Why do I need to see a dentist if my teeth don’t hurt?

Dental problems are virtually all preventable and identifiable by your dentist early on and even before you are aware of their presence. However they will only hurt you when they have progressed to much larger problems. You want to find the little problems before they become large enough for us to find ourselves. Fractures in teeth with large, old fillings are often visible long before a tooth falls apart. Likewise, a small area of caries (cavity forming decay) will make itself known to you only when it is deep enough to irritate the tooth’s nerve (often indicating the need for a root canal procedure) or weaken a cusp (corner of a tooth) causing it to fracture off. These are easy to detect when they are in the beginning stages.

Periodontal (gum) problems show early as chronic gum inflammation with bleeding and deep pockets (gingivitis). When it reaches the stage of periodontal disease, there is irreversible gum recession with infection, permanent bone loss and loosening of what may be perfectly healthy teeth. Ninety five percent of what is needed to keep your teeth and mouth healthy is simple maintenance which includes diligent home care and routine dental office hygiene. The other five percent of help needed is what you dental office provides, unless you let it get away from you. This is where the old saying comes from “ignore your teeth and they will go away”!

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What’s the best way to clean between my teeth?

It depends.  If you are a younger person (25 years or younger roughly) the problem you are trying to prevent is decay developing between teeth.  This normally occurs at the contact point between the teeth.  If there is enough plaque (and it’s acid) sitting in there it will begin to dissolve the enamel surface and eventually form a cavity.   If you are using your toothbrush regularly, properly and thoroughly it will help minimize the plaque accumulation around the teeth at the gum line.   However, it won’t get into the tight “in-between” spots.  Therefore you need to floss.

 

On the other hand if you are older and/or have some issues with gum recession or periodontal  (gum) problems, you likely are no longer as prone to the cavities of youth but can accumulate more plaque between the larger spaces between the teeth.  This in turn exacerbates the gum problem and can also lead to root surface decay.  Using only floss in this situation doesn’t really do much compared to using interdental brushes.  This was shown in a 2007 study (Dental Abstract  May/June 2007 issue) of 77 patients with periodontal disease.  After being cleaned up, these people were either instructed to use floss or use interdental brushes.  Follow up of both groups was done at 6 and 12 weeks.  Both groups showed plaque reductions but the group using the interdental brushes had significantly and consistently better results.

Is there a Santa Claus?

As everyone knows Santa Claus is real for those who believe in him and his important work. I believe in Santa. The first time I realized this was in Moose Jaw, Saskatchewan. I was five years old. I vividly remember going downstairs Christmas morning, into our living room, to discover new toys sitting there for me and my sister. They hadn’t been there the night before. And the milk and cookies were gone! Holy Cow! Santa had actually been there for ME! What a feeling of incredulous wonder! We didn’t have a chimney, but my dad explained about Santa’s magic when the analytic side of my little brain started asking questions.

As I began to “grow up” Santa became unbelievable, or rather I forgot how to believe in him. Over the years the Christmas season became more stressful, harried and mostly a date on the calendar to finally arrive at. Nevertheless, the essence of him and some of that feeling of wonder (or maybe it’s just memory) would still return to me every Christmas morning. Then I had children of my own and Santa Claus became real to me again.

We become Santa Claus when we share, feel compassion, give comfort, get involved, do a favor, help someone out, or simply make someone smile. For me, believing in Santa Claus is believing my existence can make others better off than if I didn’t exist. It’s simply acknowledging our human nature and our unique ability for compassion, sharing and most of all, love. We all share this ability and have more similarities than differences despite our language, culture, and circumstances. I hope you believe in Santa too.

Merry Christmas.

Do dental xrays cause brain tumors?

There was a recent study  (from the Yale School of Public Health in the  U.S. ) which reported  they found a relation between people  who have had frequent dental xrays also had an increased risk of benign meningioma (type of brain tumor) .  These researchers compared 1433 people who had this type of tumor with 1350 people who did not.  All patients were asked, among other things , about their history of dental treatment and the number of times they had specific dental xrays throughout their life.  They found the tumor group more than twice as likely as the comparison group to report having frequent  bitewing xrays taken.  They concluded those who had these xrays yearly or more frequently were at 40 to 90 percent higher risk to be diagnosed with a brain tumor.  However, there was no apparent increase in risk or association of tumor diagnosis for people who had frequent  full mouth series (multiple)of  xrays.  “That inconsistency is impossible to understand to me”, said an expert with the American Academy of Oral and Maxillofacial Radiology.  This inconsistency calls into question the conclusions from this particular study.  It implies that fewer bitewing type xrays may cause more problems than many or multiple xrays over may years which would be unlikely.

 

It should also be pointed out that all of the subjects of the study had their xrays done over many years when exposure levels were much higher than they are today . In any case, you only need dental xrays if there is a clear indication to take them and likely no more than once per year or so.  In any case you have to be careful  how researchers come to their conclusions and especially how the media interprets them.  In other words maybe it “it ain’t necessarily so.”

 

This headline hit the media earlier this year and raised a lot of eyebrows at the time.

Does chewing gum prevent cavities?

Depends on the gum.  It has been shown in studies that chewing gum does help remove some of the plaque which accumulates on our teeth.  That’s obviously a good thing.  Part of the reason is the gum shoves the plaque off parts of the teeth but a greater benefit is the stimulation of saliva which neutralizes some of the acid in plaque and rinses it away.  However, “four out of  five dentists” recommend sugarless gum for obvious reasons.  ( I’ve always wondered who those fifth dentists are and where they went to dental school?)

 

There is, however, really good evidence that gum with Xylitol (a natural “sugarless” sweetener) will dramatically reduce new cavity formation.  It also seems to reverse decay already present.  Bacteria metabolize sucrose (the standard sweetener in most gum and candy) into an acid compound as does sorbitol (a sucrose-free sweetener) although it produces less acid.

 

Xylitol is not metabolized by oral bacteria very well, and virtually no acid is produced.   A University of Michigan Study in the 1990’s compared 1227 public school kids in Belize for over three years.  They were 9 to 11 years old and their teachers supervised the use of gum three to five times a day.  The gums were sweetened with either sucrose, sorbitol or xylitol.  One group of kids went without any gum.

 

Dentists examined all of the kids before the study and again at 16, 28 and 40 months.  At 28 months the group who chewed the xylitol sweetened gum did not develop new cavities.  They also had re-mineralized some old cavities.  The sorbitol group showed an increase in cavities.  The kids who were without gum, had a higher rate of cavity development and the sucrose group showed the highest increase in cavities.  Another study by the same group on 6 year olds showed even better results.

So I would recommend gum-chewers get the xylitol sweetened variety.  Maybe then we can get those one out of five dentists on board with the rest of us.

 

 

Is the radiation exposure from dental xrays a health concern?

Yes and No.  Taking dental xrays is indicated when the information they provide to your dentist cannot be derived somewhere else.  There is a small potential risk to the use of any xrays but that risk is related to the total dose received over your lifetime (like the ultraviolet radiation from the sun and skin cancer).

To put this in perspective the average North American receives about one millirem of radiation dose per day (or less) from background sources.  Most of this is from natural sources like radon and cosmic radiation but includes all sources, natural or man made.  One dental xray (the small ones) are about ½ millirem or half day equivalent (or less) .  A panoramic xray which you may have had is approximately ½ to 1.0 millirem or a bit less than one day equivalent (or less).  By comparison one coast to coast airline flight will expose you to around 3 millirems or 3 days background equivalent.

With respect to the dental xrays doses I mention above I have said “or less” because of recent technology advances.  Most dental offices are or have converted to using digital xray technology.  The doses above relate to the old traditional xray film/analogue xray doses.  Digital xray sensor doses are almost one tenth of these older xray exposure levels.   In fact when we started using digital sensors, which are ultrasensitive, we had to turn our anode (xray camera) to the absolute lowest settings.  It is “just barely on” for digital compared to the settings we needed for standard film xrays.  The same applies to all dental-related xray doses now.  This is an expensive change for a dental office to make but in addition to much lower radiation, the image quality is much better and more useful.

Next time, some thoughts on the recent headline in the Globe and Mail (April 12, 2012) about a connection between brain tumors and dental xrays.

I haven’t worn my orthodontic retainers for years and am noticing my teeth are getting crowded again. Can I be “tuned up” again without braces?

This is a real common thing among those of us who had orthodontic treatment in the past.  Our teeth, especially the lower front ones, have a tendancy to want to crowd up again.  Unless we wear a retainer indefinitely (some people actually do but they seem to be a rare species) or have a permanent retainer wire bonded behind the front teeth, this will happen.

However, usually this relapse is no where near as bad as the original situation and can be       “re-tuned” without wires and brackets and all of those dental appointments.  The technique for this uses a series of very thin clear aligners which you wear 24/7.  You can take these out yourself for eating and for brushing/flossing.  Even better they are virtually invisible.  There are more than one of these systems available now but Invisalign TM was the first company to really develop the technology.  The aligners fit over all the teeth of both upper and lower arches and each one of the series moves the teeth about a quarter of a millimeter.  You wear each set of aligners  for two to three weeks. At that point you move on to the next aligner of the series and so on.  Depending on the amount of realignment needed, it can require as little as ten aligners.  The most I’ve ever had to work with was nineteen aligners.  Hence it can take from four to eighteen months to complete the relalignment.

However, you still need some version of long term retainer when it’s done or you eventually may relapse again.

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Does tooth whitening procedures cause cancer?

I have been asked this question by people from time to time.  I guess because tooth whiteners contain hydrogen peroxide.  The answer to this is no, they do not.  Evidence for this comes from a review of many other published studies which appeared in the Journal of Esthetic and Restorative Dentistry (volume 3, issue 3) in June 2006.  The compiled results concluded that tooth whitening products containing hydrogen peroxide do not cause or increase the risk of oral cancer when used as directed.  Exposure to hydrogen peroxide in whiteners is too low and to short in duration (30-60 minutes) to create any changes in oral tissues to increase any oral cancer risk.  In fact, the evidence from this review which included over 4000 human subjects showed no evidence of oral cancer or other effects associated with risk of oral cancer.

Normally when used as directed the concentration of hydrogen peroxide in these products decreases to nearly undetectable levels within 15 minutes to one hour.  Over the counter whitening products have significantly lower peroxide concentrations than those applied in a dental office under close supervision and isolation.

Why does my Dentist want to put a crown (cap) on my tooth that had a root canal?

When the pulp, or nerve in a tooth dies and the nerve canal inside the root is disinfected and sealed up with an internal filling (root canal filling), the tooth no longer has a blood supply.  It’s a “dead” tooth.  If it happens to be a tooth which gets used for chewing like the back teeth do then it takes a  lot of biting force.  Usually a tooth that has a root canal- type of problem has already had it’s share of previous problems and dental work.  It may have had a large and/or deep filling done years ago.  This by itself will compromise the strength of a tooth.  The nerve/pulp inside may succumb to problems years later.  In any case a root canal filling doesn’t strengthen a tooth.  It only makes it’s innerds pain/problem free.  However, like a dead tree branch this tooth is more prone to bigger fracture problems than a live tooth.  Especially if its one of your heavy “chewers”.  Covering the tooth with a crown/cap or other type of “lid” will prevent you from chipping, breaking or splitting off more of the tooth.  If an internal crack develops before a crown can be placed,  it typically starts out small (like a crack in your windshield).  However given enough time and chewing the crack can extend and eventually a piece of tooth can break off simply because it was ready to go.  A crown /cap works like a helmet for the tooth preventing future fractures.  Front teeth are not as at risk of this as back teeth because we (normally) don’t chew with our front teeth.