This is a question I am asked on a daily basis...
A dental implant is a titanium fixture (shaped a bit like a screw) that is placed into the jaw bone or alveolus for the purpose of replacing a missing tooth or teeth.
The procedure is quite simple, but requires careful planning and preparation to ensure the desired result. When a single tooth is to be replaced with an implant, the size of the space and quality of the bone are assessed and then an approriate implant fixture is chosen to be placed into the bone (there are hundreds of different types and sizes!). To place the fixture, the area is anesthetized with local anesthetic just as if a filling were to placed into a tooth. A small incision is made in the gum tissue to expose the bone and a hole is made using progressively larger drills to the desired size, depth and angulation. Then, the fixture is slowly turned into placed using a special torque driver. A cap is threaded onto the top of the fixture and the gum tissue is placed back to its original position.
After the fixture is placed, there is a waiting period of 3-6 months while osseointegration takes place - the surrounding bone will grow into the flutes of the fixture forming a bone/implant unit. Once osseointegration is complete, the implant is stable enough to recieve the final prosthesis. The cap is then removed from the top of the implant fixture and an impression is made of the area. The impression is used to form a dental model from which an abutment and crown are fabricated. The abutment is either made of titanium or zirconia and is attached directly to the implant fixtre in the bone. The crown is then placed over this implant abutment and either screwed or cemented into place. This completed dental unit if properly cared for will last a lifetime!
Implants are not just for replacing a single tooth. They can be used to fill larger spaces in the form of implant-supported bridges - not every tooth to be replaced needs to have a fixture. In this image, three teeth are replaced with two implants.
If the dental arch is edentulous (i.e. no teeth) a full fixed prosthetic can be made. Often 4-6 fixtures are placed and then the entire complement of teeth are attached to these fixtures. This is the ultimate replacement for dentures! This is a life altering treatment - patients will be able to eat things they haven't been able to eat since they lost heir teeth. Patients also experience a huge boost in self-confidence due the highly esthetic nature of the restoration.
Another option for the edentulous arch would be a denture (removable appliance) that snaps onto 2-4 implant fixtures. Anyone who has dentures would appreciate having something to attach their denture to; no more floppy dentures that move when you talk and eat!
If you are tired of your old dentures or embarassed by a missing tooth or teeth, please contact us and we would be happy to discuss your dental implant options.
Dr. Luke Haslam
Basinview Dental Centre
The "root canal" is the most misunderstood dental procedure. Many of you have probably heard people refer to a difficult task by saying, "It was worse than having a root canal" or "I would rather have a root canal than...".
How did this procedure get such a negative connotation when it has such a positive result?
Part of the problem is that most patients are unaware of what this procedure actually is. Another problem is that most often, when a "root canal" treatment is required, the patient is in pain. When a person experiences pain, their judgement and even their personality can be affected. Combine the negative connotation of a "root canal" and a patient in pain and then it becomes difficult for a patient to see beyond the immediate need to remove pain and see the importance of saving their tooth. Dr. Haslam has actually removed this term from the office vocabulary; we no longer refer to this procedure as a "root canal", but rather as an endodontic treatment (its true name) or by describing it as "removing the pulpal tissue from the tooth". By doing this, the patient has the chance to see the treatment as it is rather than as it has been percieved to be.
What is an endodontic procedure and when is it necessary?
When a tooth receives a trauma that causes irreversible damage to the vital tissue inside the tooth, the vital tissue must be removed to prevent pain and infection in and around the tooth. This procedure is known as endodontics. The trauma may be from an impact injury, a deep cavity (carious lesion), severe periodontal disease, excessive wear from acid erosion, bruxism (parafunction), tooth fracture, dramatic thermal injury, etc. Any of these situations may cause the vital tissues inside the tooth to be irreversibly inflammed. As the tissue inflammation increases, the pressure inside the tooth increases and this is felt as a "toothache". Often, it is described as a throbbing sensation that increases in intensity with time. If left untreated, this pain can become severe. Eventually, the vital tissues inside the tooth will become necrotic and at this point, infection begins. This infection is often very localized to the periapical region of the tooth, until it spreads to the surrounding soft tissues resulting in an abscess.
To treat the tooth, local anesthetic is applied just as when a basic restoration is to be completed. The tooth is isolated with a rubber dam and then the pulp of the tooth is accessed using a dental bur. The pulp tissue is cleaned out if the pulp chamber and then the canals inside each root using small cleaning instruments and a disinfecting solution. The canal spaces are then sealed using a plastic filling material (gutta percha) and sealant and the tooth is restored with an appropriate filling material.
This procedure has a 97% success rate! So why does everyone fear the "root canal"?
In the past, the techniques, instruments and even anesthetics were not even comparable to those of today. Most often, an endodontic treatment is completed in less than an hour! There is no pain during the procedure and any tooth pain prior to the procedure is immediately resolved. If there was infection prior to the procedure, it will quickly resolve following treatment and very rarely will a precautionary course of antibiotcs be required. Most often, patients will comment after the procedure, "That wasn't anything like I had expected. I didn't feel anything" or they are simply amazed when the procedure is completed.
Let's look forward to the new treatments and technologies of the future that will make these procedures even faster and more comfortable and avoid thinking back to the old days when these procedures gained their negative connotations.
Dr. Luke Haslam
Basinview Dental Centre
Many people do not realize that cavities in children's teeth (or dental caries) is the most prevalent infectious disease in North America with an estimated 60-90% of school-aged children affected. Areas without fluoridated water, with reduced access to oral care and of lower socioeconomic status are at the highest risk. Early chilhood caries (ECC) is a severe form of tooth decay affecting the anterior teeth and first molars. Severe-ECC affects all the teeth as demonstrated in the adjacent photo. ECC is a serious health concern and dramatically affects a child's quality of life.
I am often asked, "Why should I worry about these teeth anyway? They are only baby teeth and will just fall out eventually."
To understand why we need baby teeth, let's just consider why we need teeth at all:
The number one reason is nutrition. The consumption of nutritious foods is critical to the proper growth and development of children. If we take away the teeth, we remove the child's ability to chew and consume these nutrients. Painful teeth and infection will also affect a child's ability to eat and in turn affect growth and development. ECC, infection and reduced nutritional intake are associated with comorbidites such as asthma, diabetes, cardiac conditions, digestive problems and obesity.
Secondly, primary teeth are critical to maintain the space required for proper eruption of the permanent dentition. Early loss of primary teeth can result in severe crowding and malocclusion; which can have a dramatic effect on masticatory function and social confidence. In some cases, the crowding may result in impaction during eruption and subsequent extraction of an otherwise healthy tooth or teeth.
A third reason for primary teeth is social development. Decayed and missing teeth are a cause for social embarassment and can lead to developmental problems such as poor interpersonal skills and behavioural issues.
Many people are also not aware that dental caries is in fact an infectious disease. Not only will it spread within an individual's oral cavity, but it can be transmitted from person-to-person. How is this possible? There are bacteria of various virulence levels meaning that some bacteria or more cavity-causing than others. We are not born with these cavity-causing bacteria in our oral cavity. There is a dental term known as "the window of infectivity" which defines the age range at which babies are first exposed to these cavity-causing bacteria by another individual (most often Mom or Dad sharing food with the infant). Once the oral cavity is "infected" with these bacteria we must control their cavity-causing ability through good oral hygiene and nutrition practices.
How can we prevent ECC?
Oral hygiene practices must start early, even before the eruption of the first tooth. There are baby gum brushes available on the market or even the use of a clean, damp cloth to wipe away food debris and bacteria from an infant's gums. Begin brushing habits at the eruption of the first tooth. A children's toothpaste of the approriate age or even no paste at all to prevent the infant from swallowing too much toothpaste. Brush a minimum of twice per day and preferrably after every meal. Introduce childrens floss to clean between teeth as soon as adjacent teeth are present. Use a disclosing agent to show the older children where plaque exists and then brush until the dye is removed from all surfaces. Begin to bring your child to the dentist at the eruption of the first teeth - this is primarily to allow the children to become familiar with the dental envirnoment and to educate both the child and parents on oral hygiene and nutrition. Remember, MSI coverage in Nova Scotia for children's dental treatments is available until the age of 10.
Proper nutrition is just as important as oral hygiene. Reduction of sugar intake is important. The frequency of sugar intake must be controlled as well. Avoid chewy candies and chewy fruit snacks as much as possible. Do not allow children to sip on juice all day long or go to bed with a bottle (especially with juice). Children must be encouraged to drink from a cup as soon as possible (preferrably by age 1). The use of "sippy" cups and bottles are discouraged beyond this age. The best snacks between meals are fresh fruits and vegetables with water as the between meal drink of choice. Remember, brushing after each meal is ideal!
Cavities develop quickly in primary (baby) teeth and can double in size in a matter of only 6 months. Frequent check-ups with your dentist are important to catch these problems early and to determine the risk factors and sources of these problems.
If you have any questions or concerns about your children's oral health, please contact Dr. Luke Haslam at Basinview Dental Centre, and we would be happy to answer your questions. To read more on ECC, please refer to this document prepared by the Canadian Dental Association: http://www.cda-adc.ca/_files/position_statements/Early_Childhood_Caries_2010-05-18.pdf
Dr. Luke Haslam
68 Water St., Digby, NS
Cold sores are caused by the Herpes Simplex virus (HSV Type I and occasionally HSV Type II). These lesions are highly contagious during certain stages of growth and thus can be easily transmitted to others through physical contact. They typically last 10-14 days and may or may not be painful. Most often, the lesions present themselves on the lips, but they may spread to perioral regions. Due to the unsightly appearance of these lesions, they are often a cause of social discomfort and embarrassment.
Once an individual becomes affected by HSV, the virus attaches itself to the nerve tissue and travels along the nerve to the nerve ganglia. The virus persists in a dormant state in the nerve ganglia until biological conditions are such that the virus becomes active and produces a lesion. The stimuli for activation of the virus include diminshed immunity (due to stress, cold/flu/fever), hormonal changes (e.g. menstruation), UV light (e.g. sun exposure) and trauma.
A cold sore begins in the prodromal stage when the individual feels a "tingling" sensation in the area where the lesion will appear. The lesion will then become a red area with fluid-filled blisters. This stage is when the lesion is most contagious. Rupture of the fluid-filled blisters or vesicles allows the release of active virus cells allowing the lesion to spread or to be passed on to someone with whom physical contact is made. The vesicles eventually dry up and crust over forming a scab which persists until the lesion is healed. The scab will bleed easily with stimulation and irritation will delay healing time.
Many people are not aware of laser therapy as a form of treatment for HSV lesions. Low Level Laser Therapy (LLLT) is when energy is applied to the affected area. LLLT has been effective in preventing the formation of the lesion or reducing healing time. The lesion is best treated in the prodromal stage (tingling stage) before the appearance of blisters. Dr. Haslam has had great success in preventing the formation of lesions in this stage and most patients have reported a dramatic reduction in the frequency of lesion recurrence. There have even been patients who have gone years without an outbreak!
In cases where the lesion has already developed to the vesicle or blister stage, healing time has been reduced down to often less than one week with minimal to no scabbing afterward. Patients who have lesions treated following the formation of the scab notice a reduction in healing time as well; however, the lesion has already been present for usually a week at this point.
If you feel that "tingling" sensation, contact Dr. Luke Haslam immediately at Basinview Dental Centre so you can have your LLLT and prevent the outbreak of a cold sore! The treatment takes 10-15minutes and requires no freezing or other medications.
Dr. Luke Haslam is proud to offer a new restorative material at Basinview Dental Centre, the IPS Emax ceramic!
Emax is a lithium disilicate ceramic used for in-office Cerec restorations. It comes in a partially crystallized state which gives the block a blue hue, which is commonly referred to as the "blue state" or "blue block". The partial crystallization allows the block to be milled quickly and easily into a restoration in the Cerec milling chamber (e.g. crowns, inlays, onlays and veneers). Once milling is complete and the fit if the restoration verified, the ceramic is then "fired" in a furnace (Programmat CS by Ivoclar) for about 22 minutes. This completes the crystallization of the restoration giving it incredible strength and brings out the highly esthetic color. These restorations can also have characterizations added to them in the form of stains and glazes to give them an extremely natural look.
Due to the high strength and durability, these restorations are designed to be a long term restorative choice. Restorations of this type have a limited 20 year guarantee!
Ask Dr. Haslam if Emax is right for your restorative needs.
I am frequently asked questions like:
"Doc, why are my teeth loose?"
"I brush twice a day and use mouth wash, so why do I still have bad breath?"
"Is it normal for my gums to bleed and hurt when I floss?"
"Why do my teeth hurt when I bite or chew?"
If you have ever wondered the answer to these questions then this article is for you.
Gum disease is a chronic inflammatory condition that affects the supporting structures of teeth; i.e. the gums, ligaments and bone. The bacteria that exist in all of our mouths have the potential to cause gum disease. These bacteria live in highly structured colonies in and around our gums. Our immune response to these colonies is strong and produces cells and destructive chemicals designed to kill these bacteria. Due to the highly structured nature of the bacteria colonies, our immune response is insufficient to destroy the bacteria within. The immune response, however, does result in the destruction of our supporting structures of teeth.
The first sign of gum disease is bleeding in the gums following mild stimultaion (e.g. brushing and flossing). This is known as gingivitis. As the disease process progresses, the gums will become bulbous and bleed even when eating. Further progression leads to destruction of supporting bone and ligament tissues. The loss of supporting bone is a condition known as periodontitis and may or may not produce pain. Once the supporting bone is lost, it is unlikely that it may be reformed making periodontitis often irreversible. If the condition is properly managed and treated before advanced stages are reached, the teeth may often be saved. Ignoring these conditions will certainly lead to eventual loss of teeth.
As bone loss progresses, the condition begins to self perpetuate; i.e. biting on loose teeth makes the teeth even more loose! I always tell my patients to imagine that their teeth are like fence posts. If you push on the post over and over again, it begins to wobble more and more. If the fence post was ten feet in ground and was now only 1 foot in the ground due to loss of the supporting soil (in our case bone), it doesn't take much force to push it loose. This is a great analogy to visualize the loss of bone and to understand why the teeth become loose.
There are many gases and other chemicals released by both the bacteria and our own cells. These chemicals are the cause of bad breath. In a mouth battling gum disease, these chemicals are increased in their production and their source is chronic. Until the gum disease is brought under control, these chemicals will continue to produce both a foul taste and odor.
Bleeding gums, loose teeth, pain when chewing and bad breath are not normal. These are serious conditions that can have a dramatic effect on quality of life. Chronic bad breath can affect us in any social situation. It may keep you from meeting that special someone or perhaps from getting that dream job you 've always wanted. Pain when eating can affect our ability to eat healthy, nutritious foods and thus affect our general health. Many people do not realize the link between gum disease and other serious health conditions (e.g. heart disease, diabetes, premature birth, obesity, etc.). There are various levels of evidence to support the link between the conditions. There is strong evidence to support an increased risk of heart attack, stroke and diabetes in patients who suffer from gum disease. Please visit our Facebook page at http://www.facebook.com/BasinviewDentalCentre and check out the posting of Whoopi Goldberg discussing her battle with gum disease.
If you have any questions regarding gum disease or suffer from bleeding gums, bad breath, sore teeth, etc., please contact Dr. Luke Haslam at Basinview Dental Centre. Don't wait until the condition can no longer be treated!
Dr. Luke Haslam BSc, DDS
Basinview Dental Centre
Cerec is the most advanced and widely used CAD/CAM system in dentistry. The software and hardware advances to this system have revolutionized the process of creating ceramic restorations. The release of the Cerec 4.0 software and the upgrade of the camera to the Bluecam were much anticipated changes. The ease of fabrication was dramatically increased following these updates. Now, Sirona (the manufacturere of Cerec) has done one better and created the new OminCAM. Rather than taking indiviual photos which are then stitched together by the software (as was the case with all previous camera systems), the new OmniCAM produces a seamless, colored, digital model by way of streaming video. The video acquisition requires no optical powder to produce contrast, thus making the process faster and easier!
All of us at Basinview Dental Centre would like to extend a warm welcome to the newest member of our team, Michelle Isles. Michelle is a local resident of Digby and brings to our team a welcoming smile and energetic attitude. Please join us in welcoming Michelle to her new position as Basinview Dental Centre's office administrator. If you would like to make an appointment or have any questions about our services, insurance coverage, etc., please feel free to contact Michelle at 245-3535, or send her an email at firstname.lastname@example.org.
Manulife Financial has made a change to insurance coverage regarding scaling (or "cleaning") for individuals under the age of 19. They feel that these individuals do not develop calculus to the extent of an adult and therefore will only cover scaling to a limited amount based solely on age and not individual need. This will have a dramatic affect on the coverage that many patients will have when it comes time for their hygiene to be completed.
It is very rare for individuals over the age of 10 to not require scaling to remove the hard calculus deposits that develop on all of our teeth. Some individuals require more scaling than others depending on their rate at which they develop calculus, their oral hygiene habits, manual dexterity, diet, amount of crowding in their teeth, etc.
If you are a patient and you have Manulife insurance, please feel free to contact their customer service at 1-888-844-8889 and they will answer any questions you may have.