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Spruce Ridge Dental Blog

Porcelain Crowns

February 28, 2020

Filed under: Uncategorized — Spruce Ridge Dental @ 3:59 am

Crowns are a cosmetic restoration used to strengthen a tooth or improve its shape and colour. They are most often used for teeth that are broken, worn, have had a root canal or partially destroyed by tooth decay.

crowns

These restorations are “cemented” onto an existing tooth and fully cover the portion of your tooth above the gum line. In effect, the crown becomes your tooth’s new outer surface. They help to strengthen and reinforce your teeth.  Crowns can be made of porcelain, metal, or both. Porcelain crowns are most often preferred because they mimic the translucency of natural teeth and are very strong.

How are crowns made?

They are done in two appointments.  The first appointment the tooth is prepared for the restoration and an impression is taken and sent off to the lab.  A temporary crown will be made to protect your tooth in the mean time.  A colour shade will be chosen to make the crown match with your your other teeth.

The second appointment is very easy and quick.  The temporary crown will be removed and the real crown will be bonded on.

Two easy appointments and your tooth will be stronger from the protection of the crown and your smile will be restored back to its natural look and function!

crowns

Crowns or onlays (partial crowns) are needed when there is insufficient tooth strength remaining to hold a filling. Unlike fillings which apply the restorative material directly into your mouth, a crown is fabricated away from your mouth. Your crown is created in a lab from your unique tooth impression which allows a dental laboratory technician to examine all aspects of your bite and jaw movements. Your crown is then sculpted just for you so that your bite and jaw movements function normally once the crown is placed.

Braces

Filed under: Uncategorized — Spruce Ridge Dental @ 2:13 am

Dental braces are a device used in orthodontics to correct alignment of teeth and their position with regard to bite. Braces are often used to correct malocclusions such as underbites, overbites, cross bites and open bites, or crooked teeth and various other flaws of teeth and jaws, whether cosmetic or structural. Orthodontic braces are often used in conjunction with other orthodontic appliances to widen the palate or jaws, create spaces between teeth, or otherwise shape the teeth and jaws. Most orthodontic patients are children or teenagers; however, recently, more adults have been seeking orthodontic treatment.



How braces work

Teeth move through the use of force. The force applied by the archwire pushes the tooth in a particular direction and a stress is created within the periodontal ligament. The modification of the periodontal blood supply determines a biological response which leads to bone remodelling, where bone is created on one side by osteoblast cells and resorbed on the other side by osteoclasts.

Two different kinds of bone resorption are possible. Direct resorption, starting from the lining cells of the alveolar bone, and indirect or retrograde resorption, where osteoclasts start their activity in the neighbour bone marrow. Indirect resorption takes place when the periodontal ligament has become accellular (necrosis or hyalinization), for an excessive amount and duration of compressive stress. In this case the quantity of bone resorbed is larger than the quantity of newly formed bone (negative balance). Bone resorption only occurs in the compressed periodontal ligament. Another important phenomenon associated with tooth movement is bone deposition. Bone deposition occurs in the distracted periodontal ligament. Without bone deposition, the tooth will loosen and voids will occur distal to the direction of tooth movement.

A tooth will usually move about a millimeter per month during orthodontic movement, but there is high individual variability. Orthodontic mechanics can vary in efficiency, thus explaining a wide range of response to orthodontic treatment.

braces


Procedure

Orthodontic services may be provided by any licensed dentist trained in orthodontics. In North America most orthodontic treatment is done by orthodontists, dentists specializing in diagnosis and treatment of malocclusions—malalignments of the teeth, jaws, or both. A dentist must complete 2–3 years of additional post-doctoral training to earn a specialty certificate in orthodontics. There are many general practitioners who also provide orthodontic services.

The first step is to determine if braces are suitable for the patient. The doctor consults with the patient and inspects the teeth visually. If braces are appropriate, a records appointment is set up where X-rays, moulds, and impressions are made. These records are analyzed to determine the problems and proper course of action. Typical treatment times vary from six months to six years depending on the complexity and types of problems. Orthognathic surgery may be required in extreme cases.

Teeth to be braced will have an etchant applied to help the cement bond to the surface of the tooth. A bracket will be applied with dental cement, and then cured with light until hardened. This process usually takes a few seconds per tooth. If required, orthodontic spacers may be inserted between the molars to make room for molar bands to be placed at a later date. Molar bands are required to ensure brackets will stick. Bands are also utilized when dental fillings or other dental work make securing a bracket to a tooth unfeasible.
An archwire will be threaded between the brackets and affixed with elastic or metal ligatures. Archwires in the past had to be bent, shaped, and tightened frequently to achieve the desired results. Modern orthodontics makes frequent use of nickel-titanium archwires and temperature-sensitive materials. When cold, the archwire is limp and flexible, easily threaded between brackets of any configuration. Once heated to body temperature, the archwire will stiffen and seek to retain its shape, creating constant light force on the teeth.

Elastics are used to close open bites, shift the midline, or create a stronger force to pull teeth or jaws in the desired direction. Brackets with hooks can be placed, or hooks can be created and affixed to the archwire to affix the elastic to. The placement and configuration of the elastics will depend on the course of treatment and the individual patient. Elastics are made in different diameters, sizes, and strengths.

In many cases there is insufficient space in the mouth for all the teeth to fit properly. There are two main procedures to make room in these cases. One is extraction: teeth are removed to create more space. The second is expansion: the palate or arch is made larger by using an expander. Expanders can be used with both children and adults. Since the bones of adults are already fused, expanding the palate is not possible without surgery to unfuse them. An expander can be used on an adult without surgery, but to expand the dental arch, and not the palate.
For some patients, Invisalign might be a viable alternative to braces. The Invisalign system uses a series of clear plastic trays to move teeth into their position over a length of time. This system is not recommended for more difficult cases, or for people whose last molars have yet to erupt. However, one of the disadvantages of Invisalign is that it usually requires a longer treatment time, especially because the appliance is removable, whereas conventional braces are always working because they are fixed to the patient’s teeth. This usually allows for a faster treatment because the patient is not tempted to remove the appliance, as they may be with Invisalign.

Patients may need post-orthodontic surgery, such as a fiberotomy or alternatively a gum lift, to prepare their teeth for retainer use and improve the gum line contours after the braces come off.

Each month or so the braces must be tightened. This helps shift the teeth, into the correct position. When they get tightened the orthodontist takes off the colors, and the wire is very loose. The patient gets to choose color, and then the orthodontist tightens them. This may cause some discomfort, which is normal.

Post-treatment
In order to avoid the teeth moving back to their original position, retainers may be worn once treatment with braces is complete.

Even before getting braces some people receive spacers or separators. These go on the top and bottom back molars. Patients will wear them until their banding appointment. Spacers are small blue elastics placed between your molars. They will make space for the metal molar bands that will be fitted to the patient’s mouth when the wires are added.

Surgery can also follow treatment with braces.

Some patients find braces can be discomforting in the mouth, which can affect the post-treatment of patients with braces.

braces

Retainers

Retainers are required to be worn once treatment with braces is complete. The orthodontist will recommend a retainer based on the patient’s needs. If a patient does not wear the retainer as recommended, the teeth might move towards their original position (relapse).

A Hawley retainer is made of metal hooks that surround the teeth and are enclosed by an acrylic plate shaped to fit the patient’s palate. An Essex retainer is similar to Invisalign trays. It is a clear plastic tray form-fitted to the teeth and stays in place by suction. A bonded retainer is a wire permanently bonded to the lingual side of the teeth (usually the lower teeth only).

Pre-finisher
If a person’s teeth are not ready for a proper retainer, the orthodontist may prescribe the use of a pre-finisher. This rubber appliance similar to a mouth guard fixes gaps between the teeth, small spaces between the upper and lower jaw, and other minor problems that could worsen. These problems are small matters that dental braces cannot fix.

The pre-finisher is molded to the patient’s teeth by use of severe pressure to the appliance by the person’s jaw. The pre-finisher is then worn for the prescribed time, with the user applying force to the pre-finisher in their mouth for ten to fifteen seconds at a time. The goal is increasing the “exercise” time; time spent applying force to the appliance. Like the retainer, the pre-finisher is not a permanent addition to one’s mouth, and can be moved in and out of the mouth.

Surgery

Example of prognathism, where teeth have almost reached their final, straight position by braces. This makes the prognathism more obvious, and it will take a surgery, moving the jaw backwards, to give the ultimate result.

Orthognathic surgery

Orthognathic surgery is surgery to correct conditions of the jaw and face, including after treatment with braces. For instance, the origin of uneven teeth can actually be an uneven growth of the jaws. Then, the teeth must first be properly positioned with braces, creating an obvious prognathism or retrognathism. It is this condition that orthognathic surgery finally fixes.

Complications and risks
Plaque forms easily when food is retained in and around braces. It is important to maintain proper oral hygiene by brushing and flossing thoroughly when wearing braces to prevent tooth decay, decalcification, or unpleasant color changes to the teeth.

There is a small chance of allergic reaction to the latex rubber in elastics or to the metal used in braces. In rare cases it results Ulcerative Colitis. Latex-free elastics and alternative metals can be used instead. It is important for those who believe that they are allergic to their braces to notify the orthodontist immediately.

Mouth sores may be triggered by irritation from components of the braces. Many products can increase comfort, including oral rinses, dental wax or dental silicone, and products to help heal sores.

Braces can also be damaged if proper care is not taken. It is important to wear a mouth guard to prevent breakage and/or mouth injury when playing sports. Chewing gum and certain sticky or hard foods, such as raw carrots, large hard pretzels, and toffee should be avoided because they can damage braces. Frequent damage to braces can prolong treatment.

In the course of treatment orthodontic brackets may pop off due to the forces involved, or due to cement weakening over time. The orthodontist should be contacted immediately for advice if this occurs. In most cases the bracket is replaced.

When teeth move, the end of the arch wire may become displaced, causing it to poke the back of the patient’s cheek. Dental wax can be applied to cushion the protruding wire. The orthodontist must be called immediately to have it clipped, or a painful mouth ulcer may form. If the wire is causing severe pain, it may be necessary to carefully bend the edge of the wire in with a spoon or other piece of equipment (i.e. tweezers) until the wire can be clipped by an orthodontist.

Patients with periodontal disease usually must obtain periodontal treatment before getting braces. A deep cleaning is performed, and further treatment may be required before beginning orthodontic treatment. Bone loss due to periodontal disease may lead to tooth loss during treatment.

In some cases, teeth may be loose for a prolonged period of time. One may be able to wiggle one’s teeth for a year or two after treatment or longer.

The dental displacement obtained with the orthodontic appliance determines in most cases some degree of root resorption. Only in a few cases is this side effect large enough to be considered real clinical damage to the tooth. In rare cases, the teeth may fall out or have to be extracted due to root resorption.

Pain is common after adjustment and may cause difficulty eating for a time, often several days. During this period, eating soft foods can help avoid additional pressure on teeth.

The metallic look may not be desirable to some people, although transparent varieties are available. However, transparent braces usually do not work as well as metallic ones. Transparent braces can also become undesirably stained or discolored by eating or drinking foods with dye in them.

Root Canal

February 27, 2020

Filed under: Uncategorized — Spruce Ridge Dental @ 3:54 pm

Root canal treatment is the process of going inside the pulp space and removing the infected, dead tissue. The space is then disinfected and sealed with special materials. Nowadays, root canal treatments are performed with advanced techniques and materials, making them far more comfortable and faster. After root canal treatment is complete, your restorative dentist will usually place a crown on your tooth to safeguard against fracture.

Root canal

Every tooth consists of three different layers. The outermost and hardest layer is enamel, and the second layer is dentin. The third is pulp, which is the cavernous space where the live tissue and nerve of each tooth is located.

If for any reason the pulp space is exposed to the outside, the tissue becomes contaminated and eventually infected. The exposure of pulp happens in many circumstances, such as when you have a large cavity or a fractured tooth. Your dentist can explain the exact reason for damage to this tissue. In these cases, the treatment is usually root canal treatment.

A root canal allows you to save a tooth that would otherwise need to be extracted.  It is usually done in one appointment, however, it can sometimes require two visits.  You are given freezing so that you are completely comfortable.  A drape or rubber dam is placed over your tooth to protect your checks and tongue and improve isolation of your tooth.  The nerve is removed from inside the tooth and a filling material is placed to seal your tooth.  Often a crown is needed after a root canal to protect and strengthen your tooth to prevent a fracture and lost of the tooth.

Gum Disease

February 25, 2020

Filed under: Uncategorized — Spruce Ridge Dental @ 11:12 pm

Gum disease may refer to:

  • Gingivitis
  • Periodontitis

Gingivitis (inflammation of the gums) (gingiva) around the teeth is a general term for gingival diseases affecting the gums. As generally used, the term gingivitis refers to gingival inflammation induced by bacterial plaque adherent to tooth surfaces.

gum disease

Causes
Gingivitis is usually caused by bacterial plaque that accumulates in the spaces between the gums and the teeth and in calculus (tartar) that forms on the teeth. These accumulations may be tiny, even microscopic, but the bacteria in them produce foreign chemicals and toxins that cause inflammation of the gums around the teeth. This inflammation can, over the years, cause deep pockets between the teeth and gums and loss of bone around teeth otherwise known as periodontitis.

People with a healthy periodontium (gums, bone and ligament) or people with gingivitis only require periodontal debridement every 3-4 months. However, many dental professionals only recommend periodontal debridement (cleanings) every 3-4 months, because this has been the standard advice for decades, and because the benefits of regular periodontal debridement (cleanings) are too subtle for many patients to notice without regular education from the dental hygienist or dentist. If the inflammation in the gums becomes especially well-developed, it can invade the gums and allow tiny amounts of bacteria and bacterial toxins to enter the bloodstream. The patient may not be able to notice this, but studies suggest this can result in a generalized increase in inflammation in the body cause possible long term heart problems. Periodontitis has also been linked to diabetes, arteriosclerosis, osteoporosis, pancreatic cancer and pre-term low birth weight babies.

When the teeth are not cleaned properly by regular brushing and flossing, bacterial plaque accumulates, and becomes mineralized by calcium and other minerals in the saliva transforming it into a hard material called calculus (tartar) which harbors bacteria and irritates the gingiva (gums). Also, as the bacterial plaque biofilm becomes thicker this creates an anoxygenic environment which allows more pathogenic bacteria to flourish and release toxins and cause gingival inflammation. Alternatively, excessive injury to the gums caused by very vigorous brushing may lead to recession, inflammation and infection. Pregnancy, uncontrolled diabetes mellitus and the onset of puberty increase the risk of gingivitis, due to hormonal changes that may increase the susceptibility of the gums or alter the composition of the dentogingival microflora. The risk of gingivitis is increased by misaligned teeth, the rough edges of fillings, and ill-fitting or unclean dentures, bridges, and crowns. This is due to their plaque retentive properties. The drug phenytoin, birth control pills, and ingestion of heavy metals such as lead and bismuth may also cause gingivitis.

gum disease

The sudden onset of gingivitis in a normal, healthy person should be considered an alert to the possibility of an underlying viral aetiology, although most systemically healthy individuals have gingivitis in some area of their mouth, usually due to inadequate brushing and flossing.

Symptoms
The symptoms of gingivitis are as follows:

  • Swollen gums
  • Mouth sores
  • Bright-red, or purple gums
  • Shiny gums
  • Gums that are painless, except when pressure is applied
  • Gums that bleed easily, even with gentle brushing, and especially when flossing.
  • Gums that itch with varying degrees of severity
  • Receding gum line

Prevention
Gingivitis can be prevented through regular oral hygiene that includes daily brushing and flossing. Rigorous plaque control programmes along with periodontal scaling and curettage also have proved to be helpful.

Diagnosis
It is recommended that a dental hygienist or dentist be seen after the signs of gingivitis appear. A dental hygienist or dentist will check for the symptoms of gingivitis, and may also examine the amount of plaque in the oral cavity. A dental hygienist or dentist should also test for periodontitis using X-rays or gingival probing as well as other methods.

gum disease

Treatment
A dentist or dental hygienist will perform a thorough cleaning of the teeth and gums; following this, persistent oral hygiene is necessary. The removal of plaque is usually not painful, and the inflammation of the gums should be gone between one and two weeks. A gargling of brine water also helps. Oral hygiene including proper brushing and flossing is required to prevent the recurrence of gingivitis. Anti-bacterial rinses or mouthwash, in particular chlorhexidine digluconate 0.2% solution, may reduce the swelling and local mouth gels which are usually antiseptic and anaesthetic can also help.

Complications:

  • Recurrence of gingivitis
  • Periodontitis
  • Infection or abscess of the gingiva or the jaw bones
  • Trench mouth (bacterial infection and ulceration of the gums)

Periodontitis

Periodontitis is the name of a collection of inflammatory diseases affecting the tissues that surround and support the teeth. Periodontitis involves progressive loss of the bone around teeth which may lead to loosening and eventual loss of teeth if untreated.
Periodontitis is caused by bacteria that adhere to and grow on tooth surfaces (microbial plaque or biofilms), particularly in areas under the gum line.
Dentists diagnose periodontitis by inspecting the tissues around the teeth with a probe and by radiographs to detect bone loss around the teeth. Although the different forms of periodontitis are bacterial diseases, a variety of factors affect the severity of the disease. Important “risk factors” include smoking, poorly controlled diabetes, and inherited (genetic) susceptibility.

Etiology
Periodontitis is an inflammation of the periodontium -the tissues that support the teeth in the mouth. The periodontium is comprised of:

  • the gingiva, or gum tissue
  • the cementum, or outer layer of the roots of teeth
  • the alveolar bone, or the bony sockets into which the teeth are anchored
  • the periodontal ligaments (PDLs), which are the connective tissue fibres that connect the cementum and the gingiva to the alveolar bone.

The primary etiology, or cause, of gingivitis is the accumulation of a bacterial matrix at the gum line, called dental plaque. In some people, gingivitis progresses to periodontitis – the gum tissues separate from the tooth and form a periodontal pocket. Subgingival bacteria (those that exist under the gum line) colonize the periodontal pockets and cause further inflammation in the gum tissues and progressive bone loss. Examples of secondary etiology would be those things that cause plaque accumulation, such as restoration overhangs and root proximity.

The excess restorative material that exceeds the natural contours of restored teeth, such as these, are termed overhangs, and serve to trap plaque, potentially leading to localized periodontitis. If left undisturbed, bacterial plaque calcifies to form calculus. Calculus above and below the gum line must be removed completely by the dental hygienist or dentist to treat gingivitis and periodontitis. Although the primary cause of both gingivitis and periodontitis is the bacterial plaque that adheres to the tooth surface, there are many other modifying factors. One of the most predominant risk factors of periodontal disease is tobacco use. Another very strong risk factor is one’s genetic susceptibility. Several conditions and diseases, including Down syndrome, diabetes, and other diseases that affect one’s resistance to infection also increase susceptibility to periodontitis.

Another factor that makes periodontitis a difficult disease to study is that human host response can also affect the alveolar bone resorption. Host response to the bacterial insult is mainly determined by genetics, however immune development may play some role in susceptibility.

Signs and symptoms
Symptoms may include the following:

  • occasional redness or bleeding of gums while brushing teeth, using dental floss or biting into hard food (e.g. apples) (though this may occur even in gingivitis, where there is no attachment loss)

 

  • occasional gum swellings that recurs
    halitosis, or bad breath, and a persistent metallic taste in the mouth

 

  • gingival recession, resulting in apparent lengthening of teeth. (This may also be caused by heavy handed brushing or with a stiff tooth brush.)

 

  • deep pockets between the teeth and the gums (pockets are sites where the attachment has been gradually destroyed by collagen-destroying enzymes, known as collagenases)

 

  • loose teeth, in the later stages (though this may occur for other reasons as well)

 

Patients should realize that the gingival inflammation and bone destruction are largely painless. Hence, people may wrongly assume that painless bleeding after teeth cleaning is insignificant, although this may be a symptom of progressing periodontitis in that patient.

Prevention
Daily oral hygiene measures to prevent periodontal disease include:

  • brushing properly on a regular basis (at least twice daily), with the patient attempting to direct the toothbrush bristles underneath the gum-line, so as to help disrupt the bacterial growth and formation of subgingival plaque and calculus.
    flossing daily and using interdental brushes (if there is a sufficiently large space between teeth), as well as cleaning behind the last tooth in each quarter.
    using an antiseptic mouthwash. Chlorhexidine gluconate based mouthwash or hydrogen peroxide in combination with careful oral hygiene may cure gingivitis, although they cannot reverse any attachment loss due to periodontitis. (Alcohol based mouthwashes may aggravate the condition).

 

  • regular dental check-ups and professional teeth cleaning as required. Dental check-ups serve to monitor the person’s oral hygiene methods and levels of attachment around teeth, identify any early signs of periodontitis, and monitor response to treatment.
    Typically dental hygienists (or dentists) use special instruments to clean (debride) teeth below the gum line and disrupt any plaque growing below the gum line. This is a standard treatment to prevent any further progress of established periodontitis. Studies show that after such a professional cleaning (periodontal debridement), bacteria and plaque tend to grow back to pre-cleaning levels after about 3-4 months. Hence, in theory, cleanings every 3-4 months might be expected to also prevent the initial onset of periodontitis. The continued stabilization of a patient’s periodontal state depends largely, if not primarily, on the patient’s oral hygiene at home if not on the go too. Without daily oral hygiene, periodontal disease will not be overcome, especially if the patient has a history of extensive periodontal disease.

Treatment of established disease

This section from a panoramic X-ray film depicts the teeth of the lower left quadrant, exhibiting generalized severe bone loss of 30-80%. The red line depicts the existing bone level, whereas the yellow line depicts where the bone was originally, prior to the patient developing periodontal disease. The pink arrow, on the right, points to a furcation involvement, or the loss of enough bone to reveal the location at which the individual roots of a molar begin to branch from the single root trunk; this is a sign of advanced periodontal disease. The blue arrow, in the middle, shows up to 80% bone loss on tooth #21, and clinically, this tooth exhibited gross mobility.

Periodontal disease generally affects mandibular incisors aggressively. Because their roots are generally situated very close to each other, with minimal interproximal bone, and because of their location in the mouth, where plaque and calculus accumulation is greatest because of the pooling of saliva, mandibular anteriors suffer excessively. The split in the red line depicts varying densities of bone that contribute to a vague region of definitive bone height. If good oral hygiene is not yet already undertaken daily by the patient, then twice daily brushing with daily flossing, mouth washing and use of an interdental brush needs to be started. Technique with these tools is very important. Aged persons may find that use of these interdental devices more necessary and easier, since the gaps between the teeth may become larger.

A dental hygienist or a periodontist can use professional scraping instruments, such as scalers and curettes to remove bacterial plaque and calculus (formerly referred to as tartar) around teeth and below the gum-line. There are devices that use a powerful ultra-sonic vibration and irrigation system to break up the bacterial plaque and calculus. Local anesthetic is commonly used to prevent discomfort in the patient during this process.

It is difficult to induce the body to repair bone that has been destroyed due to periodontitis. Much depends on exactly how much bone was lost and the architectural configuration of the remaining bone. Vertical defects are those instances of bone loss where the height of the bone remains somewhat constant except in the localized area where there is a steep, almost vertical drop. Horizontal defects are those instances of more generalized bone loss, resulting in anywhere from mild to severe loss of initial bone height. Sometimes bone grafting surgery may be tried, but this has mixed success. Bone grafts are more reliable in instances of vertical defects, where there might be a sufficient “hole” within which to place the added bone. Horizontal defects are rarely if ever able to be grafted properly, as there is nowhere to secure the bone.

Dentists sometimes attempt to treat patients with periodontitis by placing tiny wafers dispensing antibiotics underneath the gum line in affected areas. However, the general scientific consensus is that antibiotic treatment is of minimal value in treating bone loss due to periodontitis. It may help to recover about one millimeter of bone, but it is questionable if this is of significant therapeutic value.

Alternatively, regular subgingival flushing with an anti-calculus composition can dissolve subgingival calculus (tartar) thus facilitating natural healing without surgery. This process is widely used for supragingival tartar via tartar-control toothpastes. Subgingival application of an anti-calculus composition requires a subgingival syringe or an oral irrigator.

One such anti-calculus composition (Periogen) contains sodium tripolyphosphate, tetrapotassium pyrophosphate, sodium bicarbonate, citric acid and sodium fluoride.

In the composition, tetrapotassium pyrophosphate (TKPP) is a cleaning agent designed to clear away biofilms in order to facilitate chemical access to calculus. Sodium tripolyphosphate (STPP) acts as the anti-calculus agent, activated by sodium fluoride (.04%), providing a chelating action on the structure of the calculus.

Sodium bicarbonate and citric acid are product activators which assist in dissolving the composition in water for periodontal delivery via a subgingival syringe or oral irrigator with a periodontal tip.

Assessment and prognosis
Dentists or dental hygienists “measure” periodontal disease using a device called a periodontal probe. This is a thin “measuring stick” that is gently placed into the space between the gums and the teeth, and slipped below the gum-line. If the probe can slip more than 3 millimetres length below the gum-line, the patient is said to have a “gingival pocket” around that tooth. This is somewhat of a misnomer, as any depth is in essence a pocket, which in turn is defined by its depth, i.e., a 2 mm pocket or a 6 mm pocket. However, it is generally accepted that pockets are self-cleansable (at home, by the patient, with a toothbrush) if they are 3 mm or less in depth. This is important because if there is a pocket which is deeper than 3 mm around the tooth, at-home care will not be sufficient to cleanse the pocket, and professional care should be sought. When the pocket depths reach 5, 6 and 7 mm in depth, even the hand instruments and cavitrons used by the dental professionals cannot reach deeply enough into the pocket to clean out the bacterial plaque that cause gingival inflammation. In such a situation the pocket or the gums around that tooth will always have inflammation which will likely result in bone loss around that tooth. The only way to stop the inflammation would be for the patient to undergo some form of gingival surgery to access the depths of the pockets and perhaps even change the pocket depths so that they become 3 or less mm in depth and can once again be properly cleaned by the patient at home with his or her toothbrush.

If a patient has 5 mm or deeper pockets around their teeth, then they would risk eventual tooth loss over the years. If this periodontal condition is not identified and the patient remains unaware of the progressive nature of the disease then, years later, they may be surprised that some teeth will gradually become loose and may need to be extracted, sometimes due to a severe infection or even pain.

 

Dental Veneers

Filed under: Uncategorized — Spruce Ridge Dental @ 4:06 am

You no longer need to hide your smile because of gaps, chips, stains, or misshapen teeth. With veneers, you can easily correct your teeth’s imperfections to help you have a more confident, beautiful smile. Veneers are natural in appearance and are a perfect option for patients wanting to make minor adjustments to the look and feel of their smile.

Veneers

veneers

They are thin, custom-made shells made from tooth-colored materials (such as porcelain) designed to cover the front side of your teeth. To prepare for veneers, your doctor will create a unique model of your teeth. This model is sent to a dental technician who creates your restoratios. Before placing your new veneer, your doctor may need to conservatively prepare your tooth to achieve the desired aesthetic result.

When your veneers are placed, you’ll be pleased to see that they look like your natural teeth. While veneers are stain-resistant, your doctor may recommend that you avoid coffee, tea, red wine, and tobacco to maintain the beauty of your new smile.

How are they made?

Veneers are done in two appointments. The first appointment the tooth is prepared for the veneer and an impression is taken so that the lab can make a model of your tooth to make your custom veneer. A temporary veneer will be made to protect your tooth and allow you to see the new shape or colour of your tooth. A colour shade will be chosen to match the Veneer match with your other adjacent teeth.

The second appointment will allow you to see the new veneer before it is bonded on.

Dental Inlays

Filed under: Uncategorized — Spruce Ridge Dental @ 12:02 am

Inlays are restoration is a custom made filling made of composite material, gold, or tooth-colored porcelain.  Porcelain inlays are popular because they resemble your natural tooth.  A porcelain inlay is made by a professional dental laboratory and is permanently cemented into the tooth by your dentist.  The colour of the inlay can be customized to match the exact shade of your tooth, therefore giving it a live like natural appearance.

Inlays

Inlays can be utilized to conservatively repair teeth that have large defective fillings or have been damaged by decay or trauma.  Inlays are an ideal alternative to conventional silver and composite fillings.  Also, they are more conservative than crowns because less tooth structure is removed in the preparation of inlays.

As with most dental restorations, inlays are not always permanent and may someday require replacement.  They are highly durable and will last many years, giving you a beautiful long lasting smile.

Inlays

Reasons for inlay restorations:

  • Broken or fractured teeth.
  • Cosmetic enhancement.
  • Decayed teeth.
  • Fractured fillings.
  • Large fillings.

What does getting an inlay involve?

An inlay procedure usually requires two appointments.  Your first appointment will include taking several highly accurate impressions (molds) that will be used to create your custom inlay and a temporary restoration.

While the tooth is numb, the dentist will remove any decay and/or old filling materials.  The space will then be thoroughly cleaned and carefully prepared, shaping the surface to properly fit an inlay restoration.  A temporary filling will be applied to protect the tooth while your inlay is made by a dental laboratory.

At your second appointment your new inlay will be carefully and precisely cemented into place.  A few adjustments may be necessary to ensure a proper fit and that your bite is comfortable.

You will receive care instruction at the conclusion of your treatment.  Good oral hygiene practices, a proper diet, and regular dental visits will aid in the life of your new inlay.

Fluoride Therapy in Spruce Grove

February 23, 2020

Filed under: Uncategorized — Spruce Ridge Dental @ 7:51 pm

Fluoride therapy is the delivery of fluoride to the teeth topically or systemically, which is designed to prevent tooth decay (dental caries) which results in cavities. Most commonly, fluoride is applied topically to the teeth using gels, varnishes, toothpaste/dentifrices or mouth rinse.

Fluoride therapy

Systemic delivery involves fluoride supplementation using tablets or drops which are swallowed. This type of delivery is rarely used where public water supplies are fluoridated, but is common (along with salt fluoridation) in some European countries.

Benefits of fluoride therapy
Fluoride therapy is commonly practiced and generally agreed upon as being useful in the modern dental field. Fluoride combats the formation of tooth decay primarily in three ways:

Fluoride therapy promotes the remineralization of teeth, by enhancing the tooth remineralization process. Fluoride found in saliva will absorb into the surface of a tooth where demineralization has occurred. The presence of this fluoride in turn attracts other minerals (such as calcium), thus resulting in the formation of new tooth mineral.
Fluoride can make a tooth more resistant to the formation of tooth decay. The new tooth mineral that is created by the remineralization process in the presence of fluoride is actually a “harder” mineral compound than existed when the tooth initially formed. Teeth are generally composed of hydroxyapatite and carbonated hydroxyapatite. Fluorapatite is created during the remineralization process when fluoride is present and is more resistant to dissolution by acids (demineralization).

Fluoride therapy

Fluoride therapy can inhibit oral bacteria’s ability to create acids. Fluoride decreases the rate at which the bacteria that live in dental plaque can produce acid by disrupting the bacteria and its ability to metabolize sugars. The less sugar the bacteria can consume, the less acidic waste which will be produced and participate in the demineralization process.
There are many different types of fluoride therapies, which include at home therapies and professionally applied topical fluorides (PATF). At home therapies can be further divided into over-the-counter (OTC) and prescription strengths. The fluoride therapies whether OTC or PATF are categorized by application – dentifrices, mouth rinses, gels/ foams, varnishes, dietary fluoridate supplements, and water fluoridation.

Fluoride therapy, while beneficial to adults, is more important in children whose teeth are developing. As teeth are developing within their jaw bones, enamel is being laid down. Systemic ingestion of fluoride results in a greater component of fluoroapatite in the mineral structure of the enamel.

Methods of delivery

Dentifrices
Most dentifrices today contain 0.1% (1000 ppm) fluoride, usually in the form of sodium monofluorophosphate (MFP); 100 g of toothpaste containing 0.76 g MFP (equivalent to 0.1 g fluoride). Toothpaste containing 1,500 ppm fluoride has been reported to be slightly more efficacious in reducing dental caries in the U.S. Toothpaste may cause or exacerbate perioral dermatitis most likely caused by sodium lauryl sulfate, an ingredient in toothpaste. It is suspected that SLS is linked to a number of skin issues such as dermatitis and it is commonly used in research laboratories as the standard skin irritant with which other substances are compared.

Prescription strength fluoride toothpaste generally contains 1.1% (4,950 ppm) sodium F toothpaste, e.g. PreviDent 5000 Plus or booster. This type of toothpaste is used in the same manner as regular toothpaste. It is well established that 1.1% sodium F is safe and effective as a caries preventive. This prescription dental cream is used once daily in place of regular toothpaste.

Mouth rinses
The most common fluoride compound used in mouth rinse is sodium fluoride. Over-the-counter solutions of 0.05% sodium fluoride (225 ppm fluoride) for daily rinsing are available for use. Fluoride at this concentration is not strong enough for people at high risk for caries.

Prescription mouth rinses are more effective for those at high risk for caries, but are usually counter indicated for children, especially in areas with fluoridated drinking water. However, in areas without fluoridated drinking water, these rinses are sometimes prescribed for children.

Fluoride therapy

Gels/foams
Fluoride therapy gels and foams are used for patients who are at high risk for caries, orthodontic patients, patients undergoing head and neck radiation, patients with decreased salivary flow, and children whose permanent molars should, but cannot, be sealed.

GC Tooth Mousse, invented by Dr Eric Reynolds, Head of the School of Dental Science at Melbourne University, at the Royal Dental Hospital Melbourne is now considered an essential management solution for at risk patients.

The gel or foam is applied through the use of a mouth tray, which contains the product. The tray is held in the mouth by biting. Application generally takes about four minutes, and patients should not rinse, eat, smoke, or drink for at least 30 minutes after application.

Some gels are made for home application, and are used in a manner similar to toothpaste. The concentration of fluoride in these gels is much lower than professional products.

Fluoride therapy

Varnish
Varnish Fluoride therapy has practical advantages over gels in ease of application, a non-offensive taste, and use of smaller amounts of fluoride than required for gel applications. Varnish is intended for the same group of patients as the gels and foams. There is also no published evidence as of yet that indicates that professionally applied fluoride varnish is a risk factor for enamel fluorosis. The varnish is applied with a brush and sets within seconds.

Fluoride therapy

 

Composite Fillings

February 20, 2020

Filed under: Uncategorized — Spruce Ridge Dental @ 12:56 am

Composite fillings (tooth colored) are used to repair a tooth that is affected by decay, cracks, fractures, etc.  The decayed or affected portion of the tooth will be removed and then filled with a composite filling.

Composite Fillings

There are many types of filling materials available, each with their own advantages and disadvantages.  You and your dentist can discuss the best options for restoring your teeth. Composite fillings are the most widely used today.  Because composite fillings are tooth colored, they can be closely matched to the color of existing teeth, and are more aesthetically suited for use in front teeth or the more visible areas of the teeth.

As with most dental restorations, composite fillings are not permanent and may someday have to be replaced.  They are very durable, and will last many years, giving you a long lasting, beautiful smile.

Reasons for these fillings:

  • Chipped teeth.
  • Closing space between two teeth.
  • Cracked or broken teeth.
  • Decayed teeth.
  • Worn teeth.
How are composite fillings placed?
Composite fillings are usually placed in one appointment.  While the tooth is numb, your dentist will remove decay as necessary.  The space will then be thoroughly cleaned and carefully prepared before the new filling is placed.  If the decay was near the nerve of the tooth, a special medication will be applied for added protection.  The composite filling will then be precisely placed, shaped, and polished, restoring your tooth to its original shape and function.

It is normal to experience sensitivity to hot and cold when composite fillings are first placed, however this will subside shortly after your tooth acclimates to the new filling.

You will be given care instructions at the conclusion of your treatment.  Good oral hygiene practices, eating habits, and regular dental visits will aid in the life of your new fillings.

Home Care

February 19, 2020

Filed under: Uncategorized — Spruce Ridge Dental @ 11:33 pm
Your personal home care plays an important role in achieving that goal.  A beautiful, healthy smile that lasts a lifetime is our ultimate goal when treating patients.  Your personal home care starts by eating balanced meals, reducing the number of snacks you eat, and correctly using the various dental aids that help control the plaque and bacteria that cause dental disease.

Home Care

Tooth brushing – Brush your teeth at least twice a day (especially before going to bed at night) with an ADA approved soft bristle brush and toothpaste.

  1. Place the brush at a 45 degree angle to the gums and gently brush using a small, circular motion, ensuring that you always feel the bristles on the gums.
  2. Brush the outer, inner, and biting surfaces of each tooth.
  3. Use the tip of the brush to clean the inside of the front teeth.
  4. Brush your tongue to remove bacteria and freshen your breath.

Electric toothbrushes are also recommended.  They are easy to use and can remove plaque efficiently.  Simply place the bristles of the electric brush on your gums and teeth and allow the brush to do its job, several teeth at a time.

Flossing – Daily flossing is the best way to clean between the teeth and under the gumline.  Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

  1. Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
  2. Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
  3. Curve the floss into a “C” shape around each tooth and under the gumline.  Gently move the floss up and down, cleaning the side of each tooth.

Floss holders are recommended if you have difficulty using conventional floss.

Rinsing – It is important to rinse your mouth with water after brushing, and also after meals if you are unable to brush.  If you are using an over-the-counter product for rinsing, it’s a good idea to consult with your dentist or dental hygienist on its appropriateness for you.

Use other dental aids as recommended by your dentist: Interdental brushes, rubber tip stimulators, tongue cleaners, irrigation devices, fluoride, medicated rinses, etc., can all play a role in good dental home care.

Dental Emergencies

Filed under: Uncategorized — Spruce Ridge Dental @ 10:18 pm

When a patient experiences a dental emergency, adherence to several steps should result in quicker care and relief:

  1. If the patient currently sees a dentist, s/he needs to call his or her own personal dentist. Most dentists belong to a call group, meaning that they trade call with other dentists. Therefore, a caller may be directed to contact the dentist who is on call.
  2. If a person with a dental emergency does not currently have a dentist of record, s/he should call the local dental association and ask for a listing of dentists who accept dental emergencies. The list is broken down by specialties and by time periods. Patients should expect to be charged for emergency care.
  3. If the dental emergency requires an oral surgeon for immediate care, the hospital emergency room personnel will call the oral surgeon who is on call. Patients will be charged for these services.

dental emergency

 

These problems require an immediate Emergency Room visit:
  • Breathing difficulties
  • Fractured jaws
  • Loss of consciousness
These problems require a dentist’s attention:
  • Broke a tooth
  • Badly chipped tooth/tooth is bleeding (not the gums)
  • Bumped a tooth hard; it used to hurt; it got better, but now it hurts again
  • Chipped a tooth
  • Knocked out a tooth
  • Loosened a tooth, pushed in or hanging out of position
  • Have pain with swelling
    • Swelling of gums around teeth
    • Swelling around the wisdom teeth
    • Swelling around the eye
    • Swelling in the roof of the mouth
    • Swelling in the jaw
  • Experiencing toothache
These problems require a dentist’s attention but not immediate unless accompanied by pain:Treat before pain develops or your bite changes.
  • Broken or lost crown or cap
  • Broken or lost filling
  • Broken denture or appliance
What should I do for a toothache? This pain can be relatively simple or quite complicated. It can be simple because sometimes by biting or chewing, a person can tell which tooth is causing pain. More often than not, biting does not identify the offending tooth; and the pain can be referred to a distant location like the ear, the chin, the corner of the jaw, or even one side of the throat (the same side the pain is on). If a tooth is hypersensitive to thermal stimulation like hot or cold food or drinks or if spontaneous pain from the mouth occurs “out of the blue” or if tooth pain awakens you from sleep, then you most likely have a toothache and should see a dentist as soon as possible.
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#20 - 4 Spruce Ridge Drive, Spruce Grove, AB T7X 4S3 CA
Dr. Mark Southwood Spruce Grove, AB dentist. (780) 962-5538 (780) 962-4485 spruceridgedental@hotmail.ca