Dr Hardeep Bhatta & Dr Allen Friesen
Suite 205 - 1465 Salisbury Ave
Port Coquitlam, BC V3B6J3
If you’re missing a tooth, you’re not alone; in fact 35 million Americans are missing all of their teeth in at least one jaw! Whether it’s one tooth or many, it’s important to replace what’s missing. Depending on the number of teeth lost, the potential drawbacks to doing nothing may become hard to ignore: impediments to eating, interference with speech, and unaesthetic appearance, for example.
Traditional bridges and dentures are the most affordable options for replacing teeth. Tooth implants — tiny titanium, screw-like substitutes for a tooth’s natural root to which natural-looking dental crowns are attached — are pricier but offer an important extra benefit. In addition to addressing the common problems previously mentioned, by acting like the original tooth root, an implant can maintain or stimulate “remodeling,” of the jawbone below. Without a tooth root to provide stimulation, mature bone cells will continue to be removed, or resorbed, but no new bone cells will regenerate to replace them, leading to a progressive loss of bone width, height and density. The more teeth are lost, and with less bone structure to support it, the whole shape of the face can change.
Unfortunately, when greater numbers of teeth must be replaced, implants can become financially unrealistic for some people. But in appropriate cases there is a third option: a bridge or denture/implant hybrid. In the case of a bridge intended to fill a gap when multiple teeth are missing, an implant can be used on either side of the gap to support the bridge, leaving the natural teeth undisturbed. Strategically placed implants can be used to support a removable denture, too.
If you would like more information about 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: Your Best Option For Replacing Teeth.”
Tooth decay can be relentless: left untreated it can work its way into a tooth’s inner core — the pulp chamber or better known as the root canal. Once this occurs, the best course of action to save the tooth may be a root canal treatment to clean out the diseased pulp (nerve) and seal the canal from further decay.
So, what signs and symptoms might you encounter if decay has invaded a tooth’s root canal? When the pulp is first infected you may experience acute pain; over time, however, the pain may suddenly dissipate. This doesn’t mean the tooth has healed itself — quite the contrary, it may mean the infected pulp tissue, including the nerves, has died. Once the nerves die, they no longer transmit pain signals to the brain.
While the pain may cease, the infection hasn’t and will continue to travel from the end of the tooth root into the bone. At this point, you may encounter pain whenever you bite on the tooth. This time the pain is originating in nerves located in the periodontal ligament that surrounds the tooth root and joins the tooth with the jawbone. This can lead to an acute abscess (with accompanying pain) or a chronic abscess that may have no pain symptoms at all. As the decay progresses you may eventually suffer bone and tooth loss.
The important point here is that you may or may not notice all the signs and symptoms that indicate deep decay within a tooth. That’s why it’s important to undergo a thorough dental examination if you have any symptoms at all, especially acute pain that “mysteriously” disappears.
A root canal treatment and removal of the decayed tooth structure will stop the progress of tooth decay and preserve the tooth. The longer you delay, though, the greater the risk your tooth will eventually lose the battle with tooth decay and infection will continue to spread.
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 “Signs and Symptoms of a Future Root Canal.”
Tooth whitening procedures and products have become increasingly popular over the last two decades. There are two main sources of application: professional procedures performed in a dentist’s office; and over-the-counter products for performing whitening applications at home. While there are pros and cons to both approaches, neither type poses a significant health risk — that is, if you match the correct product to the type of staining you have, and it’s applied according to the manufacturer’s instructions.
Although whitening treatments may differ in formula and strength, almost all use hydrogen peroxide as the bleaching agent, usually contained in carbamide peroxide which splits into hydrogen peroxide and urea upon activation. After many studies, there’s a strong consensus that hydrogen peroxide used at the levels found in whitening products doesn’t cause any harm to the body, including as a precursor to cancer.
But as the 16th Century Swiss physician Paracelsus once noted, “All substances are poisons… The right dose differentiates a poison from a remedy.” This is true of the chemicals that make up whitening products — they’re safe unless they’re overused. Going beyond their directions for use could lead to tooth enamel damage.
Further caution is also in order for teenagers using whitening products. Although they may have their permanent teeth (although younger teens may still have some primary teeth), the enamel layer is still developing and can be more vulnerable to damage from whitening chemicals than for adults.
The best approach for both a professional or home whitening procedure is to first seek consultation from our office. If nothing else, you should at least undergo a dental examination to identify the true cause of your teeth’s staining or discoloration. If the discoloration originates within the tooth, home applications and many professional treatments will not help if they bleach the outer surface only. We can also advise you on the proper application and dosage for a chosen product.
Using the right whitening product and in an appropriate manner will reduce the risk of injury to your teeth and overall health. And, the end result can be a brighter, more vibrant smile.
If you would like more information on tooth whitening, 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 Whitening Safety Tips.”
Technology for orthodontic treatments has evolved tremendously over the years. There are now more options than ever before for those seeking to straighten their teeth or fix bite issues. One of those revolutionary options is TADS (Temporary Anchorage Devices), mini-screws that can be used to more accurately control the movement and positioning of your teeth.
So, how do TADS work? Well, these very small screws are temporarily placed into the bone of the jaws to be used as non-mobile anchor units to facilitate tooth movement. They can be removed once the desired movement is complete. In addition, they can be placed using simple local anesthesia (numbing shots in the area).
The procedure is actually quite simple. After numbing the area where the TAD is to be placed, we will use gentle pressure to insert it through the gums and into the bone of your jaws. You may feel some slight pressure during the insertion, but no pain. Following the procedure, you may also feel a bit of pressure and sensitivity for one to two days, but many people experience no side effects at all. As the name suggests, TADS are temporary and usually removed after a few months, though length of time varies. Again, removing TADS also involves a quick and painless procedure.
TADS have been around for a long time, but recent refinements in the design and application procedure have allowed for more widespread use in the orthodontic office. TADS can be used for many different reasons, including eliminating the need for cumbersome appliances, such as headgear. They also offer a great way to reduce orthodontic treatment time. Finally, they allow certain cases to be treated that were nearly impossible before this technique was refined.
There’s more to orthodontics than simply moving teeth. Especially with children and adolescents, we also want to guide the development of the entire facial structure to solve certain types of malocclusions (poor bites).
One such concern involves the upper jaw and palate (roof of the mouth), known collectively as the maxilla. In some individuals, the maxilla is narrower than normal. This causes the upper teeth to fit abnormally inside the lower teeth when occluding or “biting down” and is known as a cross-bite. A cross-bite may restrict the amount of space for your teeth to erupt (appear in the mouth) in proper alignment. It can be so severe the individual may have to shift the jaw to one side to completely bite down.
If a cross-bite is caught early, there’s a non-surgical treatment to widen the maxilla and help prevent upper teeth misalignment. But there’s a limited time window of opportunity: this is because the maxilla is actually formed by two bones with a seam that runs down the middle of the palate. The two bones will eventually fuse, usually at the beginning of puberty; until then there’s a slight separation.
Before the bones fuse, we can use a palatal expander to widen this seam and encourage permanent bone growth in the resulting gap. The expander is made of two metal halves joined in the middle by a small screw device that fits between the teeth. You or your child turns the screw a very small amount once or twice a day with a special key and the action pushes the maxilla outward on either side: the slight tension created stimulates bone growth. Over time, the new bone will have added width to the maxilla and eliminated the cross-bite.
While it’s possible to correct this after the maxilla fuses, it will require surgery to separate the bones. The palatal expander helps us correct the problem in the most non-invasive way possible, but it must be done before puberty. Discovering this type of malocclusion early is one of many reasons why regular dental visits should be an important part of your child’s healthcare.
If you would like more information on palatal extenders, 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 “Palatal Expanders.”
It's not just your teeth that are on display when you smile; it's also your gums. For a smile to look appealing, there needs to be a frame of healthy pink tissue to set off those pearly whites. But just as there can be cosmetic issues with teeth, the shape or condition of the gums, too, can create an aesthetic problem. If you feel the appearance of your gums is in any way detracting from the appeal of your smile, we can help with a variety of in-office surgical procedures.
Here are some common cosmetic gum problems — and possible solutions:
Problem: Too Much Gum Tissue. A smile can look “gummy” when excessive gum tissue covers more of the enamel surface of a tooth's crown (upper portion) than normal.
Solution: Crown Lengthening. This is a procedure in which gum tissue (and rarely but sometimes a small amount of bone tissue) is removed to expose more tooth surface.
Problem: Not Enough Gum Tissue. Sometimes your gums can shrink down (recede), exposing some of a tooth's root — which is more yellow than the enamel surface of the tooth.
Solution: Gum Grafting. There are various grafting procedures that can be used to cover exposed roots by moving gingival (gum) tissue from one site in the mouth to another. Sometimes laboratory-processed donor tissue can even be used to minimize the surgery.
Problem: Uneven Gum Line. This means that some teeth are covered by more gum tissue than others, which can make a smile seem off-kilter.
Solution: Gum tissue can be recontoured (reshaped) for a very pleasing effect with either conventional surgery or the newer dental laser technology.
All of the above procedures can be performed at the dental office — usually with only a local anesthetic (numbing shot). In fact, for laser surgery you may need only a topical anesthetic gel. An examination is required to determine whether conventional or laser treatment is in your best interests. Whatever your cosmetic gum surgery needs may be, the procedures are routine and predictable — and they can work wonders for your smile!
If you have any questions about cosmetic gum surgery, 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.”
There are a number of materials and techniques available in cosmetic dentistry that help us improve our patients' smiles. Porcelain veneers stand out as one of the most popular and least interventional of these options.
As the name implies, a veneer is a thin layer of dental restorative material that covers the original tooth surface. Veneers don't require an extensive amount of tooth preparation or removal of sound tooth structure, as with a crown or bridge.
Veneers are made of dental porcelain, a material compatible with living tissue and with a very life-like appearance. The dentist as artist can fashion the porcelain to precisely imitate an individual's natural teeth, including the natural color and hue of surrounding teeth.
Are porcelain veneers an option for you? Only a smile analysis in our office can determine that. Your teeth must be in a somewhat normal position. The teeth in question must have a sufficient amount of remaining tooth structure to support veneers. And you must have symmetrical gum contours that will allow for proper framing of the teeth, which will enhance the final cosmetic result.
If your current dental health meets these criteria, then porcelain veneers could help correct spaces between teeth that aren't too wide, improve poor color, or address poor shape, contours or minor bite problems. Veneers, however, do have their limitations. They aren't effective if you have poor tooth position, if the root positions are widely out of line, or if you have a poor profile. Some form of orthodontics may be needed initially for these situations.
That being said, porcelain veneers are an excellent long-term option in the right situation. Depending on your individual circumstance and how you care for your teeth, a veneer application can last for several years, or if they come loose or become chipped they can be repaired in most cases. The material is strong enough to withstand normal pressures exerted during chewing or biting, as long as you avoid activities like opening nutshells with your teeth or chewing on very hard candy.
Overall, porcelain veneers can give your smile a whole new look with little impact on your remaining tooth structure.
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 “Smile Design Enhanced With Porcelain Veneers.”
Perhaps you or someone you know has been told they will need root canal treatment. Maybe you're experiencing some unexplained tooth pain, and you think you might need to have this procedure done. Nervous? You shouldn't be! A good understanding of this common and relatively pain-free dental treatment can go a long way toward relieving your anxiety.
What's a root canal? It's the small, branching hollow space or canal, deep within the root of the tooth. Like an iceberg in the ocean, a tooth shows only part of its structure above the gum line: That's the part you see when you smile. But about two-thirds of the tooth — the part called the root — lies below the gum. A healthy root canal is filled with living pulp tissue, which contains tiny blood vessels, nerves and more.
A “root canal” is also shorthand for the endodontic treatment that's called for when problems develop with this tissue. For a variety of reasons — deep tooth decay or impact trauma, for example — the pulp tissue may become inflamed or infected. When this happens, the best solution is to remove the dead and dying tissue, disinfect the canals, and seal them up to prevent future infection.
How is this done? The start of the procedure is not unlike getting a filling. A local anesthetic is administered to numb the tooth and the nearby area. Then, a small opening is made through the chewing surface of the tooth, giving access to the pulp. A set of tiny instruments is used to remove the diseased tissue, and to re-shape and clean out the canals. Finally, the cleared canals are filled with a biocompatible material and sealed with strong adhesive cement.
After root canal treatment, it's important to get a final restoration or crown on the tooth. This will bring your tooth back to its full function, and protect it from further injury such as fracture. A tooth that has had a root canal followed by a proper restoration can last just as long as any other natural tooth. And that's a long time.
If you would like more information about root canals, please contact us to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Common Concerns About Root Canal Treatment” and “Signs and Symptoms of a Future Root Canal.”