Pediatric Dentistry

Pediatric Dentistry

Whether nursing or bottle feeding, incorporating an oral cleaning routine with your baby establishes good dental habits and will make the transition to tooth cleaning easier when teeth begin to erupt. Use a wet wash cloth or gauze to wipe the gums and remove any debris. Between 3 and 9 months, your baby’s teeth will begin to erupt. Known as teething, this process may cause your child to be fussy. Rubbing the affected gum tissues with your finger, or using a cooled washcloth or teething ring may bring some relief. Typically teething can last several days, although for the parent this may seem much longer. Avoid teething medications that contain the topical anesthetic benzocaine or any homeopathic teething gels or tables. Several homeopathic products have been associated with toxic levels of belladonna. 

Early Childhood Caries (Decay)

This is the most chronic childhood disease in dentistry, and prevention is the best approach. A healthy diet to prevent tooth decay is as important as establishing good hygiene habits. Baby teeth aren’t just around for a few years. The last of the baby teeth typically come out at age 12. In some instances, the permanent tooth that would replace the baby tooth doesn’t form, and the baby tooth may be in place for a much longer time. Baby teeth help keep adult teeth in their right place, and premature loss of baby teeth may allow drifting of the adult teeth requiring future correction. Decay of baby teeth may cause some decay on the adjacent permanent tooth and lead to a lifetime of dental treatment. 

Dental Bridges

Dental Bridges

A bridge, or “fixed bridge” is a restoration that replaces one or more missing teeth. There are several types of bridges, but typically each end of the bridge is anchored by crowns over the abutting teeth. These crowns are attached to pontics (“fake teeth”), and together they fill the space created by the missing teeth. The bridge is held firmly in place by the abutment teeth and cannot be removed. Bridges may use implants as the abutment supports. Bridges are required for filling space left by missing teeth, replacing a removable partial denture, restoring chewing and speaking ability, and preventing remaining teeth from drifting out of position. Bridges are made from a variety of materials including porcelain and metal, usually a gold alloy. The materials have relative benefits and drawbacks, balancing strength, durability and esthetics. 

The procedure for the bridge usually involves two appointments. The first appointment involves removing any decay or old filling material on the abutment teeth, then shaping the teeth and taking an impression to provide a mold to the dental laboratory. The patient leaves the appointment with a temporary bridge or individual temporary crowns. About two weeks later, at the second appointment, the temporaries will be removed and the new bridge carefully fitted. When the bridge has been cemented in place, there is often a short-term feeling of pressure from the adjacent teeth. The bite should feel comfortable. Maintenance of bridges is the same as maintaining all teeth; brushing and flossing with regular check-ups. Patients will be instructed in the use of a floss threader to clean under the bridge. Excessive force can chip or crack porcelain and natural teeth alike. 

In each instance, Drs. Black or Itagawa consult with the patient to make the best treatment choice for their particular needs.

Wisdom Teeth

Wisdom Teeth

Known also as 3rdmolars, these are the teeth that are last to erupt in your mouth, usually sometime between the age of 13 and 18 years of age. Often wisdom teeth fail to erupt fully or are unstable in their erupted position. A panoramic radiograph (x-ray) is usually taken to visualize the extent of the roots, and the position of the teen in the jaw relative to nerves and blood vessels. Wisdom teeth that are not fully erupted are referred to as impacted, and often removal of these teeth is recommended treatment. Wisdom teeth that have not erupted may look like they can do little harm but depending on their position, these teeth may be susceptible to gum disease or decay or they may damage adjacent teeth. In people under the age of 20, wisdom teeth generally have less root development and so their removal has a lower incidence of surgical complications. Between the ages of 15 and 19, patients should have their wisdom teeth evaluated, and treatment decisions made. For people older than 25, it may be reasonable to only treat symptomatic wisdom teeth, as surgical complications increase in older patients. 

Extraction is a minor surgical procedure, done under local anesthetic. If more than one tooth is being removed, or if anxiety about the procedure is high, an oral sedative may be helpful. In particularly complex extractions, referral to an Oral Surgeon may be the best option. 

Dental Crowns

Dental Crowns Explained

A crown, also known as a “cap”, is a porcelain or gold shell that fits over a tooth to restore its esthetic and functional performance. Crowns are made from a variety of materials including porcelain and metal – usually a gold alloy. Each material has relative benefits and drawbacks, balancing strength and esthetics. In visible areas, porcelain is typically used. In minimally visible areas, gold crowns may also be used. Crowns are required for broken or fractured teeth, decayed teeth, teeth with root canals, large filling replacements, or cosmetic enhancement.

Crowns provide a durable restoration for a tooth, but like all dental work (and teeth!) they may eventually need to be replaced.

What does getting a crown involve?

The procedure for a crown usually involves two appointments. At the first appointment, any decay or old filling material is removed, then the tooth is shaped and an impression is taken to provide a mold to the dental laboratory. The patient is provided with a temporary crown, that remains until the second appointment. At this time, the temporary crown is removed and the new crown carefully fitted. When the crown has been cemented in place, there is often pressure from adjacent teeth. The bite should feel comfortable and within an hour the crown should be unnoticeable. Crowns are maintained through regular brushing and flossing, and with regular check-ups. Just like natural teeth, crowns are for chewing food, not tools for opening and cutting things. Excessive force can chip or crack crowns and natural teeth alike.

Tooth Extraction

Tooth Extraction

Teeth, like other parts of our body, may wear out over time. If a tooth cannot be repaired with treatments such as root canals, crowns, or other treatments, then extraction (removal) of the tooth may be warranted.  There are two types of extractions:

Simple – the tooth is intact and extends beyond the surrounding gum tissues. The dentist loosens the tooth with elevators, luxators or peritomes and then grabs the tooth with a forcep. 

Surgical – the tooth is severely decayed or may be under the surrounding gum tissues. The tooth may need to be cut into smaller pieces and the gum tissues may need to be lifted to gain access to the root structure. Stitches (sutures) may be used to close the wound site. 

The goal in extraction is to remove the tooth with minimal trauma to the surrounding tissues, gum and bone. Studies have shown that pail relief medications such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) 60 minutes prior to extraction provide better overall pain relief than taking medications after the procedure. As part of treatment planning, Drs. Black or Itagawa consult with each patient regarding pre-operative medications. In some cases, oral sedation may be recommended. If a greater level of sedation is required, or the case is particularly complex, referral to an Oral Surgeon may be the best option.  

Teeth Whitening

Whitening

Over time, teeth can undergo natural colour changes. There may be several causes including food and beverage staining, smoking, trauma or certain medications. There are several options to whiten teeth. Typically in our office we recommend either custom bleaching take-home trays, or whitening strips from the drugstore. Take-home trays have the advantage of a more custom fit for your teeth, allowing the bleach solution to contact the teeth more evenly. In addition, once the trays are made, you can continue to re-use them for touch-up treatments in years to come, as long as there are no major changes to your dental work.

The peroxide used in dental whitening products can cause increased tooth sensitivity. Before starting any tooth whitening, Drs. Black or Itagawa will consult with the patient to ensure there is no decay, open filling margins, infection of gum disease. Bleaching will only whiten natural tooth enamel. It will not alter the colour of fillings, veneers, crowns or dentures. This consultation is an opportunity to discuss expectations, the pros and cons of whitening,  and to determine the best course of action for the patient. 

Tooth Restorations

Here are a few things you need to know about tooth restoration

Many people take their teeth for granted, day in, day out, not ever stopping to think about how important their teeth are. Eating and chewing food for your nutritional requirements involves funtioning teeth. Smiling, which your teeth are part of, is used in non-verbal communication with other people. Your teeth are critical for proper speech. Only when something happens to damage teeth, decay or an accident, do many people stop and realize how important their teeth are. Drs. Black and Itagawa are here to provide our patients with the advice and guidance to make the right choice for their dental needs and execute the plan with excellent treatment.

Tooth restorations are used to replace the missing, decayed tooth structure. Most people will require some restorative dentistry in their lives, from a small filling to full dentures. Damage to teeth can occur through accidents, decay (caries), parafunction (grinding or “bruxing”) or gum disease (periodontitis). There are many different restorations available, often having multiple options for any given situation.

Digital X-rays

Digital X-rays

Known also as digital radiographs, X-rays have been used in dentistry for several decades. Radiographs are an important part of the exam of overall dental health. Our office uses both panoramic (providing good overview) and intra-oral (providing great detail of a small area) radiographs. In each operatory, a large monitor allows easy viewing of the X-ray images and photographs to enhance communication and treatment discussions with patients. 

Black & Associates Dentistry is equipped with the latest technology, providing excellent diagnostic capabilities while minimizing radiation exposure. X-rays are used to identify problems such as decay, broken or cracked fillings, nerve and root details that are otherwise not visible. Finding and treating problems earlier can save time, money and discomfort. The frequency of radiograph evaluation depends on the patient’s general health, age and risk for both gum disease and tooth decay. Generally, the recommended frequency for adult patients is every two years. In children, developing teeth and jaws may require more frequent X-ray examination. 

Root Canal

What is a root canal?

Root Canal Therapy (RCT) treats an infected tooth or a tooth with a dying nerve. Successful treatment saves the tooth and avoids the need to replace the tooth with an artificial tooth, such as an implant or bridge. The procedure for a root canal usually involves several appointments. Diagnosing which tooth is the cause of the problem can be tricky and is clearly critical to success. 

The initial appointment for a root canal therapy involves locating one or more canals within the tooth and removing the pulp (nerve) or cleaning out the infection. A second appointment to finish the root canal consists of further cleaning and disinfecting of the canal system. A filling material (gutta percha), along with a sealing agent fills the canal space. When the RCT has been completed, a crown is often recommended to maintain the structural integrity and aesthetic requirements of the tooth. If the tooth already has a crown, a filling may be placed in the access opening to seal the root canal filling.