Dr Hardeep Bhatta & Dr Allen Friesen
Suite 205 - 1465 Salisbury Ave
Port Coquitlam, BC V3B6J3
A crown is an effective way to save a tooth and restore its form and function. These life-like “caps” that fit over and are permanently attached to teeth have been used for decades with good results.
For this type of restoration to be effective, though, there must be enough of the natural tooth remaining above the gum line for the crown to “grab on to.” This poses a problem if the tooth has broken or decayed too close to the gum tissue.
Fortunately, there is a way to expose more of the remaining tooth for applying a crown. Known as crown lengthening, this surgical procedure is also used for “gummy” smiles, where normal tooth length is obscured by excess gum tissue that makes the teeth appear shorter.
We begin the procedure by first numbing the tooth and gum area with a local anesthetic. We then make tiny incisions inside the gum line on both the tongue and cheek side of the tooth to create a small flap. With this area below the gum line now open to view, we then determine whether we need to remove excess gum tissue or a small amount of bone around the tooth to expose more of the tooth itself. We then position the opened gum tissue against the bone and tooth at the appropriate height to create an aesthetic result.
You shouldn’t experience any discomfort during the procedure, which usually takes about sixty minutes for a single tooth area (which needs to involve at least three teeth for proper blending of the tissues). The pressures and vibrations from equipment, as well as any post-procedure discomfort, are similar to what you would encounter with a tooth filling. After the gum tissue has healed (about six to eight weeks), we are then able to fit and attach a crown onto the extended area.
Crown lengthening a small area may result in an uneven appearance if you’re dealing within the aesthetic zone. One option in this case is to consider undergoing orthodontic treatment first to correct the potential discrepancy that may result from surgery. After orthodontics, we can perform crown lengthening on just the affected tooth and still achieve an even smile.
Crown lengthening is just one of many tools we have to achieve tooth restorations for difficult situations. Using this technique, we can increase your chances of achieving both renewed tooth function and a more beautiful smile.
If you would like more information on crown lengthening, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Saving Broken Teeth.”
What is oral sedation dentistry? If you become frightened and anxious when facing a dental appointment or procedure, sedatives (also called “anxiolytics” meaning they dissolve anxiety), can completely transform the experience. Oral sedatives (taken by mouth) allow you to relax your mind and body so that you feel comfortable while in the dental chair.
How does anxiety affect my pain response? When you are afraid, your pain threshold is reduced. You experience a rush of adrenalin and you tense your muscles. As a result you end up in a state of heightened sensitivity. With sedation this sensitivity to pain vanishes along with your fear and anxiety.
What are some of the oral sedatives that my dentist may use? Most of the medications used in oral sedation dentistry belong to a class of medications called benzodiazepines, tried and tested over decades to be safe and effective. They are used in the treatment of anxiety, insomnia, and agitation. They include Valium®, Halcion®, Ativan®, and Versed®.
I'd just like to forget the experience after it is over. Can oral sedation help? Some of the medications prescribed as oral sedatives have amnesic properties (“a” – without; “mnesia” – memory). This means you will have little memory of the time in the dental chair when your procedure is finished.
What does my dentist need to know in order to prescribe the right oral sedation? We need a thorough medical and dental history, including all medical conditions you may have, and all medications you are taking — both prescription and over-the-counter (including allergies, alternative medications and even herbal supplements). We will also ask you whether you eat certain foods that could interfere with a sedative's effects.
How are the oral sedatives administered? Oral medications are either placed under the tongue (sub-lingual), and allowed to dissolve and then swallowed, or they may be swallowed whole. They are safe, effective, and fast acting. After the sedation takes effect, it will be easier to experience injections of local anesthesia if needed to numb your gums for the dental procedure.
What do I need to do before and after my appointment? Follow all directions we give you about restricting food and drink before your appointment. Until the medication wears off you may not be able to drive, operate heavy machinery or work so be sure to make arrangements to take time off and to have someone drive you to and from the appointment.
Contact us today to schedule an appointment to talk about any fears you may have about dental treatments. Using oral sedation, we can make sure that you have a relaxing experience. Oral sedation allows you to relax both your mind and body, and focus on feeling peaceful rather than anxious. You can learn more about oral sedation dentistry in the Dear Doctor magazine article “Oral Sedation Dentistry.”
Tooth decay (dental caries) is one of the world’s most common infectious diseases. Left untreated, it can lead to tooth loss. The best treatment strategy, of course, is to prevent it from occurring in the first place with a long-term approach that begins in early childhood and continues throughout our lifetime.
Here are some basic components for just such a prevention strategy.
Know your risk. We each don’t share the same level of risk for tooth decay, so it’s important to come to terms with any factors that raise your personal risk for the disease — your dental history, inadequate oral hygiene, absence of fluoride use, and lifestyle habits like smoking. Coming to terms with these and other factors — and altering those you can change — can lower your risk.
Reduce acid-producing bacteria in your mouth. Tooth decay usually arises from elevated acidic levels in the mouth caused by certain strains of oral bacteria. You can reduce these bacteria by removing plaque, a thin film of food particles that collect on tooth surfaces, with daily oral hygiene and regular cleanings in our office. In some cases, we may also recommend antibacterial mouthrinses like chlorhexidine to further lower the bacterial population.
Apply protective measures to teeth. Fluoride, a naturally occurring chemical, has been proven effective in strengthening tooth enamel and reducing tooth decay. In addition to fluoride found in many oral hygiene products and public water systems, children can also benefit from a direct application of fluoride to the enamel surface just after the teeth have erupted in the mouth. Many clinical studies have shown 99% cavity free results in over a thousand teeth receiving a fluoride application with sealants.
Control your diet. Bacteria ferment leftover sugars and other carbohydrates in the mouth; this creates acid, which can soften tooth enamel and lead to decay. You can limit this effect by eating more fresh fruits and vegetables and reducing your consumption of refined sugar. You should also limit between meal snacking — constant snacking prevents saliva, the mouth’s natural acid neutralizer, from effectively restoring the mouth’s pH balance.
A prevention strategy for tooth decay will help you avoid unnecessary pain and problems — physically and financially. You’ll also reap the rewards that come from a lifetime of good dental health.
If you would like more information on preventing tooth decay, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Decay.”
If at all possible, we want to save a tooth — it’s the best outcome for your overall dental health. In many cases, we can achieve this by filling the tooth or installing a crown over it.
Unfortunately, preservation isn’t always possible if the natural tooth has been irreparably weakened by decay or trauma. Replacing the natural tooth with a life-like artificial one is the next best option: the replacement will help you regain lost function and reinvigorate your smile. Filling the missing tooth’s space also prevents neighboring teeth from drifting into it, causing further problems with function and appearance.
Dental implants are widely recognized as the best choice for tooth replacement because of their life-like qualities, durability and positive effect on bone health. Even their biggest drawback, their cost, isn’t that great an issue if you factor in their longevity — they may actually result in less dental expense over the long-term.
A dental implant, however, isn’t always a viable option. Some patients may not have enough bone mass to support an implant. Those with certain systemic diseases like uncontrolled diabetes or a weakened immune system may not be able to undergo dental implant surgery.
Fortunately, many of these patients can benefit from a fixed bridge, a restoration option that’s been used for decades. A bridge is a series of life-like crowns permanently joined like pickets in a fence. The middle crown known as the “pontic” fills the empty space left by the missing tooth. The crowns on either side of the pontic are permanently attached to the natural teeth that border the missing tooth space. Known also as “abutment” teeth, they serve as the support for the bridge.
Bridges do have one downside — the abutment teeth must be prepared by filing them down so the new crowns fit over them properly. This will permanently alter and possibly weaken the teeth. Dental implants, on the other hand, have little to no effect on adjacent teeth.
Still, a bridge remains an effective option for many people. Properly cared for, a bridge can restore function as well as enhance your smile for many years to come.
If you would like more information on bridgework as a restorative option, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Crowns & Bridgework.”
Periodontal (gum) disease is an infectious disease that progressively weakens the attachment of supporting tissues to the teeth, including gums, ligaments and bone. If not stopped, the loss of attachment will eventually lead to bone and tooth loss.
A thin layer of plaque that builds up on teeth (mainly due to poor oral hygiene habits) is the main breeding ground for the bacteria that cause gum disease. Our main treatment goal is to remove as much of this plaque as possible from tooth and gum surfaces. Much of the plaque can be removed using special hand or ultrasonic instruments that deep clean dental surfaces, including the roots. But while effective, these manual techniques may not address the full extent of infection, especially if the disease is well advanced.
If severe bone loss has already occurred, deep pockets of infection may have developed. As bone loss progresses, teeth with multiple roots may also develop an anatomical problem known as furcation invasions where the roots of the tooth branch off. If there continues to be signs of disease, like gum inflammation, bleeding or pus formation, it’s these hard to reach areas that may still be a problem even after extensive treatment. If so, we may need to take a different approach with antimicrobial or antibiotic products.
The most effective antimicrobial substance for reducing bacteria in biofilm is a chlorhexidine mouthrinse. The typical 0.12% solution is only available by prescription — if taken for a prolonged time it can result in tooth staining, affected taste or mouth irritation. To assure the solution reaches below the gum line, it will need to be applied by us in the office, followed up flushing irrigation of the affected area.
Another alternative is topically applied antibiotics that can stop or even reverse the progression of gum disease. There’s evidence that topical applications can penetrate into these deeper areas of infection. A common antibiotic used in this way is tetracycline, which has been shown to stop inflammation and infection.
These treatments don’t eliminate the need for mechanical cleaning, and the prolonged use of antibacterial products can have a detrimental effect on “good” bacteria (needed, for example, to complete the digestive process). It will depend on the extent of the gum disease to determine how successful conservative treatment may be. It’s also important that you contribute to your own dental health with a renewed daily oral hygiene habit.
If you would like more information on treatments for gum disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Treating Difficult Areas of Periodontal Disease.”
One of the many reasons for dental implant popularity is their reliability — studies have shown 95% of implants still function well after ten years. Still, on rare occasions an implant will fail. We can minimize this risk by taking precautions before, during and after installation.
Long-term success begins with careful planning before surgery. We thoroughly examine your teeth and jaws, using x-rays or CT scanning to map out the exact location of nerves, sinus cavities and other anatomical structures. Along with your medical history, this data will help us develop a precise guide to use during implant surgery.
We’ll also assess bone quality at the intended implant site. The implant needs an adequate amount of bone for support — without it the implant will not be able to withstand the biting force of normal chewing. It may be possible in some cases to use bone grafting or similar techniques to stimulate growth at the site, but sometimes other restoration options may need to be considered.
The surgery can also impact future reliability. By precisely following the surgical guide developed during the planning stage, the oral surgeon can increase the chances of success. Still, there may be an unseen variable in play — a pre-existing or post-operative infection, for example, that interferes with the integration of the implant with the bone. By carefully monitoring the healing process, we can detect if this has taken place; if so, the implant is removed, the area cleansed and the implant (or a wider implant) re-installed.
Even if all goes well with the implantation, there’s still a chance of future failure due to gum disease. Caused mainly by bacterial plaque, gum disease infects and inflames the supporting tissues around the teeth; in the case of implants it could eventually infect and weaken the surrounding bone, a condition known as peri-implantitis. This calls for aggressive treatment, including plaque and infected tissue removal, and possible surgery to repair the bone’s attachment to the implant. Without treatment, the implant could eventually detach from the weakened bone.
Maintaining your implants with good oral hygiene and regular dental checkups is the best insurance for long-term reliability. Taking care of them as you would natural teeth will help ensure a long, happy life for your “third set” of teeth.
If you would like more information on dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Implants.”
Look around and you’ll find warning labels on lots of household items: alcoholic beverages, drain uncloggers, pesticides and pool toys (not to mention cigarettes and chainsaws). Now, California lawmakers are proposing to add one more item to the list: sugary soft drinks. A bill to that effect recently passed the California state Senate, and is presently headed to the Assembly. If approved by both houses and signed by the governor, it would require sugary beverages to carry a warning label.
The proposed label would read: “STATE OF CALIFORNIA SAFETY WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay.” It would appear on drink packaging and vending machines. While some may feel it’s an infringement on personal choice, recent polling seems to show that the tide of public opinion may have turned toward recognizing the potential health dangers of sugary drinks.
How real are those dangers? The medical groups sponsoring the bill (including the California Medical Association) point to numerous scientific studies showing, among other things, that:
No matter where you stand on the debate over warning labels, you should understand the potential dangers of consuming foods and beverages with added sugar. For years, dentists have been cautioning people to limit their intake of sugary treats, including sodas and other sweets. Initially, our warnings came from the standpoint of oral health. Now, we have evidence that many other health problems have the same cause. We want to share this information with you because we’re concerned about your overall health — not just your oral health. You can learn more by reading the Dear Doctor magazine article “Think Before You Drink.”
Nothing says confidence like a bright, beautiful smile. But problems with your teeth’s appearance — discoloration, abnormal shapes, or gaps — may be giving you reasons not to smile. If so, you may be a candidate for porcelain veneers.
A veneer is a thin covering of porcelain or other dental material permanently attached to the face of a tooth to improve its appearance. Veneers help resolve a variety of aesthetic issues: their life-like color can brighten dull, stained teeth; they can “lengthen” shortened teeth caused by wear or normalize congenitally misshapen teeth; they’re also helpful in reducing small gaps or used in conjunction with orthodontics for more serious misalignments.
The first step to a better smile with veneers is to assess your teeth’s current condition and develop a treatment plan. Your input is extremely important at this stage — what changes you believe would improve your smile. We would also offer valuable insight, based on our knowledge and experience, into what is realistically possible and aesthetically appealing regarding porcelain veneers.
Once you have decided to go forward, the next step is to prepare the teeth for attaching the veneers. Depending on their size and location, this preparation can range from no tooth structure removal to a relatively small amount of structure. If the latter is needed, we remove only what’s necessary to achieve the aesthetic result since structural reduction isn’t reversible.
After preparing an impression of your teeth, we would send it and other instructions to a dental technician to create the permanent veneers. In the meantime, we’ll install a temporary set for you to wear while the permanent set is under construction.
Once we attach the permanent veneers, they will adhere so securely a drill or laser would be needed to remove them. We achieve this attachment by creating microscopic pores on the face of the teeth and the inside of the veneer with a mild acid solution. The bonding cement seeps into these pores and creates a strong bond that virtually unites the tooth and veneer into one.
Although your new veneers are made to last, you’ll need to maintain them like your other teeth, with a little added caution when biting and chewing. All in all, though, you’ll be able to smile again with confidence — for many years to come.
If you would like more information on porcelain veneers, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Porcelain Veneers.”
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