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Archive for October 2012

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



Energy and Sports Drinks

October 18, 2012 | Posted General Information

Energy and sports drinks are definitely increasing in popularity, especially among young adults and teens. Many consume these drinks to replenish energy and electrolytes during and following exercise with little other concern for the other effects they have on our body; more specifically, on our oral cavity.
Most of these drinks are high in sugar and as we all know, sugar is broken down into acid which destroys enamel. Some drinks are sugar free, but the fruit juices and other chemicals contained in them are also acidic. Frequency is the critical aspect to consider when any foods containing sugar are consumed.  The more frquently we bath our teeth in sugars and acid, the greater the risk of tooth decay and acid enamel erosion. One drink consumed over a one hour period (e.g. during a hockey game, soccer game, etc) causes much more damage than one drink consumed over a period of 5 minutes. Even though the damage is reduced with rapid consumption, we must still limit the frequency of intake to reduce the overall number of acid and sugar attacks per day.
Water still remains the best way to hydrate during sporting events. If you do choose to use energy drinks, try to rinse them down with water afterwards to dilute the sugar and help neutralize the acid attack.

Cold Sores and Lasers?

October 10, 2012 | Posted General Information

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.

Blue Blocks!

October 04, 2012 | Posted Cerec

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

Digby, NS