Dr Hardeep Bhatta & Dr Allen Friesen
Suite 205 - 1465 Salisbury Ave
Port Coquitlam, BC V3B6J3
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?”
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.”
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.”
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.”
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.”
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.”