Preventative Dentistry

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Cleaning (Prophylaxis)

Prophylaxis refers to the cleaning of teeth as a preventative measure against periodontal (gum) disease and tooth decay. This treatment can include plaque detection, the removal of plaque and tartar in the supragingival (upper) and subgingival (lower) levels of the gum line, the application of caries-preventing agents, checking for signs of food impaction, and the checking of restorations and prostheses.

In prophylaxis, the procedures of dental scaling and dental polishing are used. Dental scaling refers to the removal of plaque and calculus from the surface of tooth, within periodontal pockets, or the surface coronal to the gingival margin. Dental polishing refers to the process of maintaining a smooth and glossy surface finish on a denture or amalgam.


Dentures

A denture is a removable replacement for missing teeth. A denture is made of acrylic resin, sometimes in combination with various metals, and comes in two types; complete denture or partial denture. Complete dentures replace all the teeth, while a partial denture fills in the spaces created by missing teeth and prevents other teeth from changing position.

Complete dentures are either “conventional” or “immediate.” A conventional denture is placed in the mouth about a month after all the teeth are removed to allow for proper healing, whereas an immediate denture is placed as soon as the teeth are removed, however a drawback to the immediate denture is that it may require more adjustments after the healing has taken place.

People who have lost most or all of their teeth are ideal candidates for complete dentures. A partial denture is suitable for those who have some natural teeth remaining.

Advantages of using a denture are that it improves chewing ability, speech and provides support for facial muscles whilst greatly enhancing the facial appearance and smile.

New denture wearers need time to get accustomed to their new teeth because even the best fitting dentures will feel awkward at first. While most people can begin to speak normally within a few hours, many people report discomfort with eating for several days to a few weeks after having dentures fitted.

Dentures are no longer the only way to restore a mouth that has little or no non-restorable teeth. Strategically placed implants can also used to support permanently cemented bridges, eliminating the need for a denture. The cost tends to be greater, but the implants and bridges more closely resemble the feel of real teeth, although not everyone is a candidate for implants. Sometimes dentures or partial dentures may irritate soft tissues in the mouth. If the irritation continues, a person may develop mouth sores, which can be found on the upper jaw, lower jaw, under the tongue, or on the palate. They are usually red and a little swollen. The main causes of theses denture sores include alcoholism, allergies, smoking and chewing tobacco.


Extractions

Extraction is the term given to a tooth extraction and can also be known as Exodontia. Tooth extraction is the removal of a tooth from its socket in the bone.

Teeth may also be extracted to make more room in the mouth prior to straightening the remaining teeth (orthodontic treatment), or because they are so badly positioned that straightening is impossible. Extraction may be used to remove teeth that are so badly decayed or broken that they cannot be restored.

Tooth extraction can be performed with local anesthesia if the tooth is exposed and appears to be easily removable in one piece. An instrument called an elevator is used to loosen the tooth, widen the space in the bone, and break the tiny elastic fibers that attach the tooth to the bone. Once the tooth is dislocated from the bone it can be lifted and removed with forceps.

If the extraction is likely to be difficult, the dentist may refer the patient to an oral surgeon. Oral surgeons are specialists who are trained to give nitrous oxide, a general anesthetic to relieve pain. Extracting an impacted tooth is one such difficult extraction.

Before an extraction, the dentist will take the patient’s medical history, noting allergies and prescription medications. A dental history is also taken, with particular attention to previous extractions and reactions to anesthetics. The tooth is also x-rayed to determine its full shape and position, especially if it is impacted.

An important aspect of tooth extraction is the aftercare and encouraging a clot to form at the extraction site. The patient should put pressure on the area by biting gently on a roll for several hours after surgery. Once the clot is formed, it should not be disturbed. The patient should not rinse, spit, drink with a straw or smoke for at least 24 hours after the extraction and preferably longer.

For the first two days after the procedure, the patient should drink liquids without using a straw, and eat soft foods. Any chewing must be done on the side away from the extraction site. The mouth may be gently cleaned with a toothbrush, but the extraction area should not be scrubbed.

Fillings

Teeth that have been affected by tooth decay (caries or cavities) require a filling.

A tooth filling is a very common procedure and is used to fill up the cavities in the teeth. There are generally three types of tooth filling: amalgam, or alloy mixed with mercury composite, or white filling with same color as that of teeth indirect filling, or filling made in a lab

Dental amalgams, also known as silver fillings, are comprised of a mixture of mercury (45 to 50 percent), and an alloy of silver, tin, and copper (50 to 55 percent). When it is combined with other materials in dental amalgam, mercury’s chemical nature changes and it is no longer considered harmful to the body.

The procedure to fit an amalgam filling involves excavating the intended tooth and removing all the decay present. The tooth is then shaped in a specific manner in order to accept silver filling. After shaping the tooth, a band is placed around the tooth and the amalgam is condensed into the prepared tooth. The final filling is then carved and adjusted to the persons bite.

A new filling takes almost two weeks to become fully hardened with light sensitivity to cold or hot occurring for up to six weeks after surgery is completed.


Fluoride Therapy

Fluoride therapy is the delivery of fluoride to the teeth, topically or systemically, to protect them from dental caries (cavities). Strictly speaking, fluoride therapy repairs rather than prevents damage to the teeth, causing the mineral fluorapatite to be incorporated into damaged tooth enamel. Fluorapatite is not a natural component of human teeth, although it is found in the teeth of sharks. The main mineral found in natural tooth enamel is hydroxyapatite rather than the fluorapatite created in the presence of fluoride. Even without fluoride, teeth experience alternating increases and decreases in mineral content, depending upon how acidic or basic the mouth is, and depending upon the concentration of different substances in the mouth. Fluoride enhances and modifies the restoration of the mineral content of the teeth, and couteracts the breakdown of the teeth from lactic acid producing bacteria.

In topical fluoride therapies, fluoride is applied directly to the surface of the teeth, most commonly by means of a fluoride toothpaste. The main reason for tooth-brushing is mechanical disposition of plaque, but fluoridated toothpaste is used to apply fluoride to the tooth surface, promoting re-mineralisation with fluorapatite instead of hydroxyapatite. Other topical fluoride therapies include fluoridated mouth rinses, lozenges, gels, foams, and varnishes.

In systemic fluoride therapies, fluoride is swallowed as an additive to drinking water, salt, or milk, or as an ingredient in tablets, lozenges, or drops.


Nutritional Counseling

Most people know that good nutrition is an important part of an overall healthy lifestyle, but did you also know that what you eat has a direct impact on your oral health. Vitamin deficiencies can have big impact on the condition of the tissues of your mouth, teeth, and gums. Poor nutrition impacts the entire bodies immune system, making it lessefficient at fighting disease, this includes oral disease. Listed below are common vitamins and their associated impact on oral health.

Vitamin B

Inadequate levels of vitamin B are among the most common deficiencies related to oral health problems. Deficiencies of some B vitamins may cause paleness and weakness of the tissue in the inner cheek and tongue. Tissue may break apart easily or slough off. Additional, oral symptoms associated with vitamin B deficiencies include mouth lesions, loss of taste, excessive salivation and enlarged salivary glands. Further, some researchers believe that reduced amounts of certain B vitamins may increase the risk of oral cancers. Oral health problems attributed to B vitamin deficiencies include:

Angular chelitis. Inflammation and cracking of the corners of the mouth typically due to a fungal infection. It is often associated with deficiency of riboflavin (vitamin B2) or folic acid.
Atrophic glossitis. Condition in which the taste buds on the tongue begin to deteriorate, affecting the sense of taste. This symptom is often associated with a lack of folic acid (vitamin B9).
Chronic oral mucosal candidiasis. Fungal infection of the mouth. This fungus is normally present in the mouth but can develop into an infection when a person has B vitamin deficiencies.
Recurrent aphthous stomatitis. These are recurring canker sores caused by anemia. This symptom is often associated with a lack of niacin (vitamin B3).

Further, some researchers believe that reduced amounts of certain B vitamins may increase the risk of oral cancers.

Vitamin C

Deficiency of vitamin C may cause gums to bleed easily. Other symptoms include fatigue and tendency to bruise readily all over the body.

A vitamin C deficiency most often occurs as the result of eating inadequate amounts of fresh fruit and vegetables and is more likely to occur in winter, when such foods may be less abundant. People who smoke are at a greater risk of developing vitamin C deficiency because smoking decreases the level of vitamin C in the body.

Vitamin A

Deficiency of vitamin A can lead to a delayed healing of sores in the mouth, incomplete tooth development or cavities in young children. Because of the liver’s ability to store vitamin A, it may take up to a year before the signs of deficiency are apparent in some patients. Excessive levels of vitamin A can lead to oral health problems such as gingivitis and fissures in the oral mucosa.

Further, Vitamin A is involved in the formation of tooth enamel. Diseases that can cause this deficiency include cystic fibrosis, liver problems, pancreatic insufficiency and chronic diarrhea.

Vitamin D

Deficiency of vitamin D may cause a jaw fracture or periodontal disease. When vitamin D deficiency occurs in young children, it can negatively impact tooth formation.

Vitamin D plays a role in the regulation of calcium and phosphate metabolism. It is essential to the formation of strong bones and teeth. Patients on low-fat diets and those with malabsorption syndromes are at higher risk for this deficiency. Others who may be at risk include people who eat a vegan diet, which prohibits foods from animal origin, and people taking anticonvulsants or sedative-hypnotic drugs.

Vitamin K

Deficiency of vitamin K can cause severe bleeding after a tooth extraction or even a general teeth cleaning such as scaling.

Vitamin K is essential during blood clotting. A deficiency normally occurs from malabsorption syndromes or complications resulting from use of antibiotics.

It is important to remember that eating a variety of foods and increasing fiber and vitamin intake may not only improve your dental health, but reduce the risk of other diseases. A well-balanced diet is vitally important for optimal health and it is equally vital to ‘fill in the gaps’ by taking the right amounts and kinds of vitamin and mineral supplements. Make sure that you’re getting the nutrients, vitamins and minerals your body needs.


Oral Cancer Screening

What is screening?
Screening is looking for cancer before a person has any symptoms. This can help find cancer at an early stage. When abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread.

Scientists are trying to better understand which people are more likely to get certain types of cancer. They also study the things we do and the things around us to see if they cause cancer. This information helps doctors recommend who should be screened for cancer, which screening tests should be used, and how often the tests should be done.

It is important to remember that your doctor does not necessarily think you have cancer if he or she suggests a screening test.  If a screening test result is abnormal, you may need to have more tests done to find out if you have cancer or any other health concerns.. These are called diagnostic testing.


Oral Hygiene

Prevention goes hand-in-hand with many dental treatments. Learn how you can prevent dental disease at home, or learn about dental treatments that are used to halt, treat, and prevent dental disease from affecting your health and wellness.

Children’s dental care is often overlooked, because many people believe those tiny baby teeth are just going to fall out one day, and be replaced with a set of second chance teeth. However, caring for baby teeth should be considered one of the most valuable lessons to teach a child.

Prevention is Key

Learning how to properly care for your teeth can mean a lifetime of great chewing and smiling. Your teeth have to last you for the rest of your life and with the right prevention and knowledge, they can. There are many things you can do at home to help prevent dental disease but there are also many important reasons to see your dentist regularly.


Periodontal Treatment

Dr. Wakim can refer you to a local periodontist when he detects an early sign of gum problems. Although subtle, dentists are trained to detect early gum problems. These signs include: pockets (when the collar of gum becomes infected and detaches from the tooth, the space it leaves is called a pocket); bleeding (although a common occurrence, gums should not bleed regularly and is an early sign that pockets and boneless will occur); bone loss (if left untreated bone loss due to periodontal decay can lead to teeth removal); loose teeth; spaces forming between front teeth (although crowding of the mandibular (lower) front incisors occurs naturally as we age, space forming between some of the maxillary (front) teeth is a sign of advanced bone loss. This bone loss is due to the lack of tooth support which is a manifestation of progressive gum disease.); halitosis (bad breath); and abscess (the expansion of a gum pocket due to trapped bacteria.)

The main cause of periodontal disease is bacterial plaque which produces toxins that irritate the gums, causing swelling and bleeding. Bacterial plaque constantly forms on one’s teeth and if it is not removed by daily brushing and flossing will harden into calculus (tartar). Additional causes of gum disease are smoking, genetics, stress, diabetes, poor nutrition, medication(s), and grinding or clenching one’s teeth.

A periodontist has a variety of treatments to aid gum disease depending on its severity. This includes non-surgical treatments such as scaling and root planing (removing plaque and tartar from deep gum pockets through the thorough cleaning of root surfaces and also smoothing the tooth root to remove bacterial viruses). Periodontal surgery would be necessary if one’s periodontist determines non-surgical treatment would be ineffective. The four most common periodontal surgical treatments are pocket reduction procedures (recommended when daily at-home oral hygiene and regular dentistry visits are insufficient due to pockets becoming too deep), regenerative procedures (recommended when the bone supporting the teeth have been destroyed, this procedure regenerates the lost tissue and bone), crown lengthening (recommended when one’s teeth have been covered with excessive gum tissue, this procedure reshapes the excess gum and bone tissue in order to further expose the natural tooth), and soft tissue grafts (recommended when gum recession leads to exposed tooth roots, this procedure is used to cover roots or develop gum tissue if it is absent.)


Root Canals

Root canal refers to a component of an individual tooth that lies within the tooth’s root. There are at least one and as many as four root canals in each tooth and their function is to connect the tooth’s nerve (which lies at the tip of the tooth’s root) to the tooth’s crown (the visible portion of a tooth above the gum line). The term is also used to describe a specialized treatment in the branch of dentistry is Endodontics.

Endodontics, or root canal therapy, is an effective way of cleaning out infected pulp from a tooth. If the pulp of a tooth becomes damaged beyond repair, it essentially means that the tooth has died. This damage is usually a result of a cracked tooth or a deep cavity and becomes visible if an abscess (a pocket of pus forming at the tip of the tooth root) develops. In this procedure, the infected pulp must be removed from the pulp chamber and the root canals. The pulp chamber and root canals are then thoroughly cleaned and enlarged after the infected pulp is removed. A filling is then attached in order to prevent bacteria from entering the root canals and pulp chamber areas. A crown is placed over the tooth in order to retain the original shape of the tooth.

If treatment is not sought at that point, there is a possibility that the infection of the pulp can spread to the root canals. In this case, the bone holding the tooth will deteriorate and can lead to the falling out of the tooth. In these instances, it is recommended that the tooth be extracted and replaced. A missing tooth will lead to the shifting of teeth, to compensate for the empty space, to the point where the existing teeth will become crooked. Due to the difficulty of cleaning between crooked teeth there is a chance that these teeth will become infected and eventually further tooth loss.