Dr Hardeep Bhatta & Dr Allen Friesen
Suite 205 - 1465 Salisbury Ave
Port Coquitlam, BC V3B6J3
The preferred outcome when treating a tooth for decay is to preserve it. If the disease is still in its early stages, we can accomplish this effectively by removing diseased tissue and then restoring the remaining tooth with filling material.
There comes a point, however, when filling a tooth isn’t the best option. If it has already received several fillings, the tooth may have become too weak to receive another. Additionally, a filling may not be enough protection from further fracture or infection for teeth weakened from trauma or abnormal tooth wear or in the event a root canal treatment is necessary.
While a diseased tooth can be extracted and replaced with a durable and aesthetically pleasing dental implant, there may be another option to consider — installing a crown. Like a filling, a crown preserves what remains of a natural tooth, but with better protection, life expectancy and appearance than a filling.
Known also as a cap, a crown completely covers or “caps” a natural tooth. They’re produced in a variety of styles and materials to match the function and appearance of the capped tooth and adjacent teeth. Crowns made of porcelain are ideally suited for visible teeth because of their resemblance to tooth enamel. A less visible tooth that endures more biting force (like a back molar) may need the strength of a precious metal like gold or new-age porcelains that can also withstand significant biting forces. There are also hybrid crowns available that combine the strength of metal for biting surfaces and the life-like appearance of porcelain for the more visible areas of a tooth.
To prepare a tooth for a crown, we first remove any decayed structure and add bonding material to strengthen what remains. We then make a mold of the tooth and bite, which is typically sent to a dental technician as a guide for creating the permanent crown. Recent advances with digital technology have also made it possible to mill the permanent crown out of porcelain in the dental office while you wait.
After the permanent crown is received and permanently bonded to the tooth, you will have a protected and fully functional tooth. From this point on it’s important for you to clean and care for it as you would any other tooth since the underlying tooth is still at risk for decay. The good news is your tooth has been saved with a bonus — a long-term solution that’s also smile-transforming.
If you would like more information on crowns and other tooth restorations, 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.”
According to popular culture, a root canal treatment is one of life’s most painful experiences. But popular culture is wrong — this common treatment doesn’t cause pain, it relieves it. Knowing the facts will help alleviate any anxiety you may feel if you’re scheduled to undergo the procedure.
A root canal treatment addresses a serious problem involving the pulp of a tooth that has become infected. The pulp is a system of blood vessels, nerves and connective tissues inside the tooth that helps the tooth maintain its vitality. It also contains a series of minute passageways known as root canals that interconnect with the body’s nervous system.
The pulp may become infected for a number of reasons: tooth decay, gum disease, repetitive dental procedures, or traumatic tooth damage. Once the pulp becomes irreversibly damaged it must be completely removed from the tooth and the root canals filled and sealed in order to save the tooth.
We begin the procedure by numbing the affected tooth and surrounding tissues with local anesthesia and placing a dental dam (a thin sheet of rubber or vinyl) over the area to isolate the tooth and prevent the spread of infection to other oral tissues. We then drill a small hole in the top of the tooth to access the pulp chamber. Using special instruments, we then remove the infected or dead pulp tissue through the access hole and then wash and cleanse the root canals and pulp chamber with antiseptic and antibacterial solutions.
After additional preparation, we fill the root canals and pulp chamber with a filling especially designed for this kind of treatment, usually a rubber-like substance called gutta-percha that easily molds and compresses when heated. We then seal the access hole with a temporary filling (until a permanent crown can be fashioned) to prevent infection from reentering the pulp space. After the procedure, you may experience some minor discomfort easily managed with over-the-counter pain relievers.
You’ll find the root canal treatment alleviates the symptoms prompted by the pulp infection, particularly acute pain. What’s more, a successful root canal will have achieved something even more crucial to your health — it will give your tooth a second chance at survival.
If you would like more information on root canal treatment, 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 “A step-By-Step Guide to Root Canal Treatment.”
Orthodontics is a specialty of dentistry dedicated to the diagnosis and treatment of misaligned teeth, or malocclusions. The goal is to help patients achieve better long-term oral health by improving teeth alignment. Sometimes, though, the misalignment is much more involved than the position of the teeth — it may be that the jaw structure is also misaligned. In that case, the skills of an oral surgeon may be in order.
The jaws are similar in shape to the arch of a horseshoe, hence the referral to either upper or lower sets of teeth as dental arches. In a normal jaw structure, the lower arch fits just inside the upper arch when you bite down and the teeth are able to function correctly. In some individuals, though, the lower arch closes in front of the upper arch, commonly known as an underbite. If the underbite is only slight, the malocclusion can be corrected by repositioning the teeth only, as with braces. If, though, the underbite is more severe it would require a surgical procedure to realign the jaws, also known as orthognathic surgery.
Orthognathic surgery can help relieve a number of functional complications caused by jaw-related malocclusions: difficulty chewing and swallowing; chronic jaw or head pain; or sleep apnea. It can also enhance the patient’s facial appearance by correcting an imbalance between the two lateral sides (asymmetry), or by minimizing a receding chin or protruding jaw.
Its primary benefit, though, is its effect on the patient’s bite and tooth alignment. For this purpose, the orthodontist and oral surgeon work together to achieve the best result possible. In some cases, the orthodontist may perform his or her work first by moving teeth into the proper position. This sets the stage for the oral surgeon to perform orthognathic surgery to complete the correction of the misalignment.
Each individual patient’s case is different — the best plan of action must begin with a full examination by an orthodontist, and a consultation with an oral surgeon if necessary. It may require time and the expertise of two specialties, but the final result will be better health and a better look.
If you would like more information on various orthodontic procedures, 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 “Jaw Surgery & Orthodontics.”
Today's periodontal (gum) surgical procedures are less painful and have fewer complications than ever before. Nevertheless, the best outcome still depends on how well you care for yourself as you recuperate. Here are some things you can do after surgery to lessen its effect.
In the first twenty-four hours after surgery, your primary objective is to prevent swelling, the major source of post-operative discomfort. You can accomplish this by applying an ice or cold pack to the outside of your face in the area of the surgery. It's best to alternate five minutes on and off with the pack for the outside, and ice chips, cold water or ice cream inside your mouth as often as possible. Your aim is to surround the surgical site with cold as much as you can with the five-minute on and off strategy.
You should eat only foods that are cold and soft (Jell-O™, applesauce, yogurt, ice cream, etc.), to help ease any swelling. The next day switch to hotter foods like soup, mashed potatoes or buttered pasta, as well as hot, salt water rinses as often as convenient. Avoid crumbly foods like chips, cookies or popcorn for a few days to help keep the incision site particle-free.
We typically prescribe a number of medications during recuperation: analgesics (usually of the aspirin or ibuprofen family) for swelling and pain, and antibiotics and antibacterial rinses to inhibit bacterial growth. Be sure to follow directions with each prescribed medication, taking the correct dosage and for the specified duration.
There is a possibility of post-operative bleeding — but don't panic. You should first attempt to locate the bleeding area, clean it, and then apply gentle pressure with moist, sterile gauze for ten to fifteen minutes. If the bleeding doesn't stop, give us a call.
You should keep the wound site as clean as possible to help avoid infection. However, don't brush, floss or rinse during the first twenty-four hours to avoid bleeding, and limit hygiene activities to antibacterial mouthrinses like chlorhexidine near the wound site for several days to weeks. During the first few days to a week after surgery avoid activities like strenuous exercise, drinking alcohol, sucking through a straw, or blowing up a balloon, as these can also increase your risk for bleeding. You should also avoid tobacco products during this time as these can inhibit the healing process. Each surgery is different and you should make sure you follow the specific instructions your surgeon will provide for you.
Taking these precautions will help keep discomfort and complications to a minimum. They will also help you recover quickly so that you can get back to your normal life.
If you would like more information on periodontal surgery and what to expect, 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 “Instructions Following Periodontal Surgery.”
Q: Why should I consider cosmetic gum surgery to improve my smile?
A: If you’re looking to enhance the natural beauty of your smile, you may have heard about various cosmetic procedures that can improve the appearance of your teeth. But don’t forget about the other, equally important element of a bright, appealing smile: the healthy-looking and well-proportioned gums that surround and support those pearly whites. Many times, cosmetic flaws are caused by gum tissue that’s covering too much or too little of the tooth’s surface; in other situations, the gum line is uneven, and covers some teeth more than others. Cosmetic gum surgery can successfully remedy these imperfections.
Q: How exactly does cosmetic gum surgery resolve smile defects?
A: There are several minor surgical procedures that may be recommended, depending on what’s best for your individual situation. For example, some people have a “gummy smile,” where teeth seem excessively “short” because they’re covered with too much gum tissue. In this case, a “crown lengthening” procedure can be performed, where gum tissue (and perhaps a small amount of bone tissue) is removed; this makes the teeth appear in better proportion to the smile. In the opposite case — where the teeth appear too “long” due to receding (shrinking) gums, tissue can be grafted (added on) to the gums. Gum recontouring procedures are used to re-shape the gum line for a more even, pleasing effect.
Q: Are there non-cosmetic reasons for having gum surgery?
A: Yes. A tooth with too much of its root area exposed is often more prone to decay, and may become extremely sensitive to hot or cold. Covering an exposed root with gum tissue is just one non-cosmetic reason why gum surgery may be necessary.
Q: What’s involved in gum surgery — do I have to go to the hospital?
A: Cosmetic gum surgery is normally performed in the dental office, and usually involves only a local anesthetic. However, if you need a deeper level of relaxation, other forms of sedation may be available. In some cases, lasers can be used instead of conventional surgical tools to remove excess gum tissue. If you need a tissue graft, the grafting material can be taken from your own mouth, or may come from donor tissue that is processed to ensure your safety. Gum surgery is minimally invasive, and most people experience only minor discomfort.
If you’d like to know whether cosmetic gum surgery could help you get the smile you’ve always wanted, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Gummy Smiles” and “Periodontal Plastic Surgery.”
While most orthodontic treatment doesn’t commence until a child is older or entering adolescence, it’s still a good idea for children as young as 6 to undergo an orthodontic evaluation. An early orthodontic evaluation may reveal emerging problems with the child’s bite and jaw development, and help inform the best course of treatment when the time is right.
A specialty within dentistry, orthodontics focuses on the study and treatment of malocclusions or poor bites. Orthodontists are most concerned with the interaction of the face, jaw and teeth, and whether these structures are developing normally and in the right position.
It’s possible to detect the beginning stages of a malocclusion as a child’s permanent teeth begin to erupt, sometime between ages 6 and 12. Children at this stage may begin to experience crowding of the teeth (or the opposite, too much space between teeth), protruding teeth, extra or missing teeth or problems with jawbone development. While these tend to be congenital (inherited conditions), some problems can be caused by excessive thumb-sucking, mouth breathing, or dental disease stemming from tooth decay. In some cases, “interceptive” orthodontic treatment might be necessary during this early period to improve the chances that future treatment for a malocclusion or poor jaw development will be successful.
An early orthodontic evaluation should be undertaken no later than age 7 to be most effective. It’s also advisable to have regular checkups beginning around the child’s first birthday to spot developing teeth and jaw problems even when only primary teeth are present. The orthodontic evaluation itself takes advantage of an orthodontist’s trained eye to locate more subtle problems with teeth and jaw growth. Knowing this well in advance can make it easier in the long run when orthodontic treatment takes place when they’re older. Waiting until after the full emergence of permanent teeth and further jaw and facial development to evaluate for treatment could make it more difficult or even impossible to correct malocclusion issues found later.
The most effective dental care starts early in life. Not only treating immediate problems but also anticipating those that will require treatment later will help ensure your child will have healthy teeth for life.
If you would like more information on childhood orthodontic evaluations, 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 “Early Orthodontic Evaluation.”
When a natural tooth can’t be preserved, it is important to have it replaced as soon as possible. Presently, there are two excellent tooth-replacement systems in wide use: traditional bridgework and high-tech dental implants. What’s the difference between the two methods?
Essentially, it comes down to how the replacement tooth is secured in the mouth. In the dental implant system, a natural looking prosthetic tooth is solidly anchored in place by a screw-like titanium implant. This is inserted directly into the bone of the jaw in a minor surgical procedure, and over a short period of time (usually 6 – 12 weeks) its titanium metal structure will actually become fused with the living bone.
With bridgework, however, the support for the prosthetic tooth (or teeth) comes from the healthy teeth adjacent to it. These teeth must be prepared (shaped) by carefully removing some of the outer tooth material (enamel and some dentin), which enables them to be fitted with coverings called crowns or caps. Crowns are often used on their own, to restore teeth that are missing too much of their structure to be treated effectively with standard fillings. But the bridgework system goes one step further.
Instead of making individual crowns for each tooth, a dental lab will fabricate a bridge — a single unit consisting of crowns for the prepared teeth, plus complete prosthetics to replace the missing tooth (or teeth). A three-unit bridge, for example, consists of one complete prosthetic tooth to replace the one that’s missing, plus two crowns for the adjacent “abutment” teeth. It’s possible to have larger bridges as well: For example, a six-unit bridge might consist of two complete prosthetic teeth in the center, with two crowns for abutment teeth on each end, all linked together in one piece.
While bridgework has been used effectively for decades, it is now being gradually supplanted by dental implants. Implants don’t require the removal of healthy tooth material from abutment teeth, and they don’t place extra stress on those teeth; plus, they generally last much longer than natural tooth bridges. However, the dental bridge remains a viable alternative for tooth replacement in many circumstances.
There are only a few teeth that are known by nicknames. The big, late-blooming third molars (“wisdom teeth”) are one set; another set is the sharply-pointed canines, also called the “eyeteeth”. These two sets of teeth have something else in common: They can both suffer from the failure to develop in the proper place. Impacted wisdom teeth are a well known problem; impacted canines, however, are an issue that’s seen less frequently — but can often be effectively treated without extraction (removal).
What does the term “impacted” mean? In dental terminology, it indicates a tooth that is growing in a position where it can’t erupt (grow in to the bite) properly. This sometimes happens in cases where the bite is “crowded” — that is, where there isn’t enough space in the jaw for all of the teeth to develop properly. An impacted tooth remains “buried” to some extent in the tissues of the gums and jaw. It may eventually cause various problems with the roots of neighboring teeth, or even form a cyst (fluid-filled sac). That’s why treatment of impacted teeth is so important.
Impacted third molars (wisdom teeth) are generally removed (extracted), and are rarely missed. Canines, however, are located near the front of the mouth, forming an important component of an aesthetically pleasing smile. Therefore, whenever possible, it’s preferable to bring these teeth into good alignment with the rest of the smile rather than remove them. How is this done?
The process begins with a series of radiographic images (x-rays or CT scans) that show the exact positions of the affected teeth. Next, a minor surgical procedure, performed under local anesthesia, is used to expose the crowns (surfaces) of the impacted teeth. Then, a bracket is bonded to the surface of the tooth, which can be attached to orthodontic appliances. These appliances will, in time, move the tooth into a better position.
Impacted canines can be a serious problem — but the good news is that, with the proper treatment, it’s often possible to bring them into alignment with the rest of your smile. If you would like more information about treating impacted canine teeth, call our office for a consultation. You can learn more in the Dear Doctor magazine article “Exposing Impacted Canines.”