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Dental Abfractions

What you see in the photograph above is an example of dental abfraction. The discolouration and loss of enamel at the gum line is not a cavity. This is caused by grinding forces on the teeth.

Teeth actually bend at the microscopic level. The enamel is thin in the areas close to the gum line. As the teeth bend from excessive grinding forces, the enamel shears away from the tooth where it is thin, at the gum line. This exposes the underlying tooth structure, the dentin, which also stains over time. This is the discolouration in the first photograph.

Once the dentin is exposed, the abrasive nature of toothpaste can wear these areas even further. These areas can be sensitive to cold and sweets.

The teeth above where repaired very simply with dental composite resin material but the patients underlying grinding problem has to be addressed as well. This often requires an examination of the jaw joint and the occlusion, or the way the teeth fit together. The treatment may be as simple as a night guard to protect the teeth from grinding forces and an occlusal equilibration, which means to balance the bite so the chewing forces are more evenly and appropriately distributed among the teeth.

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Tooth coloured fillings

Tooth coloured fillings, or composite resins, have become very popular option to restore the back teeth. They look virtually identical to natural teeth. Traditionally, they lacked the strength of amalgam fillings but recently they have been engineered to withstand the chewing forces in the back of the mouth.

bonded1 bonded4 bonded3
Broken Composite Resin Filling Filling Removed
Extensive Decay Underneath
New Composite Resin Fillings

Composite resins require specific techniques and a dry environment when they are placed. It is not uncommon to find that the teeth are sensitive afterwards. A bigger problem is the development of decay under these fillings over time. Fortunately, both problems can be avoided with good technique.

However, all fillings have a life span and old fillings can sometimes fracture, creating a situation where decay can develop under the filling. The first picture illustrates a broken filling and a filling with decay underneath. The second picture shows the extensive decay once the fillings have been removed. The final picture shows the new restorations which are bonded to the tooth, creating a seal from the oral bacteria. These should serve the patient well for many years to come.

It is important to have your fillings checked by a dentist on a regular basis. If not, decay underneath a filling can go undetected and cause more serious problems.

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All Porcelain Crowns

We are fortunate that modern dentistry allows us to repair discoloured or damaged teeth with all porcelain crowns.  A crown or cap covers and replicates the entire tooth right down to the gum level. The dental porcelains that are available today are very strong but also highly esthetic allowing us to make the crown appear very natural.

The following example shows a tooth that had been discoloured for many years.  The tooth had trauma and root canal treatment, both of which have discoloured and weakened the tooth.  The all porcelain crown masks the underlying tooth colour, allowing us to recreate a better tooth form and to protect the tooth structure underneath the crown from further damage. All the teeth were also whitened before the crown was made, overall resulting in a more pleasing smile.

teeth1 teeth2


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Titanium Implants

Dental Implants have become a common and predictable way to replace missing teeth.  A dental implant is a titanium root which is placed in the jaw.  It takes about 2 to 3 months for the dental implant to become fixed in the jaw.  After this period, a tooth can be fabricated out of porcelain to be fixed on top of the implant. The porcelain tooth looks and feels natural and functions like any other tooth in your mouth.

implants1Decayed and fractured tooth requiring extraction.

implants2 Tooth extracted and dental implant placed.

implants3Porcelain Crown placed on implant after 3 months.


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Internal Whitening of a Single Tooth

In this blog,  we are going to talk about single tooth discolouration and the procedure involved in whitening a single discoloured tooth.

Discolouration of a single tooth usually occurs after trauma to that tooth.  A tooth may become discoloured due to the leakage of blood into the porous dentin layer. This changes the color of the dentin, which can be seen through the enamel. In adults, the teeth can turn pink or red right away or over  time,  they can also turn brown or gray.

The type of dental treatment depends upon the colour the tooth takes and the type of injury.

If the tooth needs a root canal, this will not change the color of the tooth. A procedure called “internal bleaching” has to be done. This is a low risk, routine procedure used to improve the esthetics of a single discoloured tooth.

Although it is very low risk, there is still the risk of cervical root resorption and also of recurrence, so the procedure may have to be redone five or ten years later.

Materials used are peroxide (hydrogen or carbamide). The tooth is accessed from the back or lingual side and the pulp chamber is sealed. Materials are left in place and results are assessed a few days after. If necessary, the procedure can be redone to a maximum of three times. With the materials available today, this procedure is fairly predictable and often results in a dramatic change in tooth colour.

     internal1 internal2
Before Internal Whitening                 After Internal Whitening


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Dry Mouth

image1Dry mouth, also known as xerostomia, is a condition caused by a decrease in the production of saliva by the salivary glands in the mouth.  It is often a side effect of commonly prescribed medications but it can also be caused by certain medical conditions.

There are many medications that can cause dry mouth and some of the more common ones include:

    • antihistamines
    • pseudoephedrine
    • antidepressants
    • anticholinergics
    • anorexiants (diet pills)
    • antihypertensives (blood pressure meds)
    • antipsychotics (psychiatric drugs)
    • anti-Parkinson agents, diuretics (“water pills”)
    • sedatives (sleeping pills)

Medical conditions that can cause dry mouth include:

  • Radiation therapy: specifically for the treatment of head and neck cancer.
  • Chemotherapy: this is usually temporary situation but can become a problem if the therapy is prolonged.
  • Uncontrolled diabetes
  • Auto-immune disorders:  Systemic Lupus Erythematosis,  Sjörgren’s syndrome, Rheumatoid arthritis.

Treatment for dry mouth is usually directed at treating the symptoms. Palliative treatment recommendations include:

  • Staying hydrated by drinking sugar free liquids.
  • Using sugar-free mints or gum.
  • Using saliva substitutes that can be found at the pharmacy.
  • Biotene products, also available at the pharmacy, may be useful.

Patients that are suffering from dry mouth are more prone to developing cavities.  These cavities can be very extensive and occur in areas of the teeth where cavities do not usually occur.  This makes the cavities very difficult to control and restore.

It is very important to talk to your dentist if you are suffering from dry mouth before the problems occur. Other treatments, such as custom fluoride tray application, may be recommended to protect the teeth from cavities.  Please do not hesitate to ask us about dry mouth if it is an issue for you.

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Importance of Primary teeth

Many times at our clinic we get the question, “Doctor, but we should just extract this tooth, after all, it’s just a baby tooth, right?”

The truth is that “baby”, primary, or deciduous teeth have huge importance in the maintenance and development of oral health for a lifetime.

Healthy baby teeth:

  • Foster good nutrition through proper chewing
  • Aid in speech development
  • Build self-esteem by providing a beautiful smile
  • Enable a child to pay attention and learn in school without the distraction of dental pain
  • Save space in the jaw that is needed for proper development of adult (permanent) teeth

Primary teeth begin forming in utero at approximately the fourth month of fetal life. By the end of the sixth month, all the teeth have begun calcification, which is why a mother’s proper nutrition is very important.

Usually, the lower deciduous central incisors are the first to erupt thus initiating the deciduous dentition. The appearance of the deciduous second molars completes the deciduous dentition by 2 to 2 1/2 years of age. Eruption dates can vary, so if your child is early or late by a few months it doesn’t mean there is something wrong. Genetics also play an important role in eruption patterns.

The most important tooth to preserve is the deciduous second molar, because if it is lost prematurely (before 10-12 years of age) the permanent first molar migrates into the space and creates malocclusion.

The deciduous incisor teeth are functional in the mouth for approximately five years, while the deciduous molars are functional for approximately nine years.

In order to try to prevent costly orthodontic treatment in the future or having to extract teeth at an inappropriate time, it is of extreme importance to have optimal oral health at home. When a child has positive dental experiences, it will shape his/her future oral health.

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At Soho Dental, we are very happy to offer our patients the benefits of Invisalign treatment, which is an alternative to braces.

invisalignBased on your individual treatment plan, a series of custom-made, clear aligners is then created specifically for you. These aligners are made of a smooth, comfortable, BPA-free plastic that won’t irritate your cheeks and gums like traditional metal braces often do. Simply wear them throughout the day, and remove them when you eat or to brush and floss your teeth. As you wear each set of aligners, your teeth gently and gradually begin to shift into place. And because they’re virtually invisible, most people won’t even notice you’re wearing them.

Each aligner is worn every two weeks and for best and faster results must be worn for 22 hours a day, throughout your entire treatment. The average treatment time averages 9-12 months, depending on the severity of the malocclusion. Mid-treatment your doctor will take molds of your teeth and send to Invisalign for progress tracking, that way we can check that everything is going according to plan.

At the end of treatment, it is extremely important to have retainers made to prevent any relapse, as teeth have memory and like to go back to their original position. Invisalign offers the option of the Vivera retainers, which are delivered three times per year.

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