Dr Hardeep Bhatta & Dr Allen Friesen
Suite 205 - 1465 Salisbury Ave
Port Coquitlam, BC V3B6J3
Being “in the pink” is a good thing; it means you're healthy. Being “in the red” is not so good; it means your health is questionable (financially, anyway). Though they weren't coined for dentistry per se, these colorful expressions are helpful reminders when it comes to taking care of your gums: Pink is their natural, healthy color; that's what you want to see every time you look in the mirror. Red is generally a warning that something's amiss.
If your gums, or “gingiva,” appear slightly swollen and reddened at the margins and/or they bleed when lightly prodded by brushing or flossing, it's likely that you have gingivitis. This is an immune response to the buildup of bacterial plaque (biofilm) at your gum line. It is also an early red flag for periodontal disease (peri – around, odont – tooth), a degenerative process that affects not only the gums, but the periodontal ligament that attaches each tooth in its bony socket, and the underlying supporting bone.
Attentive home dental hygiene practices prevent most plaque buildup from occurring. Brushing correctly at the gum line is a good start. But even a deftly handled brush can't reach everywhere, so it's important to use dental floss or specially designed mini-brushes to get in between teeth and other hard-to-reach areas. Our office can instruct you on optimal home care techniques. We also encourage you to visit at regular intervals for professional cleanings so you are assured of addressing anything home care might miss.
In the absence of good oral hygiene, dental plaque can build and become increasingly difficult to remove as it calcifies, becoming tartar. It becomes a breeding ground for disease-causing microbes that normally wouldn't have the chance to gain a foothold. When caught early, gingivitis can be treated before any harm is done. Sometimes a thorough professional cleaning is sufficient. If the problem is ignored, however, the disease will most certainly progress to destruction of the surrounding, supporting tissues — the periodontal ligament and the underlying bone. If this happens, tooth loss could eventually result.
That said, there can be other causes for bleeding gums. These include:
Whatever the reason, red is not normal when it comes to your gums. The sooner you discover the underlying reason(s) for inflammation or bleeding and take appropriate action, you and your smile will be back in the pink and you'll have no reason to be blue!
If you would like more information about preventing or treating bleeding gums, 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 “Bleeding Gums.”
Whether they come as removable devices or wires permanently attached behind the front teeth, orthodontic retainers have a crucial job to do in your mouth. Here's the skinny on what you ought to know about them.
1) Retainers keep your new smile looking the way it should.
After having braces to move your teeth into the desired position, a retainer is needed to keep them from moving right back where they were! In time, the periodontal (“peri” – around; “odont” – tooth) structures, which are constantly renewing themselves, will adapt to their new positions, and the teeth will stabilize.
2) There are different types of retainers.
Once upon a time, retainers were made of pink plastic and bent wire, and were removable. They're still available — but a common alternative today is to have clear retainers that fit onto your teeth covering them entirely or to have thin wires bonded to the inside of the front teeth They don't show, and you don't have to worry about putting them in and taking them out. If you prefer, ask us whether this type of retainer would work for you.
3) It takes several months for your teeth to become stable in a new arrangement.
Teeth must be held in position long enough for the bone and ligament that attaches them to the jaw to re-form and mature around them. A retainer helps avoid trauma as the teeth and associated structures are adjusting to relocation, allowing the process to end slowly and gently.
4) Even when they're stable, your teeth are always in a “dynamic” state.
There is some “memory” inherent in bone and gum tissue, which tends to cause teeth to shift back to their former positions for a long period of time after treatment. But teeth aren't held in place just by bone and ligament — a balance between the forces of the lips, cheeks and tongue also helps them stay put. This balance changes over a period of time.
5) The movement of teeth is unique to each person, and is not predictable.
Contrary to what orthodontists used to believe, there is no “right” position for the teeth that assures they will stay in place permanently. In time, the position of the teeth may change due to a slow “uprighting” movement of the front teeth in the lower jaw, which causes them to crowd as they move toward the tongue. Other factors may also cause a gradual movement of the teeth. But remember to always follow our recommendations; they will help keep your smile looking its best.
If you would like more information about orthodontic retainers, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Why Orthodontic Retainers?” and “The Importance of Orthodontic Retainers.”
Every good oral hygiene regimen has two parts — the part you do (brushing and flossing) and the part we do (professional cleanings and checkups).
But what’s involved with “professional cleanings” — and why do we perform it? The “why” is pretty straightforward — we’re removing plaque and calculus. Plaque is a thin film of bacteria and food remnant that adheres to tooth surfaces and is the main culprit in dental disease. Calculus (tartar) is calcified plaque that occurs over time as the minerals in saliva are deposited in bacterial plaque. It isn’t possible for you to remove calculus regardless of your efforts or hygiene efficiency. Ample research has shown that calculus forms even in germ-free animals during research studies, so regular cleanings are a must to keep you healthy.
The “what” depends on your mouth’s state of health and your particular needs. The following are some techniques we may use to clean your teeth and help you achieve and maintain healthy teeth and gums.
Scaling. This is a general term for techniques to manually remove plaque and calculus from tooth surfaces. Scaling typically encompasses two approaches: instruments specially designed to remove plaque and calculus by hand; or ultrasonic equipment that uses vibration to loosen and remove plaque and calculus, followed by flushing with water and/or medicaments. Scaling can be used for coronal maintenance (the visible surfaces above the gum line) or periodontal (below the gum line).
Root planing. Similar to scaling, this is a more in-depth technique for patients with periodontal disease to remove plaque and calculus far below the gum line. It literally means to “plane” away built up layers of plaque and calculus from the root surfaces. This technique may employ hand instruments, or an ultrasonic application and flushing followed by hand instruments to remove any remaining plaque and calculus.
Polishing. This is an additional procedure performed on the teeth of patients who exhibit good oral health, and what you most associate with that “squeaky clean” feeling afterward. It’s often performed after scaling to help smooth the surface of the teeth, using a rubber polishing cup that holds a polishing paste and is applied with a motorized device. Polishing, though, isn’t merely a cosmetic technique, but also a preventative measure to remove plaque and staining from teeth — a part of an overall approach known as “prophylaxis,” originating from the Greek “to guard or prevent beforehand.”
If you would like more information on teeth cleaning and plaque removal, 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 “Teeth Polishing.”
We now have an amazing repertoire in dentistry to restore the look and function of damaged or missing teeth. From tooth-colored crowns to life-like dental implants, we can turn an embarrassing smile into one you’re confident to show the world.
But what if your teeth are visually unappealing but structurally sound? Perhaps they’re slightly irregular or discolored — do you still need the “heavy artillery” in our arsenal of restoration options?
Not at all — dental veneers that provide amazing aesthetic results with minimal tooth preparation may be an appropriate restoration choice for you. As the name implies, veneers are a thin layer of dental material (usually porcelain) that’s permanently bonded to the outside of a tooth. Veneers can be shaped to resemble natural teeth — especially effective for changing the appearance of small or slightly misshapen teeth — and can be customized to match an individual patient’s tooth color.
Veneered teeth require very little preparation compared to other restorations; still, most veneer applications do require some permanent enamel removal so that the applied veneers appear natural. In recent years, however, changes in veneer design and materials have made it possible for some patients to receive veneers without some tooth prep.
If taken care of properly, veneers can last anywhere from seven to twenty years (in some cases, more). While their material composition and the bonding process can withstand normal biting forces, wearers need to keep in mind porcelain is a form of glass — excessive twisting or pressures from excessive grinding habits could cause them to shatter.
And because veneers are made of an inert, non-living material, they can’t adapt to any changes that may occur biologically to your teeth and gums and may need to be updated at some point in the future. The good news is that a loosened veneer can often be repaired.
If you’d like to know if you’re a good candidate for this cost-effective, minimally invasive option, visit us for an examination. Balancing all the factors, porcelain veneers just may be your answer to achieving a better smile.
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.”
Your braces have finally been removed and you’ve unveiled your new smile to the world. You’re finished with orthodontics — right?
Not quite. If you want to “retain” your new smile you’ll need to wear a retainer appliance: depending on your age and which teeth were moved, that could be for several months or even indefinitely.
Retainers are necessary because of how teeth naturally move within the mouth. Although your teeth may seem rigidly set in bone, they’re actually held in place by an elastic tissue called the periodontal ligament. This tissue is quite dynamic in response to biting forces or even normal tooth wear. When forces are applied to a tooth, it’s the ligament that transmits pressure against the teeth to gradually move them to a more accommodating position. In response, the bone resorbs (dissolves) on the side of the tooth moving toward the new position while laying down new growth on the other side. This bone growth will help anchor the tooth in the new position.
Braces use this natural process to gradually move teeth; both the ligament and bone will reform as needed. But this reforming process takes time. Furthermore, there’s a natural balance between the teeth, the tongue and the lips and cheeks. Although the new position created by orthodontics may be more aesthetically pleasing, it may disrupt the natural balance of these surrounding muscles. The influence of habits like clenching or grinding of your teeth may also disturb the new tooth position. The natural tendency is to revert back to the original tooth position.
We use retainers to prevent this reversal. Nearly all orthodontic patients will initially wear them all the time, and for younger patients this may be reduced to wear only during sleep time. Total wear time usually lasts a minimum of eighteen months, until the bone and ligament have fully reformed.
For older patients, though, retainer wear may need to continue indefinitely to prevent “relapse.” In these long-term cases another option to a removable retainer is to permanently bond thin retainer wires to the inside surfaces of the front teeth. The wires can remain in place for several years and are much less noticeable than a removable retainer.
While retainers are often considered inconvenient, they’re absolutely necessary for preserving the results of orthodontic treatment. In the end they’ll help you keep the form and function of your new smile.
If you would like more information on orthodontic retainers, 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 “Why Orthodontic Retainers?”
There are dozens of brands of mouthwashes and rinses on drugstore shelves that American consumers buy each year for clean breath and oral health. But the question is do they really work?
To properly answer that, you should first know that mouth rinses fall into two general categories: cosmetic and therapeutic. A cosmetic rinse can give you a temporary “clean” feeling in the mouth (usually masking bad breath with a more pleasant smell) but in the long run doesn't contribute to better oral health. On the other hand, therapeutic rinses do enhance oral health; they contain one or more ingredients that can help prevent the development of tooth decay and/or inhibit bacterial growth.
Although some therapeutic rinses are prescribed by dentists, many are available over-the-counter (OTC). Decay-fighting rinses usually contain sodium fluoride, which has been amply demonstrated to strengthen the surface of teeth and thus inhibit tooth decay and the likelihood of new cavity development — but only when used in combination with good hygiene practices. Anti-bacterial rinses contain ingredients such as triclosan, zinc or essential oils like menthol that reduce the level of bacteria in plaque (when also coupled with good oral hygiene). This also helps reduce the growth of decay.
For some patients a prescription rinse may be in order, especially during recuperation from oral surgery or where normal plaque control is difficult. The most common rinse contains chlorhexidine, a chemical that prevents bacteria from sticking to the teeth. The effectiveness of chlorhexidine, especially in helping to control gingivitis (inflammation of the gums) and preventing tooth decay, is well-documented after many years of research and use. While it may cause teeth staining in some patients, the staining can be alleviated by ultrasonic scaling or polishing.
So then, should you incorporate a mouth rinse into your daily hygiene regimen, and if so, what kind? That will depend on your own individual oral health needs, which we can advise you on. Knowing what your own needs are and the different kinds of mouth rinses and what they are designed to do, you can make an informed choice.
If you would like more information on the use of mouthwashes or rinses, 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 “Mouthrinses.”
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.”
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