2013 - Downtown Toronto Dentist | Toronto Dentistry | Soho Dental 2013 - Downtown Toronto Dentist | Toronto Dentistry | Soho Dental

Downtown Toronto Dentist | Toronto Dentistry | Soho Dental

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Archive for 2013

Happy Holidays!

We wish all of you the very best for the Holiday Season! May the New Year bring to you and your families much joy and happiness and life. We look forward to continuing to provide you with the very best in dental care.

To your good health,

The Team at Soho Dental

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Cracked Teeth

A cracked tooth is a challenge both to diagnose and to treat. Patients will often present with a sharp pain on biting but they are unable to localize it to a specific tooth. Sometimes the problem tooth

is obvious. It may have a large filling in it, or cracks may be visible on the surface of the tooth. We sometimes have the patient bite down on an instrument that isolates the bite force on just one part of the tooth in order to localize not just the tooth but the cusp that is affected. Once the problem tooth is identified the next step is to determine how to treat the tooth.

The difficulty is that we cannot visualize the extent of the crack on radiographs (x-rays) or clinically and yet treatment success depends entirely how far the cracks have progressed. These cracks can travel down the root, below the gum or even into the nerve of the tooth.

Cracks that are above the gum line can usually be treated successfully. The fractured segment is removed and the tooth is crowned to prevent further fractures of tooth or filling. If the crack involves the nerve of the tooth, a root canal in addition to a crown will be required.

Any crack that extends below the gum line and travels down the root is more difficult to treat and thus the treatment has a poor prognosis. Even if the tooth can be saved (usually with root canal treatment, a small gum surgery to expose the crack and then a crown) the prognosis is poor and it advisable to discuss other treatment options that may have better prognosis. The photo above shows just such a crack. I had to extract the tooth because the crack extends well onto the root surface and into the nerve of the tooth causing the patient significant discomfort.

If you have a cracked tooth it is important to discuss all you treatment options with your dentist and realize that despite our best efforts to save the tooth, it may be lost eventually in the future.

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Which toothpaste should I use?

There are many varieties of toothpaste available for purchase. There are those for dental caries prevention, for the prevention of periodontal disease, for  treatment of sensitive teeth,  for whitening and bleaching,  and others that claim to have a specific purpose.  It is no wonder that our patients frequently ask us for advice concerning which toothpaste they should be using.

Anticavity or anticaries toothpaste will typically contain 1000-1500 ppm of fluoride in order to inhibit the development of cavities, as fluoride helps to re-mineralize enamel surfaces.

Gingivitis and periodontitis are caused by the bacteria in dental plaque, which is removed by our daily brushing and flossing. Some toothpastes contain various antiseptic and antibacterial agents, such as triclosan, hydrogen peroxide, chlorhexidine, and baking soda in order to prevent bacterial growth.

Sensitivity toothpastes usually have an analgesic or numbing effect in order to treat sensitive teeth. These toothpastes tend to contain various fluoride compounds, silicates, arginine, and/or strontium salts, which help to block dentin tubules in our teeth, reducing or inhibiting the transmission of impulses to the pulps (nerve-containing centres) of our teeth.

Whitening toothpastes contain abrasive particles that are harder than stain molecules, and therefore stains are removed when we brush our teeth with these toothpastes.  A significant side effect is enamel and dentin abrasion, which in turn leads to increased tooth sensitivity. The abrasiveness of toothpaste is indicated by its RDA (Relative Dental Abrasivity). The larger the number, the more abrasive a toothpaste is. For example, Sensodyne Pro-Enamel has an RDA value of around 32 to 37, and Colgate Total has an RDA value of 70, while Colgate Total Whitening has an RDA value of around 120 to 150.

Your choice of toothpaste should be based on your own personal dental needs and preferences. If you experience sensitivity on a daily basis, it’s best to use a sensitive toothpaste such as Sensodyne Pro-Enamel or Colgate Sensitive Pro-Relief, and whitening toothpastes should be avoided. If you are prone to developing surface staining on your teeth and sensitivity is not an issue, you can consider using a whitening toothpaste from time to time to help prevent stain accumulation in between dental cleanings. There are also many toothpastes out there that serve more than one purpose. For example, Colgate Total contains fluoride in order to fight cavities, as well as triclosan which acts as an antibacterial.

It should be noted that most of the common toothpaste brands contain fluoride (Sensodyne, Crest, Colgate, etc), and these brands have all been approved by the Canadian Dental Association.

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Dental Operating Microscope

D7K_9321At Soho Dental we have always taken great pride in providing our patients with the highest level of dental care utilizing the latest technologies.  We are pleased to include a dental operating microscope as one of our newest technologies for the benefit of our patients.

With the use of a microscope, we are able to diagnose dental problems at an earlier stage before they become difficult and more costly to treat.  As a practitioner, I am able to see dental conditions far better than with the naked eye or magnification loupes. It allows me to provide treatment more comfortably and with more precision than ever before.

One of the biggest advantages of increased visualization is more conservative treatment. Modern dentistry keeps moving to more conservative treatments and I have already noticed how the microscope allows me to keep cavity preparations as small as possible. This results in a smaller filling which is always better for the overall health of the tooth.

Please do not hesitate to ask us any questions that you may have regarding the dental microscope and its benefits in helping us provide you with the best possible dental care!


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In-Office Whitening

The last whitening option that we will discuss is in-office whitening.  As the name implies, the whitening is done in the office and the procedure takes approximately 1 hour.  Since the treatment is done in the office, the highest concentration of peroxide is used to achieve a maximum whitening affect. Typically, a hydrogen peroxide of about 40% is used on the teeth. A protective material is placed on the gums to prevent the gel from irritating them.  The application is repeated 3-4 times within the hour until the desired affect is achieved.  With some systems, a light is used to activate the gel, but studies have shown that in-office whitening with or without the light achieve the same effect.

The results vary and what I have found is that to achieve the maximum effect, this treatment has to be done in conjunction with take-home whitening.  This way, the results are more dramatic and longer lasting as well.  For this reason, at Soho Dental, we always include take-home whitening trays and gel for our patients who have the in-office treatment.  This also allows them to touch up the whitening at home from time to time.

Many of you might have seen tooth whitening being offered in aesthetic spas, at the airport etc. Be careful of any claims that are made.  As a dentist, I can use the highest strength products and despite this, the results are variable. This is why, a proper assessment before treatment is essential so that that you can have an idea as to what kind of result to expect.

The pictures below show the results after 1 hour of in-office whitening.  These results are typical.  The teeth will whiten further as the patient continues  the process at home with the take home whitening trays as described in the previous post.

white1jpgBefore 1 hr whitening

white2After 1 hr whitening

Do not hesitate to contact us if you have any further questions regarding tooth whitening!

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Custom Tray Whitening

The next whitening option that we will discuss is also one of the most popular.  This type of whitening is commonly referred to as take home whitening or custom tray whitening.  Typically, a mould is taken of the teeth and then thin flexible trays that fit very precisely over the teeth are fabricated.  The trays are comfortable to wear and fit very well as they are made from impressions of your teeth. The whitening solution, again a hydrogen or carbamide peroxide is placed in the trays and the trays are worn for about an hour a day for 10-14 days.

The advantage with the custom tray whitening is that the whitening solution is well contained in the tray. Therefore, a peroxide solution of much higher concentration can be used.  As a result, the degree of whitening is greater than with over the counter products that have a lower concentration of peroxide.

We use a carbamide peroxide gel of 16% to 35 %.

The side effects are very similar.  Tooth sensitivity is common but transient and it does go away after the whitening period. The take home gel that we use does have ingredients to help reduce the amount of sensitivity that occurs.

The trays are long lasting and can be used for touch up treatments for many years after the initial treatment.

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Over the Counter Whitening Products

This week we will talk about whitening products that are widely available over the counter in many drug stores.  These products deliver peroxide (usually hydrogen or carbamide peroxide) to the teeth with a strip or moldable plastic that contains it.  These products are indeed effective for some patients, especially if the teeth are not heavily stained. I always encourage patients whose teeth are not heavily stained to try these products, and I would recommend Crest Whitestrips as a good product to try.  Unlike whitening toothpastes, which as we discussed, work by virtue of their abrasiveness, whitening strips that contain peroxide allow the material to penetrate the tooth and remove stains from within the tooth.

There are some minor side effects that need to be considered.  Whitening your teeth with these products can cause a temporary sensitivity, especially to cold. I have been whitening my teeth for years and I always have sensitive teeth during the whitening treatment. The good news is that it is never permanent and the sensitivity is gone in a few days.  One can also irritate the gums if too much peroxide material comes in contact with the gums.  This is also a temporary condition that heals itself in a few days.

The limitation of these products is that the concentration of peroxide tends to be too low for most patients to see a significant result.  Also, the strips can be awkward to wear for the recommended treatment time, tending to be unstable the longer they remain in the mouth and they can move around.  It is inevitable that one ends up ingesting a bit of the whitening material due to the lack of seal between the teeth and the tray or strip.  As a result, better options do exist.  We will discuss these options in the next blog.

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Whitening Toothpastes

Tooth whitening has become extremely popular over the last few years and with the number of whitening products that are available in the market, it can all be quite confusing. It is difficult to know what works and what does not.  Over the next few blogs, we will cover the different whitening options that are available both over the counter and professionally.

This week we will consider whitening toothpastes. The number of whitening toothpastes that are available has increased dramatically over the last few years. Some whitening toothpastes have a peroxide component that the manufacturers may claim has a tooth whitening effect. In reality, the peroxide concentration is too low and it does not have enough time in contact with the teeth to have any real effect.  The main mechanism of action of whitening toothpaste is its abrasiveness.  Whitening toothpastes tend to be more abrasive and thus mechanically polish off the stains.  The drawback is that they can be abrasive to the enamel as well.  In combination with a hard bristled toothbrush and an aggressive brushing technique, this can lead to wearing away of the enamel.  Tooth enamel once gone is gone for good!

Whitening toothpastes used once in a while to polish away surfaces stains will likely do no harm.  However, I find that they are just too abrasive to be used on a regular basis and thus I would not use them myself nor would I recommend them for our patients.  Any claim made as to whitening the teeth beyond removal of surface staining is unlikely, as the whitening product does not have enough time to penetrate the enamel.

If you have more questions on whitening toothpastes, please do not hesitate to ask us when you are in for your next appointment!

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Simple Tips for Cavity Prevention

There are many simple things that one can do to prevent cavities:

Fluoride:  Fluoride is a naturally occurring mineral that helps prevent cavities. Fluoride can even reverse the earliest stages of tooth damage — by helping the teeth repair themselves. Due to its benefits for cavity prevention, fluoride is now added to many public water supplies. It’s also a common ingredient in toothpaste and mouth rinses.

Practice daily home care: A highly fluoridated toothpaste (PreviDent) may be commended for you if you are very prone to dental decay.  Always use a soft-bristled toothbrush that fits your mouth comfortably. Consider using an electric or battery-operated toothbrush, especially if you have arthritis or other problems that make it difficult to brush effectively. Floss; gently pull the floss from the gum line to the top of the tooth to scrape off plaque. Rub the floss against all sides of the tooth. If it’s hard to manipulate the floss, use a floss holder or an interdental cleaner — such as a dental pick or stick designed to clean between the teeth.

Minimize sugar and acid:  Minimize sweets over periods of the day. It may not be quantity but frequency of the sugar intake that causes decay. Beware of sugar content in foods – e.g chips, milk, pasta sauce and fruit juice. Try using sugar substitutes in coffee and tea.

Dental checkups: Keep your regular dental checkups, at least every 6 months.  Have appropriate radiographs (x-rays) taken for early detection, removal of decay and to receive professional fluoride treatments

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What is a cavity?

This a frequent question that we get asked. Most people are aware that a cavity is a “hole” in the tooth.

What is not commonly understood is that it is in fact an infectious process.  A cavity, also called tooth decay or caries, is a bacterial infection of the tooth that results in the destruction of tooth structure by acid.  This acid is produced by the bacteria in our mouths when we ingest sugars, which are used by the bacteria as a food source.  A small cavity may cause no pain but a large cavity can result in tooth pain as well as fracture of the tooth as a result of the decayed and softened tooth structure.  Any kind of acidity in the mouth can contribute to cavities as well , whether it is from our diet (acidic foods such as fruit juices, soft drinks etc.) or from stomach acids (acid reflux).

Here are some reasons you may be at risk:

• Frequent snacking
• Sipping sugary drinks (coffee or tea with sugar, soda pop )
• Eating or drinking a high amount of fruit juices or fruit (especially citrus fruit)
• Exposed root surfaces
• Teeth that trap food
• Dry mouth from medications

Our next post will cover simple recommendations to prevent cavities.

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