF can be applied to both children and adults to help control the spread of cavities.  However with most things in life, this isn’t a magic bullet and has some downsides.  The biggest is that it stains any part of the tooth that is a cavity a black/brown color.   In addition, if a patient can move forward to restore a tooth traditionally with a filling, that is still the best treatment.  So who is SDF for?  Mainly uncooperative children, patients who may not be able to afford to have all their needed treatment done at once, elderly patients who have difficulty to access to care, or patients who have a high cavity risk and are trying to prevent further spread of cavities.  

SDF is easy to apply and usually takes less than five minutes.   To prevent any temporary staining, we apply a small amount of Vaseline to the lips and cheek.  Then we isolate the area where SDF will be applied.  Once the area is dry, SDF is applied in small drops to the desired area and allowed to sit for 1-3 minutes, then rinsed off.  A white restoration may be applied to cover back staining if the area is visible.  This restoration usually can be applied without the use of drilling or anesthetic.  A second application 2-4 weeks later can increase the successful stop or prevention of the cavity.   SDF is relatively cheap compared to other dental treatments and is covered by many insurances. 

The Elevated Dental team is excited about this product as we discover uses that can apply to our individual patients.  A great example is a small cavity starting under a crown, which can prevent full replacement of that crown.  Another exciting use is to strengthen, desensitize and stop root surface cavities.   We have also had the opportunity to apply it to some children who are too young or not cooperative with having a tooth drilled on.  By stopping the cavity now, we can buy some time to allow the child to age and become more cooperative.  My son being one of them!  We are watching these cases closely for success.  

Feel free to ask us about this product and if it may benefit you!

Do I really need a crown?

Why Do I need a crown?


Help Dr Buttars just said I need a crown on my tooth! Is this necessary? Do I really need this or is Dr Buttars Just trying to finance his new pair of skis?

Since crowns are one of the more common restorations that people need on their teeth, most dentist are regularly asked the question, “Do I really need a crown.” It is a completely fair question because even with insurance, crowns may cost you hundreds of dollars.

The reason they are recommended so frequently is that a dental crown is often the best option to extend the life of a tooth for years to come.

 The reason dentists would recommend a crown is multifactorial. 

1.     Protecting the tooth. 

a.     The main reasons for a dental crown are to protect the integrity of compromised tooth/teeth. 

b.     Crowns are recommended when there is less than 50% of tooth structure missing.  Missing tooth structure can be either in the form of decay and/or filling material.

2.     Chips and Cracks.

a.     Crowns are recommended when there are cracks or chips within the tooth structure.  Cracks and chips are not always visible externally and may also exist internally.

3.     Root Canals

a.     After a tooth has had a root canal, it usually becomes more brittle and is at a higher risk or breakage (mostly back teeth as there are a lot of biting forces on our back teeth).

4.     Cosmetics.

a.     For some a crown is recommended because the appearance, shape, color or spacing does not meet the patient’s expectations.  A crown can overcome the above concerns and restore a beautiful, long lasting restoration

But Dr Buttars can it wait?

So what really are the implications of waiting?

1.     Nothing will happen.

2.     The tooth could chip- simple repair. Or it could crack and would need a crown.

3.     In rare cases waiting could cause a root canal to be needed.

4.     The tooth could split, which could require additional surgery or even extraction.

The truth is your tooth can survive for a little while without the crown, but you never know when it might be too late.  If it bothers you, it’s too late. Sadly the number one reason patients get a tooth extracted is when there is a delay in getting a crown.

 So what are my options?

Thanks to modern advancement in dentistry, there are three options for crown restorations.  Unfortunately dentistry has not come up with the perfect material and there are both advantages and disadvantages to each option

1.     All Gold Crown

a.     Gold is the closet material to a perfect dental material.  It’s commonly referred to as “the gold standard” in dentistry.

b.     Gold crowns are super strong at very thin thicknesses and require very little tooth reduction to gain strength

c.     Gold is very close to your natural teeth hardness and thus wears evenly with your adjacent teeth. 

d.     Gold often lasts the longest and produces the tightest seal between tooth and crown.

e.     The main disadvantage to gold is well its gold color.  Thus it mainly indicated for the very back teeth that require extra protection from the heavy biting force, but often can not be seen.

f.      Due to the high price of gold, these crowns are often the most expensive

2.     Porcelain Fused to Metal (PFM)

a.     A PFM crown has a gold interior with a porcelain cover to make it strong, yet still white.

b.     PFM crowns require more tooth reduction in order to accomidate the extra bulk required for both the gold and the porcelain.

c.     PFM have been around for a long time with great results.  However it is more prone to fracture between the metal and porcelain, often resulting in crown replacement. 

3.     All Ceramic Crowns

a.     These are the most advanced crowns around.

b.     Due to the lack of a metal center, they reflect light very similar to the way a natural tooth does.  Making them the most cosmetic and natural looking. 

c.     The main disadvantage is that they need the most aggressive tooth reduction in order to obtain the needed thickness for strength and to prevent breakage.

d.     They are also the hardest to get a near perfect union between tooth and crown and will need replacement sooner than a full gold crown.


At Elevated Dental, we evaluate all options and review them with you before recommending a crown or set of crowns. We consider you our partner in maintaining your dental health and we will take the time to fully explain our treatment plan recommendations to your satisfaction!

I came for the skiing and stayed for the dentistry!

Being new to the Telluride area, I love seeing all of the, "I came for the skiing and stayed for the Library!", bumper stickers.  It gives me a little laugh and a smile!  How silly it is to think an avid skier could actually think the library would become the reason for staying in this fantastic ski town!  If you ask my three boys, however, they would testify just how awesome the library really is!  The library has at least three more converts to their cause!  

As I see the stickers throughout Telluride, it makes me wonder if its possible that our services and dental care could make someone who actually came here for the skiing, stay for the dentistry? Could we be as awesome and provide so many services right here in our small town?  I thing that idea is something to shoot for and would hope we could be just as amazing at providing our service of dental care as the library is at their job. 

Here at Elevated Dental, we strive to provide top level dental care and a range of specialty care to prevent you from having to travel away from Telluride.  We all moved here for a reason:  for the beauty , the activities, the adventure, and ,yes, possibly even the library.  Why then leave every time you have a dental care need? 

I graduated from a one year AEGD, or Advanced Education in General Dentistry, residency as well as a one year Advanced General Dentistry Preceptorship.  Each program exposed me to all dental specialties and many services beyond my dental school training.  I was trained in IV sedation, complicated tooth extraction, cosmetic dentistry, implant dentistry, difficult root canal therapy and crown and bridge work just to name a few.  In each program, I worked side by side with experienced specialists in each dental specialty. Although it was not easy, this training provided me with experience and training way beyond what was discussed or even possible in dental school.  Each instructor guided me through diagnosis and treatment of  complex cases and procedures.  They Informed me of each mistake, corrected me, instucted me, and gave me tips and ways to improve.  This one on one attention and guidance is just not provided in dental school!  I value these opportunities as some of the best experiences of my life!  I came to understand dental care on a much deeper level.

With my background and attention to patients' needs and desires, I hope that when you leave our office you think, "wow, I actually do want to stay because of the dentistry!"

Dr Trent Buttars, DMD