Bonding

Afraid to smile because your teeth are chipped, uneven or discoloured? Why not try bonding — a treatment that is used to repair chipped or stained teeth. It may even be used to reduce gaps between teeth. By bonding, you can perk up your appearance and self-image.

Dentists mix composite resin, a type of plastic, into a paste, tint the mixture to whiten or match the colour of your teeth and apply several layers to a tooth. Each layer is hardened under a special light. Final steps include shaping and polishing the resin material so the finished tooth looks natural and smooth.

Bonding can also be used to build up older teeth to make them appear younger. Everyone can have their teeth bonded, including children, because the resin can be replaced, if necessary, as teeth grow.

Veneers

Are you too self-conscious to smile because your teeth are chipped, discoloured or poorly spaced? Cheer up. Your dentist may be able to apply a porcelain laminate veneer to your teeth and give them a whole new appearance. Veneers are strong, thin pieces of porcelain that are bonded to the teeth. They are used to repair chipped, decayed or stained teeth and may help in closing gaps between teeth. With a bit of contouring, veneers may also correct slightly crowded or overlapping teeth. If your teeth have discoloured with age, a veneer may improve their appearance.

Veneers can also be used for cosmetic reasons instead of crowns, which are more often used for badly damaged or decayed teeth. The tooth enamel needs to be ground down slightly in order to accommodate the veneer. Veneer preparations frequently require the use of local aesthetic and, depending on colour and shade, may take more than one appointment to complete.

Bridges/Implants (Prosthodontics)

When indicated, missing teeth should usually be replaced in order to restore your smile, regain your chewing and to prevent other teeth from shifting.

There are three main types of artificial teeth and each one is designed for a particular situation:

Dental Implant

A dental implant is made by surgically placing one or more small metal posts beneath the gum into the jawbone. In a few months, when the implants are fused to the surrounding bone, the artificial tooth or teeth are then attached and the missing tooth or teeth are restored.

Removable Denture

A removable denture replaces all of the lost teeth in the arch with one appliance. The denture is held in place by clasping some of the remaining teeth, or by suction where none of the natural teeth are left.

Fixed Bridge

A fixed bridge is a tooth replacement restoration that is attached to the teeth on either side of a gap. The adjacent teeth, called abutments, are each prepared to receive full crowns or caps, and the bridge consists of two or more caps and the missing tooth/teeth. When completed, the bridge is cemented into position over the adjacent abutment teeth.

Crowns/Caps

Prepared by your dentist, a crown or cap is a cover that fits over a tooth that has been damaged by decay, broken, badly stained or misshaped.

A crown can be made of acrylic, metal, porcelain or porcelain bonded to metal. All-porcelain crowns look more like your natural teeth, and therefore are usually used for front teeth. Porcelain bonded to metal is stronger and better for crowns in the back of the mouth. Sometimes, all-metal crowns are used for back teeth because of the metal’s strength.

To prepare your tooth for a crown, the tooth is first anesthetised (frozen) and then filed down so the cap can fit over it. An impression of the teeth and gums is made and a temporary cap is fitted over the tooth until the permanent crown is ready.

On your next visit, the dentist will remove the temporary cap and cement the crown onto the tooth. The crown will closely match the colour and shape of your natural teeth.

Early Childhood Caries (Baby Bottle Syndrome)

Nursing caries in baby’s first teeth occur when babies habitually fall asleep sucking on a bottle that contains cow’s milk, juice, formula or sugary drinks. The sugar turns to acid and begins to dissolve the tooth enamel. Breast-fed babies are also susceptible if they constantly fall asleep with breast milk on their teeth. Early signs of nursing caries include white spots/tooth discolouration. If the process continues, rampant decay and discomfort to the child often results.

Children need their baby teeth to chew and to learn to speak properly. Fortunately, you can protect your baby from early childhood caries. Don’t let your baby go to bed with a bottle unless it contains plain water. Never let your child use a bottle as a daytime pacifier because all-day sucking is as bad as nighttime sipping. Clean your baby’s mouth and teeth after meals and breast-feeding. Finally, if you suspect your child has early childhood caries, contact your dentist immediately.

Gums (Periodontics)

Adults lose more teeth to gum disease than any other reason. During your lifetime, you could be one of the nine out of 10 people worldwide who suffer from this disease.

Periodontal or gum disease is an infection that affects the gums and jawbone and, in the early stages, is symptomless. However, some early signs are swollen and tender gums, bad breath and gums that bleed during flossing and brushing. Although the accumulation of excessive amounts of plaque is the primary cause of gum disease, some people may be genetically pre-disposed. Fortunately, periodontal disease can be treated at all stages.

Gum disease can be prevented. Visit your dentist regularly and brush and floss your teeth to remove plaque. If it is not removed, bacterial plaque will affect your gums, causing inflammation, which may lead to bleeding or bone loss. This stage of gum disease is called gingivitis. Plaque that is not removed may cause your gum tissue to recede, pockets may develop between the gums and teeth and the tissue that attaches the tooth to the jaw may be weakened.

Infection Control (Office Sterilization)

Sterilization kills harmful bacteria and viruses. The New Brunswick Dental Society recommends sterilization guidelines for dentists to follow to protect patients from infectious diseases, including AIDS. There is no evidence that AIDS (a virus usually transmitted through sexual activity or by sharing needles) or any other virus can be transmitted during dental treatment if proper preventive measures are used.

Today, dental professionals wear masks, protective eyeglasses and latex gloves when performing procedures. They also sterilize dental instruments, operating rooms and equipment before each patient. There is even a sterilizer monitoring service to help dentists ensure their sterilization systems are operating properly. Also, dental teams use disposable items such as needles, paper towels, plastic wrap, aluminum foil or pre-made covers and gloves to protect patients.

Orthodontics

A dentist can help give you a great smile by applying braces to the surface of your teeth and periodically adjusting the wires that hold the braces together to stimulate the movement of your teeth in the desired direction.

If your teeth are properly aligned and your bite is good, the teeth, gums and jaws will most likely be healthy. A poor bite can loosen, chip or wear down teeth prematurely as well as strain jaw joints and cause pain.

There are several factors that may cause teeth to become crooked and move out of line: poor jaw alignment, loss of the first teeth before they’re ready to come out, thumb-sucking, or the inherited trait of large teeth and a small jaw. If teeth are badly crowded, some may need to be extracted to create space for proper realignment.

Braces were once considered strictly for children, but, today, more adults are considering orthodontics to help enhance their smile.

Root Canal Treatment (Endodontics)

A root canal is a treatment for diseased (abscessed) teeth. Your dentist can provide this treatment, or you may be referred to another for further consultation and treatment.

In healthy teeth, the interior of the tooth is filled with living tissue called pulp. Once the tooth is injured, cracked or decayed, it is necessary to open the tooth and clean out the infected tissue in the centre. This space is then filled and the opening sealed. During the procedure the area around the tooth is anesthetised (frozen).

Once the root canal treatment has been completed, a crown or cap, as well as a post, may be necessary to protect the tooth. Teeth that have had root canal treatment can stay as healthy and last as long as other teeth. In most instances, you won’t be able to feel or see a difference.

Teeth Whitening

Before purchasing any tooth whitener, you can likely save yourself some time and money by consulting the expert on these products — your dentist. Taking into account your unique oral health conditions, your dentist will be able to determine what, if any, tooth whitener is the right one for you.

The appearance of new “whitening” options for consumers has paralleled the growing public interest in cosmetic and aesthetic procedures, fitness and wellness.

The most common options are:

• In-office bleaching
• At-home bleaching
• Whitening toothpaste

In-office bleaching usually takes about 30 to 90 minutes and one to three visits to the dental office. A protective gel, shield or rubber dam is used to protect your gums from the bleaching agent, which is usually a form of hydrogen peroxide. A bleaching agent is then applied or “painted” onto your teeth and heat or high-intensity lights used to enhance the whitening process.

At-home bleaching is usually done by applying a bleaching solution to a custom-formed mouth guard that is left in the mouth for a specified time. Some products are intended for twice-a-day use for up to two weeks. Others are intended for overnight use for one to two weeks.

Some patients may find that the soft tissue of the gums can become sensitive or irritated by the mouth guard or the solution. If you have concerns, it is important that you bring these to the attention of your dentist.

All toothpastes remove surface stains through the action of mild abrasives. Whitening toothpastes contain special chemicals or polishing agents that have additional surface-stain removing properties, but don’t alter the intrinsic colour of the teeth.

It’s important to know that not everyone’s teeth will “whiten” to the same degree. It depends on the number of teeth involved, the severity of discolouration and the natural colour of your teeth. The perception of the colour of your teeth is also influenced by skin tone.

Further Reading

“The Safe Use of Home Tooth Whitening Kits” – Health Canada website.

Temporomandibular Disorders (TMJ)

Temporomandibular joints (TMJ) are your jaw joints and muscles used to open and close your mouth when talking, chewing, singing and swallowing.

Temporomandibular disorders (TMDs) are a group of conditions that can affect the jaw joint or jaw muscles and may cause facial, tooth and earaches, as well as “clicking” in the jaw, “tension headaches” and even neck, shoulder or back pain. You may experience pain ranging from minimal to severely debilitating, especially when chewing and opening your mouth wide, or your jaw may lock or be prevented from opening fully.

TMDs can be caused by injuries to the face and jaw, whiplash, poor posture, bite problems, badly fitted dentures, grinding teeth and chronic jaw clenching.

Systemic diseases that affect the joints of the body, such as rheumatoid arthritis and lupus, may also affect your jaw joint and can cause degeneration.

Ask your dentist about examining your TMJ if you are experiencing any of these symptoms. Special tests, including X-rays or MRI scans of the joints, are sometimes carried out. Most patients benefit from simple treatment, including physiotherapy, dental bite guards and anti-inflammatory medication. Patients with persisting, severe pain may require surgery, in which case your dentist may refer you for further consultation and treatment.

Wisdom Teeth

Wisdom teeth don’t make you smart, but they can create problems. These third molars are the last teeth to erupt and usually appear between the ages of 17 and 21, but can begin causing problems as early as age 13.

Sometimes, these teeth don’t always have enough space at the back of the lower and upper jaw, thus developing at an angle that causes them to jam and become impacted. When this happens, a cyst may form in the tissue surrounding these teeth, which can cause deterioration of the jawbone or the teeth in front. Sometimes, the wisdom teeth only partially erupt (i.e., come above the gums) and become prone to recurrent infection and decay. This condition can lead to swelling, pain and difficulty opening the jaw. The eruption of wisdom teeth can sometimes be painful and may be associated with sore throats, headaches and gum infections. By monitoring the development of your wisdom teeth during regular checkups and dental X-rays, your dentist can determine whether your wisdom teeth have enough space to erupt through the gum, or if they should be removed.

Still have concerns? Please talk to your dentist.