ASK A DENTIST

Restorative Treatment

Q:

I have heard silver fillings are dangerous. Should I replace all my old silver fillings with white ones?

A:

Family Dentistry, Edmonton, Alberta DentistFirstly, it is very important for patients to know that dental amalgam has been used for over 150 years and there is NO sound scientific evidence of harmful effects of silver alloy fillings. It is known that silver fillings do release minute amounts of mercury vapor - however, this amount is estimated to be in the neighbourhood of 3 millionths of a gram (0.000006 g) a day, and this amount is not associated with any risks to the general population. There ARE individuals who are sensitive to components of amalgam restorations in the same way that there are individuals who are sensitive to environmental elements, certain foods, or even elements of composite (white) fillings.

Firstly, it is very important for patients to know that dental amalgam has been used for over 150 years and there is NO sound scientific evidence of harmful effects of silver alloy fillings. It is known that silver fillings do release minute amounts of mercury vapor - however, this amount is estimated to be in the neighbourhood of 3 millionths of a gram (0.000006 g) a day, and this amount is not associated with any risks to the general population. There ARE individuals who are sensitive to components of amalgam restorations in the same way that there are individuals who are sensitive to environmental elements, certain foods, or even elements of composite (white) fillings.

Q:

What is the difference between all the restorative dental techniques and materials?

A:

Generally, we can divide restorations into two main groups, direct and indirect.

Direct restorations or fillings are restorations that are placed by the dentist into a cavity in a tooth. Fillings are generally done in either amalgam (silver ) or composite (white).

Amalgam fillings are made of an alloy consisting MOSTLY of silver, but also tin, copper, and traces of zinc which is mixed with elemental mercury to form the alloy. Amalgam fillings are placed in a soft state, shaped by the dentist, and then harden in several minutes (24 hours are required for total setting).

Composite fillings are made of two components - a "resin" (like glue) and "filler" (microscopic glass beads). Composites are placed in the tooth in a putty-like state, and are hardened using a "curing light"

Two other direct fillings materials in use are compomers and sealant. Compomers are very similar to composite materials - however, they contain fluoride and release it into the tooth. Compomers are often used as temporary fillings in very deep cavities, or in cavities along the gumline. Sealants (also discussed in another section) are also like composites - they contain much less "filler", and are used to seal the tiny pits and fissures in teeth.

Indirect restorations are restorations that are placed by the dentist in stages of a couple of visits. They are inlays, onlays, veneers crowns and bridges. These restorations are composed of gold, porcelain or ceramic or a combination. See detailed information about a crown in section below.

Veneersare wafer-thin (egg shell-like) porcelain restorations that are bonded to the face of teeth to improve their shape and shade for improved appearance.  Veneers generally require the removal of some tooth structure, but the amount of reduction varies from case to case.

Bridges are much like crowns but have a false tooth attached to replace a missing tooth.

Q:

What is a crown?

A:

A crown is a restoration a dentist may place on a tooth that is broken, has a large filling, or requires a "built up". A dentist prepares a tooth for a crown (also called a cap) by shaving the tooth down by approximately 1 - 1.5 mm in all dimensions in an approximate peg shape. A high accuracy impression is taken of the prepared tooth, and the dentist gives the dental lab technician directions to construct the crown that will be placed over the prepared tooth. The crown may be gold, porcelain fused to metal, or all-ceramic. While the crown is being fabricated a temporary crown made of tooth-colored material is placed over the prepared tooth for about 2 weeks. On a second visit, the temporary crown is easily removed and the final crown is permanently placed over the prepared tooth with special dental cement. We cannot predict how long any restoration will last in your mouth but we see that crowns GENERALLY last 5-10 years.

Q:

How can I replace missing teeth in my mouth?

A:

There are three main ways to replace missing teeth. They range in cost, complexity and longevity.

1.

Removable dentures are also known as "false teeth" or "plates". Dentures may replace ALL the teeth in the upper or lower dental arch (complete denture) or some of the teeth in either arch (partial denture).

A partial denture is similar to a complete denture in that it is removable and is largely made of acrylic or casted metal and acrylic. A partial denture is supported by two or more teeth, and often has metal clasps to hold it in place.

Dentures are made by taking impressions of the gums and fabricating a custom-fit acrylic prosthesis that fits over the gums.

A denture usually lasts 5-10 years, although many people wear a set of dentures for much longer than this and are unaware that the fit has changed over time. Others find dentures uncomfortable to wear, and they may consider the following alternatives.

2.

Bridges are another way to replace missing teeth. A bridge is composed of two or more crowns (retainers) that are joined by false teeth that replace the missing teeth (pontics). A bridge is permanently cemented (glued) over the prepared teeth and the space of the missing teeth.

Bridges are a very good restorative option for many patients - however, there are several factors that make them less than ideal for some individuals. Firstly, a bridge ties together two or more teeth - this means that flossing is made more challenging and the use of special "floss threaders" is required to properly maintain oral hygiene. Secondly, a bridge necessitates the drilling down of at least two teeth. If the teeth to be drilled down have large fillings, this is less of a factor, but if one or more of the teeth have no filling, the dentist may be reluctant to drill them down as much as is necessary to place a bridge. Usually, a bridge lasts 5-10 years although there are MANY factors that can shorten their lifespan.

3.

Implants are an increasingly common choice to replace missing teeth. An implant is unique in that it functions as an artificial root on which a false tooth is placed. The placement of an implant is a surgical procedure - a hole corresponding in size to the implant to be placed is carefully made in the jaw bone. The implant, which is a small titanium screw, is placed in this hole under strict sterile conditions. In approximately 12 weeks, the implant will have integrated into the bone. This means that the implant isn't just "screwed" into the bone - it literally is fused to the bone. A crown is then placed on the implant. The wonderful thing about replacing a missing tooth with an implant is that the final product is very similar to a natural tooth - you can floss it just like your natural teeth. Implants can also be used to replace multiple teeth by placement of an implant-supported bridge, and can be used to stabilize complete dentures.

Q:

I want to whiten my teeth - what are my options?

A:

Tooth whitening is a very popular cosmetic service whether a patient just wants to whiten their teeth in general, or is undergoing extensive cosmetic work and wants to whiten their teeth in conjunction with the work.

The simplest option is "over-the-counter"whitening products such as self-applied gels, WhiteStrips®, and whitening toothpastes. Whitening toothpastes whiten the teeth by incorporating abrasive particles in the paste - much like a tooth polishing by a dental hygienist, the paste "scrubs" stain from the teeth. Self-applied gels and WhiteStrips® use a similar agent to professional whitening systems in a much lower concentration than what we use at the office.

We offer "at-home"whitening. We take an impression of your teeth and make custom-fit trays in which a peroxide based gel is placed. The trays are worn for about two hours on alternating days for about two weeks.

Root Canals

Q:

What is a root canal and why do I need one?

A:

It used to be that there were few things patients feared more than the dreaded root canal. A root canal (endodontic therapy) is a VERY common procedure and all steps are taken to maximize patient comfort. Many people think that when a tooth has a root canal, the root is removed but that is not the case. Understanding tooth anatomy is helpful. The outer layer of a tooth is called the enamel. It covers the inner layer of the tooth which is called the dentin. Dentin makes up the root of the tooth. In the middle of each root of a tooth is at least one canal which contains the dental pulp. The dental pulp contains an artery, a vein, and a nerve. During root canal therapy, the dentist uses very tiny instruments to remove the dental pulp from the core of the roots. Once removed, the canal is filled with a rubbery material.

The most common reason a tooth needs a root the nerve inside a tooth has died, or is dying. This can happen because the tooth has a cavity that has is very close to or entered the pulp, deep fracture, or trauma to the tooth. When one of these things happens, the body tries to break down the pulp and fight any infection present. This can result in inflammation, and leads to an abscess.

Dental Hygiene

Q:

What is gingivitis?

A:

Gingivitis is inflammation of the gums (gingiva). It occurs as a result of the accumulation of plaque along the gumline. The presence of this plaque leads to an immune response which results in the characteristic reddish, swollen gums of gingivitis. The gingival tissue becomes tender and bleeds during brushing and flossing. With proper home care and professional hygiene treatment, gingivitis is totally reversible.

Q:

What is periodontitis?

A:

Periodontitis is inflammation of the superficial AND deep tissues surrounding the tooth (periodontium). These tissues include not only the gums, but also the periodontal ligament (which holds the tooth into the bone) and the bone around the tooth itself. Periodontitis occurs when plaque is retained BELOW the gumline. The presence of bacteria and the toxins they release in the periodontal pockets results in an inflammatory response which leads to destruction of the bone surrounding the teeth. If periodontitis remains untreated, it will likely result in tooth loss. Periodontitis MUST be treated professionally as home care does not clean the deep pockets thoroughly enough.

Q:

Is gum disease linked to heart disease?

A:

Yes, current research shows that people with periodontitis (gum disease affecting the supporting structures of the teeth) are at higher risk for heart disease especially stroke. One reason is that the bacteria under the gums contribute to the bacteria lining the blood vessels throughout the bloodstream. The bloodstream bacteria contribute to the blood clotting process (which leads to heart attacks and strokes). Another reason for the higher risk is that toxins from bacteria in your mouth circulate throughout the body. These toxins activate the immune system and the body releases inflammatory cells to fight the toxins. Unfortunately, these inflammatory cells can contribute to build up in heart arteries. Significant build up can lead to heart attacks and strokes.

Q:

Why does my hygienist recommend I have appointments every 6 months, while my friend goes every 9 months?

A:

Everyone has specific dental needs and your hygienist and dentist recommend a hygiene schedule that caters to your oral health. The main factors in recommending timing between hygiene care visits include presence of disease under and around your gums, how well you clean you mouth at home, the rate at which you build up hard plaque (tartar or calculus) and tooth sensitivity.

Q:

Why do my gums bleed when I floss?

A:

It is likely that you have gingivitis (puffiness and redness of the gums caused by bacteria). You need to strengthen your gums and remove the bacteria by flossing daily. The bleeding should reduce within 2 weeks of beginning to floss. Make sure to visit you dentist and hygienist regularly so they can monitor and treat gum disease as well as prevent further deterioration.

Q:

Are electric toothbrushes better that hand toothbrushes?

A:

A regular soft-bristled toothbrush is adequate for most people. However, many people love using an electric brush and we usually see an improvement in gum health when a person switches to the electric brush. A good quality electric brush stimulates the gums and leaves the teeth feeling very clean. Also, most of them include 2-minute timers that bring awareness to the minimum amount of time needed to thoroughly brush. In cases where a person has limited hand movement, the electric brushes are easy to use. We stock Oral B Triumph ® brushes at our "cost" price to our patients. Ask any of our team members for more information.

Dental X-Rays

Q:

Why do I need dental x-rays?

A:

Dental x-rays (radiographs) are the ONLY way your dentist can see hidden areas of your teeth and mouth. X-rays let the dentist look for cavities between the teeth, check the bone level around the teeth, check for abscesses, and screen for suspicious lesions in the jawbones. IN GENERAL, we recommend a full set of check-up x-rays once a year and a full jaw x-ray every five years. The dentist may also recommend specific x-rays of a trouble spot.

Q:

What are digitial images?

A:

We use digital x-rays, which use a digital sensor instead of film. It still uses radiation but can be at a lower dose than film-based radiographs. We are pleased that this method also eliminates the need for harsh processing chemicals used in the past.

Q:

Are dental x-rays dangerous?

A:

One of the most common questions we are asked is, "Are dental x-rays are dangerous?" The simple answer is "NO". A person living in North America is exposed to approximately 3 mSv (milliSeverts) of radiation from environmental sources in a year. By comparison, a single dental film exposes the patient to approximately 0.004 mSv of radiation, and a full jaw (panoramic) x-ray exposes the patient to 0.050 mSv. In other words, you could have a full jaw x-ray AND 737 single dental x-rays and would only then be equal to the amount of radiation you're exposed to naturally! A digital full jaw x-ray exposes the patient to a dose of radiation in the neighbourhood of 0.005 mSv and a single x-ray is significantly less than this. In other words, with our digital equipment a patient would need to have 638 FULL JAW x-rays to equal yearly radiation exposure from natural causes!

We've taken every step available to minimize patient exposure to radiation from dental x-rays.

Children's Dental Care

Q:

At what age should my child start visiting the dentist?

A:

In general, a child should be seen for the first time before they are 18 months old. Although achieving cooperation at young ages is sometimes challenging, we often will suggest that the child come to a "fun" appointment consisting of a ride in the chair and a trip to the prize cabinet to be familiarized with the dental office. We always explain what we do in non-threatening terms to the child (such as "Can we count your teeth today?"), and are focused on making their early visits comfortable.

Special Cases

Q:

I'm pregnant. Can I have dental work done, and what about x-rays?

A:

Maintaining your regular oral health care program during pregnancy is very important. Hormonal fluctuations result in gums that are very susceptible to inflammation so careful home care and regular professional care is critical. Generally, hygiene treatment can be safely performed during all three trimesters.

During the first trimester, the growing fetus is very vulnerable - as such, we avoid any elective treatment but CAN provide emergency treatment. At this stage, we may want to consult with your medical doctor in regards to treatment or prescriptions.

The second trimester is the best time during pregnancy to provide routine dental care. We still recommend postponing any elective work or extensive work until your baby is born. Routine dental care can still be provided in the early third trimester but elective dental care may be postponed due to the discomfort and stress it puts the mother under.

Dental x-ray doses to a patient are VERY low, and are even lower to a developing fetus. With that being said, it is safe to have a dental x-ray taken if necessary during pregnancy - however, if we CAN postpone treatment or x-rays until after the birth of the baby, we will.

Q:

My physician says I need antibiotics before dental treatment. Why?

A:

Some people do require antibiotics prior to dental treatment. These patients may have heart valve conditions, previous rheumatic fever, joint replacement, or immune disorders. Dental procedures that may cause bleeding may also allow bacteria into the blood system (bacteremia). In most individuals, this is not an issue as the immune system easily deals with it. In the previously mentioned people, their health condition may result in the bacteria in the blood attaching to valves/joints/etc which could lead to serious complications. As such, these patients may need to take a prophylactic dose of antibiotics prior to the dental procedure. If you suspect this may apply to you, be sure to tell your dentist and consult with your physician prior to any dental treatment.