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Is tooth whitening/bleaching damaging to my teeth?

Thursday, April 18, 2013

There are numerous questions and concerns we keep on hearing at our Downtown Vancouver office about teeth whitening

Myth 1: whitening strips enamel permanently from teeth
Myth 2: scrubbing teeth hearder will clean them better

Myth 3: Using a medium or hard toothbrush will clean your teeth and stain away better

How does bleaching works?
Enamel is made out of billions of organized tubes called enamel rods that are aligned like a honeycomb. Underneath the enamel lie the dentinal tubules.

Dentin is the sensitive and yellow part of the tooth. That's why the thinner the enamel, the yellower and more sensitive the teeth become. So by scrubbing your teeth with a medium/hard brush with a “whitening toothpaste”, which often contains a stronger abrasive, your teeth may get yellower and sensitive over time.

With time, stain infiltrates between the enanel rods and becomes intrinsic stain. The only way to remove that stain without damaging the enamel is through a chemical that reacts with them, like hydrogen peroxide. Hydrogen Peroxide reacts with the stain molecules and cleaves them into smaller & lighter molecules that get washed away. These stain molecules also provide some isolation by plugging access to cold water & air to the sensitive dentin. That’s why your teeth become very sensitive after a teeth whitening session (it actually means that the whitening is doing its job.)

We hope we demystified some of those myths. If you may have any questions, comments or to book a consult, don't hesitate to contact us at: http://www.ariadental.com/contact.php

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My tooth had a root canal... Is my tooth dead?

Tuesday, April 9, 2013

My tooth had a root canal... Is my tooth dead?

This is a common question our patients ask us at Aria Dental Vancouver.

A Root Canal therapy consists of Accessing, Cleanning, Shaping, Disinfecting/Sterilizing and Sealing the complexe root canal system of the tooth.

Tooth anatomy
Each tooth consists of a Crown (the part that we see) and roots (parts that are anchored to the bone by a ligament.)
Inside each root there is at least one (sometimes 2 or more) major canal(s). In the canals, there are usually nerves, blood vessels, lymphatics, cells, etc. They all meet up in the pulp chamber.

When a pulp becomes infected or inflammed due to a deep cavity or a deep filling for example, it "self-destructs itself" (Irriversible Pulpitis).

Irriversible Pulpitis is an inflammatory reaction that can cause a dull intense pain that can last anywhere from a couple of minutes to hours. It is one of the major emergencies seen in a dental office. Its classic symptom is a diffuse dull ache (tooth ache) after the consumption of a hot substance. Usually the pain is aleviated by something cold. Patients often are seen sipping on icy water. There are 2 solutions for this pain: root canal or tooth extraction (we prefer to save the tooth whenever possible.)

If nothing is done, the pulp ends up dying, and the pain goes away... Only to come back as an abscess pain: i.e. pain to touch or biting.

The alternative to a root canal is extraction. Leaving an abscessed tooth is usually not an option, as it can be life threatening due to their proximity to the airways and blood circulation to the brain, i.e. there is a risk of dying from a tooth abscess.

In other words, a root canal treatment's purpose is to save the tooth when the pulp is either dying or dead.
The pulp's biggest job and function is to form the tooth and its roots.

Once this job is accomplished, the pulp's remaining function is as an "Alarm system", warning you when a cavity is present and causing pain sensations - like when you eat Ice cream.

It also has a nutritive function to the organic 30% of the dentin structure of the root (Collagen matrix mainly). A root canaled tooth is actually weaker then a tooth with a healthy pulp, and that's part of the reason.

It also protects by forming secondary dentin when injured. That's why a tooth darkens up with time after an impact, as seen here on one of our patients teeth.

Traumatised tooth

If you have any question, comments or would like to book an appointment, don't hesitate to contact us at: http://www.ariadental.com/contact.php

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Will my filling last forever?

Sunday, April 7, 2013

One of the most asked questions in our office is: "Will my filling/crown last forever?!?"

No matter how strong a material is, it is as strong as the weakest material surrounding it.
Sometimes, it is the tooth itself that fails. Teeth can decay, crack, fracture... This would unfortunately lead to failure of the restoration.

The filling material and its bonding agent (glue that keeps it in place) can also fail due to material fatigue. Material fatigue is a progressive and localized structural damage that results from repeated cyclic loading of an object. We chew on average 1,500 times per day. Add to that the abuse from teeth clenching and grinding, ice &/or gum chewing, nail biting (or ear biting in the case of Mike Tyson) etc... Like teeth, fillings will wear down.

Last month, we had a case of a failing tooth colored (composite) filling.
Failing filling
The patient complained of sensitivity to biting and to cold on her upper left teeth. She had those fillings placed over 10 years ago, and they haven't bothered her until now.

Exam findings:
1. She felt pain when the pressure was specifically placed on the filling on tooth 2.6 (14 for US dentists)
2. A gap was felt between the filling and the tooth indicating an open margin

There is likely failure of the bond between the filling and the tooth (the glue that links the filling to the tooth)

The filling needs to be replaced.

We started by numbing the tooth and isolating it with a rubber dam. It is an important step to avoid contaminating the area. One of the main reasons why a tooth colored filling fails prematurely is if a film of saliva ends up on the tooth surface while the filling is being placed. That film will compromise the longevity of the filling by weakening the strength of the bond between the materials and the tooth.

After the filling was replaced
The filling was successfully replaced. When we saw the patient for her recare appointment, a week later, she was happy that the pain was gone.

Do you have a comment, a question or would like to schedule a consultation? Follow this link for our contact information: http://ariadental.com/contact.php

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Case of the Fractured tooth!

Saturday, April 6, 2013

Thursday afternoon, a patient searching for a dentist in vancouver to repair her broken tooth while she's on a trip, calls our office.  Sara answers her call and books her an appointment.

The patient fills in the forms and is seated in the dental chair. After the interview, the exam and a radiograph, fair enough, the cusp is fractured! (tooth is confirmed broken) :-O

The suspect: A failing silver (amalgam) filling on tooth 4.6 (30 for US dentists, lower right first molar). This is generally why we recommend to change old failing amalgam fillings.

The solution: The tooth needs a ceramic-onlay to replace the missing cusp and the old amalgam filling. ie we have to fix the broken tooth.

The patient was frozen and the tooth was isolated with a rubber dam.

Fractured tooth

The old filling is removed and the tooth is prepared to recieve an onlay.
Note: The stain in the middle is caused by tertiary dentin and corrosion residue from the amalgam filling. It is solid and there is no need to remove it. Removing it would lead to pulpal (nerve) exposure and the need for a root canal treatment. So a root canal treatment was avoided here.

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Onlay prep

The tooth was scanned with the Omnicam - CAD capture camera and the margins were traced...
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Prep scan
 Then the ceramic onlay was designed and adjusted to fit the tooth...

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Onlay design
The designed onlay was then milled from a block of ceramic that matches the colour of the tooth

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Milling preview

The milled onlay was then microetched and treated for the final cementation

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Milled onlay

The onlay was then cemented... It disappeared in the tooth... Can you guess where it is?

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Cemented Onlay!

The patient was thrilled! She went on with her journey.

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Et voila!

Do you have a comment, a question or would like to schedule a consultation? Follow this link for our contact information: http://ariadental.com/contact.php

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Saving The Wisdom!

Friday, April 5, 2013

Although wisdom teeth may be hard to maintain and treat, some patients refuse to part from them.
Wisdom teeth often represent a challenge for dentists due to the complexity of their anatomy and their remote position in the mouth.

We recently had a patient who insisted on saving his wisdom tooth. He is in his 60's, he has a few teeth left, among them a wisdom tooth.  He wanted to hold on to it, even though it wasn't functional (no opposing teeth to chew on).

Preoperative picture of the wisdom tooth, upper left side. The rubber dam is in place. A mirror is needed to photograph the tooth.

The tooth was prepared for an onlay. The ceramic will be mainly retained from the inside of the tooth, to preserve as much of the tooth as possible. Note: The tooth had a root canal treatment in the past. 

Omnicam 3D scan of the wisdom tooth and the tooth adjacent to it. No impression or powder involved. 

Onlay design by the Omnicam - CAD component. The margins were traced and the computer generated the crown.

The Onlay design, as it will be milled by the Cerec CAM component out of the block of ceramic.

The cemented crown, after it was stained and glazed.

The crown in the patient's mouth 1 hour later! The patient was thrilled with the results :-)
Do you have a comment, a question or would like to schedule a consultation? Follow this link for our contact information: http://ariadental.com/contact.php

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Case report - Saving heavily decayed teeth

Wednesday, April 3, 2013

A patient presented with 2 heavily decayed teeth. She thought that her teeth were hopeless and that they needed to be pulled.

Preop picture - heavily decayed teeth

Initial assessment: both teeth are heavily decayed and the premolar (smaller tooth) is fractured to bone level, i.e. we cannot isolate the tooth predictably to do a root canal or place a filling/crown.

1. First Step to saving her two teeth: perform Clinical Crown lengthening procedure.
  • Crown lengthening is a minor gum surgery that involves:
    • Detaching the gum from around the tooth to expose the bone,
    • Ensuring there is a 3mm clearance between the bone and non decayed tooth (or crown/filling margins)
    • Result: allow the gums to attach to the root of the tooth, and seal the sterile/clean bony tissue from the oral cavity (the mouth). 
2. Second Step:  Predictably isolate the teeth then treat them.
  • Root canal treatment on both teeth
3. Third Step:  complete the temporary fillings - with correct anatomical shaping & seeing the patient in 1 week to place the final crowns (to be made at the office using the Cerec 3D Omnicam)
  • Temporary fillings placed and shaped to the correct anatomy
  • Copack dressing was applied (Band-Aid for the gums)
  • Patient scheduled to place final crowns after proper healing has occured.
Do you have a comment, a question or would like to schedule a consultation? Follow this link for our contact information: http://ariadental.com/contact.php

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