Dr Hardeep Bhatta & Dr Allen Friesen
Suite 205 - 1465 Salisbury Ave
Port Coquitlam, BC V3B6J3
Periodontal (gum) disease is an infectious disease that progressively weakens the attachment of supporting tissues to the teeth, including gums, ligaments and bone. If not stopped, the loss of attachment will eventually lead to bone and tooth loss.
A thin layer of plaque that builds up on teeth (mainly due to poor oral hygiene habits) is the main breeding ground for the bacteria that cause gum disease. Our main treatment goal is to remove as much of this plaque as possible from tooth and gum surfaces. Much of the plaque can be removed using special hand or ultrasonic instruments that deep clean dental surfaces, including the roots. But while effective, these manual techniques may not address the full extent of infection, especially if the disease is well advanced.
If severe bone loss has already occurred, deep pockets of infection may have developed. As bone loss progresses, teeth with multiple roots may also develop an anatomical problem known as furcation invasions where the roots of the tooth branch off. If there continues to be signs of disease, like gum inflammation, bleeding or pus formation, it’s these hard to reach areas that may still be a problem even after extensive treatment. If so, we may need to take a different approach with antimicrobial or antibiotic products.
The most effective antimicrobial substance for reducing bacteria in biofilm is a chlorhexidine mouthrinse. The typical 0.12% solution is only available by prescription — if taken for a prolonged time it can result in tooth staining, affected taste or mouth irritation. To assure the solution reaches below the gum line, it will need to be applied by us in the office, followed up flushing irrigation of the affected area.
Another alternative is topically applied antibiotics that can stop or even reverse the progression of gum disease. There’s evidence that topical applications can penetrate into these deeper areas of infection. A common antibiotic used in this way is tetracycline, which has been shown to stop inflammation and infection.
These treatments don’t eliminate the need for mechanical cleaning, and the prolonged use of antibacterial products can have a detrimental effect on “good” bacteria (needed, for example, to complete the digestive process). It will depend on the extent of the gum disease to determine how successful conservative treatment may be. It’s also important that you contribute to your own dental health with a renewed daily oral hygiene habit.
If you would like more information on treatments for gum disease, 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 “Treating Difficult Areas of Periodontal Disease.”
Look around and you’ll find warning labels on lots of household items: alcoholic beverages, drain uncloggers, pesticides and pool toys (not to mention cigarettes and chainsaws). Now, California lawmakers are proposing to add one more item to the list: sugary soft drinks. A bill to that effect recently passed the California state Senate, and is presently headed to the Assembly. If approved by both houses and signed by the governor, it would require sugary beverages to carry a warning label.
The proposed label would read: “STATE OF CALIFORNIA SAFETY WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay.” It would appear on drink packaging and vending machines. While some may feel it’s an infringement on personal choice, recent polling seems to show that the tide of public opinion may have turned toward recognizing the potential health dangers of sugary drinks.
How real are those dangers? The medical groups sponsoring the bill (including the California Medical Association) point to numerous scientific studies showing, among other things, that:
No matter where you stand on the debate over warning labels, you should understand the potential dangers of consuming foods and beverages with added sugar. For years, dentists have been cautioning people to limit their intake of sugary treats, including sodas and other sweets. Initially, our warnings came from the standpoint of oral health. Now, we have evidence that many other health problems have the same cause. We want to share this information with you because we’re concerned about your overall health — not just your oral health. You can learn more by reading the Dear Doctor magazine article “Think Before You Drink.”
Have you heard the news about red wine? Every so often, the fruit of the vine is touted for some potential health benefit. Several studies over the past few years have suggested that it could help prevent heart disease and even certain types of cancer — only to have their conclusions called into question by new research. Just recently, newspapers trumpeted a new study from the Journal of Agriculture and Food Chemistry suggesting that certain chemicals in the vino might one day be used to help prevent cavities!
So is red wine good for your health, or isn’t it?
The jury’s still out. But there’s one thing we do know: Regardless of whether it has any affect on cavities, red wine is one of the major culprits in tooth staining.
Of course, it’s not the only offender: Coffee and tea, tobacco in any form, certain foods and some types of medications can all cause extrinsic stains on teeth — that is, stains that affect the exterior surface of the tooth. In addition, intrinsic stainsā??those that arise from the interior of the tooth — may be caused by root canal problems, or by certain dental filling materials.
If you have stained teeth — whether from red wine or another cause — can you do anything to make them whiter?
Oftentimes, the answer is yes — but finding the best way to do so can be challenging. You can begin by identifying habits and dietary factors that could cause staining. Then, reduce or eliminate the stain-causing factors, and enhance the beneficial ones. For example: stop smoking, modify your diet, practice regular, effective oral hygiene… and come in to the dental office twice a year for a professional cleaning and check-up. In addition, check whether any of your medications could cause staining or reduced saliva flow — a major contributor to the problem.
If making these changes isn’t enough to control teeth staining, the good news is that a number of treatments are available that can help bring your teeth back to a pearly shine — or even give you the “Hollywood white” smile you’ve always wished for. Depending on the cause of your teeth staining, and your desired level of brightening, these treatments can range from professional bleaching to porcelain veneers.
If your smile needs a little help to look its brightest, contact us or schedule an appointment to find out what we can do. For more information, see the Dear Doctor magazine articles “Tooth Staining” and “Important Teeth Whitening Questions Answered.”
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.”