Category: Dental Education

What are Inlays & Onlays?

When a tooth is too damaged to support a tooth filling but not damaged enough for a dental crown, you end up somewhere in the middle. Capping a damaged tooth unnecessarily with a dental crown removes more tooth structure than needed. But a large dental filling can weaken the remaining structure of the tooth, causing the tooth to break, crack or eventually need a root canal. When you’re faced with the choice between a large tooth filling or a dental crown, do you save money now and risk major dental problems down the line or undergo possibly an unwanted dental treatment?

There is a dental restoration that can solve your problem: dental onlays. Dental onlays fall somewhere in between dental fillings and dental crowns. Like dental inlays, onlays restore large cavities without having to use a crown.

What’s the difference between an Inlay and an Onlay?

Dental inlays and onlays are the same kind of restoration, but they cover different proportions of the tooth. A dental inlay fills the space in between the cusps, or rounded edges, at the center of the tooth’s surface. The dental onlay works like an inlay but covers one or more cusps or the entire biting surface of the tooth. Because of their extensive coverage, dental onlays are sometimes referred to as “partial crowns.”

Inlays and Onlays are a very effective and cosmetic cost effective method of treating teeth that significantly broken down and weaker. They may be thought of as fillings fabricated in a dental laboratory like crowns, and manufactured of the same materials – porcelain or gold.

What is Root Canal Treatment?

Root canal treatment, also known as endodontic treatment, is a dental procedure in which the diseased or damaged pulp (nerves and vessels) of a tooth is removed and the inside areas (the pulp chamber and root canals) are filled and sealed.

When is Root Canal Treatment necessary?

Inflamed or infected pulp (pulpitis) most often causes a toothache. To relieve the pain and prevent further complications, the tooth may be extracted (surgically removed) or saved by root canal treatment. Root canal treatment has become a common dental procedure; more than 14 million are performed every year, with a 95% success rate, according to the American Association of Endodontists.

Once root canal treatment is performed, the patient must have a crown placed over the tooth to protect it, although timing for this can vary from tooth to tooth. The cost of the treatment and the crown may seem expensive. However, replacing an extracted tooth with a fixed bridge, or a removable partial denture, or an implant to maintain the space and restore the chewing function is typically much more expensive. It is usually advisable to maintain the teeth that you have and thus endodontic therapy is a very valuable procedure for patients.

Root canal treatment may be performed by a general dentist or by an endodontist, a dentist who specializes in endodontic (literally “inside of the tooth”) procedures. Inside the tooth, the pulp’s soft tissue contains the blood supply, by which the tooth gets its nutrients, and the nerve, by which the tooth senses hot and cold. This tissue is vulnerable to damage from deep dental decay, accidental injury, tooth fracture, or trauma from repeated dental procedures (such as multiple fillings over time). If a tooth becomes diseased or injured, bacteria build up inside the pulp, spreading infection from the natural crown of the tooth to the root tips in the jawbone. Pus accumulates at the ends of the roots, forming a painful abcess which can damage the bone supporting the teeth. Such an infection may produce pain that is severe, constant, or throbbing, as well as prolonged sensitivity to heat or cold, swelling and tenderness in the surrounding gums, facial swelling, and discoloration of the tooth. However, in some cases, the pulp may die so gradually that there is little noticeable pain.

Root canal treatment is performed under local anesthesia. A thin sheet of rubber, called a rubber dam, is placed in the mouth to isolate the tooth. The dentist removes any tooth decay and makes an opening through the natural crown of the tooth into the pulp chamber. Creating this access also relieves the pressure inside the tooth and can dramatically ease pain.

The dentist determines the length of the root canals, usually with a series of x rays. Small wire-like files are then used to clean the entire canal space of diseased pulp tissue and bacteria. The debris is flushed out with large amounts of water or other fluids (irrigation). The canals are also slightly enlarged and shaped to receive an inert (non-reactive) filling material called ‘gutta percha’. However, the tooth is not filled and permanently sealed until it is completely free of active infection. The dentist may place a temporary seal, or leave the tooth open to drain, and prescribe an antibiotic to counter any spread of infection from the tooth. This is why root canal treatment may require several visits to the dentist.

Once the canals are completely clean, they are filled with gutta percha and a sealer cement to prevent bacteria from entering the tooth in the future. A carbon fibre post may be placed in the pulp chamber for added structural support and better retention of the crown restoration. The tooth is protected by a temporary filling or crown until a permanent restoration may be made. This restoration is usually a gold or porcelain crown, although it may be a gold inlay, or an amalgam or composite filling.

There is no typical preparation for root canal treatment. Once the tooth is opened to drain, the dentist may prescribe an antibiotic, then the patient should take the full prescribed course. With the infection under control, local anesthetic is more effective, so that the root canal procedure may be performed without discomfort.

The tooth may be sore for a few days after filling. Pain relievers, such as ibuprofen (Advil, Motrin) may be taken to ease the soreness. The tissues around the tooth may also be irritated. Rinsing the mouth with hot salt water several times a day will help. Chewing on that side of the mouth should be avoided for the first few days following treatment. A follow-up appointment should be scheduled with the dentist for six months after treatment to make sure the tooth and surrounding structures are healthy.

What is Oral Cancer?

According to the Ontario Dental Association, Oral cancer is a disease resulting from abnormal cell growth in the mouth, lips, tongue or throat. In 2003, an estimated 3,100 new cases of oral cancers were identified in Canada, and about 1,090 deaths occurred as a result of the disease. People over the age of 45 are most at risk. The good news is that oral cancer can be treated successfully if caught early enough. Your dentist has the expert skill and training to detect early signs of the disease and can help you to understand your risk.

Signs and symptoms of oral cancer

• White or dark red patches in your mouth, or on your lips or tongue.
• Lumps or changes in the texture or colour of the mouth tissues.
• Bleeding or numbness in the mouth; sores or patches that do not heal.
• Difficulty swallowing; changes in taste or tongue sensation.

Risk factors

The actual cause of oral cancer is not known but risk factors include:

• Consumption of tobacco products (cigarettes, chewing tobacco, cigars, etc.)
• Heavy alcohol consumption (it is especially dangerous to combine smoking and alcohol)
• Oral sex when a person is infected with HPV
• Prolonged, repeated exposure of the lips to the sun
• Poor diet; genetics and gender (more men develop the disease than women)
• A history of leukoplakia – a thick, whitish-colour patch inside the mouth

Diagnosis and Treatment

Treatment depends on the severity and location of the disease, as well as the age and health of the patient. If oral cancer is suspected:

• a biopsy (surgical removal and microscopic examination) of the suspicious area may be taken
• imaging tests such as X-rays, ultra sounds, CT scans or MRIs may be taken
• chemotherapy, radiation therapy or surgery may be necessary to remove a tumor

How to help prevent oral cancer

• see your dentist regularly for dental exams, and ask about oral cancer screenings
• stop using tobacco products – ask your dentist about tools to help you quit
• limit alcohol consumption
• limit sun exposure and use U/V protective lip balms
• eat a healthy diet with lots of fruits and vegetables
• check your mouth regularly for signs or symptoms and report any changes in your mouth to your dentist right away

What are Partial Dentures?

Partial dentures can either be made with a plastic base or a metal framework that supports the number of teeth that need to be replaced. It is held in the mouth by using clasps and rests that are carefully adapted around the natural teeth. The partial denture that uses a metal framework is the traditional design, due to the rigidity and strength of the metal. Plastic partial dentures have normally been used as emergency or temporary replacements of missing teeth, allowing the gums and bone to heal before a definitive restorative solution is obtained. Recently however, various materials such as Valplast have been developed to provide durable, flexible alternatives in certain situations.

Prevention is the key to keeping a healthy smile. Caring for your teeth with an understanding of how to prevent dental problems before they start will not only give you a better smile, it will save you time and money. There are a number of ways to keep teeth and gums healthy, no matter how old you are. Good habits start early. Parents can help their children by:

• brushing and flossing daily to remove plaque until the children can clean their teeth well on their own
• using fluorides
• limiting the number of snacks containing sugar or carbohydrates
• taking your child for a dental check-up at least once a year
• providing mouthguards for sports
• modeling good dental health habits for your child by taking care of your own teeth and gums

Fluoride

Fluoride is a mineral that is found naturally in most water supplies. Drinking water with the right amount of fluoride is the best and least expensive way of preventing tooth decay. Fluoride assists in the remineralization of tooth enamel to make the enamel stronger and more resistant to decay. People of all ages benefit from drinking fluoridated water.

Fluoride sources include:

• fluoridated water (naturally occurring or added to community water supply)
• some foods and drinks
• fluoride toothpaste and mouth rinse
• school fluoride mouth rinse programs
• fluoride gels, varnishes, tablets or drops (only when recommended by a dentist or dental professional)

Preventative Resins

Preventative resins are not fillings. They prevent tooth decay. They are clear or shaded plastic material applied to the chewing surfaces to protect the teeth from decay causing bacteria that hide in the deep pits and grooves.

Toothbrushing

Toothbrushing removes plaque and food particles from teeth and gums. The best kind of toothbrush for general use is one with round-tipped, soft bristles. A child will need a smaller brush than an adult. Replace a toothbrush when the bristles become bent or frayed, (usually every three or four months) or after an illness.

There are several methods of toothbrushing that may be used. Here is a recommended method:

• Hold the toothbrush against the teeth, with bristles at a 45-degree angle to the gum line.
• Gently move the toothbrush back and forth several times with very short strokes on two teeth at a time. Repeat until all areas are clean.
• For the inside of the front teeth, tilt the brush upright and use small vibrating strokes or small circles with the tip of the brush. Thorough brushing takes 3 to 4 minutes.
• Brush the tongue. This will remove bacteria and freshen the breath.
• Rinse your toothbrush well after brushing. Store the brush in a clean, dry place out of contact with other brushes.

Flossing

Flossing removes plaque and food particles from between the teeth and under the gum line, areas where your toothbrush can’t reach. Gum disease and cavities often start in these areas, so it is important to clean them thoroughly once a day. Flossing becomes easier with practice. You will find that flossing takes only a few minutes.

• Break off a piece of dental floss about 45 centimeters (18 inches) long.
• Wrap most of the floss around the middle finger of one hand. Wrap the rest around the same finger of the other hand.
• Hold the floss tightly between the fingers and slowly work it between the teeth and under the gum line using a gentle back and forth motion.
• When the floss is at the gum line, curve it, making a “C” around the tooth, and slide it into the space between the tooth and the gum until you feel resistance. Then gently slide the floss up and down against the side of the tooth to remove the plaque.
• Repeat this process on each tooth, using a clean section of the floss each time.
• Remember to floss the backs of the very last teeth.

Dental Visits

Don’t wait for an ache! Visit the dentist at least once a year for a thorough dental examination, preventive services and treatment.

Diet

The teeth and gums, like the rest of the body, need a well-balanced diet to stay healthy. Following Canada’s Food Guide to Healthy Eating is an easy way to make sure children get the nutrition they need for good general and oral health. The bacteria in plaque feed on carbohydrates and sugars and become active whether you eat a meal or a cracker. Every time you put food in your mouth, you feed the bacteria, putting you at risk for tooth decay. It is important to choose healthy snacks.

Good snack choices include:

• fresh vegetables and fruits*
• milk, cheese and yogurt
• meat, poultry, fish, eggs and nuts*
• bread and cereals

Many cheeses increase the amount of saliva (spit). Examples are aged Cheddar, Mozzarella, Monterey Jack, Swiss, Blue, Brie and Gouda. This helps reduce the harmful effects acids cause the surface of your teeth. Serve cheese as a snack or at the end of a meal.

*For children under 4 years of age, reduce the risk of choking by cutting these foods in the following way:

• slice grapes lengthwise
• remove pits from, e.g., peaches, cherries, plums
• slice wieners lengthwise
• shred, grate or finely chop hard vegetable pieces
• shred or finely chop hard fruit pieces

Do not give nuts to small children

Medicine

Medicine can be a source of sugar that is often overlooked. Ask your doctor about prescribing sugar free medicine, and:

• when buying over the counter medications, choose sugar free products whenever available
• if a child must use a medicine containing sugar, clean the teeth or rinse after administering the medication

What Types of Problems Do Dental Veneers Fix?

Veneers are routinely used to fix:

• Teeth that are discolored — either because of root canal treatment; stains from tetracycline or other drugs, excessive fluoride or other causes; or the presence of large resin fillings that have discolored the tooth
• Teeth that are worn down
• Teeth that are chipped or broken
• Teeth that are misaligned, uneven, or irregularly shaped (for example, have craters or bulges in them)
• Teeth with gaps between them (to close the space between these teeth)

What’s the Procedure for Getting a Dental Veneer?

• Diagnosis and treatment planning. This first step involves your active participation. Explain to your dentist the result that you are trying to achieve. During this appointment, your dentist will examine your teeth to make sure dental veneers are appropriate for you and discuss what the procedure will involve and some of its limitations. He or she also may take x-ray and possibly make impressions of your mouth and teeth.
• Preparation. To prepare a tooth for a veneer, your dentist will remove about 1/2 millimeter of enamel from the tooth surface, which is an amount nearly equal to the thickness of the veneer to be added to the tooth surface. Before trimming off the enamel, you and your dentist will decide the need for a local anesthetic to numb the area. Next, your dentist will make a model or impression of your tooth. This model is sent out to a dental laboratory, which in turn constructs your veneer. It usually takes 1-2 weeks for your dentist to receive the veneers back from the laboratory. For very unsightly teeth, temporary dental veneers can be placed for an additional cost.
• Bonding: Before the dental veneer is permanently cemented to your tooth, your dentist will temporarily place it on your tooth to examine its fit and color. He or she will repeatedly remove and trim the veneer as needed to achieve the proper fit; the veneer color can be adjusted with the shade of cement to be used. Next, to prepare your tooth to receive the veneer, your tooth will be cleaned, polished, and etched — which roughens the tooth to allow for a strong bonding process. A special cement is applied to the veneer and the veneer is then placed on your tooth. Once properly position on the tooth, your dentist will apply a special light beam to the dental veneer, which activates chemicals in the cement, causing it to harden or cure very quickly. The final steps involve removing any excess cement, evaluating your bite and making any final adjustments in the veneer as necessary. Your dentist may ask you to return for a follow-up visit in a couple of weeks to check how your gums are responding to the presence of your veneer and to once again examine the veneer’s placement.