Big Red Tooth – Dr Candice Schwartz

Where teeth and health meet

Do I need to visit the dentist when I am pregnant?

YES YES YES. For some reason women think that because they are pregnant they do not need to visit the dentist. It is quite the opposite. It is during this time that the most damage can be done to your teeth without you knowing it. It is very common for pregnant women to complain of bleeding gums during their pregnancy. This is the first sign that you must visit your dentist asap. Gingivitis is more prevalent while women are pregnant. The general oral hygiene of most women suffers during this time because they are concentrating on their developing baby and there is such a massive shift in their body that they tend to neglect their mouths. Bleeding gums is aggravated further by the change of hormones during pregnancy. This is known as pregnancy gingivitis. Some expecting mothers out of fear of bleeding avoid proper brushing or flossing. This further worsens the situation.

The unavoidable consequence of inadequate oral hygiene is an increase in dental plaque which leads to dental decay. Cavities will rapidly develop. Often women will come to me for a dental check up, after having their baby. I will find numerous teeth that are severely decayed and extensive restorative dental treatment is then required. It is far better to prevent this from happening. I recommend seeing your dentist at the beginning of your pregnancy and every 3 months thereafter for a scaling and polishing and a quick look over of the mouth (without xrays) till you have had your baby. 8 weeks after your baby’s birth you should come in for a full routine dental checkup with full xrays. If any fillings are required they may be completed at this appointment.

Dental treatment is possible during pregnancy however. Most dental procedures can be completed while you are pregnant. It is not in your interest, nor your baby’s interests to leave underlying infection in the mouth. Especially if you are in any sort of pain, rather see your dentist early on so the problem can be diagnosed and treated. There is a large amount of research that supports the notion that bacteria from the mouth can enter the bloodstream and affect your unborn baby. Do not neglect your mouth during your pregnancy. Visit your dentist and take responsibility for the things you have complete control over during your pregnancy. Excellent oral hygiene is the first step. Be Proactive! See your dentist today.

 

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What is a nesbit denture?

A nesbit denture is used to replace a lost single tooth, on one side of the mouth. Often teeth which have had a root canal treatment many years prior, present to me with a recurrent abscess. The treatment options are limited and depend of the size of the abscess and the extent of damage. If patients live with type of condition for a long time is becomes chronic (occurs over a long period of time) and they do not notice the pain. This is coupled with resultant bone loss around the tooth root. In these cases tooth extraction is needed. Sometimes patients want to hold on to their teeth and it may be viable to refer to patient to a specialist to have an apicectomy procedure. This may prolong the lifespan of the tooth, however the abscess generally will recur a few years down the line and the tooth will need to be extracted.

When a single tooth has been extracted there are a few different options for replacing it. A dental bridge, a dental implant or a removable partial denture may be used. These patients may not be ready for implant placement if a large amount of bone loss occurred, or they may not want an implant. The solution to replacing a tooth temporarily or a removable long term option is a nesbit denture. Traditionally these appliances contained metal clasps. However the nesbit denture is constructed completely out of an acrylic vinyl material. It is light and if made properly has good retention capabilities. These are now commonly used as interim replacements while patients are waiting for implant restoration.  They do require a natural tooth posterior and anterior to the edentulous space and are not appropriate for “free end saddle” situations (patient has no posterior tooth to support the partial denture).

 

The procedure for making a nesbit denture is very simple and requires some dental impressions which are then sent to the laboratory. After a week or two most patients are comfortable and used to wearing their nesbit denture. The nesbit denture is a cost effective, quick solution to tooth replacement.

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Dental fear

The large majority of my patients (particularly new patients who I am seeing for the first time) arrive stricken with fear for the dentist. It seems that this fear stems from negative childhood experiences. However there is a stigma attached to dentists, that we are sadists, massachists of the oral cavity, gloved and masked demons waiting to cause pain and terror. It is in reality quite the opposite. Each and every dentist has their own methods and means of creating a happy patient experience and reducing the pain associated with dental treatment. I have a few tricks up my sleeve when it comes to painless injection techniques, patient calming strategies and a generally happy & peaceful environment in my surgery. With time, I hope, more and more people will enjoy their dental experiences as technology moves forward and the standard of dentistry increases. But until then, we, as dentists, try to shake off the stigma and change perceptions of fearing the dentist, one patient at a time.

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What is the best toothpaste to use?

I usually stick to one brand of toothpaste that I recommend to all my patients. The best toothpaste on the market, in my opinion, is Elgydium Anti Plaque. Elgydium has a unique combination of ingredients that actually prevents plaque from adhering to the tooth surface. Chlorhexidine is the active ingredient in this toothpaste which is responsible for the inhibition of harmful bacteria that causes tooth decay and harms gums. When you use Elgydium Anti Plaque you will notice your teeth are smoother (fur-free!) for much longer.

If your teeth are free of plaque, they are less likely to decay. The presence of plaque is what results in dental decay. So Elgydium may be slightly more expensive, but in the long run it will certainly cost you less in dental bills. In addition, only a very small amount of toothpaste is required for it to be effective. You only need a “pea size” blob of toothpaste on your toothbrush for it to be effective.

Elgydium also makes a ‘sensitive’ toothpaste. This is a very good alternative when you suffer with tooth sensitivity. I usually recommend you use Elgydium Anti Plaque in the morning and Elgydium Sensitive at night.

If you use this toothpaste, a mouthwash is usually not needed (unless otherwise prescribed by your dentist if you are for example in the process of having periodontal treatment). Other brands of mouthwashes may give you that fresh breath feeling, however this is a false sense of freshness that is achieved by the evaporation of alcohol in the ingredients. The mechanical removal of plaque during flossing and brushing combined with the anti plaque effects of Elgydium will ensure a clean mouth and healthy gums.

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Full mouth rehabilitation – Case report

Before
This patient came to see me and wanted a brighter, whiter smile. When he smiled, he did not like the colour of his teeth, especially the contrast in color between his natural teeth and the crowns. He had no pain. His concern was only esthetic.

Diagnosis:

The upper and lower anterior natural teeth have intrinsic staining. Intrinsic staining occurs naturally with age. It is unlikely that tooth whitening will make any substantial improvement on the shade of these teeth. There is also a colour discrepancy between the natural teeth and the adjacent dental crowns. The crowns also have a very opaque “dead” look to them in comparison to the natural teeth. The posterior teeth (molars and premolars) have mild to moderate gingival recession. This shows a distinct line where the natural tooth meets the tooth margin. This is very unsightly and also leads to sensitivity. On radiographic examination secondary decay was visible at the margins of some of the existing crowns.

Treatment plan:

Replacement of all existing crowns and crowning of the remaining natural dentition was the only way a uniform colour and brilliant dentition could be achieved. I discussed with the patient that the anterior teeth were “virgin teeth” (never been drilled/filled) and a large proportion of tooth structure would be sacrificed in the crown preparation process. However he was adamant that he wanted a “bright white smile”. For this reason I chose to place Emax(all-ceramic) full coverage crowns on the upper and lower 6 anterior teeth and porcelain fused to metal crowns on the posterior dentition. I choose the porcelain fused to metal crown as it is stronger and I believe the marginal seal between the crown and tooth is superior to all ceramic crowns in the posterior teeth. This reduces the risk of secondary decay and fracture under high occlusal stresses.

The chair time for this type of treatment is very long, for the dentist and the patient. Frequent breaks between drilling are essential and a sense a humour is always a great advantage!

The results are beautiful and the patient is very pleased.On the right side of the mouth there is still staining visible on the last upper and lower molar teeth. I did not place crowns on these teeth as they are not visible at all when the patient talks/smiles and they were completely healthy teeth. A bite plate was made and i recommend it is worn every night. Because almost every tooth in the mouth is crowned, these precious pearls need to be protected and a bite plate will prevent any porcelain fracture during tooth grinding at night. The shade of the teeth is A2. I felt that the shade A1 would be too light for this patient. I always try and persuade my patients to choose the most natural looking shade instead of unrealistic whiter colours.

I am very happy with this result and enjoyed every step of the treatment process. (:

After

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