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All posts by Dr. Feisel Haji

Oral Appliance Therapy

Oral appliance therapy is an effective treatment option for snoring and obstructive sleep apnea (OSA). A custom-fit oral sleep appliance can improve your sleep, restore your alertness and revitalize your health. Here is a guide to help you get started with this life-changing treatment.

About Oral Appliance Therapy

Worn only during sleep, an oral appliance fits like a sports mouth guard or an orthodontic retainer. It supports the jaw in a forward position to help maintain an open upper airway. Research shows that oral appliance therapy is an effective treatment option for snoring and obstructive sleep apnea.

If you and your doctor decide that oral appliance therapy is the best treatment option for you, then your doctor will write a prescription for you to receive a custom-made oral appliance. You also will receive a referral to a qualified dentist who can provide oral appliance therapy. More than 100 oral appliances have received FDA clearance. Your dentist will recommend the oral appliance that is best for you. Oral appliance therapy is covered by many medical insurance plans.

Advantages of Oral Appliance Therapy

Oral appliance therapy is an effective, non-invasive treatment that fits easily into your lifestyle. Patients like oral appliance therapy because it is:

  • Comfortable
  • Easy to wear
  • Quiet
  • Portable
  • Convenient for travel
  • Easy to care for

How a Dentist Can Help: The First Visit

Dentists work closely with physicians to treat snoring and sleep apnea. At your first visit, your dentist will talk to you about the benefits of treatment. You also will receive information on the potential side effects and the cost of therapy.

Then your dentist will conduct a complete clinical evaluation. This will include an examination of your teeth, jaw, tongue and airway, and possibly a new X-ray of your mouth.

Making and Fitting Your Oral Appliance

Oral appliances are customized using digital or physical impressions and models of your teeth. These models are sent to a dental lab where the appliance is made.

Once your oral appliance is ready, you will return to your dentist’s office for a fitting. Your dentist will adjust the appliance to maximize its comfort and effectiveness. You also will learn how to clean the oral appliance and maintain it. After this fitting, your sleep doctor may schedule you for a sleep study to verify treatment success.

Follow-Up Visits

Follow-up visits with your dentist will be needed to ensure the optimal fit of the oral appliance. Effective oral appliances are always custom fit and adjusted over time to ensure maximum effectiveness. Your dentist also will schedule you for an annual assessment. These routine visits are an important part of your long-term treatment success.

Living with Oral Appliance Therapy

Treating snoring or obstructive sleep apnea with oral appliance therapy can help you feel like a new person. You will find that your symptoms, and your quality of life, can improve dramatically when you remain committed to your treatment and use it nightly. It is likely that you will sleep better, have more energy and feel sharper throughout the day. You may find that your bed partner begins to sleep better, too!

Treating sleep apnea promotes a healthier heart, body and mind. With your dentist’s help, you can improve your sleep and your health!

 

 

Article originally appeared at: http://www.aadsm.org/

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Instrument Sterility at Soho Dental

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At Soho Dental, we take the sterilization of our surgical instruments very seriously.

The pictures above show what your instruments look like before your appointment at Soho Dental.  All our instruments are thoroughly cleaned, placed in cassettes, wrapped and then autoclaved.  The process of autoclaving sterilizes the instruments using high heat, saturated steam and pressure. Most importantly, your instruments remained sealed in the wrapping until they are ready to be used.  Just before your appointment, the packages are opened as the room is prepared for your treatment.

Regular testing of the sterilizer is done to ensure instruments are in fact being sterilized and that all infectious organisms are killed. With these testing procedures we can be confident that the instruments have been completely cleaned and sterilized.

A number of items in the dental office are used on patients only once and then discarded. Disposable items include gloves, needles and syringes, protective coverings for instrument trays, and certain instruments that cannot withstand the sterilization process. Discarded needles are placed in a designated container to prevent needle-stick injuries, not in the regular waste collection. Dentists are especially concerned about needle injuries and the risk of infection they pose, so they are handled very carefully.

The area in which your treatment occurs is cleaned and disinfected after each patient, and/or disposable covers are used to protect surfaces for contamination. These covers are replaced after treating each patient.

The above highlight only a few of our infection control measures. If you have any questions regarding our sterilization procedures, please do not hesitate to ask. We would be more than happy to answer any of your questions!

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Dr. Haji Continues His Commitment to Lifelong Learning

This week I have been away from the office to complete a course presented by the world renowned Dr Dider Dietschi from Geneva Switzerland. The title of the course was “Excellence and Innovations in Composites: Direct Anterior Techniques and the “No-Prep” Ultra-Conservative Treatment of Tooth Wear”

Dr Dietschi is an advocate of conservative treatments for extensive and complex dental problems like tooth wear. The knowledge and skills that he has shared will enhance my ability to provide complete dental care with primary concentrations in dental occlusion, the temporomandibular joints and comprehensive esthetic restorative dentistry.

This was a wonderful journey in which I was able to meet and learn from a true master, who  is a meticulous dentist and great teacher. I made new friends from around the world including Denmark, Kuwait, Lithuania as well as other fellow Canadians. It was such a joy to meet like- minded dentists who are committed to providing their patients with the very best in dental care!

-Dr Feisel Haji

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Cavities Underneath Old Fillings

Many patients are surprised to know that they can get a new cavity underneath a previous placed filling. This can occur for a number of reasons. It is very important to have your fillings checked regularly so that these cavities can be repaired before the tooth needs more extensive treatment.

This picture shows an old tooth coloured filling with a very small crack in the filling. The crack is enough to allow bacteria to enter the tooth and cause decay.

The filling is removed to get access to the decay. The decay is evident by the brown discolouration. The yellow tooth colour represents healthy dentin.

The decay has been removed. The picture shows healthy dentin free of bacteria.

A new filling has been placed which is nicely sealed and integrated to the surrounding enamel. Notice the natural contours and tooth anatomy which allow cleaning with floss and proper function with the opposing tooth.

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Esthetic Crowns

The materials that we have at our disposal in dentistry today are highly esthetic such that it is often difficult to distinguish between natural tooth structure and dental ceramics.

The patient in the photo had two old crowns on the upper front teeth that looked unnatural. The two teeth on either side of the crowns were grey from trauma and previous root canal treatment.

We replaced the two front crowns in addition to crowning the side teeth to improve the overall esthetics and her smile.  Notice how the new crowns are natural looking in terms of colour and contour.

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Dental Implant Maintenance

Does cleaning dental implants differ from cleaning natural teeth?

In a nutshell, cleaning around implants differs from maintenance of natural teeth for two reasons: The first is that each attaches to surrounding bone and gums in a very different way; secondly, the materials from which implants are made are very different from natural teeth.

Dental implants replace the root parts of the teeth. Artificial crowns, bridgework or removable dentures — tooth replacements that make up the visible (crown) part/s of teeth — are attached to the implants. In between the implant and the crown of a tooth there is often a connector known as an abutment. The success of the whole system is based on the implant’s attachment to bone. Titanium, the metal of which implants are made, is uniquely osteophilic — literally “bone-loving.” It fuses to bone in a process called osseointegration (“osseo” – bone; “integration” – fusion or joining).

Above the bone where the integration process ends, the abutment comes in contact with the gum tissue where it is supported by a connective (i.e. “connecting”) tissue composed of fibers made of a tough material called collagen. The fibers run beneath the surface parallel to the implant ending at the top of the bone. They hold the gum tissues against the implant surface.

At the very top of the implant assembly, the abutment and lower part of the crown attach to the gum (the surface “skin” layer) via a specialized structure known as an epithelial attachment (“epi” – on top; “thele” – nipple). The cells actually attach to the highly polished metal or ceramic, of which the implants are made, by means of microscopic suction pads.

By contrast, a tooth root is attached to the bony socket that surrounds it — by a periodontal ligament (“peri” – around; “odont” – tooth). The ligament is composed of tiny fibers that insert into the bone on one side and into the tooth root on the other. Above the bone, the fibers attach from the tooth into the gum tissue. An implant has no such attachment. Since the whole periodontal ligament has a greater blood vessel supply through which it can bring cells and nutrients, it is more readily able to resist and fight against infection.

Infection Is The Enemy

Cleaning implant-supported tooth replacements is just as important as cleaning natural teeth, as both depend on healthy surrounding tissues for support. Bacterial biofilm (plaque) collects on implant crowns just as it does on natural teeth, and must be removed on a daily basis at home. Without daily biofilm removal, infection can develop known as peri-implantitis (“peri” – around; implant “itis” – inflammation), which can result in loss of the attachment described above. Unlike inflammation around teeth, this reaction can be quite catastrophic both in rate and amount, quickly leading to a well- or dish-shaped loss of bone around an affected implant. Bone loss can rapidly progress to loss of the implant.

The dental hygienist has an important role to play in keeping dental implants infection-free, and there are many factors to be considered in selecting the right instruments for a professional cleaning. They include: the nature of the debris, meaning whether soft (biofilm, foods) or hard (calculus or tartar, calcified material); the location of the deposits; the type of surface on which they accumulate; and the stubbornness with which they adhere.

The Right Tools For The Job

Your hygienist must select instruments for cleaning that will not damage the crown, abutment, or the implant itself. Maintaining the highly polished, smooth surface of the abutment and crown are critical. If they are scratched they can attract and harbor bacteria. That’s why the instruments used, called scalers and curettes, are most often made of plastics and resins. Natural teeth don’t scratch in the same way, and therefore metal instruments can be used to clean them.

A number of power (ultrasonic) instruments have nylon or plastic sheaths or tips to minimize implant damage. They clean by using high-frequency vibration, which may be necessary if large quantities of debris have accumulated. They are used on a low power setting with a lot of water irrigation, and sometimes antibacterial solutions, to clean and flush material.

If any part of the implant body (root replacement portion) itself is visible, this may mean there is infection that has resulted in gum and/or bone loss. The implant surface becomes exposed following loss of its fusion to the bone. Implant surfaces are generally microscopically “roughened” to increase surface area for bone attachment. But this surface roughness makes implants difficult if not impossible to clean and disinfect. Additionally, some implants are screw-shaped and their threads just add to the cleaning dilemma.

Brushes are used to clean biofilm from exposed areas of an implant wherever possible. If calculus or dental cement (used to secure the crowns) is present on an implant surface, the hygienist needs to use instruments that are effective in removing these contaminants. In such cases the clinician must ensure no scratching or damage is caused by completing the task.

Despite these special cleaning challenges, implants are highly successful. In fact, studies indicate long-term success rates well over 95%. However, the prevention of peri-implant disease is fundamental to implant health, maintenance and function. And cleaning implants and their related components is an important part of success. Your question indicates that your hygienist is on top of it.

 

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Closing Spaces in Between Teeth Using the Bioclear Technique  

This patient presented with spacing between her two front teeth that that she found displeasing. The space really bothered her and she asked if we could close the space using bonding.

Trying to close such a small space with bonding is a difficult task because it is hard to control the bonding  material such that we do not get excess material in between the teeth and below the gums. Excess material can cause irritation and inflammation of the gums.

The Bioclear technique allows us to close small spaces in a predictable way so that we can have good anatomical contours that are smooth and do not irritate the gums.

Our next blog will feature a video that shows the Bioclear technique.

 

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Old or Discoloured Bonding

Bonding with composite resin allows us to repair chips, fractures and discoloration conservatively. The underlying tooth structure is not removed and the integrity of the tooth is intact. This is different from some other treatment options such as crowns or veneers.

Bonding has a lifespan of about 5 years at which time it may chip or discolour.  The good news is that it is easily replaced and because the underlying tooth structure remains unchanged, re-doing the bonding is just as conservative as the original treatment.

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