Dr Hardeep Bhatta & Dr Allen Friesen
Suite 205 - 1465 Salisbury Ave
Port Coquitlam, BC V3B6J3
You may think the structures of your face and mouth stop growing when you reach adulthood. That's not true: your skeletal structure, facial features and soft tissues continue to change all through your life, even into old age. In fact, there's as much change from ages 25 to 42 as there is from ages 18 to 25. This fact of continuous growth and change affects the approaches we may take to satisfy your oral and dental needs.
We should especially consider facial changes due to aging as a factor when planning orthodontic treatment. For example, as we age the profile of our face will tend to flatten, which makes our nose become more prominent (and, yes, our noses continue to grow longer as we grow older). A good plan will take advantage of this, especially during expected growth spurts such as right before puberty. As the position of the patient's bite improves through treatment, the continuing growth of their facial profile will continue to bring the angle of the jaw into a more aesthetic position.
Likewise, where there are multiple issues with the mouth and face, orthodontics can be employed with other treatments such as rhinoplasty, the surgical improvement to the shape of the nose, or orthognathic surgery, procedures that correct problems associated with the position and structure of the lower jaw. As we employee these techniques, we keep in mind that the mouth and face are essentially a “moving target” — that is, they will continue to move in the direction of change due to aging. We coordinate the outcomes of treatment to eventually meet up with that eventual growth.
Armed with an understanding of how change occurs during aging, we can coordinate these procedures into a well-timed strategy that actually takes advantage of the aging process. The end result is a more favorable aesthetic appearance for the long-term.
If you would like more information on how aging can affect your dental health and treatment options, 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 “Understanding Aging Makes Beauty Timeless.”
Diabetes and periodontal (gum) disease are two types of inflammatory conditions that have more in common than was once thought. There is strong evidence to show that each of these diseases is a risk factor for the development and growth of the other. Studies have also found that treating one condition successfully may have a positive impact on the treatment of the other.
From the Greek meaning “to pass through the urine,” diabetes mellitus causes an abnormal rise in blood glucose level that can't be adequately controlled by insulin, the body's primary hormone for that task. Either the pancreas can't produce an adequate supply of insulin (as with Type 1 diabetes) or there is resistance to the hormone's effects (as with Type 2 and gestational/pregnancy diabetes). If you are a diabetic patient, you face many difficult issues with your health: your body develops an altered response to inflammation that may severely inhibit wound healing. You also may become more prone to chronic cardiovascular disease.
Periodontal (gum) disease describes a group of diseases caused by dental plaque, a whitish film that contains infection-causing bacteria. As infection rises within the gum tissues, the auto-immune system of the body responds to this threat and inflammation results. If the person is also a diabetic, this response may be impaired and may have a direct effect on how severe the periodontal disease progresses.
Periodontal disease can also affect your blood glucose level, if you are a diabetic. A number of studies have demonstrated that diabetic patients who have improved control of their periodontal disease through better oral hygiene and dental treatments have shown improvement in their blood sugar levels. There's even some evidence that effective periodontal treatment that reduces inflammation may improve the body's sensitivity to insulin. Likewise, bringing diabetes under control with supplemental insulin or positive lifestyle changes can help lessen the likelihood and severity of periodontal disease.
To sum it up, if you have been diagnosed with some form of diabetes, taking care of your teeth and gum tissues can have a positive impact on your diabetes. Likewise, making healthy changes in your lifestyle to bring your diabetes under control can reduce your risk for periodontal disease.
If you would like more information about periodontal disease and its effect along with diabetes, 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 “Diabetes and Periodontal Disease.”
One of the top concerns in healthcare is the interactions and side effects of medications. Drugs taken for separate conditions can interact with each other or have an effect on some other aspect of health. It's important then that all your health providers know the various medications you are taking, along with other lifestyle habits. That includes your dental team.
Calcium channel blockers (CCBs) are one type of medication that can have an effect on your oral health. CCBs are used primarily to control hypertension (high blood pressure), and to treat other cardiovascular conditions like angina or abnormal heart rhythm. They work by dilating blood vessels, which makes it easier for the heart to pump.
CCBs are now recognized as a contributing factor in the development of a condition known as gingival hyperplasia in which the gum tissues “overgrow,” extending in some cases abnormally over the teeth. This abnormal growth can be painful and uncomfortable, and can make oral hygiene more difficult to perform. The overgrowth of tissue can also be socially embarrassing.
There's also a secondary factor that can increase the risk for tissue overgrowth in patients taking a CCB — poor oral hygiene. In the absence of a good hygiene routine, a layer of bacterial plaque known as biofilm can build up on tooth surfaces and lead to various forms of gum disease, including hyperplasia. The overgrown tissue contributes in turn to this disease process by inhibiting effective oral hygiene.
If you've already developed gingival hyperplasia or some other form of gum disease, it's important for you to receive periodontal treatment for the disease as soon as possible. Once we have the condition under control, it's then a matter of regular dental checkups and cleanings to reduce the risk of disease, including gingival hyperplasia. We can also help you develop effective hygiene practices that inhibit this condition while you are taking a CCB.
If you would like more information on the effects of medication on 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 “Blood Pressure Medications.”
That “squeaky clean” feeling on your teeth might be the most noticeable result of a professional cleaning performed by a dental hygienist. Rest assured, though, there's more to it — regular professional cleanings yield long-term benefits to your oral health.
A basic procedure known as coronal cleaning removes plaque (bacteria and leftover food deposits) on the crowns, the visible portion of the teeth. If you are showing signs or are at risk for gum disease (a bacterial infection of the gum tissue) your hygienist may also initiate cleaning below the gum line with a procedure called scaling. This common technique removes plaque and tartar (hard deposits) above and below the gum line using either a traditional set of hand instruments (known as curettes) or an ultrasonic scaler, a device that uses vibrations from ultrasonic frequencies and water to remove plaque and tartar.
Root planing takes the cleaning even deeper, using curettes to remove plaque and tartar adhering to tooth roots. This is typically necessary for patients with advanced gum disease, and may need to be repeated over a number of visits as inflammation subsides.
Polishing is another common hygienic procedure performed both above and below the gum line. It's the procedure you most associate with that feeling of smoothness after a cleaning. The hygienist will typically apply to the teeth polishing paste held in a small rubber cup attached to a motorized device. As the motor rapidly rotates the rubber cup, the paste works into the teeth to remove surface stains and bacterial plaque. While it's considered a cosmetic procedure, it's more accurately defined as a prophylaxis, a dental term derived from the Greek meaning to guard or prevent beforehand.
Professional cleaning performed by a dental hygienist is only one half of an overall hygiene plan; the other half is your own daily habit of brushing and flossing. Both your daily hygiene and regular dental checkups and cleanings will go a long way toward preserving your teeth as they were meant to be — for a lifetime.
If you would like more information on teeth polishing, 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 “Teeth Polishing.”
Sports drinks have grown in popularity since University of Florida football trainers developed Gatorade® in the 1960s. They're widely viewed as a convenient fluid and nutrient replacement after strenuous workouts. Recently, another beverage has become wildly popular — the energy drink, whose high caffeine promises heightened concentration and physical ability.
While energy drinks have raised health concerns, sports drinks are widely regarded as safe. Both kinds of drinks, however, may be a cause for concern when it comes to your dental health.
While both are substantively different, they do have one thing in common — both beverages contain high levels of citric and other acids to improve taste and shelf life. This high acidity can have a detrimental effect on tooth enamel.
When the mouth becomes too acidic after eating or drinking (4 or lower on the pH scale), the tooth's outer protective enamel begins to erode, a process known as demineralization. Saliva with its neutral pH of 7 can neutralize this over-acidity in about thirty minutes to an hour after eating and the enamel will actually begin to remineralize. But when there's an overabundance of acid, as with these beverages, saliva's neutralizing ability becomes inhibited. The mouth remains too acidic for a longer period, resulting in greater erosion of the enamel.
Generally speaking, we don't recommend energy drinks at all. If, however, you occasionally take in a sports drink, add the following precautions, if possible: combine the drink with a mealtime and rinse your mouth with pH-neutral water to wash away residual acid from the sports drink; and wait an hour before brushing your teeth — since some demineralization occurs before saliva neutralizes the acid, you could brush away some of the softened enamel before it can remineralize.
Finally, consider this: pure, clean water is still the best hydrator in the world. Replenishing your fluids with it after exercise might also be the better choice for your dental health.
If you would like more information on the effects of sports and energy drinks on 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 “Think Before you Drink.”
Taking care of your teeth is a lifetime commitment, if you want your teeth to last a lifetime. But it can be especially challenging if you're wearing traditional metal braces. With a little extra attention, though, you can reduce the risk of dental disease during orthodontic treatment.
The goal of oral hygiene is to remove biofilm, a layer of leftover food particles called plaque that is a haven for disease-causing bacteria. Orthodontic braces make access more difficult for performing oral hygiene. A little extra effort and attention, though, can make a big difference.
First, be sure you're eating a healthy diet and avoiding unhealthy snacks (especially those high in carbohydrates) between meals; this will discourage the growth of bacteria in the mouth. You should also limit your intake of sodas, sports or energy drinks since their high acidity contributes to tooth enamel erosion.
Although more difficult for someone wearing braces, brushing is still essential to good hygiene. Begin by holding a soft, multi-tufted bristle brush at a 45-degree angle, and then brush the surface area between the gum and the braces all the way around. Return to your starting point and brush the area from the braces to the edge of the top of the teeth in the same direction. Be sure you do this for both the upper and lower jaw and on both the cheek and tongue side.
Flossing is also more difficult, but not impossible. Instead of conventional floss thread, you can use special floss threaders, small interdential brushes, or an irrigation device that sprays pressurized water to remove food particles between teeth.
Above all, it's important to keep up regular office visits with us. In addition to monitoring overall dental health, we can also apply or recommend additional fluoride products to help strengthen teeth or prescribe antibacterial rinses to reduce the mouth's bacterial level.
Keeping up a good daily hygiene regimen and regular checkups will ensure that the smile you gain from wearing braces is healthy as well as beautiful.
If you would like more information on oral hygiene while undergoing orthodontic 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 “Caring for Teeth During Orthodontic Treatment.”
One of the most common parental concerns is the habit of many children, even late into childhood, to suck their thumbs or fingers. Many parents have asked us, “Could this affect their teeth?”
The answer, unfortunately, is yes — thumb sucking can contribute to a malocclusion (bad bite) that could eventually require orthodontic treatment. Before making any assumptions, however, we need to understand the bigger picture.
To begin with, infants have a different swallowing mechanism than adults and older children. When you as an adult swallow, you'll notice the tip of your tongue positions itself just above the back of the top front teeth. An infant, however, will thrust their tongue between their upper and lower jaw as they swallow (also known as an infantile swallowing pattern or primary tongue thrust). The infant normally begins changing to an adult swallowing pattern when their primary (baby) teeth begin to erupt.
However, if a child's swallowing transition is slower than normal and the tongue rests between the jaws for a longer duration, it can inhibit the full eruption of teeth, believed to be the main cause of an open bite (a gap between the upper and lower teeth when the jaws are shut). The thumb during sucking resting between the teeth can have the same effect.
Thumb sucking may not necessarily lead to a malocclusion — for example, an abnormally developing jawbone could be the culprit. If prolonged thumb sucking does become a concern, however, there are steps we can take to reduce the impact of the habit. We can install a thin metal “tongue crib” behind the upper and lower incisors that will not only discourage thumb sucking, but also help retrain the tongue not to rest between the upper and lower teeth. There are also exercise routines known as orofacial myofunctional therapy (OMT) that can retrain specific muscles in the mouth to encourage more normal chewing and swallowing patterns.
These steps may not prevent future orthodontic treatment, but they could reduce its extent. The key is regular dental checkups and consultation to ensure your child's teeth and bite are developing normally.
If you would like more information on the effects of chronic thumb sucking on the mouth, 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 “How Thumb Sucking Affects the Bite.”
In the early 1900s, a Colorado dentist noticed many of his patients had unusual brown staining on their teeth — and little to no tooth decay. What he unknowingly observed was the power of a chemical substance in his patients' drinking water — fluoride. While commonplace today, fluoride sparked a revolution — and some controversy — in dental care during the 20th Century.
After decades of research and testing, most dentists now agree that fluoride reduces decay by interfering with the disease process. The optimum pH level for the mouth is neutral; however, this environment constantly changes as we eat, especially if we ingest foods or beverages high in acidity. A high acid level softens tooth enamel (a process called de-mineralization) and can lead to erosion if not neutralized. In addition, a thin layer of bacteria-rich plaque called biofilm that adheres to tooth surfaces is also acidic and is the cause of tooth decay, possibly more so in teeth made more susceptible from enamel erosion.
When fluoride is in “the right place” (present on the tooth surface and in our saliva, the body's natural acid neutralizer), it helps inhibit de-mineralization and aids in the re-hardening of the enamel (re-mineralization).
Although fluoride needs to come into direct contact with tooth enamel for optimum effectiveness, ingesting it can also prove beneficial. The fluoride we ingest eventually becomes deposited in bone. As bone grows and changes it releases this reserved fluoride back into the bloodstream where it eventually becomes part of saliva; the saliva brings it into contact with tooth surfaces.
The two most prominent ways we encounter fluoride are through fluoridated drinking water and in toothpaste. There continues to be concerns about what constitutes safe levels of fluoride in drinking water and over possible side effects like teeth staining and changes in bone structure. However, extensive studies have conclusively shown that even minimal levels of water fluoridation and the use of fluoride toothpaste have reduced tooth decay.
As the Colorado dentist discovered over a hundred years ago, fluoride is truly remarkable as a cavity fighter. Whether you have access to fluoridated water or not, we encourage you to use fluoride toothpaste to strengthen your teeth against decay.
If you would like more information on fluoride, 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 “Fluoride & Fluoridation in Dentistry.”