Ask a Toronto Dentist

Does chewing ice harm my teeth?

2010-08-22T12:27:00.000-07:00

Q:

I have a habit of chewing ice, it feels good and relaxes me after a long day. Will this have any long term impact on my teeth? via email Saturday August 21, 2010 from Marsha.

A:

Thanks for the question! Chewing ice can be detrimental to your teeth as it is a repetitive force that is applied to your teeth. Ice a hard substance which when chewed between teeth over time can have the potential to cause small fractures on the tooth surface. These small fractures on the surface of the tooth can over time become larger until a piece of tooth actually fractures off.

As well, ice is cold thus the temperature change in the mouth may cause existing fillings in the teeth such as composite (white) or amalgam (silver) fillings to contract and when the ice is taken away to once again expand. When this happens repeatedly, the area between the filling and the tooth can become weaker and allow leakage between the tooth which has the potential to irritate the pulp and nerve of the tooth.

I would recommend trying to stop this as it can be harmful to the dentition. As well, I would suggest you seen your physician as repetitive ice chewing can be related to anemia (low iron levels), this is called Pica.

Have a great day!

Nathan Haas

Toddler and Child Day at the Dentist at Stonebrook Dental

2010-08-13T07:48:00.000-07:00

Tomorrow is another Toddler and Child Day at the Dentist, Saturday August 14, 2010 from 9am-2pm. Looking forward to seeing all the children and their parents for another exciting day of introducing dentistry to little ones!

We are booking for our next Child Day at the Dentist on Sat. September 18, 2010 from 9am-2pm.

Stonebrook Dental

4256 Bathurst St, Suite 405 (Bathurst Medical Centre)-just south of Sheppard Ave.

Toronto, On

M3H 5Y8

(416)636-4227

drnathanhaas@hotmail.com

http://www.drnathanhaas.com/

Braces for teeth that are crooked

2010-08-07T11:00:00.000-07:00

Q:

For as long as I can remember my teeth have been crooked and over the years they have seemed to become even worse. I am very unhappy with the look of my smile and thinking about straightening them. I want to do the best thing possible, what do you suggest for crooked teeth? Via email Thurs. August 5, 2010 from Emily.

A:

It is hard to answer your question on a whole since I have not examined your teeth in person, but I will provide some answers below which you may explore to see what is the best option for you.

The first choice is orthodontics (braces) as these will address the alignment of both your teeth and jaw, thus providing a more harmonious bite and long term aesthetics. Orthodontics are optimally done by an orthodontist who has many years of expertise/training with straightening teeth and ensuring it is done properly. The time span for orthodontics can vary from a short period of time (sometimes less than a year) to multiple years depending on the situation that presents upon examination and x-rays.

Another choice is veneers. Veneers are thin tooth coloured shells that are cemented onto the teeth. When teeth are out of alignment, crooked or have small spaces between them, custom made veneers may be permanently adhered to individual or groups of teeth to give the appearance of straight, evenly spaced teeth and smile. Veneers are not an option for everyone and prior to going with this choice the dentist should fully examine and assess whether veneers are a good long term option for your teeth, smile and aesthetics. Veneers do not last forever, the lifespan can be anywhere from 5-10 years and then they will need to be changed to new ones.

Regardless of which route you take to straighten your teeth, please see a qualified dentist to assess the right route to go.

Great question!
Nathan

Sore on lip that is not healing

2010-07-20T05:35:00.000-07:00

Q:

I have had a sore on my bottom lip for two months, the size stays about the same but over the last two months it has formed a scab a few times and then fallen off. When the scab falls off it seems to heal for a few days then it comes back again. I am concerned only because it never seems to heal and go away completely. I am 45 years old, a previous 1 pack a day smoker up until 4 years ago. Should I go see my dentist?
Via email Monday July 20, 2010 from Anthony

A:

Hello Anthony, sorry to hear about the sore on your lip. I urge you to see your dentist or physician as soon as possible to assess the lesion as any lesion within the oral cavity or the surrounding structures should heal and go away within two weeks maximum. The fact that you have been a smoker in the past puts you at higher risk for possible changes in your oral tissue due to the exposure to harmful chemicals within cigarettes.

Your dentist and physician should be made aware this has been occurring for two months and it has not went away, this will help them diagnose the lesion better. As well, they may also perform a biopsy to test the tissue to see what it is.

Good luck and if I can be of any assistance please do not hestitate to ask.

Regards,
Nathan Haas

Dry mouth due to medication's side effects

2010-05-26T09:19:00.000-07:00

Q:

I have been on Celexa for over a year. About one month after I started this medication my mouth became very dry, upon reading the side effects for this medication it said that one of the possible side effects was dry mouth. I have found it has become worse during the year, so much at times that my tongue can stick to the top of my mouth and when I wake up in the morning my mouth is like a desert. If I continue on this medication long term, can my body become used to it and will my mouth become less dry? I am unhappy with the side effect (this seems to be the only one so far) but it has helped tremendously in other aspects so I want to continue. (via email from Riley May 24, 2010).

A:

Thank you for your question Riley. The medication you are on is a SSRI, which is commonly used for people who have depression and anxiety. I am glad to hear it is helping you! A common side effect of SSRI's is decreased salivary flow/dry mouth. I cannot tell you if this side effect will go away or not, as everyone's body responds differently to medication and I am not in a position as a dentist to answer that question.

What I can help you address is the dry mouth. Dry mouth and decreased salivary flow can put you at higher risk for developing dental cavities and possibly gingivitis/periodontitis. Salivary is important for it's ability to 'wash' the teeth. The liquid component of the saliva helps to rinse/wash the teeth of debris (food and bacteria) so they can be swallowed and not stuck on or in between the teeth. When food becomes stuck and it is not washed away then the potential for cavities to form is much higher. Saliva also has what is called amylase which is an enzyme which begins the process of digestion, specifically starches in the mouth. As well, saliva has the ability to buffer the oral cavity (decreasing the acidity level) to lower the risk of cavity formation.

Tips to help with dry mouth both to help your mouth feel better and prevent cavities

1. Drink water during the day (preferably water with fluoride in it as this will help keep the teeth strong).

2. Chew sugar-free gum after meals if you are not able to brush/floss, this will help mechanically remove food from the teeth and may increase salivary flow to help buffer the mouth).

3. Brush a minimum 3x day for 2 minutes with a fluoridated toothpaste to remove plaque from the teeth

4. Floss a minimum of 1x day to remove plaque from between the teeth

5. Use a fluoride mouthwash 1x day to help remineralize the teeth to prevent decay.

6. You can use a product called Biotene which are dental products specifically designed for those who have dry mouth, it can help stimulate saliva flow.

7. Use a humidifier at night to put moisture into the air that can be transferred to the oral cavity.

8. Use Sorbees sugar-free hard candies during the day to stimulate saliva flow. These candies were created for diabetics but they are also great for people who have dry mouth as they are sugar-free.

9. See your dentist and dental hygienist regularly for cleanings and check-ups to help prevent problems before they begin.

I hope this has been of some assistance to you.

Regards,

Nathan Haas

My doctor told me to see my dentist....

2010-05-09T07:13:00.000-07:00

Q:

I recently visited my physician for an annual check-up and to have my blood sugar levels monitored as I am diabetic (this started in my late 40's). At my check-up my doctor asked me if I visit my dentist on a regular basis, I thought it was a funny question since my he doesn't usually ask about my mouth or teeth. He told me that being diabetic can affect my teeth, I am puzzled as I have never heard that before? Can you please let me know how being diabetic can affect my teeth and why I need to see a dentist as I don't have a problem with my teeth. I haven't seen a dentist in 2 years due to negligence on my part. via email Trevor on May 8, 2010

A:

Hello Trevor, thank you for a great question. As well, I applaude your physician for telling you to see the dentist as diabetes and periodontal disease have been directly interrelated and having one can put you at higher risk for developing the other.

I have recently written an article on this very topic,The-Reasons Why Periodontal Disease and Diabetes Are Interrelated.

When I am seeing a diabetic patient (whether for the first time or subsequent visits) an in-depth screening of both the soft and hard tissue of the mouth is performed. This is to make sure that oral disease of any kind, such as gingivitis or periodontitis is well-controlled, as any exacerbation of these infections can also make managing your blood sugar difficult. As well, diabetic patients usually benefit from having shortened intervals between their dental hygiene maintenance appointments so as to remove bacterial biofilm (layers of bacteria under the gumline) and prevent an inflammatory process from developing.

To keep your teeth and gums healthy when you are diabetic it is imperative to;

1. Control your blood sugar by eating regular meals/snacks with good proportions of carbohydrates, fats and protein.

2. Taking blood sugar medications as prescribed your physician

3. Try to get daily exercise to assist with weight maintenace to help with blood sugar control.

4. Monitor your blood sugar at home to ensure they are staying within normal limits

5. Brush, floss and use an anti-bacterial rinse daily to remove bacterial plaque before it can cause inflammation.

So as you can see, keeping your oral cavity well-maintained and healthy can go a long way to keeping the rest of your body healthy, in this case possibly preventing exacerbation of your diabetes.

Please see a dentist if you can so he/she can let you know the condition of your mouth and to assist you in obtaining optimal oral and systemic health.

Regards,

Nathan

Dark spot on back tooth, could it be a cavity?

2010-05-06T06:49:00.000-07:00

Q:

Yesterday when I brushed my teeth I noticed a dark spot on the biting surface of one of my lower back teeth. I have not had any dental care for a lyear due to moving and the need to find a new dentist. I have noticed this area has been sensitive to cold and occasionally when I eat stuff food that are sweet. Could this be a cavity? via email Tuesday May 4, 2010 from Henry.

A:

Hello Henry, thank you for your question. Without examining your mouth and the tooth in question I cannot specifically answer what is going on but I can give you some ideas.

A dark spot on a back tooth (which sounds like you are talking about a molar) could be a cavity. The way to determine this is by a dentist checking it with a dental explorer to see if the area is 'sticky' or 'soft'. If this area is either of the two a cavity can exist. Basically a cavity is breakdown of the enamel tooth structure (the outermost portion of the tooth) or other exposed areas of the tooth (cementum or dentin) due to prolonged increased acidity due to bacterial byproducts. Sensitivity to cold or sweets can signal that their is a deficiency in the enamel-that which protects the internal tooth structures from the oral environment. When enamel is broken down then transmission of cold, hot, sweet can be felt in the pulp of the tooth where the nerve is.

That being said, a dark spot can also exist on the tooth due to staining. If the area is not sticky or soft then simple staining exists which may or may not be able to be removed. The staining can be related to many things like coffee, tea, and consuming othe foods continuously that have 'pigment' to them. They all have the potential to stain if consumed on a regular basis. Usually though staining of a tooth does not cause any type of sensitivity.

I recommend that you see a dentist to have this area examined, as leaving may cause it to progress, become larger and thus more extensive treatment warranted.

Thank you for your question.

Nathan Haas

Open wide for good systemic health!

2010-04-29T06:44:00.000-07:00

Thought I would share this great dental article released by Newswire.ca yesterday.
http://www.newswire.ca/en/releases/archive/April2010/28/c6490.html

Take care of your teeth and you will help maintain the rest of your body and health!

Have a good one!
Nathan

Not a question, but a report on elder oral care from the ODA.

2010-04-18T09:01:00.000-07:00

http://www.oda.on.ca/ontario-dental-association-calls-for-help-for-the-frail-elderly.html

Something for all of us to think about and with this report that increased access for elders can be attained.

Nathan

Should I avoid dentistry while I am pregnant?

2010-04-11T12:42:00.000-07:00

Q:
via email April 9, 2010 from Yasmin J

I am 8 weeks pregnant and I am wondering when I can get my teeth cleaned as I have noticed that my gums are bleeding and sore. My last dental cleaning was over 1 year ago so I am definitely due.

A:

Thank you for your question Yasmin and congratulations on your pregnancy! Dental care during your pregnancy is very important both for yourself and for your baby. Typically my personal recommendation is as minimal dental treatment possible within the first trimester when the fetal organ's are developing. While dental treatment may not harm this development, it is best to limit potential risk. I recommend dental treatment be done in the second trimester and third if need be (after fetal development is complete). Dental treatment in these latter trimesters should allow for flexibility of movement for the mother as laying on the back for an extended period of time can place pressue on the interior vena cava, so movement during the appointment is necessary.

A dental cleaning in the second trimester and a subsequent one prior to the birth of the baby is important to remove bacterial plaque and tartar to help prevent pregnancy gingivitis-pregnancy hormones and increased blood flow cause the gums to become increasingly sensitive to bacterial plaque, thus inflammation of the gums occurs. Brushing and flossing at home to remove the bacterial plaque is vital to maintaining a healthy mouth during pregnancy, while visiting the dentist assists in removal of both bacterial plaque and tartar both above and below to prevent gingivitis and allowing it to heal.

Pregnancy and your teeth

X-rays are normally not taken during a check-up at your dentist while pregnant so being aware of any warning signs of dental problems is very important, for example a new area of sensitivity, ache/pressure or bad taste/pus should be thoroughly checked to ensure no dental issues are occurring.

Great question, thank you!

Nathan

Why is my front bottom tooth dark?

2010-04-07T12:21:00.000-07:00

Q:
Via email Monday April 5, 2010 from Chris.

I have noticed over the past two years my lower front tooth has become darker than the teeth beside it. The tooth almost looks grey. When I was 17 (I am now 26) I fell on my face off a skateboard. At that time I cut up my lips a lot and banged my bottom teeth, but nothing happened at the time and I haven't thought of it since until I noticed my tooth was going grey. I don't have any pain, but I do not like how it looks at all.and wondering what to do.

A:

I cannot comment specifically on your tooth as I haven't examined it, but I can give you some broad answers that may help guide you in what to do next.

First, a tooth that darkens overall and has a greyish appearance typically is one in that the nerve and pulp is dying or dead. A healthy tooth has a rich vascular network within the pulp which nourishes the tooth, when trauma occurs that blood supply overtime can coagulate like a bruise and the nerve of the tooth ceases having sensation. This is when the grey colour appears and unfortunately stays.

The solutions to this may vary, in most cases a root canal can be performed which takes the dead nerve and pulp out of the tooth and replaced with an inert material which fills the space. After the root canal is performed a dental crown or cap may be recommended to protect the remaining tooth structure and prevent fracture. This new dental crown can be matched to your existing adjacent teeth to look as natural as possible.

In select cases where a dental crown or cap is not the choice, dental bleaching may be done on the inside of the tooth to remove the staining on the inside of the tooth. After this bleaching is completed a permanent filling would be put on the tooth to cover the hole where access was made to perform a root canal.

I hope this has helped. Your next step is to visit a Toronto Dentist to assess your particular dental situation.

Thanks for the great question!
Nathan

How many teeth should my child have?

2010-03-28T09:17:00.000-07:00

Q:

How many teeth should my 3.5 year old child have? (Question from Child/Toddler Day at the Dentist Program-Sat.March 27, 2010)

A:

A child that has all of his/her primary teeth should have 20 teeth total. Just remember their are always exceptions where a tooth may not form or an extra (supernumerary) tooth is formed.

Great question! Thanks!

Why should I consider a dental implant for my newly missing tooth?

2010-03-24T12:33:00.000-07:00

Q:

Recently I lost one of my teeth due to a skiing accident this past winter. I fell and ended up hitting my mouth in the process, as a result one of my front top teeth became very loose over a period of 2 weeks. Unfortunately I did not see a dentist during that time period and ended up only seeing one once the tooth was very loose and started to ache upon eating food. I saw an emergency dentist who removed the tooth and made a small denture for me to wear to replace the missing one. I have worn this small denture now for 1 month and I cannot stand it, it moves all over the place and when I eat food gets stuck underneath. As well, I have to take it out at night and I cannot even look at myself in the mirror when it is out because I look funny. I am 34 and I don`t think I want to have this denture for the rest of my life. I have read some stuff about dental implants and dental bridges, but I am not sure which one is right for me.

A:

I am sorry to hear about the loss of your front tooth, it can be traumatic to lose your tooth and the smile you are used to. Thankfully dentistry nowadays can allow you to restore you smile to what it was before your accident.

When deciding whether a dental implant or dental bridge is the right choice for you, we need to look at the circumstances in your mouth. First we need to look at the overall health of your oral cavity-the gums, the bone levels and your teeth surrounding the site where the implant or bridge will go. If your gums and bone levels are healthy then you may be a candidate for either a dental implant of dental bridge. Second I would assess the health of the surrounding teeth, do they have large fillings on them or are they virgin teeth- thost that have not been filled, fractured or damaged previously.

A dental implant in itself can fully replace the missing tooth. Dental implants once placed can fully replicate the tooth you have lost both aesthetically and functionally if good care is taken when placing it into the bone and allowing the healing process to occur (typically 3-6 months). The nice thing about dental implants as well, if they are taken good care of, can last many years to a lifetime. Prior to placing a dental implant, an implant dentist must do a thorough assessment of your bite, bone levels at the site where the implant will be placed and dental impressions. Through this a map is made to guide in the placement of the titanium dental implant through to healing and completion of your dental implant.

Another option is a dental bridge. A dental bridge basically spans the space where the missing tooth is. A dental bridges attaches at both sides to what is called an abutment (the teeth that are present on each side of the space) and in the middle is what is called a pontic (an artificial tooth)which is attached to the abutments. A dental bridge when made well can be aesthetically pleasing but you must remember that since the bridge itself is passive and not held by the bone itself, bone and gum tissue underneath the missing tooth may be lost overtime. If bone and gum loss occur a space may become present that can be obvious when you smile. This does not occur in all cases but is a possiblity.

The most important thing is that you have a thorough examination of your oral cavity and your treatment options explained to you prior to making a decision. I hope I have helped you gain some information so you can make an informed decision.

For more info about dental implants and dental bridges please see the links to my site below,
Dental Implants
Dental Bridges

What is considered cosmetic dentistry?

2010-03-23T07:46:00.000-07:00

Q:
From Anthony via email Monday March 22, 2010

I would like to join your dental practice and I am considering some cosmetic dentistry for my front teeth which I am not sure is considered cosmetic dentistry or not? I have a dental insurance plan through my work and was informed through the company that cosmetic dentistry is not covered under my plan. I feel at this point I would like my front teeth fixed to look good regardless of what my insurance covers. What are my options for fixing my front teeth, overall I would like them whiter but I also think my teeth look very straight across the bottom like they are worn down.

A:

Thank you for your question. Dentistry can usually be categorized into two categories, elective and non-elective. Cosmetic dentistry is dentistry which is done to enhance your smile and is elective-your choice to do it. Non-elective treatment is usally that type of dentistry which needs to be fixed or repaired due to cavities/decay, fracture or wear, this type of dentistry is typically covered by a dental insurance plan.

Choices for cosmetic enhancement of your teeth may include the following and depend on your individual circumstance;

-Porcelain Veneers
-Teeth Whitening or Bleaching
-Porcelain Crowns
-Dental Bridges
-Dental Implants
-Gum contouring with a dental laser
-Bite Analysis

Prior to proceeding with any dental treatment it is important to fully examine both the teeth and your bite. A full exam like this includes a smile analysis which takes into effect the size/shape/colour/symmetry and overall characteristics of your smile and teeth. In this way we can fully describe the options available to you for enhancement of your smile.

I would be happy to see you and invite you to my Family, Laser, Cosmetic and Implant Dental Practice in Toronto.

Visit my website at, http://www.drnathanhaas.com/

Brushing your young child's teeth and toothpaste

2010-03-14T10:52:00.000-07:00

Q:
via email March 12, 2010 from Avery P.

I have a question, which I'm sure you get asked often. My daughter is at that age (almost 2)where she wants to do everything herself, including brushing her teeth, but she can't yet. It is always a struggle and usually (I'm embarrassed to say) she usually wins and brushes them herself. Is there a way I can have her let me brush her teeth without her freaking out.

Also, what is a good toothpaste for her? We found a natural one from walmart, Toms of Maine.

A:
Great question. These are very common questions which are asked.

It is important that you brush for her, which you know. Typically I will have both child and mom have a toothbrush and either both of you brush at the same time OR let her know you will have a turn after she is finished. As well, if you find it really difficult, get something to distract her like a book, toy or tv (if you need to) and have her sitting in your lap facing away from you and you can brush her teeth while she is watching/playing.

Any toothpaste without fluoride is fine at this time, until she can really spit it out well (usually around the age of 4) . You do not want fluoride, until she can spit it out thoroughly, as she may swallow it and it can cause stomach upset and fluorosis long term.

Feel free to check out our young Child and Toddler Day at the Dentist program which has been in existence for 2 years. The aim of this program is to instill a positive association with dentistry and provides a positive and fun first experience at the dentist. See, Toddler and Young Child at the Dentist in Toronto

Thank you,

Nathan

Painful new crown/cap

2010-02-25T18:32:00.000-08:00

Q:
Via email Wed. Feb. 24, 2010 from Cheryl

I had a crown placed on the rear bottom tooth on the left side a couple of months ago, and when the freezing wore off after placement of the permanent crown, I was up every few hours taking painkillers - it was the worst pain I've ever had. This tooth had never bothered me in the past, but a small piece had broken off, and my dentist recommended getting a crown.

I went back several times, and he gave me prescriptions for antibiotics, painkillers, ground the tooth down, and eventually, after about 3-4 weeks, the pain subsided.

A week ago, it has started up with a vengeance. It is excruciatingly painful, will wake me up out of a sound sleep.

He never did give me a reason as to why it happened in the first place, why placing the permanent crown would cause such awful pain.

Any help you can give would be appreciated.

A:
Thank you for your question. I am sorry to hear you are in pain from your newly placed crown. A permanent crown can give discomfort for a few reasons.

Sometimes after initial preparation and placement of a new crown the nerve can flare up and cause discomfort in the tooth. This will typically settle down with time. If it doesn't then the new crown may be 'high' and need adjustment (ie. grinding the crown down a little) so it doesn't meet with the opposing teeth in an irregular manner. When a tooth is high it can aggravate the nerve and cause discomfort, almost how a bad bruise gives you discomfort, so can a irritated nerve of a tooth. This should be alleviated after adjustment (grinding of the tooth), typically it would go away within a few days.

The last reason may be that the nerve is irritated irreversibly (due to bacteria, trauma or otherwise) and thus may need a root canal (simply put the removal of the pulp) so you will not have the pain any longer.

You will need to see your dentist to assess the situation of the tooth so a solution can be found.

Nathan

How many teeth should an adult have?

2010-02-21T11:08:00.000-08:00

Q:

Received via email Fri.Feb 19, 2010 from Anthony G.
How many teeth should an adult have?

A:

Thank you for your question Anthony. This is a question I am asked quite frequently from both adults and children alike.

An adult who has his/her full set of teeth, including their wisdom teeth should have 32 teeth. Exceptions can always occur though, some people these days do not form all four wisdom teeth thus they may have less than 32 teeth. As well, occasionally a person may either be missing a tooth (it does not form) or form an extra tooth, these are exceptions to the rule.

Impacted wisdom teeth

2010-02-15T06:55:00.000-08:00

Q:

Via email Fri.February, 12, 2010. Anonymous.
A friend of mine has recently been examined regarding some pain in his jaw that one dentist already misdiagnosed as cavity pain. It turns out that after being examined by specialists at a very good university research hospital that in fact he has some very seriously disoriented wisdom teeth – teeth that are growing horizontally inside the gum and the roots are tangled up with nerves that control feeling in the tongue. They say that operating will very likely cause a loss all feeling in his tongue..for life. That sounds pretty horrible and there seems to be no alternate solution. What advice can you give in a case like this? Is a good surgeon really likely to damage the nerves in this area or are they just ‘speaking cautiously’? Are there any alternative options?

A:

Thank you for the question. First off, I am glad that he has got a second opinion from a specialist, I am assuming the specialist he saw was an oral surgeon. Wisdom teeth unfortunately can form and be impacted (under the jaw either interfering with other teeth or imbedded in the jawbone itself). It sounds like in your friend's case his are horizontally impacted which would then mean they would be moving towards his teeth in front of the wisdom teeth and in near the inferior alveolar nerve. In many cases where the wisdom teeth are impacted in this way they interfere or are intertwined near this nerve, this is when the decision whether to take the wisdom teeth out or leave them in comes to play. It sounds like he is having discomfort with the wisdom teeth and the teeth they are impeding on, in this case the decision to extract them needs to be weighed with the possible side effect of developing paraesthsia (numbness) due to damage to the nerve during the extraction. In some cases this cannot be avoided as the nerve is directly around the wisdom tooth.

I would suggest your friend think about the decision to extract after a thorough discussion with the oral surgeon he is being examined by.

Nathan

Options to replace a front tooth...dental implant or dental bridge?

2010-02-10T16:19:00.000-08:00

Q:
Via email Saturday February 6, 2010 from Hillary
Two years ago I was in a car accident and lost one of my front top teeth. At the time the dentist I was seeing took the rest of the tooth out that was remaining and provided me with a denture to replace the tooth. I am very unhappy with my smile as the denture does not look like my other teeth, as well the denture moves and food gets stuck underneath it when I eat. I am only 30 years old, I want my smile to look like others my age. Are there any other options other than a denture for my missing tooth?

A:

Thanks for your question. Please be aware I am answering this question broadly concerning your specific situation as I haven’t examined your mouth, thus making a diagnosis via computer is impossible as many other factors exist which can direct us in one direction or another.

A first option for tooth replacement is a dental implant. A dental implant is very similar to a natural tooth as it is composed of a root portion that is implanted into the jawbone and a crown portion, that part that is visible above the gumline (like the enamel portion of your tooth). Dental implants are wonderful because they can completely replace a tooth that is missing as well, once they are in and restored they can function just like a natural tooth. When assessing whether dental implant is an option we would like at the quality and quantity of bone that is present at the site of the missing tooth, the bone is very important because this is what holds the implant in the jawbone. If not enough bone is present a procedure called bone augmentation can be done to increase bone in the area prior to implant placement. Occasionally if a tooth has been missing for a long period of time and a person has not worn anything like a denture to maintain the space, the remaining teeth can shift into the open space. In this situation we need to assess whether the space is large enough for an implant to fit. A big benefit is that other teeth are not prepared in order to put a dental implant in. To see how a dental implant is made you can see photos at Dr.Nathan Haas' Dental Implants

A second option is a dental bridge. We all know what a bridge does-it spans an empty space-this is exactly what a dental bridge does as well, it spans the space of a missing tooth. A dental bridge connects on one tooth, spans the space where the missing tooth is with what is called a pontic (an artificial tooth) and connects on the other side to an existing tooth. Bridges are an consideration if space is too small for a dental implant and tooth movement to reopen the space is impossible. Dental bridges can give good aesthetics but the lifespan is not indefinite, a typical bridge can have a lifespan of 10-20 years (of course there are always exceptions). One downfall of a bridge is the fact you need to prepare the teeth that will hold the bridge, this means they will need to be shaved down so the dental bridge can be cemented on top. To see how a dental bridge is made you can see a photo at Dr.Nathan Haas' Dental Bridges

I hope this helps you in your decision to restore your missing front tooth.

Nathan

Sore wisdom teeth on bottom jaw.

2010-01-31T07:47:00.000-08:00

Q:

Received via email Thursday January 28th, 2010 from Cassidy
I have had my wisdom teeth on my bottom jaw in for a few years. A few times in the last few years they have become really sore at times, not so much the tooth itself but the gum around them. I have found it really sore to chew or bite when it gets sore like this and I have found that the only thing that gets ride of the pain is using anbeseol and cleaning the area really well with an electric toothbrush and listerine. Why does this come and go like this and how can I prevent it in the future?

A:

Thank you for your question Cassidy. What it sounds like is your are experiencing swelling in the gum(s) around your wisdom tooth. This swelling can be caused by food/bacteria becoming caught underneath the gum and thus a localized gum infection starts. If a flap of tissue is remaining around the wisdom tooth (this can be from incomplete eruption of the tooth or just an excess of gum tissue remaining). If an operculum (flap of tissue) is present then it can be harder for you to keep the area clean as food/bacteria can get stuck underneath the flap. If this happened continuously I would either recommend a operculectomy (which is a simple removal of the extra flap of tissue) or in the case where the wisdom tooth was not aligned or erupted properly, possibly removal of the tooth would be a better solution.

Operculumectoy can be done by a scalpel (knife) or laser. In our office, the choice hands down is using the laser. With the laser you get minimal bleeding and the laser initiates healing at 4x the normal rate. As well usually we can use a topical gel (put on with a dental q-tip) for freezing instead of a injection or needle. Typically the day of you would shy away from acidic foods, but by the next day you are able to eat normally again.

I believe that wisdom teeth that can be cleaned properly and maintained without repeated cavity formation can be left in the mouth and thus no need for extraction. But in order to assess that it needs to be on a person by person basis. Wisdom teeth once served a purpose for cavemen as they needed to chew their coarse and unmodified foods much more than we do these days with processed foods. The wisdom teeth served as an extra set of teeth assisted them with this. These days we see some children not forming some or all of their wisdom teeth, society has evolved and the need for wisdom teeth has a well.

Great question, thank you!

When should I start flossing my child's teeth?

2010-01-24T08:44:00.000-08:00

Q:

This question was asked at our Toddler Day at the Dentist program yesterday. My child is 2 and has all of her teeth, when should I start flossing them? Jan 23, 2010.

A:

Flossing a child's teeth can start as soon as they have teeth. At this stage it is more or less to introduce the young child what flossing feels like and to incoporate it into a daily habit. When all a young child's teeth have erupted it is vital that the teeth are flossed daily to remove food and bacteria both above and below the gumline to prevent decay and gingivitis (inflammation of the gums). Some children have more spacing between their teeth than others, regardless of spacing floss all the teeth.

A great way to floss a young child's teeth is to have them lay down facing away from you and have their head in your lap, this will allow you access to both the bottom and top teeth. Gently rub the floss up and down along the tooth, remember that if you are going between two teeth you need to rub the floss up and down on each tooth.

If you start flossing early, it will become a positive lifelong habit to both the child's oral and systemic health.

Why the space between my front teeth?

2010-01-21T09:22:00.001-08:00

Q:

Via email Wednesday January 20, 10 from Kelly L
Since I can remember I have had a space between my top front teeth (I am 22 yrs old). I would like my teeth to be straight and not have a space between them. When I last visited my dentist he told me that the space is because of the muscle that attaches my lip to my gum tissue below my teeth. He recommended I have this muscle cut and stitched up. Can you explain to me a bit further what this muscle attachment is (why is it there?) and what I can do to bring my teeth together?

A:

Thank you for your question Kelly. The muscle attachment you are speaking about is called the frenum. Throughout our mouths we all have frenums and like you said they attach our cheek to our gum tissue. In most circumstances the frenum has no effect on the gum tissue or the teeth, but in some the frenums are tight or they are attached very close to the teeth where they can cause problems like gum recession or spaces between teeth (like in your situation).

Frenums can be separated from the gum tissue through a dental procedure called a frenectomy. A frenectomy can be done in two ways, with a scalpel which involves stitches or with a dental laser which typically does not need stitches and is bloodless. In our office we use a diode dental laser for all frenectomies and patients report that the tissue heals very quickly and are comfortable the day of the procedure. We do not do scalpel frenectomies as with new technology there is no need to use a scalpel and stitches.

The frenectomy itself may or may not allow your teeth to move together, generally the teeth will not move together by themselves once the frenum is removed, BUT once the frenum is removed tooth movement can be faciliated via orthodontics (braces). As well, once the teeth are moved together after braces they are less likely to move back to prior alignment because the frenum is no longer present.

If you would like more information about diode dental lasers, vist my website at www.drnathanhaas.com

Milk in a bottle for a two year old at bedtime

2010-01-19T07:42:00.000-08:00

Q:

Via email Monday January 18, 2010
My two year old son loves his bottle of milk at bedtime, but he only will drink it to settle him to sleep. I have tried giving it to him before bedtime then brushing his teeth and putting him to sleep but he wants his bottle. Should I stop this habit, how? Gina

A:

Great question Gina! Basically we want a completely clean mouth to go to sleep with. Any kind of food (especially carbohydrates) have the potential to cause decay of the teeth, this applies to both children and adults. If you are putting your son to bed and the last thing to coat his teeth is milk (not toothpaste) you are risking your son developing decay. This happens because the bacteria in the mouth digest the carbohydrates which are coating the tooth structure, when this happens the acidity level rises in mouth and sets up an environment for tooth decay to occur.

I commend you trying to brush after giving him the bottle, optimally this is what you need to be doing. I think breaking the habit may be a hard one but one that definitely needs to occur, possibly slowly as to not upset your son.

A recommendation I may make is to go slowly and try the following. Try diluting the amount of milk with water over a period of a few nights. Once you get to completely water that is fine as water washes the mouth and obviously does not have any carbohydrate content. What I may also be inclined to do is switch your son over to either a sippy cup or a water bottle if he does need a drink before bed or at night. Long term use of a bottle is not ideal for growth of the mouth and eruption of the teeth (this is not true in all cases, but some).

Overall, do not stress the process and do it slowly as to not to disturb the household and it should go smoothly.

I have a bad taste in my mouth, could it be from my teeth?

2010-01-16T06:50:00.000-08:00

Q.

Via email Fri. January 14, 2010
For the last 2 months I have had a bad taste in my mouth that pretty much lingers all the time. My teeth do not hurt, but I have not been to the dentist in 2 years (due to nervousness) so I am not sure if something is going on or not. Can the bad taste be from something other than my teeth?

A.

Thank you for the question. This is a very broad question and I will answer it, but since I have not examined your mouth I cannot comment on your exact situation.

The bad taste can be from a variety of situations. First off, if you had not had your teeth cleaned for awhile it could be from the accumulation of plaque and calculus (tarter) underneath your gumline. When deposit accumulates as such bacteria and food debris above and underneath the gumline overtime it can start to develop an odor/taste, this is both because it could be starting to
cause gum inflammation (gingivits) and if left to proceed can develop into periodontitis (inflammation of both the gum tissue and destruction of the bone underneath the gums). Obviously when a disease process is going on and left unattended to, overtime this can cause a bad odour or taste in the mouth.

A bad taste in the mouth may also be an indicator of an infection going on with one of your teeth. Overall, an infection of the tooth may in turn produce pus which can give you a bad taste. Sometimes even without obvious discomfort or pain, a tooth may develop a chronic infection that produces pus. This is why dental exams and xrays are important to rule out infections/diseases of the mouth.

Lastly, systemic illnesses or medications may cause a bad taste in your mouth. Problems with digestion, reflux or stomach diseases can cause a bad taste in the mouth. As well, many medications that we take have side effects, one of the most common side effect of them is dry mouth. When the mouth is dry or drier that usual the mouth is not cleansed because their is insufficient saliva produced. Saliva is very important in keeping our mouth clean, via washing food particles down our stomach so they do not accumulate in our mouths.

So as you can see this question has many answers. I would do a full investigation into what is causing the bad taste in your mouth, see a dentist and dental hygienist for a full examination and cleaning followed by a visit to your family physician to rule out other issues.

Why Floss?

2010-01-13T11:48:00.000-08:00

Q:

Via email Tuesday January 12, 2010.
I brush my teeth numerous times a day with an electric toothbrush and I use Listerine mouthwash 2 times a day but I do not floss at all, I find it a hassle and I don’t like doing it. Everytime I see the dental hygienist she informs me I need to floss because my gums are bleeding, but I don’t see bleeding when I brush, only when I go to the dentist. Isn’t brushing and rinsing enough?

A:

Thank you for the question, we get this question a lot from many of our patients. The reason your dental hygienist is informing you to floss because it is really one of the most important things you can do to reduce bleeding and inflammation of your gums. When you brush and rinse with a mouthwash you clean all of the tooth structure above the gumline, but you are missing most of the area below the gumline. Below the gumline is where the really harmful bacteria that can cause gingivitis (inflammation of the gums) and periodontitis (inflammation and destruction of the bone around your teeth) thrive-it is dark, warm, moist and food is present, a perfect breeding ground for bacteria. Then imagine this bacteria sitting there for months because you are not flossing, basically you will have layers upon layers of a variety of bacteria.

When certain types of bacteria exist in the mouth that cause soft tissue disease, they can cause ulcerations within the gum tissue. These ulcerations are basically open sores (basically like an irritative response to them sitting against the gum tissue). This is why if you do floss and you don’t do it regularly you will see bleeding and when the dental hygienist sees you and she probes to check below the gumline she detects bleeding. Many times if you brush and rinse, but don’t floss the ulcerations are underneath the gums and not visible to the naked eye, this why regular visits are important as gingivitis and periodontitis (in early stages) can be painless and the patient unaware of what is going on underneath the surface.
So yes, flossing is VERY important to remove bacterial plaque below the gumline, but proper technique is vital. With flossing going below the gumline and cleaning the tooth structure is the key to optimal bacteria plaque removal. When going between two teeth, the main thing to remember is to go below the gumline on both teeth, not just in between the teeth. If you are questioning your flossing technique, ask your dental hygienist to review it with you.

Optimally flossing should occur one time a day, when you do it doesn’t matter, as long as you do it. Personally, I like to floss, brush and rinse in the evening but that is just because it is convenient for me and I like to have a perfectly clean mouth to go to bed with. Like Nike says, “Just Do It!” I recommend that same and remember, Floss The Teeth You Want to Keep!

A simple (and I mean simple ;) diagram below of where floss reaches. Notice the red areas are where bacteria builds up and can cause inflammation below the gumline.

When should I start cleaning my baby's teeth?

2010-01-10T06:18:00.000-08:00

Q:

Via email Saturday Jan 9, 2010
I have a 8 month old baby and he has 4 teeth, when should I start cleaning them? Laura M

A:

Thank you for your question about your child's teeth Laura. I am glad you are thinking about cleaning them as it is very important to prevent decay from occuring. Cleaning should ultimately start when the teeth first erupt, but it is never too late to start.

Cleaning of a baby's teeth should take place 2-3 times a day, ultimately morning, noon and evening before bed (after the last meal/breastfeed/bottle). You may use an infant brush which fits on the finger, a very small toothbrush or a damp washcloth wrapped around your finger. At this stage you do not need toothpaste, but if you do use one make sure it is the infant kind which is fluoride-free. To clean the teeth simply run the brush or facecloth along the teeth and along the gumline to ensure plaque (food and bacteria) is removed from the tooth structure. This is sufficient in keeping the teeth clean and the gums healthy.

All children should be visiting by 2 years of age at the latest to have their teeth checked and cleaned.

For other great tips on oral health care for your child, please see my wife's article on Oral Health and Your Child at www.toronto4kids.com/content/view/448

As well, our office runs a free program called Toddler Day at the Dentist which welcomes all children in city of Toronto to our office for examination and cleaning. This day was developed to instill a positive and fun first experience at the dentist.

Staining on Teeth

2010-01-08T07:43:00.000-08:00

Q.
Via email Friday January 8, 2010
It seems that my teeth stain very easily. Once I leave the dentist my teeth are clean but within 1-2 months I develop quite a bit of stain on my front teeth. Why is that? Steve C.

A.
Thank you for the great question Steve. First off, stain on the teeth can result from both extrinsic (on the outside of the teeth) or intrinsic (from the inside). It sounds like in your case we are talking about extrinsic so I will just touch on that.

Extrinsic stain can come from certain sources, mainly be what we consume (food or beverages). Think of the exposed portion of your tooth (the crown) and what it is made of enamel, to be similar in composition to a china cup. When you have tea in a china cup over time you get brown stain accumulating on it, this is quite similar to how stain forms on your teeth.

Besides tea, many foods that have pigments have the potential to cause stain such as berries, vegetables, sauces like soya, chili, ketchup and a variety of others that I will not list here. Beverages such as, coffee, cola, grape juice and red wine all have pigments that can stain. As well, smoking can be very staining (besides an oral health concern).

Extrinsic stain can be easily removed with a dental office polish, but you can do a few things at home to prevent stain from accumulating between dental visits. First, try using baking soda a few times a week on your toothbrush, this may help remove light stain on the teeth if used consistently (please ask your dentist if this is appropriate prior). Using an electric Sonic toothbrush is great to help prevent stain buildup. Lastly you can try drinking beverages using a straw as it prevents contact of beverages on the teeth.

Some toothpastes on the market proclaim that they whiten but in my personal opinion I don't find that these toothpastes to contact the teeth long enough to do really anything BUT some may help prevent stain buildup as they are slightly more abrasive (once again please ask your dentist prior to using these as they may not be suitable for every situation).

Thanks for a great question!

Elderly dental patient question.

2010-01-06T10:57:00.000-08:00

Q.
Via email Wednesday January 6, 2010 from Mary F.

My elderly mother has dentures to replace her top and bottom teeth, her dentures are comfortable, but I am wondering does she need to come to the dentist anymore?

A.

Thank you for your question Mary. You did not specify if your mother has any natural teeth left or not so I will assume that she does not. Even with dentures that replace all of her missing teeth, your mother should visit her dental office on yearly basis to have a complete check-up of her oral cavity. In my dental practice, at this visit we would remove her dentures and examine all the tissues of her oral cavity, besides checking for areas where the denture may not be fitting properly ,we also perform a visual and Vizilite (www.vizilite.com) oral cancer examination. Oral tissue like any other tissue in the body has the potential to develop cell changes overtime and a yearly exam of the mouth is important to catch any possible changes. An improperly fitting denture over time also may have the potential to cause tissue changes. Overall, even people without natural teeth should have their mouths examined on a yearly basis or more if they have had any sores/lesions or precancerous changes in the past.

In the next year my dental practice will hold a new Oral Cancer Screening Program. This program will be free and open to all residents of Toronto. More information to come on my website at www.drnathanhaas.com/news