Unless otherwise stated, the information concerning the following topics is obtained from the Canadian Dental Association.

 

 Cosmetic Dentistry

 Bleaching

 Fillings and Dental Materials

 Sealants

 Root Canal Therapy

 Restoring and Replacing Your Teeth

 Orthodontics

 Creating a Naturally Beautiful Smile 

 

 

 

 

 

 


 

 Cosmetic Dentistry

 

Cosmetic dentistry can help you out when you aren't happy with the way your teeth look. You can improve the appearance of healthy teeth that are broken, chipped, cracked, widely spaced or stained.

 

There are two main types of cosmetic treatment:

  • Veneering, involves applying a composite resin (or plastic) directly to tooth surfaces and hardening it with light (Direct Veneering) or casting porcelain or acrylic veneers in a laboratory and affixing them to the natural teeth (Indirect Veneering).

  • Bleaching, uses a chemical agent to lighten the colour of teeth and remove discolorations.

Another method sometimes used to whiten teeth is micro-abrasion.

 

Will it be a success?

 

Bleaching may lighten most stains from your teeth, but not all stains.  If your teeth are discoloured because you took a medicine called tetracycline when you were a child, your teeth may be harder to bleach.

 

Veneers are stronger than bonding. They are also less likely to change colour or stain. Porcelain veneers are stronger than acrylic veneers.

 

Veneers can chip or peel off if you do not take care of them.  Don't bite your fingernails or chew on hard objects.

 

How long will it last?

 

Teeth that have been bleached may need to be redone 1 to 3 times a year.

 

Bonding does not last as long as crowns. It may need to be touched up about every 3 to 5 years. But crowns can last for about 10 years.

 

Veneers can last from about 3 to 12 years.

 

What will it cost?

 

In general, bleaching costs less than bonding or veneers.

 

Bonding costs a lot less than crowns. Crowns used to be the only way to make chipped, widely spaced, or discoloured teeth look better.

 

Cosmetic dental treatments like bleaching, bonding or veneers might not be covered by your dental plan. You may have to pay the costs yourself.

 

How long will it take?

 

Bleaching most often takes a few visits before teeth are lightened.  Each visit lasts about a half-hour.

 

Bonding is quick. In most cases, several teeth can be bonded in 1 visit.

 

Veneers take at least 2 visits, and sometimes 3. Some of these visits might last longer than others.

 

What can happen after treatment?

 

Bleaching may sometimes damage tooth pulp. Pulp is the soft part of a tooth that has nerves and blood vessels it it. Pulp runs through the centre (or root canal) of a tooth. If tooth pulp is badly damaged, you may need a root canal.

 

If composite resin is not fully sealed (or bonded) onto your tooth, stains or cavities can form under the composite resin.

 

Once you have veneers, you cannot reverse the treatment because a part of your enamel has been removed. And until the veneers are attached to your teeth, your teeth may be sore and look strange.

 

If a veneer chips or peels off, or if a cavity forms under a veneer, the veneer must be redone. The other option is to put a crown on the tooth.

 

What about eating, drinking and smoking?

 

Tobacco, coffee, tea, blueberries, grape juice, cherries and red wine can stain bleached and bonded teeth, just like they stain natural teeth.

 

Veneers do not stain as easily, but they can be chipped if you are not careful when biting into hard or chewy foods.

 

Other things to think about:

 

Bonding can be used on children's teeth, because the composite resin can be removed and replaced as children's teeth grow.

 

Cosmetic dental treatments like bleaching, bonding and veneers can make your teeth look better, and make you feel better about yourself and your smile.

 

 


 

 Bleaching

 

The source of the following information is the Academy of General Dentistry.

 

How can you brighten your smile?

 

Your wedding is coming up and you want your smile to be its brightest. Or maybe you have an important speaking engagement. Whatever the reason, tooth bleaching isn't just for the movie stars, and it isn't just for one day. Many people have had their teeth bleached, and probably millions more are thinking about it. The desire for a brighter smile with whiter teeth is very strong, and tooth bleaching safely lightens the color of the teeth, lasting for up to five years. The most effective and safest method of tooth bleaching is dentist-supervised.

 

Is bleaching for you?

 

Generally, bleaching is successful in at least 90 percent of patients, though it may not be an option for everyone. Consider tooth bleaching if your teeth are darkened from age, coffee, tea or smoking. Teeth darkened with the color of yellow, brown or orange respond better to lightening. Other types of gray stains caused by luorosis, smoking or tetracycline are lightened, but results are not as dramatic. If you have very sensitive teeth, periodontal disease, or teeth with worn enamel, your dentist may discourage bleaching.

 

What's involved?

 

First, the dentist will determine whether you are a candidate for tooth bleaching and what type of bleaching system would provide the best results.

 

If you're in a hurry for whiter teeth, you may decide to have your teeth lightened immediately. Your dentist will use either an in-office bleaching system or laser bleaching while you sit in the dental chair. However, most patients choose dentist-supervised at-home bleaching, which is more economical and provides the same results.

 

At the next appointment if you don't choose laser bleaching, the dentist or hygienist will make impressions of your teeth to fabricate a mouthguard appliance for you. The mouthguard is custom made for your mouth and is lightweight so that it can be worn comfortably while you are awake or sleeping. The mouthguard is so thin that you should even be able to talk and work while wearing your mouthguard. Along with the mouthguard, you'll receive the bleaching materials. You'll be given instructions on how to wear the mouthguard.

 

Some bleaching systems recommend bleaching your teeth from two to four hours a day. Generally this type of system requires three to six weeks to complete, and works best on patients with sensitive teeth. Other systems recommend bleaching at night while you sleep. This type of system usually requires only 10-14 days to complete.

 

How long does it last?

 

Lightness should last from one to five years, depending on your personal habits such as smoking and drinking coffee and tea. At this point you may choose to get a touch up. This procedure may not be as costly because you can probably still use the same mouthguard. The retreatment time also is much shorter than the original treatment time.

 

How does it work?

 

The active ingredient in most of the whitening agents is 10 percent arbamide peroxide (CH4N2O2), also known as urea peroxide; when water contacts this white crystal, the release of hydrogen peroxide lightens the teeth.

 

Is it safe? Any side effects?

 

Several studies, during the past five years, have proven bleaching to be safe and effective. The American Dental Association has granted its seal of approval to some tooth bleaching products. Some patients may experience slight gum irritation or tooth sensitivity, which will resolve when the treatment ends.

 

What are realistic expectations?

 

No one can really predict how much lighter your teeth will become. Every case is different. Typically, there is a two-shade improvement as seen on a dentist's shade guide. The success rate depends upon the type of stain involved and your compliance. Bleaching can only provide a shift in color from gray to a lighter shade of gray, for example. Bleaching does not lighten artificial materials such as resins, silicants, or porcelains.

 

 


 

 Fillings and Dental Materials

 

One of the things your dentist looks for during your regular dental check-up is tooth decay. If you have decay, and require treatment, you can choose from a number of different dental materials and treatment options to restore your teeth to good health. Your dentist can advise you on the type of dental materials that will work best in your particular case, and inform you about the esthetic and cost implications associated with each one. But the final decision on which dental material is placed in your mouth belongs to you.

 

Before you decide on a treatment plan, it is important to inform your dentist if you are taking any medications, or if there have been any changes in your health status since you last updated your medical history. Various health conditions may influence the range of treatment options available to you. Your dentist is aware of these considerations, and can advise you of any known concerns. Remember, it is your responsibility to inform your dentist of your current medical condition, or if you are pregnant.

 

If you have any questions about the dental materials and procedures described in this pamphlet, talk to your dentist. Your dentist can explain the advantages and disadvantages of each option and material, relative to your specific needs and personal circumstances.

 

Although your dentist also uses restorative materials to repair broken, stained, missing or damaged teeth, they are most often used to treat caries, which appear on your teeth as brown or black spots. These spots are actually areas of diseased tissue. Left untreated, caries can penetrate through the tough outer layer of your teeth, known as the enamel, into the more sensitive inner layer, or dentin. This can lead to pain, discomfort and, if left untreated, tooth loss.

 

Your dentist treats caries by carefully removing all traces of diseased tissue, or decay, from the affected tooth. Once the decay is removed, your dentist shapes the resulting cavity and fills it with a suitable restorative material.

 

Restorative Materials

 

Restorative dentistry has undergone a virtual revolution in the past 20 years with the introduction of a wide range of new materials and techniques.

 

Today, four main types of restorative materials are available: metals, composite resins, ceramics and glass ionomers. Each material offers unique advantages and disadvantages, depending on your own specific circumstances and needs.

 

In addition, there are two main classifications of dental materials, direct and indirect.

  • When direct materials are used, your dentist can often restore your decayed tooth in a single appointment. These materials are placed directly into the cavity your dentist has prepared, and harden quickly.

  • Indirect materials usually require a minimum of two appointments to place, because they must be fabricated before they are inserted into the cavity. In most cases, indirect restorations are fabricated in a dental laboratory. Once they are fabricated, they are cemented into place by your dentist.

Dental amalgam is the best known direct material. Although cast gold alloy may be the most durable indirect material, ceramics are increasing in popularity because of their longevity relative to other tooth coloured materials.

 

To choose the treatment plan that’s right for you, ask your dentist to explain the risks and benefits, advantages and disadvantages, and the costs, of the different alternatives which could be used to treat your specific problem.

 

 

 


 

 Sealants

 

The source of the following information is the Academy of General Dentistry.

 

What is a sealant?  

 

A dental sealant is a thin plastic film painted on the chewing surfaces of molars and premolars (the teeth directly in front of the molars). Sealants have been shown to be highly effective in the prevention of cavities. They were developed through dental research in the 1950s and first became available commercially in the early 1970s. The first sealant was accepted by the American Dental Association Council on Dental Therapeutics in 1972.

 

How effective are sealants?

 

Scientific studies have proven that properly applied sealants are 100 percent effective in protecting the tooth surfaces from caries. Because sealants act as a physical barrier to decay, protection is determined by the sealants' ability to adhere to the tooth. As long as the sealant remains intact, small food particles and bacteria that cause cavities cannot penetrate through or around a sealant. In fact, research has shown that sealants actually stop cavities when placed on top of a slightly decayed tooth by sealing off the supply of nutrients to the bacteria that causes a cavity. Sealant protection is reduced or lost when part or all of the bond between the tooth and sealant is broken. However, clinical studies have shown that teeth that have lost sealants are no more susceptible to tooth decay than teeth that were never sealed.

 

How are sealants applied?

 

Sealant application involves cleaning the surface of the tooth and rinsing the surface to remove all traces of the cleaning agent. An etching solution or gel is applied to the enamel surface of the tooth, including the pits and grooves. After 15 seconds, the solution is thoroughly rinsed away with water. After the site is dried, the sealant material is applied and allowed to harden by using a special curing light. Other sealants are applied and allowed to harden much the same way nail polish is applied to fingernails. Sealant treatment is painless and could take anywhere from five to 45 minutes to apply, depending on how many teeth need to be sealed. Sealants must be applied properly for good retention.

 

How long will a sealant last?

 

Sealants should last five years, but can last as long as 10 years. One study reported that seven years after application, an impressive 49 percent of treated teeth were still completely covered. Sealants should not be considered permanent. Regular dental check-ups are necessary to monitor the sealants' bond to the tooth.

 

Who should receive sealant treatment?

 

Children, because they have newly erupted, permanent teeth, receive the greatest benefit from sealants. The chewing surfaces of a child's teeth are most susceptible to cavities and the least benefitted by fluoride. Surveys show that approximately two-thirds of all cavities occur in the narrow pits and grooves of a child's newly erupted teeth because food particles and bacteria cannot be cleaned out. Other patients also can benefit from sealant placement, such as those who have existing pits and grooves susceptible to decay. Research has shown that almost everybody has a 95 percent chance of eventually experiencing cavities in the pits and grooves of their teeth.

 

Are sealants covered by insurance?

 

Although insurance benefits for sealant procedures have increased considerably, coverage is still minimal. The trend is toward expanded coverage of this benefit, especially as companies start to realize that sealants are a proven preventive technique. This preventive measure can help reduce future dental expenses and protect the teeth from more aggressive forms of treatment.

 

 


 

 Root Canal Therapy

 

Root canal treatment is sometimes the only way to save a tooth. Severe damage to a tooth- may be the result of a deep cavity, gum disease, or an injury- can usually only be repaired by root canal treatment. Successful treatment means you can keep your tooth.

 

Also called endodontics, root canal treatment is the process of removing the infected, injured, or dead pulp from a tooth. Pulp, the soft tissue containing nerves and blood vessels, runs through the centre or root canal of a tooth.

 

Your tooth's pulp can become infected by a deep cavity or gum disease. Watch for signs of a tooth becoming discoloured or for pain and swelling around a tooth. Your tooth can also become damaged by an injury. If your tooth is badly broken, it is often necessary to perform a root canal.

 

Don't wait until it hurts. Call your dentist as soon as you experience symptoms or have an injury. He or she can almost always repair or save your tooth. Timely attention to a broken tooth or to signs of pulp damage is important to ensure that root canal treatment is successful and your tooth can be saved.

 

There may, in some cases, not be any obvious signs of damage. Your dentist looks for infection and damage to your teeth during regular dental visits. Frequently, only a dental X-ray can detect the need for root canal treatment.

 

While your dentist may perform some endodontic treatments, he or she may refer more complicated cases to a specialist, called an endodontist. In the case of baby teeth, your dentist may refer your child to a specialist, called a pediatric dentist.

 

Here's How It's Done:

  • Your dentist makes a small hole in your tooth. This exposes the root canal and the damaged pulp. Local anaesthetic is usually, but not always, required.

  • He or she removes the damaged pulp and enlarges the root canal by carefully cleansing it with precision instruments. You may be given topical antiseptics to prevent infection.

  • Once the root canal has been cleaned of all damaged pulp, it is filled and sealed with a safe, rubber-like material. The root canal treatment is now complete. However, your tooth still needs to be restored to it's normal function and appearance.

  • Your dentist may bleach, fill, or crown your tooth. The restorative treatment selected will depend on the extent of the discolouration or damage involved, and on which tooth has had the root canal treatment (most back teeth need to be repaired with a crown).

  • Some people may experience mild swelling or discomfort after root canal treatment, although this is rare. If this occurs, call your dentist- he or she may prescribe medication or recommend additional treatment.

Why Root Canal?

 

Successful root canal treatment lets you keep your tooth.

 

The only alternative is to have your tooth removed. Dentists today believe that the best teeth are your own, and they do their utmost to make sure you don't lose any.

 

Retaining your tooth has short and long-term benefits. It helps to prevent neighbouring teeth from drifting out of line and causing jaw problems or gum disease.

 

Saving natural teeth avoids more extensive and expensive replacement treatments, such as bridges or implants.

 

Things to Consider  

 

Root canal treatment generally requires one to three lengthy visits, depending on what tooth has been damaged (molars can have three or four canals), on the degree of pulp infection (badly infected versus recent pulp exposure), and on the technique used to restore your tooth (crowns required for back teeth, treatment of gum disease, bleaching of iscoloured teeth, for example).

 

Anaesthetic is usually used to numb the area around your tooth, and drilling is required to reach the pulp chamber. Some people may experience some mild discomfort and/or swelling after treatment, although this is rare.

 

Sometimes a root canal can cause discolouration of the tooth, requiring bleaching, bonding, or crowning to restore the natural colour.

 

If the tooth is abscessed (meaning the pulp has died and the infection has entered the bone that anchors the tooth), the infection may have to be drained before the empty root can be filled.

 

Having a root canal and a crown does not guarantee there will be no future decay or gum disease.

 

Although the success rate is high for endodontic treatment, a small percentage of cases are unsuccessful. Under most circumstances, these teeth can still be saved. A minor surgical procedure is usually the next step. In rare cases, all attempts to save the tooth fails and it must be extracted.

 

 


 

 Restoring and Replacing Your Teeth

 

Dentists believe that the best teeth are your own teeth.  They will do all they can to make sure you keep your teeth. But sometimes, a tooth is badly damaged or lost. The good news is, there are a number of ways to restore a badly damaged tooth and replace a lost tooth. This section is about restoring and replacing your teeth. If you need to have a tooth (or teeth) replaced, your dentist may do it, or refer you to a prosthodontist. A prosthodontist is a dental specialist with at least 2 years extra training in this area. If you are having an implant, your dentist or prosthodontist may refer you to an oral surgeon (also called an oral and maxillofacial surgeon) for surgery.

 

Crowns

 

If your tooth is damaged but not lost, a crown (also called a cap) can be used to cover the damaged part of your tooth. A crown protects your tooth from further damage. You may need a crown if:

  • you have a root canal,

  • you have a large filling in a tooth,

  • you have a broken tooth,

  • your tooth is badly stained, not the right shape, or out of line.

Crowns can be made of different kinds of metals, porcelain, or porcelain fused to metal. They are strong and last for about ten years if you take good care of them.

 

Brush and floss your crown, just like you clean your natural teeth.

 

But crowns and replacement teeth may not be as strong as your natural teeth, so:

  • do not bite down on hard objects,

  • do not use your teeth to open or cut things,

  • do not do these things with your natural teeth either.

Here's how a crown is made:

  • Your dentist may make a mold (or an impression) of your tooth to fit a temporary crown. A temporary crown protects your tooth until the final, permanent crown is ready. Temporary crowns may not have the same shape and colour as permanent ones.

  • Your dentist gives you freezing (called a local anesthetic). He or she then files down your tooth to make room for the crown.

  • Another mold (or impression) of the filed-down tooth and nearby teeth is taken. Then the temporary crown is placed over your tooth and you are sent on your way.

  • This mold is sent to a dental lab where your permanent crown is custom made. The mold of your tooth is used to make a model. A filling (or restoration) that is the same size and shape as your tooth is built based on the model.

  • On your next visit, your dentist takes off the temporary crown and puts on the permanent one. Your dentist checks to make sure the crown is the right fit, shape and colour. If it is, your dentist cements the crown into place. Your tooth will look and work very much like a natural tooth.

These are the steps dentists most often follow in making a crown, but your tooth may need special care. You may need orthodontic treatment or gum treatment. It may take more than 2 visits to your dentist, or your visits may last longer.

 

Bridges

 

If a tooth is lost, it is important to replace it with a false (or artificial) tooth as soon as possible. This will prevent the teeth that are left from drifting out of line and causing other problems. 

 

A bridge is also called a "fixed bridge" or a "fixed partial denture".  It can replace one or more missing teeth. It is held firmly in place by healthy teeth on each side of the missing one(s). You cannot take a bridge out. It is permanent.

 

Here's how a bridge is made:

  • The teeth on each side of the missing one(s) are prepared for crowns.

  • The false tooth (or teeth) and 2 crowns are custom made in a dental lab as one piece.

  • The unit is placed in your mouth.  The crowns are cemented to your 2 healthy teeth on each side of the missing one(s).

A bridge should last for about 10 years, if you take good care of it. Your dentist will show you how to use a floss threader to floss under and around the false tooth (or teeth) in the middle of the bridge.

 

Dentures

 

There are two types of dentures: partial dentures and full dentures.  Both are made in a dental lab, based on a mold (or impression) or your mouth. 

 

A partial denture is also called a "removable partial denture" or a "partial". It is made up of one or more false teeth, and held in place by clasps that fit onto nearby teeth. You can take the partial denture out yourself, for cleaning and at night. A partial denture may be used when nearby teeth are not strong enough to hold a bridge, or when more than just a few teeth are missing.

 

You need to care for a denture as carefully as you would look after your natural teeth. Here's how:

  •  Keep your denture clean. Plaque builds up on a denture just like it does on natural teeth. Unless plaque is removed from your denture, it can spread to your natural teeth and gums, causing gum disease and cavities.

  • Remove your denture every night. Brush your natural teeth and your gums carefully with a soft toothbrush. If your tooth brush hurts you, run it under warm water to make it softer, or try using a finger wrapped in a clean, damp cloth.

  • Soak your denture overnight. It can be soaked in a special cleaner (called denture cleanser), in warm water, or in a mix of warm water and vinegar (half and half). If your denture has metal clasps, soak it in warm water only. Soaking will loosen plaque and tartar, so they will come off more easily when you brush. Brush and rinse your denture before you put it back in.

  • See your dentist on a regular basis. Your mouth is always changing, so your denture will need adjusting from time to time to make sure it fits well. If you have a partial denture, regular check-ups are important to make sure that your natural teeth and gums get the care they need.

Dental Implants

 

Dental implants are used to replace missing roots and support replacement teeth. The replacement teeth may be fixed to the implant(s), or you may be able to take them out yourself.

 

Here's how an implant is done:

  • Your dentist (or oral surgeon) will put a small metal post into your jawbone.

  • Over time, the post will bond with the bone around it.

  • The post (or implant) will act like an anchor to hold one or more false teeth in place.

Because implants stick to the bone, false teeth attached to implants look and act much like natural teeth. But implants are NOT as strong as natural teeth. You must brush and floss your implant(s) very carefully. Be gentle, but make sure you brush all sides of your implant(s). A toothbrush that has longer bristles at the tip may help clean behind your implant(s). At least once a day, floss very carefully. You will need to be gentle with the floss where the implant meets the gum (called the gumline). You may find a floss threader useful to clean this area.

 

Implants are not for everyone. You must:

  • be in good general health,

  • have healthy gums,

  • have enough bone in your jaw to support the implant(s).

It's normal for bone to shrink if it no longer has teeth to support. Because an implant sticks to the bone, the bone is less likely to shrink. But if you have been missing teeth for some time, you may have lost bone. A bone graft can build the bone so it can support an implant. When a bone graft is done, bone is added to the area where your jaw bone has shrunk. Your dentist or dental specialist will tell you if this can be done in your case.

 

You must also be willing to:

  • see your dentist or dental specialist several times until the work is done and

  • take very good care of your implant(s).

In addition, implants can cost more than other kinds of replacement teeth.

 

 


 

 Orthodontics

 

Teeth that are crooked, crowded, or that stick out (protruding teeth) can:  

  • affect the way you look,

  • affect your bite (the way your teeth fit together),

  • be more difficult to clean.

If you are not happy with the way your teeth look or work, orthodontic treatment may help.  This section is about orthodontic treatment.

 

Orthodontic treatment straightens your teeth so they look better and work better. It may even make your face look better, and help your jaw muscles function.

 

Orthodontic treatment uses braces or other appliances to put gentle pressure on your teeth. Gentle pressure over a number of months or years can move your teeth into the right position.

 

Your dentist may do basic orthodontic treatment or refer you to an orthodontist. An orthodontist is a dental specialist with 2 to 3 years of extra university training in this area.

 

 


 

 Creating a Naturally Beautiful Smile

 

The following information is part of an article by Steve Ratcliff, DDS, Resident Faculty at the Pankey Institute.

 

As part of your comprehensive evaluation, you and your dentist may have had a discussion regarding the appearance of your teeth and changes you would like to make. This may have been as simple as wanting to lighten your teeth or as complex as wanting to change the position and size of your teeth.

 

After spending time with all the diagnostic aids gathered during the evaluation process, your dentist will make suggestions on how best to achieve your esthetic wishes for your smile. The best dentists understand that comprehensive dentistry includes creating the most esthetic result possible and that by restoring the proper form to the dentition, naturally beautiful results will follow.

 

The explosion in new technologies gives dentists wonderful techniques and materials to create that natural beauty in a manner that was not achievable a few short years ago. Your dentist may suggest any number of modalities to help you maximize the result you desire.

 

If you are wondering what the possibilities might be for yourself, the best dentists can help create a vision for you as you discover together what might work for you. Part of that vision might be a "wax-up"; or wax mock-up of what is possible in your mouth. It might be pictures of other individuals who have similar issues. You might spend time looking at images of your face and smile and altering those images until they reflect what you would like to achieve. However it might happen, it is important to understand what you most want and then determine how it can happen.

 

The results can be spectacular.