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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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Healthy Snacks to Maintain Strong Teeth For Life

If you want to maintain strong teeth for your lifetime, you need to ensure you are eating enough whole grain breads and cereals, fruits and vegetables and lean meats.

Some healthy snack choices include:

  • nuts and seeds
  • peanut butter
  • cheese
  • plain yogurt
  • popcorn

Acid Erosion

There are some drinks and snacks that are bad for your teeth and may contribute to acid erosion. Acid erosion happens when food or drink with a low PH level (more acidic) are consumed. That acid can linger in your mouth, taking the minerals away and softening the surface of your teeth. This makes your teeth more susceptible to damage and often leads to increased sensitivity and may require treatment. The big offenders seem to be soft drinks, orange juice and lemonade.

Nutrition Tips

  • Try to avoid acidic food and drink between meals; there isn’t as much saliva in your mouth at these times to protect your teeth
  • Don’t clean your teeth right after eating. If you brush while the acid is still in your mouth you are removing some of your teeth’s surface. If you wait about an hour the saliva will help your teeth battle the acid so it is safe to brush
  • Try to finish your breakfast, lunch or dinner with a little cheese or milk as these products help cut down on the acid in your mouth.

A Note About Sweets

When it comes to your teeth, it’s not about the amount of sweets you eat, but the length of time that you leave your teeth exposed to sweets. So it’s better to eat sweets at mealtimes rather than between meals, as the amount of saliva produced at mealtimes will help protect your teeth.

If you cannot avoid sweets between meals, choose something with less sugar like those listed above. Sticky sweets like toffee or hard candy should be avoided as snacks.

Do you have more questions about these issues? Speak to your dentist today.

Content courtesy

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Toothpastes For Sensitive Teeth – Which is Best?

Almost all the toothpastes discussed below include sodium lauryl sulfate (SLS) as a surfactant. It’s what gives the toothpastes their pleasant foaminess. Some people find that SLS irritates their mouths, however, contributing to the incidence of canker sores or other mouth discomfort. Another problem dentists frequently encounter is sensitive teeth — teeth that hurt when touched by hot or cold food or drink.

A lot of things can cause canker sores and sensitive teeth, but most toothpastes designed for sensitive mouths and teeth don’t include SLS, which can dry the gums and lining of the mouth. Some toothpastes for sensitive teeth made by Sensodyne and other brands also contain potassium nitrate, an ingredient that can alleviate tooth sensitivity. Dentists say that some patients only need to use a toothpaste for sensitive teeth for a month or two, for example if you’re using a whitening product, like strips, that may contribute to sensitivity, while others need to stay with it indefinitely. We cover teeth whitening products in a separate report.

There’s no doubt about it: the brand Sensodyne reigns supreme when it comes to products made for sensitive gums and teeth. Sensodyne ProNamel Gentle Whitening (Est. $10 for 2) is a popular choice. It is designed to restore teeth to their natural whiteness and protect enamel against acid erosion, which causes teeth to grow yellow, thin, transparent and dull. This makes it a good choice for heavy coffee drinkers and people at risk of acid erosion, as it reportedly strengthens acid-softened enamel and prevents further enamel from dissolving. In addition, its desensitizing formula actually has a cumulative effect — it makes teeth less sensitive over time.

Sensodyne ProNamel Gentle Whitening is a top pick among experts, and user reviewers are very pleased with the product. They say it has a pleasant taste and that it does gradually whiten teeth. A number of users remark that regular brushing with this toothpaste essentially cured their hot/cold sensitivity. Some people who don’t have sensitivity issues say they used this product to decrease their sensitivity before switching to a stronger whitening product, such as strips or gels. Many also say it provides long-lasting fresh breath. It does not carry the ADA seal due to its whitening ingredients, which the ADA does not evaluate.

Alternatively, if you don’t want or need whitening but want a top-rated toothpaste for sensitive teeth, consider Sensodyne Repair and Protect Toothpaste (Est. $5). Its active ingredient is stannous fluoride, which prevents cavities from forming. The product earns high praise from users, who praise the taste and gentle formula. Sensodyne Repair and Protect is ADA approved.

Another solid choice for people with teeth or gums sensitivity is Colgate Sensitive Complete Protection Toothpaste (Est. $7). Like Sensodyne, it contains potassium nitrate as an anti-sensitivity agent that gradually builds tolerance for hot, cold and sugary foods. It also contains fluoride, which promotes plaque removal and healthy gums. This product has also earned the ADA Seal of Acceptance.

Colgate Sensitive Complete Protection gets positive feedback from users, with most saying it is very effective for treating teeth and gums sensitivity. A number of reviewers remark that they were advised to try the product by their dentist, and several commenters say that it is more or less comparable to Sensodyne, yet the taste of Colgate toothpaste to Sensodyne products.

Another go-to toothpaste for mitigating sensitivity is Aquafresh Sensitive Toothpaste (Est. $16 for 4). Like the Sensodyne products and Colgate Sensitive Complete Protection, Aquafresh Sensitive contains potassium nitrate as an anti-sensitivity agent and is intended to lessen teeth and gum sensitivity after a few weeks of use. It comes in “Smooth Mint” flavor or as a “Maximum Strength Sensitive + Whitening” toothpaste.

Although Aquafresh Sensitive is well liked among its many user reviewers, some note that it can be hard to find in stores. Reviewers remark that the toothpaste is effective at reducing sensitivity and that it isn’t as abrasive as equivalents by other brands. Some say the taste is too mild or leaves a bad aftertaste; others say they like it just fine. It does not carry the ADA seal, again, due to its whitening claims.

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