Big Red Tooth – Dr Candice Schwartz

Where teeth and health meet

First dentist visit. What age should I bring my child to the dentist?

Many parents ask me when they should bring their child to the dentist for the first time. My response to this is always, whenever you see the first tooth grow out.

The reason I request to see children so early on is not to jump into their mouths and do a long examination. In order to prevent dental fears later on in life, a relationship with your dentist, based on trust and understanding is essential. It is easy to slowly nurture a bond with a child if I see them on a regular basis from an early age. You should be bringing your child to the dentist every 4-5 months, throughout their childhood. This good oral awareness will stay with them for the rest of their life.

Do not expect too much from the first dental visit. Encourage your child to be excited about this first experience at the dentist and always speak about the dentist in a positive light. You must ensure that you do not transfer your own fears onto your innocent child. I will never forget an experience I had early on in my career. A mom brought her young daughter to see me, she was 3 years old. The child walked into my surgery with confidence and a big smile on her face and jumped with enthusiasm into the dental chair. She was so excited to be at the dentist. As I was taking her back in the chair, her mother piped up “don’t be scared honey, the dentist is not going to hurt you”. All of a sudden the child’s entire attitude shifted. She was afraid and started crying and the entire appointment was downhill from there. The mother transferred her own negative expectations onto her child and ruined any chance of it being a positive experience.

Be very aware of the type of words and language you use. NEVER use negative nouns/adjectives like “pain, hurt, fear, scared, injection etc etc”. Be selective in your description of the dentist so the child is only expecting good, positive things.

Also be informed about which dentist you choose for your child. Phone the dentist rooms beforehand to find out if they are child friendly. Many dentists do not have the patience or interest in treating young children. Make sure you take your child to a pediatric dentist. It will make all the difference.

Another reason for bringing your child to the dentist from the time the first tooth enters the mouth, is actually for you, the parent. A pediatric dentist will take a lot of time and energy explaining preventive measure to you and teaching you about what to expect in the mouth and how to prevent cavities. Technology and ideas about prevention have changed a lot since you were a child. Educate yourself so you can give your child the greatest gift; the opportunity of having a healthy, cavity free mouth.

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The benefits of chewing gum

I recommend my patients chew chewing gum between meals. And NOT sugary gums. It must be a sugar free chewing gum (usually they contain xylotol or another type of natural sweetener). Chewing gum changes the pH of your saliva. Bacteria thrive in an acidic environment and it is this acid that cause the dissolution of your teeth and ultimately leads to tooth decay. If the pH of your saliva becomes more alkaline, you are less likely to have bacteria living in your mouth and therefore less likely to have cavities.

The second benefit of chewing gum, is that it stimulates more saliva production. People who suffer with a dry mouth (or are mouth breathers) are more susceptible to tooth decay. So another effective strategy for reducing your risk of tooth decay is by bathing your teeth and mouth in a constant fresh flow of saliva.

And lastly, chewing gum mechanically removes excess plaque and food from the surfaces of your teeth. This is turn removes the decay causing bacteria from your teeth.

 

So carry a pack of sugar free gum in your pocket and chew in between meals!

 

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What is a Periodontist ?

Many patients come for a routine dental visit and are then referred off to see a “periodontist“. Here I will answer what a periodontist does and you can then decide if you need one.

I am going to being with a few definitions to get us on the same page:

PERIODONTIUM: This refers to all the supporting structures that surround the teeth. The specific tissues that make up the periodontium are the alveolar bone, periodontal ligament, cementum and the gingiva (or gums).

PERIODONTICS: This is the study of the periodontium and the branch of dental specialty that treats diseases of the periodontium.

Therefore, a periodontist is a specialist dental practitioner who treats and manages diseases and conditions of the periodontium. Most often a patient requires the expertise of a periodontist when they suffer from periodontal disease. Anyone can develop periodontal disease. It is usually a slow process (but sometimes can be very acute & develop rapidly) of destruction that develops over time when the oral hygiene of the mouth is poor. Initially patients suffer with bleeding gums. People assume that this is normal and do not seek treatment. Bleeding gums then become a part of their daily life. The bleeding is caused from a chronic inflammation of the gums due to the presence of bacteria in dental plaque. This is known as gingivitis. The dental plaque present on the tooth surfaces will turn to calculus, a hard accretion that cannot be removed with a toothbrush. The gingivitis, if untreated, will turn into periodontal disease which causes the destruction of the alveolar bone that houses teeth. The result is loosening of the teeth and if untreated, eventual loss of the teeth. The primary role of a periodontist is to treat periodontal disease, by removing the calculus that has accumulated and reverse the chronic inflammatory process. The objective is to halt the destructive process of bone loss through a number of minor surgical and non surgical procedures.

In addition the treating periodontal disease, a periodontist may place dental implants, surgically extract problem teeth, place bone grafts and place gingival grafts.

In general, it is advisable to see your dentist for an assessment first before booking directly with a periodontist. An astute dentist will be able to assess the severity of any possible gum problems and refer you to a suitable periodontist if you need one.

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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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Case report

 

 

 

 

 

 

 

Before

 

 

 

This patient came in for treatment to restore the esthetic appeal of his smile. He felt his teeth were not visible enough and they had been neglected over the years. He wanted to be able to smile confidently again.

Dentist talk: The staining and severe wear you are seeing on this dentition is not caused from dental decay. The severe tooth wear is caused by attrition, abrasion and erosion. Abrasion is the loss of tooth structure by mechanical forces from a foreign element, namely a toothbrush. When your toothbrush is too hard and you use it too aggressively, it leads to gingival (gum) recession. Gingival recession exposes the root surface of the tooth, which is a lot softer than the tooth crown because it does not have a hard enamel covering. As you continue to brush in an abrasive manner, tooth structure is destroyed at the gumline. Attrition is the loss of tooth structure by mechanical forces from opposing teeth. Tooth grinding is directly related to stress levels. With the ever increasing stresses of daily life, jaw clenching and tooth grinding have become a common problem. The immediate problem is the vertical loss of tooth height as grinding continues. The flat occlusal plane (biting surface) seen in the above pictures is an excellent example of the results of years of tooth grinding when it goes untreated. Erosion is caused by excessive consumption of acidic foods and drinks ‘dissolving’ away the surface of the tooth, like fruit juice, coca cola and dried fruit. This is more commonly seen on the palatal surface of the teeth, however this patients’ diet did consist of a lot of acidic foods and it did contribute to the overall tooth wear.

Besides the obvious esthetic problem, the bigger dental issue is the loss of vertical tooth height. Due to the excessive grinding habit, the teeth are much shorter than they were originally. This leads to the bite becoming “closed”. As the vertical height gets shorter, the face will begin to collapse which ages the patient tremendously and adversely affects chewing functions and parafunction. In order to treat the problem, the vertical height needs to be restored to its original height. Therefore the “bite needs to be opened”. Opening the bite requires increasing the height of every tooth in the mouth with full crown coverage of the entire dentition. Because the patient is a chronic bruxer (grinder), porcelain fused to metal crowns are used as these are stronger. Dental implants will be placed into the areas where there are missing molar teeth.

After

 

 

 

 

 

 

 

 

 

 

 

 

 

There is one more lower mandibular tooth that requires a crown. This will be completed once the implants have been placed and all the molar teeth will be restored at one time. You will notice that this patient only has teeth up to his premolar teeth. This is in fact adequate for chewing and gives sufficient chewing surfaces for normal function. The molar teeth implants will complete the dentition for the perfect result. A bite plate was also made for the patient to wear at night to prevent porcelain fracture and ease the grinding habit. After opening the bite 3mm, the patient was extremely happy with the increased length of teeth that are now far more visible during speech, smiling and function. I was also very pleased with the good result.

With attention to fine detail and careful planning this type of case is very exciting to treat and so rewarding when patients’ lives are changed by their new smiles (:

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And dont forget to floss…..

Have a great weekend ! (:

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