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Bleaching (Dental Esthetics)

Teeth gradually darken because they absorb colour from food and beverages. Some medications, such as the tetracycline family of antibiotics, can also darken teeth. Also, teeth that have been injured by an impact can become dark.


How Can Teeth Be Whitened?

Peroxide, or materials that release peroxides, can remove some of the colour that builds up within tooth structure. They come in various strengths. These gels are used in thin plastic trays that your dentist custom makes for your teeth. Alternatively, over-the-counter whitening systems are available from pharmacies.


Custom tray whitening systems

Your dentist can make very thin comfortable custom whitening trays from impressions. These are designed to hold the gel on the parts of the teeth that require whitening and keep the gel away from the gum tissue. This approach can be used to control how much you whiten each individual tooth so that they will all be an even colour when finished.


Over-The-Counter Whitening Systems

These systems use pre-loaded universal size strips or trays to deliver the whitening gel. They cannot control the degree of whitening of individual teeth, so unless your teeth are a very even shade, these systems may not be suitable. They are also bulkier to wear. They are usually less expensive than the custom tray approach.


What about "Laser Zoom Whitening"?

“Laser Zoom Whitening” uses a strong concentration bleach material applied to the teeth in the dental office. A blue light is shone on the teeth, supposedly to increase the whitening power. Many studies have confirmed that the light actually makes no long term difference, but it looks fancy. Because of the short whitening contact times with this method, only slight true whitening is achieved. Much of the apparent whitening is just due to drying out the teeth. The stained colour reappears when the teeth rehydrate. Offices that use this approach tend to include a custom tray whitening kit (described above) which does most of the long-term whitening. We do not use this approach because of the sensitivity it induces and its limited effectiveness.


Does It Make Teeth Sensitive?

Yes. Whitening can induce sensitivity to hot and cold, especially in younger patients. This usually resolves shortly after finishing treatment. Choosing an appropriate whitening agent and use of desensitizing gels should minimize sensitivity



Are Dental Whitening Agents Safe?

These materials have been used for more than 40 years. They have a very good safety record when used appropriately.


How Well Does Whitening Work?

It always removes some colour, but the amount varies depending on the type and amount of tooth discolouration. Generally, the darker the teeth your teeth are the more noticeable the result.


Can I Over-Whiten?

Yes. A fresher more youthful result is pleasing, but too much whitening can look unnatural. And some teeth become too translucent when over-whitened. This makes them look darker, as the dark colours from inside the mouth show through.


Veneers

Veneers are tooth coloured covers that can be used to improve the shape and colour of front teeth.


Porcelain Veneers

Porcelain veneers are the more durable and colour-stable form of veneers. The teeth are sometimes re-shaped slightly and an impression is made. Temporary plastic veneers may be needed until the following appointment, when the porcelain veneers are ready to be bonded. If you are engaged in contact sports, a mouth guard may be advised to lessen the likelihood of fracture.


Direct Composite Veneers

Direct composite veneers are made directly on the teeth with tooth coloured plastic. They can be very attractive, but are not as strong or colour-stable as porcelain veneers. However, if they do fracture, they are simpler to repair than porcelain veneers

Cavities (Caries)

What Are Cavities?

Cavities are holes in teeth made by bacteria. Cavity risk varies widely amongst different people. Some may be prone to cavities while others are naturally resistant. Our cavity rate can increase with age due to decreased saliva production. Cavity risk is lower with excellent oral home care (brushing and flossing), a low sugar diet, and drinking fluorinated tap water.


How Do They Occur?

Much of the plaque layer that grows on the teeth is composed of cavity-causing bacteria. When these bacteria come into contact with sugars or starch, they produce acid, which eats a hole into the tooth. If this cavity gets deep enough it will cause pain. A deep enough cavity may reach the nerve, causing increased pain and potential infection.


How Are Cavities Repaired?

Cavities are repaired by cleaning out the softened infected tooth structure and replacing it with a filling material. A deep enough cavity may reach the nerve, requiring more expensive treatments such as a root canal treatment and crown. If a cavity becomes too large, the tooth may need to be removed.


How Are Cavities Prevented?

Preventing cavities involves effective daily removal of plaque bacteria through flossing, brushing, and minimizing sugar intake. Fluoride reduces the number of cavities by making the enamel more acid resistant.


What Materials Are Used To Treat Cavities?

Cavities are repaired with a number of different materials; sometimes one of these materials the most practical. In other cases there may be several suitable materials. These materials are described below.


What Is Composite Resin?

Composite resin is a tooth coloured plastic, reinforced with ceramic particles. It is moderately strong and natural looking. It does not resist fractures or further cavities as well as some other materials.


What Is Glass Ionomer Restorative?

Glass ionomer is a tooth coloured material that is better at preventing recurrent cavities than composite. However, it’s weaker and does not suit all types of cavities.


What Are Inlays?

Inlays and onlays are fillings that are made outside the mouth. They are very strong and durable. They can be made of porcelain (which matches the tooth colour beautifully) or gold. They are more expensive and may take two appointments to place.


What Is Silver Amalgam?

Silver amalgam is an alloy of silver and mercury with traces of other metals. It has been used in dentistry for more than 165 years. It is durable and inexpensive. It resists cavities much better than composite resin. However, it has an unnatural silver grey appearance, and does not reinforce teeth as well as some other materials. It has been studied extensively and found to be very safe.


What Are Sealants?

Sealants are a simple, inexpensive, and perfectly comfortable way to prevent cavities in the deep grooves on the biting surfaces of permanent (6 year and 12 year) molars. These thin acrylic coatings seal the deep grooves, keeping bacteria out. Without sealants many permanent teeth will develop cavities and need fillings.

Dental Examination

Why?

The dental examination gives the dentist the information needed to understand how to help you keep your teeth comfortable, healthy, and attractive. It is needed to determine what (if any) treatment is needed and how to prevent dental problems in the future. There are several different kinds of dental exams.


The New Patient Exam

When you first arrive at a dental office as a new patient, the dentist knows nothing about your dental health. The new patient exam is a very detailed exam of the whole mouth, including the teeth, jaw and soft tissues (gum, cheeks, tongue etc.). As the dentist cannot see between the back teeth, or under the fillings, X-rays are often needed to check these most cavity prone areas. This thorough exam takes into account your medical and past dental history and allows you to express your concerns about your dental health. It provides the information needed to know what treatments might be needed and how to prevent future dental problems.


Recall Exam

The recall exam is the periodic follow up exam to check for dental problems. Although the same factors are examined as in the new patient exam, the recall exam is much shorter, as we already know a lot about your dental health. It is recommended at intervals of 6 months, 9 months or annually depending on your individual dental status.


Emergency Exam

An emergency exam is for assessing an unexpected specific dental problem. It can vary from a short simple exam to a highly detailed one, depending on the nature of the emergency.


Oral Diagnosis Exam

The oral diagnosis exam is a very detailed checkup that is done periodically if there have been significant dental changes that need to be addressed. It is very similar to the new patient exam.


Specific Exam

For certain conditions and treatments (such as the treatment of periodontal disease), we may need to follow up to determine whether the treatment has been successful, and whether further care is still needed. A specific exam is used to assess this.

Fluoride

Fluoride is one of the greatest modern advances in public health. It has vastly reduced the risk of cavities, preventing untold pain and damage to teeth.


The Fluoride Story

In the early 1900s, dentists in Colorado and in Italy noted that certain communities had much lower cavity rates than others. It was found that the water supply of these low cavity areas contained fluoride, a natural mineral. If fluoride was present in too high concentrations, teeth could develop brown stains. In concentrations below 1ppm there were almost no staining problems and cavities were still vastly reduced.


Custom Fluoride Trays

For people with very high cavity rates, thin plastic covers (called custom fluoride trays) can be made for daily home fluoride treatments. When brushing with fluoride toothpaste the fluoride gets diluted in the mouth. Fluoride trays are more effective than simply brushing with fluoride as the fluoride gel is held against the teeth at full strength for 4 minutes

Fillings, Crowns and Onlays (Restorative Dentistry)

What Are Crowns?

Crowns are porcelain or metal covers that surround a tooth. They are used to hold weak teeth together, to prevent fracture (which can lead to tooth loss). Porcelain crowns can also be used to improve the colour and shape of teeth. It usually takes two appointments to place a crown. In the first stage the weak tooth is reshaped to make room for a crown. An impression is made and a temporary plastic crown placed. At the second appointment the temporary crown is removed and the final crown bonded in place.


What Are Onlays?

Onlays are similar to crowns but smaller and cover only a part of the tooth. They can be made of porcelain (which matches the tooth beautifully) or gold.


Fillings

Fillings (dental restorations) are used to repair tooth damage caused by cavities, fractures and erosion. There are a number of materials that can be used, depending on the size & location of the cavity, and on the individual’s cavity susceptibility.


Composite Resin

Composite Resin is an acrylic material that is reinforced with ceramic. It is tooth coloured, and moderately durable. It can partially reinforce weak teeth, but it may not resist cavities as well as some other dental materials.


Glass Ionomer

Glass Ionomer is a tooth coloured material that resists cavities well, but is weak, and does not resist wear well, so it can only be used in certain types of cavities. It can be used in conjunction with composite resin to increase cavity resistance. It reinforces weak teeth slightly.


Silver Amalgam

Silver Amalgam is a metal filling material that has been used for over a century. It is composed of silver (and traces of other metals) dissolved in mercury. This mixture hardens into a stable inter-metallic compound (alloy). It is strong, and resists wear and cavities. But its dark silver-grey colour can be an esthetic problem if it shows in the smile. From a safety perspective, it is probably the most highly researched medical material – and has been shown to be at least as safe as other dental materials (no measurable risks except for a very few individuals who are allergic to it).

Missing Teeth

Should Missing Teeth Be Replaced?

Tooth loss usually results in the other teeth tipping out of position. The remaining teeth have to support increased chewing forces, which can lead to more wear and fractures on the remaining teeth. Loss of too many teeth ('loss of support') can affect the appearance of the whole face - the lower face height decreases making the face look old.


How Can They Be Replaced?

Teeth can be replaced with implants, bridges, or removable partial dentures.


What Are Implants?

A titanium root shaped implant is placed at or after the time of tooth loss. The implant is restored several months later with an abutment (a part which raises the implant above the gum line) and crown. In some cases, bone grafting is needed. For certain cases a cone beam (3D) x-ray may be required to assess the proposed implant site. The cone beam x-ray sometimes indicates that there is insufficient bone to place an implant. Implants are the restorative option most like a new tooth. They have a high (75-95% per implant) success rate. But note that smoking, local infection and active gum disease all increase the risk of implant failure. Implants have the advantage of not altering or depending on the other teeth.


What Are Bridges?

A conventional fixed bridge is made by reshaping the adjacent teeth into crowns which hold the "pontic" (false tooth). This requires the adjacent teeth to be reduced to allow placing of the crowns. This can be an advantage if the adjacent teeth are weakened with large fillings or need reshaping for cosmetic reasons. However, this is a disadvantage if the adjacent teeth are intact. Cavities under the bridge are sometimes not restorable and may result in loss of the bridge. For people with a low cavity rate and with appropriate home care they can last a long time and may be an excellent restorative choice.


What Are Resin Bonded Bridges?

A resin bonded (or "Maryland") bridge is a more conservative form of bridge. A pontic is suspended by a thin layer of metal or porcelain bonded to the inner aspect of the adjacent teeth. This requires much less reshaping of the adjacent teeth. It may be a more suitable choice when the adjacent teeth are not heavily filled. However the success rate is lower (30% debond), and they are not suitable for many situations.


What Are Partial Dentures?

Partial dentures are removable dentures that clip to the remaining teeth. They can replace one or many teeth. While they can look fairly natural, they are bulky to the tongue and can move while eating. Food can get caught under partials. They do not actually add support; the bite forces are passed to the other teeth and gum tissue. They do fill spaces and prevent the remaining teeth from tipping out of position. They can be made from plastic or metal.

Orthodontics

Why?

Some of us develop lovely straight smiles naturally, but others have smiles that are not ideal. Teeth that are excessively crowded or spaced, tipped, or rotated detract from our appearance. A deep overbite or open bite or a midline that is shifted to one side can affect the smile. These conditions can lead to increased risk of cavities & gum disease. Virtually all these anomalies can be improved with orthodontic treatment.


Invisalign

The Invisalign system uses a series of thin clear plastic trays that snugly fit the teeth to gradually move the teeth to a more ideal position. The trays are virtually invisible on the teeth. Many (but not all) cases can be managed with this comfortable approach.


Fixed Braces

For more complex cases that can't be treated with the Invisalign approach, fixed braces may be needed. Braces are smaller and more comfortable than in the past, and some systems use clear (tooth coloured) brackets.


Who & When?

In children, orthodontic anomalies are identified by the family dentist during routine checkups. Some malocclusions are advised to be treated early, while others can be left to about age 12. Adults of all ages can be treated and given the smile they want.

Periodontal (Gum) Disease

What Is Gum Disease?

Periodontal disease is inflammation and destruction of the gum tissue (which holds the teeth) by bacteria. Without appropriate home and professional care, it affects almost all adults. The two major forms of gum disease are Gingivitis and Periodontitis. In these diseases, the pocket (the narrow ditch under the gum line) deepens. This pocket is routinely measured at the dental office to check for gum disease. Bone loss is visible on dental X-rays.


What Does Gum Disease Look Like?

Gum disease may appear as the tendency of the tissue to bleed when brushing or flossing. It is important to note that the bleeding is not usually caused by the brushing or flossing, but by the gum disease. The gum tissue may look swollen and red. But sometimes there are NO visible signs, especially with smokers. The gum tissue may recede, but sometimes the disease is completely hidden under the tissue.


What Is Gingivitis?

Gingivitis, the early stage of gum disease, is inflammation and destruction limited to the soft (gum) tissue. At this stage the underlying supporting bone has not yet been destroyed. It is caused by bacteria growing on the teeth at and under the gum line. Left untreated it usually leads to periodontitis.


What Is Periodontitis?

Periodontitis is the destruction of the bone that holds the teeth by the same layer of bacteria that causes gingivitis. If caught and treated early enough, further bone loss can usually be prevented. But bone that is lost is lost forever. Left untreated it leads to acute infection (abscess) or the loss of teeth.


Are There Any Medical Risks Associated With Periodontal Disease?

People with periodontitis have a higher risk for a number of conditions including stroke, heart disease and diabetes. Periodontitis may also be a risk factor for premature delivery. Whether the gum disease causes these risks, or is co-incident, is not yet known.


Do Medical Conditions Affect Periodontal Disease?

Diabetes increases the probability of having (and the severity of) gum disease.


Does Smoking Affect Periodontal Disease?

Yes, smoking substantially increases the likelihood and the severity of gum disease.


How Do You Treat Periodontal Disease?

Mild periodontal disease is usually treated with professional cleaning (periodontal scaling) and improved home care (brushing, flossing etc.). Moderate gum disease may require surgery. Advanced gum disease may result in loss of teeth.


How Do I Prevent Periodontal Disease?

Careful daily removal of plaque (the bacterial biofilm that grows on teeth), and regular professional periodontal scaling are the core of periodontitis prevention and treatment. The home care techniques and the professional cleaning intervals vary according to the individual's state of dental health.


Recession

Strictly speaking, receding gums are a form of periodontitis. Recession may or may not be accompanied by increased pocket depth. Some individuals have very thin gum tissue ("thin biotype") and are very prone to recession.


How Is Recession Treated?

Adjusting tooth brushing techniques is sufficient for minimal recession. More severe recession can usually be treated by surgically 'grafting' more gingival tissue over the recession areas to increase tissue height and thickness.

Sensitivity

What Is Root Sensitivity?

Root sensitivity is a common condition caused by receding gingiva (gum) exposing the root surface. The thin cover on the outside of the root (cementum) soon wears off. This exposes the sensitive underlying dentin. The exposed dentin has numerous microscopic tubules leading in to the sensitive pulp. Usually, most of these tubules are blocked by debris (the smear layer). But if these tubules are open at the root surface, the root becomes very sensitive to contact, sweets, and cold. Acidic beverages such as pop and juice tend to unblock the dentinal tubules, leading to root sensitivity.


How Is Root Sensitivity Treated?

Mild sensitivity can be helped with desensitizing tooth paste (such as Colgate Sensitive Pro Relief, or Sensodyne). Persistent sensitive surfaces can be coated with a protective layer or a filling. In some cases the best solution is to repair the recession with a gingival (gum) graft.

Snoring & Sleep Apnea

Snoring

Snoring is a noise caused by partial airway obstruction during deeper stages of sleep. The tongue falls against the back wall of the throat and vibrates with the passage of air. Snoring is very common in both male and females, and can even occur in children.


Sleep Apnea

Sleep Apnea is a more serious form of snoring which results in decreased oxygen flow to the brain. It increases the risk of many medical conditions, such as hypertension, heart disease, and liver dysfunction. It can increase the risk of motor vehicle accidents because it causes daytime fatigue. Sleep studies are used to determine whether snoring or apnea is present and measure the severity.


CPAP

CPAP (continuous positive airway pressure) appliances are devices that blow gentle positive pressure air through a mask to open the airway and provide better oxygenation. This device is prescribed and provided by sleep physicians. It is effective in most cases, but some individuals cannot adapt to it.


Dental Oral Appliances

This is an oral appliance that is similar to orthodontic appliances. It holds the lower jaw in a more forward position to prevent the tongue from falling against the back wall of the airway during sleep. They are almost as effective as CPAP in mild and moderate apnea, and may be easier to adapt to. They are prescribed by the sleep physician, and made by the dentist. A detailed dental exam is required first and careful design and construction is needed to avoid moving or loosening teeth.

Treatment Plans

When there are significant dental problems, a treatment plan can be developed. The plan clearly explains the dental condition and the various treatment approaches, together with the advantages and disadvantages of each, and the probable fees for each.

Worn Teeth

Teeth can be healthy and last a lifetime. But for many people, the teeth wear too quickly, requiring involved dental reconstruction. This rapid wear can occur even in teen years. Teeth can wear on the biting surfaces or on the inside of the front teeth.


Why Do Teeth Wear?

Para-function habits (unconscious grinding or clenching, either at night or during the day) can cause the teeth to wear out rapidly. This form of tooth structure loss is called attrition. Acid erosion of tooth structure, from acidic beverages such as pop and juice, also results in tooth structure loss. The combination of para-function (also called bruxism) with acid erosion is especially destructive.


How Is Tooth Wear Treated?

With minimal tooth wear, simply removing the cause of excess tooth wear may be sufficient. This involves becoming aware of and avoiding daytime para-function and using a custom night guard to prevent night-time para-function. If the tooth wear is visibly noticeable, it may require treatment such as composite fillings, onlays, veneers or even crowns. The definitive treatment is determined by analyzing models of the teeth made from impressions (molds). In complex cases, a treatment plan is created to help explain the various treatment approaches.


Night Guards

Night guard appliances are acrylic covers to prevent tooth wear and joint discomfort caused by para-function. Precise models of the teeth are made from impressions and bite records, and an acrylic cover is made for the upper (or sometimes the lower) teeth. This appliance needs to be precisely fabricated to avoid inducing jaw joint problems.


How Is Acid Erosion Treated?

With minimal erosion, if it has not affected the appearance of the teeth, simply removing the cause of erosion may be sufficient. This may mean eliminating external (dietary) or internal (such as reflux) sources of oral acids. More extensive erosion may also require restoring the teeth with composite fillings, onlays, veneers or even crowns. Analyzing models of the teeth made from impressions (molds) is useful in determining the treatment options. A treatment plan can help explain the various treatments.

X-Rays (Dental Radiographs)

Why?

Your dentist cannot see between the back teeth or under dental restorations such as fillings or crowns. These are where almost all cavities occur. X-rays allow us to catch such problems early while the treatment is simple. X-rays are also critical in diagnosing and treating periodontal (gum) disease.


What Are X-Rays?

X-rays are a short wavelength form of light that can see through things that are opaque to visible light. They pass through objects and leave a shadow on a sensor.


How Safe Are X-Rays?

Modern dental x-ray digital sensors are very sensitive, so taking an image requires very little X-ray exposure. For a digital sensor, one dental x-ray (6 microseiverts) is about the same amount of radiation as an average person receives for one day of background exposure - a negligible amount relative to the unavoidable solar and background radiation we all receive every day.

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