Preventive Dentistry Services in Pembroke
Proper day-to-day oral hygiene and preventive care can help prevent the need for expensive treatments now and in the future. Dr. Bruce Harle and his staff provide a number of preventive dentistry services in Pembroke, Ontario for patients in communities throughout Renfrew and West Pontiac Counties. Click on any of the following headings to jump directly to that section. Have questions? Contact us to learn more.
Dental Sealants
Composed of clear or tooth-coloured acrylic-like materials that bond to the teeth, dental sealants are applied to the chewing surfaces of hard-to-clean back teeth to form a protective barrier that covers the pits and fissures. Sealants are safe and applied painlessly and offer an affordable solution for protecting your teeth. Because sealants may only be applied to teeth that are free of decay and fillings, children are often better candidates than adults for this treatment.
Primary teeth, or “baby teeth” generally don't need to be sealed, but sealing baby molars may be recommended if there is a high risk of decay. Pit and fissure sealants are recommended once the adult teeth have erupted. The greatest chance of decay occurs during the first year after the teeth come in; however, it's never too late to apply a sealant.
Athletic Mouth Guards
The number and degree of injuries experienced by participants in contact sports can be wide-ranging, running the gamut from lost teeth, fractured jaws and bone loss to tooth fragments embedded in the lips, soft tissue lacerations and concussions. The long term considerations of not wearing a mouth guard, including monetary costs and future additional treatment can be significant.
A properly fitted mouth guard does much more than just preventing chipped or broken teeth. It also protects the soft tissue around the mouth, and in more serious injuries can reduce the risk of jaw fracture by absorbing some of the force applied to the jaw. Some studies have indicated that there is a reduction of risk for concussion or severity of concussion when athletes wear mouth guards.
Ideally, you want a mouth guard that provides maximum protection and is resilient, durable, and comfortable, i.e. it fits properly and doesn't impede breathing or cause gagging.
There are 2 main types of athletic mouth guards available that vary in cost, comfort and effectiveness:
Ready Made/Boil and Bite – Store Bought
- Adequate for younger athletes participating in light-to-moderate contact sports
- Suitable for younger athletes whose bite is changing due to growth and development
- Typically the fit is not precise; they are often bulky and loose and provide a lesser amount of comfort, protection and durability compared to the custom made mouth guard.
Custom Made at a Dental Office
- Provides the best fit, protection and comfort and is the most durable
- Best for athletes participating in moderate-to-heavy contact sports
- Best suited for athletes whose dental growth and development is complete
Fluoride
Fluoride, a natural element that is found in soil, water and some foods, has a positive impact on oral health, making teeth stronger and more resistant to decay and even reversing incipient tooth decay. Extensive research conducted over the past 50 years has consistently demonstrated the safety and effectiveness of fluorides in the prevention of tooth decay. Fluoride hardens and protects tooth enamel (the outer layer of the teeth), strengthening the tooth’s structure and making it more resistant to the effects of bacterial plaque and acids present in your diet. Fluoride can also help to repair tooth enamel that has been attacked by these acids. The regular use of fluoride can also reduce sensitivity to hot and cold along the root surfaces of teeth, a common problem for many older adults.
Modern fluoride treatments are available in various forms, including gels, rinses and varnishes. Your dentist can deliver a strong dose of fluoride directly to the exposed tooth surface in his office.
Sensitive Teeth
Dentin sensitivity, more commonly known as tooth sensitivity, is not a disease but a condition that causes your teeth to ache when you eat or drink something cold, hot, sweet or sour, or when you brush your teeth. Approximately 1 in 4 adults suffer from tooth sensitivity with most sufferers between 20 and 50 years old. The effects of sensitive teeth typically manifest as a short, sharp twinge or stabbing pain that passes quickly. It is uncomfortable and can make you want to change what you eat and drink or how you brush your teeth.
What Causes Tooth Sensitivity?
Enamel and gum tissue are intended to protect your teeth, but there are a number of factors that can cause their natural protection to weaken. Over time, the protective enamel can become worn, so that the inner part of the tooth (called dentin) becomes exposed. Dentin is porous and contains nerve endings. When dentin is exposed, the nerve can become irritated and cause discomfort.
Some of the causes of tooth sensitivity include:
- Diet: "Acidic" foods or drinks such as soda pop, certain alcoholic beverages, citrus fruits and drinks, or pickled products can "soften" the hard enamel that covers the tooth surface.
- Tooth Wear: Brushing too hard or grinding your teeth can gradually wear away the enamel.
- Gum Recession: Many people experience gum recession with aging, but brushing too hard can also affect your gums by pushing them back until they no longer cover the tooth at the natural gum line.
Helpful Tips
Here are a few helpful tips for coping with tooth sensitivity:
- Reduce the amount of acidic foods in your diet
- Be aware that stomach acids can also harm your teeth. If you suffer from frequent vomiting or eating disorders, you should talk to both your physician and dentist.
- Maintain proper oral hygiene. Brush and floss your teeth thoroughly but gently every day. Use a soft-bristled brush and nonabrasive toothpaste.
Oral Cancer
Oral cancer can occur anywhere in the mouth from the lips to the throat. The most common areas for oral cancer to develop are the sides and bottom of your tongue and the floor of your mouth. Some lifestyle factors, such as smoking, chewing tobacco, and alcohol abuse can also increase the risk of oral cancer.
Oral cancer is an aggressive disease that accounts for approximately 2% to 3% of all new cancer cases in Canada each year. In fact, oral cancer carries a higher mortality rate then either melanoma or cervical cancer. The 5-year survival rate for oral cancer is low, at just below 50%; however, early detection can raise the survival rate to as much as 80%. Most early signs of oral cancer are difficult to detect without examination by a dentist. If you notice a mouth sore or anything out of the ordinary that does not go away or heal after a couple of weeks, discuss it with your dentist. Oral health is a lifelong commitment, whether you have your teeth or not.
Your dentist has the medical training, expertise and the greatest opportunity to detect oral cancer during your regular dental exam. During an examination, a dentist will inspect your mouth to detect any possible abnormal tissue changes. Your dentist also watches for signs of other cancers that can affect the head and neck. If your dentist identifies a suspicious lesion, he/she may recommend a tissue specimen (biopsy) be sent to the pathologist for analysis.
Human Papilloma Virus (HPV) and Mouth Cancer
Classically, mouth cancer occurs in smokers and drinkers with poor oral health and most often in people age 50 or older. But more recent studies have shown that HPV 16, the same virus associated with cervical cancer, is also linked to oral cancers in younger people with good oral health and no history of either smoking or drinking alcohol. Studies indicate that the occurrence of this new type of mouth cancer has been increasing since the 1990's and are currently increasing faster than any other type of mouth cancer. Fortunately, these HPV mouth cancers appear to be more responsive to treatment and the survival rate is much better than for non-HPV mouth cancers.
Periodontal Disease
Also referred to as gum disease, periodontal disease is a low-grade chronic bacterial infection. Often painless and generally slow to develop, it is one of the most common dental problems. You may not notice any warning signs until the disease has become serious and you are in danger of losing your teeth. Having periodontal disease is like having termites in your house. Above the ground the house looks fine, but the foundation is slowly being destroyed, possibly without you even knowing it. Just because it doesn't hurt doesn't mean all is well.
Over time bacteria-harboring plaque and tartar tend to collect between the teeth and gums. If this debris is not adequately removed bacteria can migrate deeper under the gum line to create a "pocket" between the tooth and gum. Once these pockets form, you cannot reach them with tooth brushing and flossing, which in turn allows more debris and bacteria to accumulate. As the bacteria multiply, the gum cells release a variety of substances that aggravate and inflame the sensitive gum tissues. As a result, first the gum tissues and then the supporting bone are slowly destroyed. If enough bone tissue is destroyed the teeth become loose and eventually will be lost.
When detected early, further progression of gum disease is easier to prevent, so it is a good idea to keep watch for any abnormalities. Bleeding is a strong indicator of gum inflammation. Healthy gums do not bleed at all when brushed or flossed. If your gums bleed when you clean your teeth, your gums are inflamed. Treating gum disease will help control the bacterial growth and inflammation and thus help prevent the progression of pockets.
Depending on the stage of the disease, treatment will require one or a combination of the following:
- Scaling and root planing are performed by your dentist and/or your dental hygienist and consist of removing (scaling) the plaque and tartar from above and below the gum line, smoothing away any rough spots (root planing) on the root of the tooth. This treatment also removes bacteria and provides a clean, smooth surface for the gums to heal and reattach to the teeth.
- Antibiotics can be used as an adjunct to help control or reduce the amount of the bacteria linked with gum disease. Antibiotics can be used in combination with scaling and root planing and/or surgery. The antibiotic is applied locally by gently inserting it below the gum line into periodontal pockets where the bacteria thrive. In certain situations a prescription for prolonged antibiotic use can be helpful.
- Surgery is needed if the tissues around your teeth are still unhealthy even after the application of conservative treatments, such as scaling and root planing or antibiotic medication. The purpose of surgical periodontal therapy is to eliminate the pathologic changes in the pocket, creating a stable, maintainable environment and if possible, to promote periodontal regeneration. Surgical techniques will reduce the pocket depths, improving accessibility to previously hard-to-reach surfaces of the teeth and making it possible for the patient to maintain those surfaces free of plaque.
Once treatment for gum disease is complete, you will enter into a maintenance phase of care. Maintenance care is intended to keep your gums free of inflammation. You will need to be seen frequently enough to ensure that gum inflammation does not return. We know that it takes about 8 to 12 weeks for bacteria to migrate back under the gum line. In many cases we see patients for maintenance care every 3 to 4 months. Other patients with a less imposing risk profile do not need to be seen as frequently. A determination of how frequently you need to be seen is based on your risk factors, as well as your previous treatment history and current findings.
Temporomandibular Joint Disorder (TMD)
Temporomandibular joint disorder (TMD) is a degenerative disorder caused by a dysfunction of the temporomandibular joint. It can cause chronic pain in the jaw, face, head or neck.
The temporomandibular (TM) joints are located on either side of the head, just in front of the ears. They connect your mandible (lower jaw) to your temporal bone (skull). Because the TM joint rotates, moves forward, backward, and side-to-side, it is considered one of the most complex joints in the body. This joint, in combination with other muscles and ligaments, makes it possible for you to chew, swallow, speak and yawn. When problems arise with the tissues of the TM joint, you may have a TMD.
Signs and Symptoms of TMDs
Patients suffering from TMDs may experience pain or discomfort in or around the ear, jaw joint, muscles of the jaw, face, temples, and neck on one or both sides. Symptoms can be aggravated by stress and may manifest without warning. Frequency and intensity of TMD symptoms may progress, sometimes over a period of months or years. Other symptoms associated with TMDs include clicking, popping, locking of the jawbone, limited opening or deviating jaw movement, chewing difficulties, and headache.
Causes of TMDs
TMDs are typically caused by a combination of factors such as trauma to the mandible (lower jaw), joint disease such as arthritis or arthrosis, the loss of posterior teeth, and loss of oral vertical dimension. Activities such as jaw clenching or bruxism may also cause TMD or make existing TMD symptoms worse. Stress is another related factor.
Bruxism Facts
- Bruxism is an involuntary habit that imposes forceful contact between the biting surfaces of the upper and lower teeth. It is defined as “a grinding or clenching of the teeth associated with forceful jaw movements, resulting in rubbing, gritting together of the teeth, usually during sleep."
- Everyone bruxes, but some do it more than others. People may brux while under stress, while deep in concentration or when they are angry. Over 95% of bruxers are nighttime bruxers and more than 80% of bruxers don't realize they are doing it!
- Nighttime bruxers' teeth can grind up to 40 minutes of every hour of sleep.
- Bruxing can exert as much as 600 lbs. of force per square inch on your teeth and restorations (10 times the force registered during normal chewing).
Possible Signs and Symptoms Specific to Bruxism
(in addition to TMD signs/symptoms)
- Flat, worn teeth
- History of broken, chipped teeth
- Generally sensitive teeth
- Areas of gum recession and root exposure or wear in the absence of other oral/dental disease
- More than normal mobility (looseness) of teeth in the absence of other oral/dental disease
Treating TMDs
Some TMD patients treat the condition on their own by modifying their daily activities in an effort to control their destructive habits. For other patients a clinical and radiographic exam may be needed to develop a treatment plan. The treatment plan may include relaxation techniques or a referral to a physiotherapist to help relieve muscle pain. Different types of intraoral appliances are often used. These are indicated if your jaw is out of position (repositioning appliance) or if bruxism is a factor (bruxism appliance/night guard). These appliances are constructed of acrylic and fit over the biting surfaces of your teeth on one side of the jaw so that you bite against the appliance rather than your opposing teeth. This will help your jaw joints and muscles relax and will also help protect your teeth from excessive wear. Sometimes medicine for pain, inflammation and tense muscles may be prescribed in conjunction with other treatment modalities.
