Given the prevalence of osteoporosis and the increasing proportion aging population many more people are taking a bisphosphonates to increase bone density. Taking such drugs can interfere with jaw bone healing after dental surgery including tooth extraction. This put them at a increased risk of a condition called BRONJ (Bisphosphonate related osteonecrosis of the jaw).

 In patients taking bisphosphonates, such as Fosamax, Boniva, Actonel, Aclasta etc. the increase
risk of osteonecrosis of the jaw changes their dental management limiting their treatment options. It is often difficult or impossible to achieve a health and comfortable mouth for such individual. Most people don’t associate a diagnosis of osteoporosis with a need to see a dentist.

 As always, inform your dentist to any changes to your medications. Regular dental exams and hygiene are your best bet for keeping problems away. Waiting until it hurts or is broken means irreparable damage has already been done.

                                               CROWNS                                                                                                                                                      

What is a crown and why do you need one?

A crown is an artificial tooth that covers and restores a tooth’s shape, appearance and  function.  You may need a crown if you have had a root canal, a large filling or a have a broken tooth.   Crowns can also be used to cover a discoloured or misshapen tooth.  Once a crown has been placed on a tooth it will look and work much like a natural tooth.

How will your Dentist make a crown?

1.       Your dentist will give you a local anaesthetic.

2.       The dental assistant will take an impression of your teeth.

3.       Your dentist will then file down the tooth that needs to be restored, to make room for the crown.

4.       Another impression of the filed-down tooth and nearby teeth is taken.  This impression is used to custom make your final crown so it will be the right shape for your mouth.  This impression will be sent to a dental lab to fabricate your crown.

5.       Until your final crown is ready your dentist places a temporary crown over the tooth that needs to be restored.  The temporary crown is made from an impression of your tooth before it was filed down.  It protects your tooth until the final crown is ready.   A temporary crown may not have the same shape and colour as a final crown.

6.       On your next visit, approximately 2 weeks later, your dentist takes off the temporary crown and puts on the final one.  Your dentist checks to make sure the crown is the right fit, shape, colour and bite.  If it is, your dentist cements the crown into place.

These are the steps dentists most often follow in making a crown, but your tooth may need special care.  If this is the case your dentist will discuss this with you accordingly.

Crowns are strong and generally last for about 10 years or longer if you take good care of them.  Brush and floss your crown, just like you clean your natural teeth.  Crowns may not be as strong as your natural teeth.  So like your natural teeth, remember not to bite down on hard objects or use your teeth to open or cut things.

The Greater Vancouver area water source is not fluoridated. While having fluoride is a proven way of reducing dental caries (decay) in the general and at risk populations, there is much concern about it being ingested. Topical application of fluoride to the teeth remains the mainstay of prevention in dental offices and is the bases of using such toothpastes at home. Many patients attend my office unaware that Richmond's water is not fluoridated and/or not selecting a fluoride toothpaste for themselves or their children. There is more difficulty in keeping their teeth healthy, diet and hygiene are paramount but also products that contain 'recaldent' can help.

RECALDENT™, with the technical name casein phosphopeptides - amorphous calcium phosphate, or CPP-ACP. Developed from casein, part of the protein found in cow's milk, its unique formula helps to strengthen teeth by delivering calcium and phosphate (the building blocks of tooth enamel) to the tooth to remineralize the enamel. RECALDENT™ can penetrate tooth enamel and remineralize the areas that have been affected by plaque bacteria.

MI Paste is the only product for professional use containing the active ingredient RECALDENT™ (CPP-ACP), a special milk-derived phosphopeptide that binds calcium and phosphate to tooth surfaces, plaque and surrounding soft tissue. MI Paste is a water-based, sugar-free créme that is applied directly to the tooth surface or oral cavity. MI Paste with RECALDENT™ (CPP-ACP) restores the oral mineral imbalances that cause demineralization by replacing minerals while improving saliva flow and fluoride uptake as well as soothing sensitive surfaces - making it an ideal treatment for:

• Reversing tooth sensitivity and restoring enamel gloss after whitening procedures
• Relieving dry mouth caused by certain medications
• Reducing high oral acid levels from excessive soft drink consumption , acid reflux, bulimia
• Reversing tooth sensitivity before and after professional cleaning
• Reducing high oral acid levels - sometimes a consequence of pregnancy
• Buffering acids produced by bacteria and plaque
• Regular conditioning during orthodontics, during and after bands or brackets have been removed, to prevent and reverse white spot lesions
• Providing a topical coating for patients suffering from erosion, caries and conditions arising from xerostomia

Use MI Paste™

• Elderly patients
• After tooth whitening
• For pregnant women
• For children six years and under
• During and/or after orthodontics
• For desensitizing
• To provide extra protection for teeth

With Recaldent, Trident Xtra Care provides significant remineralization of subsurface enamel lesions over and above just the salivary stimulation from chewing regular sugar free gum alone.

I was so excited to hear about this event, I had to join in the fun! The Steveston Merchant Association is organizing the evening complete with shopping sales, late hours, food and drink specials and not to mention a Botox open house hosted by Harmony Dental Studio. Move over Salmon Festival, I think this will be Steveston's event of the year.

I recently had to opportunity to contribute an article to a great website, vancouvermom.ca. The site is a great resource for local parents. If you have never browsed its pages I highly recommend spending some quality time with your computer mouse and navigating the on-line magazine.

You can find my article "Show us Your Smile: Pregnancy and Teeth" at www.vancouvermom.ca under For Mom - wellness.

    Bryn is my 20 month old daughter. We read this book for story time over the weekend. This book has nice sturdy pages that Bryn found easy to turn. It is a quick read but has great pictures and nice details. We both really liked the bunnies on Millie's pyjammas! When asked the final question "Do you like clean teeth too?" Bryn answered with a loud "YES!". Perfect, time to brush... 

   Co-operation for tooth brushing is a struggle for most parents and I am no different. Most days we get through it with mild resistance and sing a couple songs to pass the two minutes. I brush her teeth on the change table with her lying down, top of her head to me. You can see alot more when you are in the "dentist" position. It is important that you are able to see the gumline to check for plaque and decay. This is where it is most common in children in the 0-4 age group. Lift the lip and try to get a good look. Any white or brown patches need to be looked at by a pediatric or general family dentist.  Brushing after breakfast and after the last snack or bottle gives the best protection. Most kids resist brushing at some point (hopefully not forever) and with everything practice and patience is key. Try to make it fun you can brush together, let them brush your teeth, try to sing the ABC with a mouthfull of paste, ask them to count their teeth in the mirror make a special trip outside to brush on the front steps in your jammies or whatever works. No one's brushing is perfect all the time but best efforts go a long ways. Let's set them up for a cavity-free life!

  

THE OBJECTIVE: Teeth whitening is a way of lightening the natural colour of your teeth without removing any of the surface enamel. While the procedure cannot make a complete color change, it can lighten the existing shade and make your smile and teeth look brighter.  A full exam and x-rays must be done first to make sure you are a good candidate.

THE PROCEDURE:  May involve one in-office  appointment or a fabrication of a take home whitening kit.  The in-office whitening  appointment  is approximately one hour.   The take home whitening kit involves 2 appointments ½ hour each in office to take impressions  and deliver the kit with instructions to be carried out at home by yourself.  The in-office procedure involves bleaching of the teeth, where a gel is placed on the gums to protect the soft tissue and then a whitening product is applied directly to the tooth surface.  The active ingredient in the product is usually hydrogen peroxide or carbamide peroxide. The peroxide is broken down on the tooth surface and oxygen passes into the enamel to make the tooth color lighter over time.   

a)        The at home treatment involves dabbing a small amount of whitening gel inside of your custom made dental tray.  It can be worn once or twice a day for 1 hour for up to 4 weeks.

b)       Immediately after an in office treatment your teeth will be 3-4 shades lighter and may lighten another couple shades in the next few days.  The at home treatment works more slowly, it may take 3-4 weeks to get the same results as the in office treatment.

THE OUTCOME: The teeth should gradually appear whiter and brighter in appearance as a result of this dentistry, although it may take 4-5 weeks before you see the best results. The effects are not permanent but should last for approximately 4 months, and may depend on whether you smoke or continue to consume food or drinks that have a staining effect.

THE RISKS: There are few risks associated with teeth whitening treatment but complications particular to it include temporary tooth sensitivity and sore gums. You may get a sore throat or white patches on the gum line. Teeth whitening can only lighten existing tooth colour and only works on natural teeth. The treatment cannot work on dentures, fillings, crowns and veneers.

THE POPULARITY: Teeth whitening is becoming a very popular procedure for people of all ages and is often used to counter the effects of general discolouration of the teeth, which happens over time, because of food, drink, smoking and natural ageing. Tartar build up (composed of mineral salts, food, and other debris that has hardened over time) can also affect the colour of teeth and some people may have staining under the surface, which can be caused by certain antibiotics or tiny cracks in the teeth which absorb stains

What a great day! Such a great opportunity for community outreach. Barb, Lauree and I all managed to spend some time at the expo talking about oral health to the attendees. For the first and busiest hour Barb faced the crowds alone but did a great job answering questions about denture stabilizing implants and sonicare toothbrushes. She was also handing out flosser samples and stamping passports. Talk about a multitasking CDA!