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