Dr Hardeep Bhatta & Dr Allen Friesen
Suite 205 - 1465 Salisbury Ave
Port Coquitlam, BC V3B6J3
You've probably never thought of the saliva swishing around in your mouth as amazing. The fact is, though, life would be a lot harder without it. Digestion would be quite unpleasant without its enzymes breaking down food during chewing; the soft tissues of our mouth would suffer more environmental abuse without its protective wash; and without its ability to neutralize acid, our tooth enamel would erode.
What's also amazing is what saliva can reveal about our health. As researchers discover more about this phenomenon, it's leading to better and less invasive ways to diagnose disease.
Similar to blood, saliva is composed of proteins containing RNA and DNA molecules which together hold the genetic instructions the human body needs to reproduce cells. We can therefore test saliva for health conditions as we do with blood, but with less invasive collection techniques and far less hazard to healthcare workers from blood-borne diseases. For example, doctors now have a saliva test that can detect the presence of HIV viruses that cause Acquired Immune Deficiency Syndrome (AIDS). Another saliva test will soon be available that can test for hepatitis.
Unfortunately, only a few such tests now exist. Researchers must first identify and then catalog saliva's biomarkers, protein molecules that correspond to specific health conditions — a daunting task since most are marked not by one but hundreds of proteins. Then it's a matter of developing diagnostic devices that can detect these biomarkers.
Although that too is a huge task, existing technology like mass spectrometry (already used to help detect early stages of oral cancer) could be a promising starting point. This process measures the portion of the light spectrum emitted by a molecule, a feature that could help identify a saliva protein by its emitted light signature.
Thanks to the work of these researchers, many of them in the dental profession, information about our bodies contained in saliva may soon be accessible. That accessibility may lead to earlier diagnoses and more successful treatment outcomes.
If you would like more information on saliva and your oral health, 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 “Secrets of Saliva.”
Your upper canine teeth are pretty easy to identify — they’re usually longer and more pointed than other front teeth, and are normally positioned just under the eyes (hence their other name, eyeteeth). Besides helping us chew and bite our food, upper canines are part of a normal smile — when they don’t appear in the mouth (erupt) properly, the person’s smile may appear unnatural or “off.”
Unfortunately, upper canines can become impacted, meaning the teeth have grown and developed in positions that prevent them from erupting. Because impacted teeth can develop abscesses and cysts, or damage the roots of neighboring teeth, it’s necessary to treat them.
The first step is a thorough orthodontic evaluation to assess not only the teeth in question, but also how they could affect the position of other teeth in the future. Next, we must locate the exact position of the impacted canines through some form of radiographic examination, either x-rays or 3-D imaging using a cone beam CT scanner (CBCT). This evaluation will determine our treatment options for these teeth.
If the teeth are in a reasonable position, the best option is to expose the impacted tooth and prepare it for movement into proper position. To expose the tooth, a surgeon creates a small, surgical opening or flap in the gum tissue closest to the crown of the tooth. Once gaining access, the surgeon then bonds a small bracket to the crown and attaches a small gold chain to it. The chain can then be looped over orthodontic hardware attached to adjacent teeth, which will pull the impacted tooth over time into the proper position. Although this may sound complicated, coaxing the impacted canine in this manner into a proper eruption is actually quite routine and predictable.
If at all possible, saving impacted upper canine teeth should be the primary treatment goal — extracting them could have an adverse effect on biting and chewing, as well as disrupting your appearance. If they must be removed, however, tooth replacement such as dental implants can help restore any lost form or function.
If you would like more information on impacted teeth, 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 “Exposing Impacted Canines.”
Chronic pain and reduced function of the jaw joints, muscles and other surrounding tissues is generally known as a temporo-mandibular joint disorder (TMJD or TMD). It’s also possible that sufferers of TMD may also experience chronic pain in other parts of the body.
TMD affects from 10 million to 36 million American adults, mostly women of childbearing age. Although the exact causes are still elusive, most researchers believe this family of conditions arises from a combination of gender, genetic, environmental and behavioral factors. This may also hold the key to its connection with other painful conditions in the body.
About two-thirds of patients with some form of chronic jaw pain or disability also suffer from three or more similar medical conditions, including fibromyalgia, chronic fatigue syndrome, rheumatoid arthritis, headaches or sleep disturbances. Investigating the connections between these conditions is a fertile area for developing treatment strategies that would benefit all of these associated conditions.
In the meantime, there are both thermal and surgical treatments for alleviating and managing pain associated with TMD. About 90% of TMD patients respond well to thermal treatments, including hot and cold compresses applied to the jaw area and hot baths. Surgical treatment, however, has a mixed result: some studies show only a third of those undergoing surgical procedures experience noticeable pain relief and restored function and nearly half indicate worse symptoms after the surgery.
The best approach is to begin with an examination by your primary physician or specialist to be sure you are not suffering from a medical condition mimicking the symptoms of TMD. If this should eventually lead to a diagnosis of TMD, you should first try thermal techniques with over-the-counter pain relievers to ease the symptoms. A diet with softer foods that don’t require strenuous chewing may also prove helpful.
If you receive a recommendation for extensive bite treatment or surgery, you should discuss this thoroughly with your dentist, or even seek a second opinion. Surgical treatments in particular are not reversible and the results may not be favorable.
For more information on TMD and networking opportunities with other patients, be sure to visit the TMJ Association (www.tmj.org) on the Web.
If you would like more information on chronic jaw pain, 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 “Chronic Jaw Pain and Associated Conditions.”
In dentistry (as well as other branches of medicine) pediatric conscious sedation is becoming more widespread than ever — but some people aren’t yet familiar with this beneficial therapy. Conscious sedation can remove anxiety and produce a feeling of calm and relaxation during dental treatment; however, unlike general anesthesia, it doesn’t cause the loss of consciousness. That means patients can still breathe normally and can respond to certain stimuli, while feelings of pain and anxiety are blocked.
Conscious sedation is often employed for invasive procedures such as tooth extractions or root canals — which cause some people a great deal of apprehension, no matter what their age. It can be especially useful for children, however, who may have a more limited ability to understand (and cooperate with) their dental treatment. Because the medications are commonly administered orally (by mouth), there’s no needle to provoke fear. And when it’s over, there is usually little or no memory of the procedure that was done.
Pediatric conscious sedation is typically administered in an office setting by a dentist with special qualifications. The American Dental Association, the American Academy of Pediatric Dentistry, and the American Academy of Pediatrics have jointly established criteria for its use. Specialized training and continuing education are part of the qualification process; additionally, the dental office must be equipped with advanced life-support equipment and trained staff, who can help in the unlikely case of an emergency.
While your child is receiving conscious sedation, he or she will be monitored by a designated staff member who keeps a close watch on vital signs like blood pressure, oxygen levels, pulse rate and respiration. This helps to ensure that the level of sedation remains safe, yet effective. When the procedure is over, the medications wear off quickly; however, children will certainly need a ride home, and shouldn’t return to school until the next day.
As new medications are developed, more dentists receive special training, and the cost of associated equipment becomes more reasonable, the practice of pediatric conscious sedation is becoming more widespread. For many kids, it could mean the difference between having fearful childhood memories of the dental office that linger on through life — and remembering almost nothing at all.
If your child has dental anxiety or requires invasive procedures, pediatric conscious sedation may be a good option for you to consider. For more information, call our office to arrange a consultation. You can learn more in the Dear Doctor magazine article “Sedation Dentistry for Kids.”
The proliferation of drugs to treat all manner of diseases and conditions has heightened concerns not only about general side effects, but also how a particular drug may affect treatments for other conditions. There are indications, for example, that drugs classified as blood thinners could cause complications for patients undergoing oral surgery.
Blood thinners like Warfarin are typically prescribed to patients with artificial heart valves or who are at significant risk for stroke, heart attack, or the formation of clots that could potentially damage the heart and lungs. The drug reduces the coagulation (clotting) mechanism in blood; aspirin taken regularly should also be considered a blood thinner.
As with any invasive procedure, blood thinners can complicate oral surgery. Blood doesn’t clot normally and so bleeding during a procedure is more difficult to stop. This doesn’t necessarily mean the surgery can’t be performed. For one thing, many oral procedures like tooth removal involve little trauma to tissues and bleeding in the hands of a careful and experienced surgeon. The surgeon can also use hemostatic agents during surgery that will stabilize blood clotting, as well as suturing the incision in such a way as to reduce bleeding from surface capillaries. In the case of a tooth extraction, a bone graft placed within the empty socket not only reduces bone loss from a missing tooth, but can also enhance bleeding control.
In consultation with your medical doctor, it’s also possible to temporarily stop or reduce your medication dosage in anticipation of a pending oral surgery. While it may not be safe to stop the drug altogether, a reduced dosage can ease the anti-coagulant effect and reduce any complications from bleeding that might occur during the surgery. You can then resume normal dosage soon after the procedure.
During your pre-op examination, it’s important to let your surgeon know about any drugs you are currently taking, including over-the-counter drugs like aspirin. The oral surgeon will then be able to take the necessary steps, including working with your medical doctor, to ensure your surgical procedure is safe and uneventful.
If you would like more information on oral surgery precautions while taking blood thinners and other medication, 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 “Oral Surgery & Blood Thinners.”
If you have certain health conditions, your medical doctor may prescribe an antibiotic for you to take prior to a dental visit. The reason why is a story that dates back to the mid-20th Century.
In the early part of the last century, a theory became popular that bacteria in the mouth could migrate to other parts of the body and cause systemic illness or disease. During the 1930s and 1940s evidence arose that indicated a connection between dental procedures that caused bleeding and two serious health conditions: bacteremia (the presence of bacteria in the bloodstream) and infective endocartitis. The latter is the inflammation of inner tissues of the heart (including the valves) caused by infectious agents, most notably bacteria. It became common then to prescribe antibiotics to patients susceptible to these conditions as a preventive measure. Later, patients with prosthetic joints or poor immune systems were added for this kind of treatment.
For many years, the American Heart Association (AHA) recommended pre-visit antibiotic treatment for a wide array of heart patients. After several years of research that indicated the treatment wasn't necessary for most people and might even be detrimental, they updated their guidelines in 2007 and reduced their recommendation list to just a few conditions. They now recommend the antibiotic treatment for patients with artificial heart valves, a history of infective endocartitis, heart transplant recipients with valve problems, and certain congenital (inherited) heart conditions.
If you have a condition that calls for a pre-visit antibiotic treatment, all the providers involved with your care will need to communicate. Your medical doctor will most likely prescribe two grams of amoxicillin (or a similar antibiotic if you are allergic to amoxicillin) that you would take an hour before the dental procedure. We in turn would communicate with your medical doctor concerning the dental procedures you're scheduled to undergo (including regular cleanings), in case your doctor would like to make adjustments in your medication.
Your health and well-being is of utmost importance to all your healthcare providers, medical and dental. Working together, we can ensure the dental procedures you need for oral health won't have an adverse impact your general health.
If you would like more information on antibiotic treatment before a dental visit, 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 “Antibiotics for Dental Visits.”
When most people think of orthodontic treatment, they may think of braces worn during the teenage years. But there are some types of malocclusions (bad bites) that may benefit from intervention much earlier than adolescence. A cross-bite is one example.
A cross-bite occurs when the front teeth of the lower arch bite in front of the upper teeth rather than behind them. The condition can have an adverse effect on any of the six front teeth of either arch. This type of malocclusion can develop quite early in childhood.
Orthodontists have developed a two-phase treatment for a cross-bite, with the possibility that the first phase may be all that’s needed. If your child has a cross-bite, your orthodontist may first recommend he or she wear a specially-designed retainer for a few months. The retainer could stop and correct an existing problem before it becomes worse, or it could prevent a deeper problem from developing in the first place. The retainer could also help guide jawbone development during these formative years, even as early as age 7, for children at risk.
Even if this first phase doesn’t fully correct the cross-bite and the second phase (most likely braces or a similar orthodontic device) becomes necessary, it could still help to make the second phase easier and less costly. On the other hand, if orthodontic treatment is postponed until adolescence when the mouth structures are more fully formed it may become quite difficult or even impossible to correct the problems that have developed.
As a result, early intervention for this or similar orthodontic conditions is the most efficient strategy, even when later treatment is necessary. As part of your child’s regular dental care (which should begin ideally around their first birthday), we can advise you on any need for an orthodontic evaluation based on our observations. An orthodontist can then best advise whether waiting until later for treatment is best, or whether intervention now could lessen problems later.
If you would like more information on preventative orthodontics, 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 “Preventative & Cost Saving Orthodontics.”
Do you have gum disease? According to the U.S. Centers for Disease Control, about half of the adults in America have a mild, moderate or severe form of this disease. But if you’re 65 or older, your chance of having it goes up to 70 percent! Periodontal (gum) disease is sometimes called a “silent malady” because major symptoms may not appear until it has reached an advanced stage. How can you recognize the early warning signs? Here are some clues to look for:
Gum disease is a widespread problem — but it’s also very treatable. If you would like more information, call our office to arrange a consultation. You can learn more in the Dear Doctor magazine articles “Warning Signs of Periodontal (Gum) Disease” and “Understanding Gum (Periodontal) Disease.”