Your Dental Health  

Don't let pain be your motivation

Think for a moment, about your last visit to a dental office. What were the circumstances that got you there? Was is time for your twice-annual examination and cleaning? Or were you there because something hurt?

All patients may experience dental discomfort from time to time, for a variety of reasons, but if you are someone who typically waits until something hurts before you pick up the phone to make an appointment, it's time to reconsider your approach to oral health.

I am constantly amazed by how the range of tolerance for dental disease varies among patients. Meet (for a fictional moment) Jane, a patient that has high standards for her dental health and has always seen her dentist for regular examinations and cleanings. Jane also has x-rays taken about every 24 months to ensure any problems that show up underneath the tooth or gum surfaces are diagnosed and treated right away.

Also meet Peter, who is quite Jane's opposite. Peter can't remember the last time he was at the dentist, but is sure he hasn't been in the last three years. He typically waits until something is really painful before he goes in to see a dentist and all he can recall about those past visits is that going to the dentist hurts!

Now imagine that both Peter and Jane are at the dental office today to have an x-ray taken. Jane's x-ray is a matter of routine, as it has been 24 months since she last had dental x-rays taken. The dentist finds a small area on one of Jane's teeth that is decalcifying and softening a bit where it contacts the neighbouring tooth. When asked by her dentist if the tooth has been sensitive to sweets, Jane recalls that, on occasion, she has experienced sweet sensitivity in that area, but only periodically. She is given instructions on how to floss more effectively and is prescribed a fluoride rinse to help remineralize the tooth surface.

Peter's is having an x-ray today because for the last two days his back molar tooth simply won't stop hurting. He hasn't been sleeping well and the tooth is extremely sensitive to just about everything: pressure, sweets, hot and cold foods. The dentist shows Peter on the x-ray that a large cavity has been developing in his tooth and that the infection (the decay) has reached the middle of the tooth where his nerve tissue is. Peter's only option for saving the tooth is to have the nerve and blood vessel of the tooth removed (a root canal) and the cavity filled. Following this, Peter will need a crown on the tooth as well. The dentist also warns Peter that because there is an acute infection present, it may be difficult to "freeze" the tooth because it has become so hypersensitive.

Do you identify with either of these patients? I see plenty of Janes and lots of Peters every day in my practice and I am always astounded why patients like Peter waited so long to give a little attention to their teeth! Just look at the bottom line for treatment. Jane simply need to floss a bit better and use a mouth rinse. Peter has now signed up for a root canal, filling and crown; not to mention a significantly higher bill than Jane and a lot more time in the dental chair. No wonder his memories of the dentist are unpleasant!

So as your mother used to say, an ounce of prevention is worth a pound of cure. See your dentist regularly and be attentive to the needs of your teeth and gums before your teeth and gums need to get your attention!

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.

Bridge or implant?

Dental implants are getting a lot of press these days, and deservedly so. I don’t think there has been another technological advancement in the last 20 years that has changed dentistry more. Most commonly, implants are used to replace individual or multiple teeth, similarly to how a bridge does. Used in this way, implants are incredibly versatile and successful.

However, there are many times when dental implants still may not be the treatment of choice, as recommended by your dentist. What follows here are a few points to help clarify when you might want to consider an implant, or when a bridge might be a better option.

Photo: Contributed

Implant

First off, understand that an implant is simply a titanium screw placed in the jaw bone where a tooth used to be--for simplicity, let’s assume only one tooth is missing. On top of that screw, where it emerges out of the gums, we can place a porcelain crown. Now you have a new “tooth.”

A bridge, on the other hand, replaces a missing tooth in a different way: both teeth neighbouring the space are trimmed down to allow a porcelain (sometimes gold) crown or “cap” to be placed over top of them. Before the two crowns are cemented on, a false “pontic” tooth is soldered between them, effectively joining all three pieces together. This “bridge” is then cemented as a single, three-piece unit onto the prepared teeth, spanning the gap with a new “tooth”.

The most basic advantage of a dental implant is that we don’t have to trim down or otherwise involve the neighbouring teeth. Implants are wonderfully conservative in this regard. As well, the long-term success rate of implants is generally better than that of a bridge. Implants are the most tooth-like restorations we place in dentistry, in terms of both esthetics and function.

Photo: Contributed

Bridge

Bridges also have some distinct advantages, however. Consider the scenario where one or both of the teeth neighbouring the space are heavily restored, damaged, decayed or otherwise in need of a crown. A bridge for this area takes care of two or even three significant needs with one procedure, providing crown structures to the two adjacent teeth and filling in the missing tooth all at the same time. When replacing a single lost tooth, bridges are typically less costly than an implant and more commonly covered by dental insurance.

Also to consider when deciding on an implant or a bridge is how many missing teeth are involved. Sometimes the span or space for which teeth need to be replaced is simply too great to be successfully treated using a bridge. Other times, there may not be an adjacent tooth next to a space at all (like at the back of the mouth). Implants or possibly even a partial denture are better choices in these cases. Likewise, sometimes the spacing is adequate for a bridge, but the teeth that would carry that bridge simply aren’t anchored well enough themselves in the surrounding bone. Again, you should probably consider going with an implant.

Think about what you want your dental experience to be like as well, both at the dental office and at home when you are caring for your teeth. Both procedures take about the same amount of time in the dental chair, but because they have to heal in the bone, implants take anywhere from three to 12 months start to finish. A bridge will usually take just two appointments and about two hours of total time in the dental chair to complete. When treatment is done, caring for an implant is just like caring for a natural tooth, in terms of brushing and flossing. For a bridge, you have to learn a bit of a new flossing technique called “threading” to be able to floss under the false tooth portion. If the idea of increasing your dental homecare really doesn’t appeal, perhaps the implant is your better choice!

Of course, there are many factors, specific to each individual case which should be discussed in detail with your dentist. Age, systemic health, grinding and bruxing habits...many things come into play. Use what you have learned here to start the conversation and be well educated in the decision making process!

Keep Flossing!

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.

Grinding your teeth

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.

To snack or not to snack?

Whenever I discuss diet and dental health with patients, two things always happen. First, patients always seem to already know that sugar causes cavities and are eager to tell me that they really don’t eat a lot of candy (phew!!). Second, patients are always surprised to find out that equally as important as what they eat, is how often they eat it. In fact, for many patients, frequency of sugar exposure represents the most critical aspect of their diet when it comes to oral health.

Let’s cover a few basics. When we talk about “sugar” in dentistry, what we really mean is sugar and carbohydrates. Why is this important? Well, carbohydrates encompass a great deal more of your diet than just what you think of as sugars. Crackers, potato chips, corn chips, bread, pasta, rice, cereals…the list goes on.

All of these contain carbohydrates which the bacteria in your mouth convert to sugar and then into acid. Granted, the total load of “sugar” might be less when you eat a slice of bread compared to your favourite candy bar, but the key here is to understand that carbohydrates are a significant source of the “sugar,” and subsequently the acid, that your teeth get exposed to.

Understanding the carbohydrate-to-sugar-to-acid conversion helps shed a bit of light on why frequency of sugar consumption is such a crucial part of the story. Chew on this: each time you expose your teeth to carbohydrates, bacteria produce acid for the next 20 minutes following that exposure—acid strong enough to demineralize your tooth enamel. It takes an additional 45 to 60 minutes before your saliva neutralizes the acid and returns your oral environment to normal.

It’s not difficult to visualize the threat this presents to your teeth. When carbohydrates are consumed frequently, even in small amounts, your mouth simply never gets a chance to neutralize the acidic environment. Additionally, it takes more than an hour for your saliva to “recover” and start the process of remineralizing the enamel surface damaged by the acid.

Photo: Thinkstock.com

So where does this leave us? Well, if you are prone to snacking on carbohydrates throughout your day, you are significantly increasing your cavity risk compared to those don’t. And remember: carbohydrates means more than just the candy jar. Be aware of the 5 or 6 cups of coffee with sugar or even milk (lactose is a sugar!). Watch the non-sugarless breath mints or chewing gum. Close the potato chip bag or box of crackers after lunch instead of munching away all afternoon.

Instead, limit your carbohydrate exposure to meal times only and, better yet, eliminate the total amount of sugars in your diet period. If you need something between meals to get you by, choose non-carbohydrate snacks (cheese and veggies are great!) to do the trick. Lastly, be especially aware of snacks or drinks that not only have sugars, but are themselves already acidic. Things like pop, sports drinks and even fruit juices are an acid bath waiting to happen.

If you’re going to snack, snack responsibly!

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.