Manual or Electric Toothbrushes

Toothbrushing is the most effective way to remove food debris and plaque from the teeth, which helps prevent cavities, gingivitis, periodontitis, candidiasis and bad breath.
There are manual and electric toothbrushes. Within each type, there are a few options available. So, what kind of toothbrush is best?

Let’s look at manual toothbrushes first.

There are two major types of manual toothbrushes.

The first type is made of natural wood sticks from miswak, neem or babool trees. All three are traditional chewing sticks prepared from the roots or twigs. Studies have demonstrated that they all have an antibacterial effect against Streptococcus mutants, a cavity and gum disease-causing oral bacteria.

The sticks needed to be prepared by chewing the end to create the bristles. However, the strands tend to be hard. The filaments can be difficult to effectively brush the areas between molars and the backs of the front teeth because the filaments are in a straight line with the stick and cannot be bent to reach those areas. Despite its potential antibacterial and anti-inflammatory effects, the sticks can cause damage to the gums, which leads to gum recessions. It is also challenging to get the tips of the bristles to effectively scrape the plaque and food debris away from the tooth surfaces.

Photo courtesy from the article “A review of the therapeutic effects of using miswak (Salvadora Persica) on oral health.” SaudiMed J.
Authors: Mohammad M. Haque, BDS, MPH and Saeed A. Alsareii, SB (Surg), JBGS

The other type is made with a plastic, wood or bamboo handle with nylon bristles at about 90 degrees to the long axis of the handles. That configuration allows better contact with the molars and other difficult-to-reach areas. Dentists only recommend using toothbrushes with soft bristles to prevent “brushing” the gums away. There are a few different shapes, sizes, arrangements of the toothbrushes for diverse needs and purposes.

There are two major types of electric toothbrushes too!

The first type is the oscillating rotary heads, which are circular heads that spin and move back and forth. The exemplifying one is by Oral-B. The newer one has a blue tooth connection to your smartphone that can monitor your brushing in terms of time spent, pressure on the teeth, power level, etc.
The second type is the sonic brush heads which vibrate back and forth extremely fast. Philip Sonicare is the best-known brand using this technology. It also has a blue tooth connection to an app on your phone to monitor the brushing like the Oral-B.

Courtesy of Oral-B and Philips Sonicare

Overall, electric toothbrushes are more effective and efficient in removing plaque and debris simply because they have much faster strokes/vibration per minute than manual toothbrushing. The brush heads of the electric toothbrush are usually smaller than the manual toothbrush heads, especially the Oral-B one; therefore, the bristles can effectively contact the hard-to-reach areas like the molars, the spaces between teeth and the back of the front teeth.

Using electric toothbrushes needs less hand movement and requires less hand dexterity. Hence elderlies with poor hand coordination, patients with muscular dystrophy, multiple sclerosis and parkinsonism can benefit from the do-it-for-you movements of electric toothbrushes.

Patients with braces may also find it easier to clean their teeth with electric toothbrushes.

Despite the superiority of electric toothbrushes in food debris and plaque removal, they do have some factors that some patients may find to be unacceptable. For example, the sound and vibration may be too uncomfortable for certain patients. The initial cost to purchase an electric toothbrush is higher than the manual one. So as the cost of the replacement heads for the electric one is more expensive.


Management of Stressors in Dentistry

Last week, I blogged about dentists’ stress in their clinical lives.

Stress can never be eliminated from a dental practice. However, it must be minimized as much as possible to avoid the many stress-related physical and emotional problems that it causes.

The key to successfully managing stress is recognizing and understanding its causes. Once the causes have been identified and understood, preventive steps can be taken.

Stress can lead to dysthymia, anxiety, loss of appetite, physical health deterioration and depression. Dentists with excessive stress constantly can end up with alcoholism and drug abuse, unstable family life, divorce, burnout, mental breakdown and suicide.

Statistically, divorce dentists are three times more likely to commit suicide than divorced people in the general population.

The cause of these mental health issues can stem from various things. Many dentists work long hours and can get burnt out quickly. There is a lot of pressure on the job to do things perfectly. Plus, you might not always have the most pleasant patients to deal with.

Some of the preventive measures that could minimize the stress of dental practice are as follows:

  • Confinement

I like to have large windows in all my operatories in my practice. I like the operatories to be large and not fully enclosed with drywall and doors. There are a lot of dental offices in a shopping plaza which provides a limited view of the outside world with windows.

However, the average dentist spends most of their life confined to a small, sometimes windowless operatory. Besides adding windows, most of the time is impossible; there are other ways to improve the working environment; dentists can hang photos or pictures on the walls, install glass wall partitions instead of solid wall partitions, and enhance the lighting by adding more warm light (2700K – 4000K) to the bright daylight lighting.

The dentist should sit upright on the dentist’s chair with easy movement around the patient’s head. The dental equipment and instruments should be easily reached without excessively straining the dentist’s head, neck, back and shoulder. It is all about ergonomic with good design and layout of the treatment cabinets, patient’s chair and dentist’s chair.

  • Isolation

When dentists practice alone, there is less opportunity to share and solve problems with their colleagues. Dentists need to have a broader network of fellow practitioners to share issues and frustrations. Through peer support, problems can be solved easier.

I recommend joining the local dental society, which regularly provides social networking and seminars. I, for one, am a member of the Burlington Dental Academy, which allows me to have more venues to communicate with my colleagues.

We should communicate more with colleagues, health care practitioners, friends, and staff about issues and concerns.

Having more than one dental practitioner in practice, with associates or partners, often can alleviate the mental stress with isolation and lack of understanding.

  • Long hours

I have been there and done that; I worked seven days a week with extended hours each day. Long hours put a lot of stress on my mental and physical health.

Working more sensible hours and taking time each day for a leisurely lunch break;

Have a longer buffer time between each patient and ensure enough time for the lunch break.

  • Lack of exercise

Adopting a program of physical exercises, such as regular walking or working out at a local health club;

Take a leisure walk during lunchtime.

  • Stress of perfection

The relentless pursuit of perfection and permanence in an inhospitable oral environment is a significant cause of stress and frustration for dentists. The emphasis on perfection is instilled in dental school. However, it must be tempered with the realization that a perfect restoration will ultimately be rendered imperfect by time and patient neglect, despite the dentist’s efforts.

Most important, being kinder to yourself and less critical and demanding of your efforts.

We cannot meet all patients’ unrealistic expectations. We need to tell the patients who demand such expectations that we cannot provide such treatment and recommend the other options. Be prepared to refer the patients to specialists or colleagues for a second opinion.

  • Economic pressure

The cost of dental education can easily be over $250,000 to complete if the dental education is in Canada. For those who got their education done in the United States or overseas, the cost can easily be over $500,000 in us dollars.

In addition, the cost of setting up a new dental office can easily be over $500,000. The cost of buying an established practice is even higher – it can easily be two million dollars or more.

Once in practice, the dentist soon learns that office overhead rises to meet income. The overhead often surpasses the revenue in the first few years.

The financial burden is whopping! The dentist who works all the time and never takes time off might make a few dollars more, but there is a high price to pay — BURNOUT! And when dentists burn out, they become emotionally and mentally exhausted, develop a negative, indifferent or cynical attitude towards their patients and their staff, and negatively evaluate themselves.

We need to manage our overhead well, do the expansion with caution, and know the return on investment. We need to be careful about our expenses on professional social media management, the cost of marketing, the cost of equipment updates and acquiring newer technologies.

We need to have a spreadsheet showing the expected incomes versus the cost of the purchases and expenses, including your time and health.

We may want to start as an associate first to pay back the student loan and then consider the ownership of a practice.

Much of the stress that dentists experience is self-inflicted and a product of acting out their strivings and ambitions. In other words, dentists themselves often are the source of most of the stress they experience.

  • Staffing pressure

Keeping a supportive and stable staff has been extremely difficult through the history of practice ownership. The situation is worse nowadays with the COVID.

Hiring and keeping the right staff is an art that no single course can teach you.

An excellent dental management consultant can provide you with some advice and management, but they can be very costly.

There are a few basic principles that the staff will more likely want to work with you and stay working with you. Take home money is essential, but it is not all. All staff want a non-stressful environment where they feel comfortable performing their required duties and responsibilities with respectful recognition and acknowledgment from their employers.

If you do not provide enough training, direction, and communication of your expectations, the staff will feel stressed out when performing their duties. It is a vicious cycle that will perpetuate and multiply. They want respect and recognition.

We need to lower our expectations and recognize that each person has a different level and scope of capabilities. We need to make professional development a Top Priority and encourage a conduit for all-way communication in the office.

  • Time pressure

Attempting to stay on schedule in a busy dental practice is a chronic source of stress. As we all know, once we are behind schedule, there is no way to catch up. It is important to book enough time for each procedure, provide buffer time between patients, and ensure enough sterilized instruments and supplies for the day.

Make sure there is a time for emergency patients, and do not be afraid to turn away some patients or rebook the patients back for further appointments. You cannot see everyone and make every patient likes you.

  • Compromise treatment frustration

Most important, being kinder to yourself and less critical and demanding of your efforts.

Invite the patient back for the remedial work with no charge. Do not count the cost but gauge the degree of satisfaction

We need to know our limits and refer out for additional care if the case is too challenging. Engagement with continuing dental education can also help us to improve our skills and knowledge.

  • Patient anxiety

The psychological stress of working with apprehensive and fearful patients can be devastating to the dental practitioner. There is now considerable evidence that dentists experience patterns of physiological stress responses (increased heart rate, high blood pressure, sweating, etc.) that parallel the patient’s responses when performing dental procedures that evoke patient fear and anxiety. We need to learn how to handle patient anxiety and hostility better.

If you have an extremely fearful and anxious patient, suggesting things like rescheduling or offering general health and wellness tips can help.

Sedation like anxiolytics and nitrous oxide can be very helpful for certain patients. Referral to a dental specialist who can provide the needed sedation or general anesthesia can save the grace.

  • Processing a good dentist’s personality:

We should show compassion to ourselves and know our limitations. Besides managing the daily operation of the office, managing stress in the office is equally essential.

Things like mindfulness, leisure walk and meditation can help you throughout the day.

We need to be mindful of ourselves, our stress, lives, and families. Harmonious family life will reduce stress at work. Being content leads to security, and security leads to happiness.

Managing your stress every day is crucial to getting through some of the things listed above. Be mindful, relax and seek help if the stressors start to cause problems to you.



Maximize your dental insurance benefits

Many patients procrastinate their dental treatments, so it may sound awful to you when a dental staff advises you about maximizing your dental insurance coverage. You probably think that the dentist is trying to maximize his benefits from your insurance. However, when it comes to dental health insurance, utilizing your dental insurance wisely can save you money and maximize your oral wellness at the same time. It can have a significant impact on your life.

All dental insurance policies are different for each individual. Some have more extensive coverage than others. Some have more conditions and restrictions. The differences are basically in the following:

  1. Yearly maximum. Most of the insurance has a maximum of $2500 per yearly period. Some insurances have an annual coverage for $1000, but some have no maximum on the minor treatments. The minor treatments include examination, x-ray, cleaning, dental fillings, extraction, root canal etc.
  2. Yearly deductible.  Most insurance has no deductible, but a few have $50 per family or family member.
  3. Yearly renewal date. Most of the insurance has a renewal date on the 1st of January. Some have a different date on the calendar year.
  4. Percentage of coverage. Some cover 100%, but some cover only 80%.
  5. Year of the fee guide. Most insurance pays the current Ontario Dental Association fee guide, but some pay the previous years.
  6. Supplementary coverage on major dental treatments and their percentage of coverage. Some insurance covers major dental treatments but at a reduced percentage, like 50%. The major dental treatments may include orthodontics, crowns and bridges, dentures and implants etc.
  7. Criteria for the coverage. Some only cover a limited number of examinations. X-rays and amount of dental cleaning in terms of the unit of time. Some only reimburse specific treatments with dental specialists only. For example, the insurance policy may only allow more units of time for cleaning with a periodontist only.

Because of the different coverages, working with your dental clinic to maximize your coverage each year is vital for your health and wellness.

Since it is December, for most patients, their insurance coverage periods end on the last day of this month, and it is the time of the year for those patients considering getting their needed dental work done.

The fact is that the unused benefits cannot be carried over to the new year. The other point is that if you wait until the very end of your benefit period, there may not be enough time to finish all of them, especially the more extensive treatments like crowns and bridges, endodontics with crowns etc.

Because of the many factors that can affect how much your insurance will cover for the remaining period, you will need to work with your dental clinic to figure out which treatments are more urgent and can be helped by your insurance benefits.  The rest of the required treatments can then be looked after in the new year, which is less than a month from now. In this way, your dental insurance can be fully utilized to maximize your benefits.

By getting dental treatment done before the year is over, you can also take advantage of the deductibles that you have paid for the year already.

Do not let your cavities grow more extensive, allow the gum disease to advance further or watch the infected tooth becomes swollen. You should get all the essential dental treatments done within the benefits allowance and finish the rest in the new year to have good dental health and wellness.







Dental bridges and implants

Both dental bridges and dental implants are suitable to replace missing teeth in the mouth.

The replacement tooth using the surrounding teeth for support and anchorage can be fixed like a bridge in a dental bridge. The bridge is cemented firmly to the supporting anchorage teeth, and so it stays on the teeth as if it is part of the natural teeth. The advantage of dental bridges is the simplicity of treatment procedures. They do not require a long waiting time, usually four to six months, for the implants to integrate into the jaw bone after surgical implant placements. However, a dental bridge can be done in a week with only two office visits in most cases. Like anything in this world, there are disadvantages associated with dental bridges. The two anchor teeth on both sides must be reduced and shaved down to receive the bridge properly. The two supporting teeth need to remain healthy for the bridge to stay solid and functional. Because a dental bridge splints the supporting teeth together, making daily cleaning more demanding and challenging underneath the bridges.

An implant-supported replacement tooth will not need to rely on the adjacent teeth for any support because it does not attach to the other teeth at all, which is one of the advantages of an independently self-supporting structure. The additional advantage would be the embedded implant will maintain the quality and quantity of the surrounding jaw bone – so that the bone would not shrink. The disadvantages of implants are the surgical procedure to place the implants in the jaw bone and the time needed to integrate the implants fully. Placing an implant with a crown attached to it can be more expensive than a dental bridge.

In some circumstances, a bridge cannot be considered a suitable treatment. Those circumstances include:

  • The teeth surrounding the missing tooth/teeth are not healthy, like abscess teeth, teeth with gum disease, grossly decayed teeth, mobile teeth, and short supporting roots.
  • There are only teeth on one side of the space but no teeth on the other side.
  • There are too many missing teeth to be replaced with a bridge. Especially the molars are the missing teeth.

In those circumstances, implants supported teeth can be considered to replace the missing teeth. However, certain cases make implants more challenging when there is not enough jaw bone to place an implant into. With the technology we have, we can use different techniques to increase the size and quality of bone. The techniques include:

  • Guided bone regeneration – using hard tissues from the patient or cadaver to increase the amount of bone in the site where the implant is going to be placed
  • Sinus lift – when the sinus floor is low and therefore the amount of bone is thin, and this technique will increase the thickness of the bone.
  • Socket preservation – a technique that bone is placed into the socket of the tooth just got removed to help the bone fill in the socket and prevent resorption of the remaining bone surrounding the socket.
  • Emdogain – it is an enamel matrix derivative. “This mixture of natural proteins can induce biological processes that usually take place during the development of the periodontium and may stimulate certain cells involved in the healing process of soft and hard tissues.”

The different options have their merits and cons. You will need to consult with your dentist to find out which one is the most suitable for you to replace your missing teeth.






Do we have too many dentists?

Just a moment ago, I was Googling for dental offices near my office in Burlington; the search returned 19 offices. Then I searched for Tim Hortons, and 20 locations were found.

Interestingly, when I had my first dental clinic soon after I graduated from the University of Toronto Faculty of Dentistry in 1990, my office was the only one on Bayview Avenue in Richmond Hill within a few blocks. There were about 3 Tim Hortons restaurants in the area then. The growth of dental clinics outpaces the growth of Tim Hortons in the last 31 years.

We could interpret that the demand for dentistry has increased faster than the need for coffee from Tim Hortons over the last 30 years. Or we could say that there is an oversupply of dentists nowadays.

We know that Tim Horton’s business model puts more restaurants in areas with high demand or growth. They have professionals and specialists to do research and study on this matter. Not so among dentists; we do not have the financial means to hire experts to do the demographic studies and find out what the individual dentists are making in the areas in question before setting up new dental clinics there.

I doubt that patients see their dentists as often as they visit Tim Hortons in a year. I do not believe that the general population is more educated about seeing dentists regularly. I know that there are a lot more dentists per capita nowadays than 30 years ago.

Back in 1990, when I was the only dentist on Bayview Avenue in my area. Within a few years, I had about 4000 patient charts in my file cabinets. At that time, no dentists had a website and used social media platforms for marketing. I did not need to do much advertisement in the newspaper or delivery flyers to the neighbours. I was overwhelmed with the number of patients I treated in a typical 12 hours super-long day during the weekdays and 8 to 9 hours on the weekends. I felt stressed out because of the confinement in my office for many hours a day, the constant struggle with being on time for my patients and yet being able to deliver high-quality treatments for my patients. The stress level was skyrocketing when facing phobic and anxious patients or unexpected issues with some of the treatments I rendered not too long ago. I was getting all the stressors listed below:

  • Confinement
  • Isolation
  • Long hours
  • Lack of exercise
  • Stress of perfection
  • Economic pressure
  • Staffing pressure
  • Time pressure
  • Compromise treatment frustration
  • Patient anxiety
  • Processing a good dentist’s personality:
    • Compulsive attention to details
    • Extreme conscientiousness
    • Careful control of emotions
    • Unrealistic expectations
    • A marked dependence on individual performance and prestige

I was working seven days a week with extended hours each day. I did not have time to continue education, get involved with friends, and recharge my mental and physical health.

I would argue that there was a undersupply of dentists at that time in Richmond Hill then.

Because I was so stressed out, I sold my practice eventually and became a dentist associate in a smaller city in southwest Ontario for 11 years. I learned how to live a life, cope with stress in dentistry, improve social and leadership skills, rebuild my physical and mental health, and hone my dental knowledge.

Fast track forward to 2019, I started Affinity Dental Care from scratch at the corner of Walker’s Line and Rockwood Drive in Burlington. It has been three years, and I only have a few hundred patients despite spending money to do much more marketing like what all the dentists do – my website, social media exposure, and advertisements in newspapers once in a while. I only work 8 hours a day and five days a week.

I am not as busy as my previous office in Richmond Hill, but I feel more gratified with my profession. I am happier with far less stress. What has happened is that I am seeing fewer patients a day, and I can focus more on each patient on their diagnoses, through treatment plannings to providing the care. I am on schedule all the time, with support from my incredibly skilful staff and hygienists. I am more knowledgeable and confident in my dentistry and handling of anxious patients. I have a better social network and more time for professional development and involvement with sports.

So are we having too many dentists in Burlington? My answer would be no, and I think there is just the right amount of dentists per capita nowadays.


Does it matter missing a single tooth?

In modern society, missing a tooth at the front can be devastating because it is visible. A conspicuous black hole at the front makes you unattractive and diminishes your socioeconomic status unless you are a well-known NHL player. Most people would not think twice before having missing front teeth restored.

What if the missing tooth is in the back of your mouth out of the vision of other people? Because it is out of sight, some people do not see the immediate need to replace it because it is out of the mind. However, leaving a space at the back of your mouth can severely affect your health, appearance, and daily life.

A healthy tooth has many roles to play in the back of your mouth. It not only helps you chew and crush food without a problem, but it also mutually supports the teeth’ stabilities around it. Besides, a tooth stimulates the cells and maintains the jaw bone’s healthiness, keeps the cheek or lip full, prevents the lower jaw from over closure that affects the look of the face, and facilitates articulation.

Once a tooth is missing due to extraction, gum disease, gross decay or tooth fracture, there will be a space where the tooth occupies before. The teeth beside the void will gradually drift and tip into the hole, resulting in open contacts (small gaps) between the other teeth further away from that void. The small gaps form food traps that can lead to more gum disease, bone loss and cavities further out from the original space, like a domino effect.

Moreover, the opposing tooth on the opposite jaw of the space may over-erupt into the void, causing excessive and uneven wear of the enamel of the tipped teeth, interference of chewing movement of the lower jaw, and possibly loosening of the tipped or over-erupted teeth.

The jaw bone where the missing tooth’s roots were embedded shrinks in all three dimensions to make the matter worse. The gum tissues overlying the shrinking bone will follow the contour of the shrinking bone and become thinner and smaller.

There will be less support of the lips and the cheeks because of the space and diminishing bone. Hence the facial appearance will change – wrinkles, suck-in look, saggy cheeks etc.

Because of all the aforementioned adverse effects, there will be a chain reaction of unwanted consequences. Food chewing can be inefficient, with more chances of losing the other teeth because of gum disease and constant banging on the tipped or over-erupted teeth during food grinding and bruxing. Higher prevalence of cavities and bad breath, Lack of confidence because of the changed appearance, and possible damage to the temporal mandibular joints are all the sequelae of just one missing tooth.

With the technology we have, we can replace a missing tooth with a replacement tooth. The replacement tooth can be anchored to the adjacent teeth to bridge the gap literally. The material utilized for making the false tooth is natural-looking ceramics such as zirconium, acrylic, composite resin or porcelain fused on a metal substructure. The replacement tooth using the surrounding teeth for support and anchorage can be fixed like a bridge or removable like a denture. The replacement tooth can also be attached to an implant embedded in the jaw bone. An implant-supported replacement tooth will not need to rely on the adjacent teeth for any support because it does not attach to the other teeth at all, which is one of the advantages of an independently self-supporting structure. The additional advantage would be the embedded implant will maintain the quality and quantity of the surrounding jaw bone – so that the bone would not shrink.

The different options have their merits and cons. You will need to consult with your dentist to find out which one is the most suitable for you to replace your missing teeth.


Did dentists invent Halloween?

Probably not! Halloween began as an ancient Celtic holiday called Samhain.  The Gaelic festival marks the end of the harvest season and the beginning of winter, considered “the dark half of the year.” Celebrants believe that it is the day of the dead. On that day, the boundary between the worlds of the living and the dead became blurred. Thus the ghosts can return to the living world for a visit during that day.

Trick-or-treating going from door-to-door, singing songs or praying to the dead is part of the festivities. Traditionally, food and drinks were given out to the mummers, but nowadays, candy and sweets are the main giveaways.

Children come home with bags of candy and sweets after an evening of door-to-door trick-or-treating. So what can the parents do to maintain their family’s oral health with all the candy and sweets collected?

It is alright to enjoy the candy collected from Halloween, but consuming the sweets with the following plans and patterns is important to stay healthy.

  1. Eat Halloween candy with meals or shortly after mealtime. During meals or shortly after, the saliva production and flows are at the highest level; this helps wash out the food debris, neutralizes the acids produced by bacteria in your mouth, and remineralizes the enamel surfaces with the calcium and phosphate ions in the saliva.
  2. Store the candy away between meals so that the children cannot snack on the sweets anytime between meals.
  3. Limit the amount of candy your children can have a day.
  4. Avoid hard candy and other sweets that stay in your mouth for a long time. The length of time sugary food is in your mouth plays a role in tooth decay. Candies that remain in the mouth for a long time subject teeth to an increased risk of tooth decay.
  5. Sticky sweets like caramel toffee and gummy are chewy. They stick to the teeth, especially firmly into the pits and grooves on your teeth, making them hard to wash and even brush away.
  6. Look for organizations that collect candies or donate to some dental offices that have a candy take-back program.
  7. Drink more water after eating the candy, and brush your teeth with fluoridated toothpaste one more time per day.
  8. Maintain a healthy diet by having rough fresh vegetables and fruit like apples to help to scrap the plaque away from the gums. Snacking on cheddar, mozzarella, and Swiss cheese stimulate saliva and have shown cavity-fighting properties.
  9. Reduce other sugary intakes like soda and sports drinks.
  10. Chewing sugarless gum helps to increase saliva flow. But chewing gum too long and too often can cause excessive enamel wear, TMJ disorder and increase the likelihood of teeth chipping. It is advisable not to chew gum for more than 20 minutes a day.
  11. Flossing the teeth can help to remove food and debris between teeth that toothbrushes cannot reach.

Medical Emergencies in the Dental Office

A medical emergency can happen, usually when least expected, in a dental clinic during treatment. Approximately 90% of the crises were mild, but 8% were more serious. Only 35% of the patient who had medical emergencies were known to have some underlying disease, while only 33% of those patients were found to have a cardiovascular disorder. In other words, medical emergencies can arise in any person who has no alarming medical conditions during routine dental treatment.

The most common medical emergencies to occur in a dental office:

  • Vasovagal syncope (faint)
  • Hyperventilation due to panic attack
  • Acute asthma attack
  • Angina/myocardial infarction
  • Epileptic seizures
  • Diabetic emergencies – likely low blood sugar level
  • Allergies/hypersensitivity reactions
  • Choking and aspiration
  • Adrenal insufficiency
  • Cardiac arrest

Medical emergencies were most likely to occur during and after local anesthesia, primarily during complicated tooth extraction and prolonged root canal treatment that required multiple local anesthetic injections to remove the pain. Among the different emergencies, over 60% were syncope, with low blood sugar level the next most frequent at 44%, followed by mild allergic reaction at 8.8% and ingestion of foreign bodies at 4.1%.

This blog focuses on the prevention of medical emergencies from happening during a dental or surgical procedure.

To mitigate the frequency and severity of medical emergencies in dental offices, the patients can play an essential role by telling the dentists all their past medical history, including health conditions, hospitalization and surgeries. The medications they are taking and their dosages can also give the treating dentist an idea about the severity of the medical conditions.

The patients need to disclose the history of medical emergencies during their previous dental treatments, anxiety and reactions, a dental experience like painful TMJs after a lengthy procedure, and difficulty in having good freezing from the local anesthesia in their previous treatments.

Dentists and their team should be skilful in picking out the predisposing medical conditions when reviewing medical and dental history. The medical and dental questionnaire forms should be simple for the patient to complete, yet inducive of any pertinent medical and dental information to screen potential medical complications. The medical and dental history takings are crucial to screen out the patients who are prone to having medical complications during dental treatments. The vital signs of all patients should be noted and taken. Patients of high risk should have a medical consultation with their physicians and medical specialists before extensive dental treatments.

Proper treatment planning can help to minimize the risk of eliciting medical issues. The planning involves looking for alternative procedures like extractions instead of root canal therapy, using silver diamine on the cavities instead of fillings, placing a fixed bridge instead of an implant to replace a missing tooth.

When it comes to local anesthetics, the dentist can choose those without epinephrine to minimize the cardiovascular workload.

The dentist can break a long appointment into two shorter appointments, and sedation can be a helpful adjunct for some instances.

The treating dentist and the team should be well prepared to deal with medical emergencies when they happen. Everyone in the office should be trained and certified in doing CPR. The recognition of the symptoms is essential because if the symptoms are not recognized early on, the medical condition can spiral down quickly if not appropriately managed early on.

The components of a sound medical emergency plan for the dental office should include:

  • Medical emergency prevention
  • Development of an action plan
  • Recognizing a patient’s distress and management of medical emergencies
  • Emergency drugs and equipment

During the dental procedure, the vital signs are checked periodically with a machine. The patient is asked regularly about the feeling to make sure they are in good condition.

A thorough pre-operative discussion with the patient can reduce the anxiety by answering questions the patient may have about the procedures, pain during and after the process, expectations etc. Showing empathy and care to the patient can calm the patient down. The more detail the dental team has, the better and more effective a plan of action can be

There are some other techniques that the office and the patient can do to alleviate anxiety include:

  • Deep breathing during times of particular stress.
  • Distraction through music, podcasts or video.
  • Discuss medication and sedation options that might be right for you.
  • Establish control through hand signals so your dentist knows when to stop.
  • If sedation is not used, advise patients, especially those who are anxious, to eat before treatment to maintain a stable blood glucose level during stressful treatment.
  • Recline the patient in a supine or semi-supine position for treatment.

Cosmetic Dentistry Burlington

Affinity Dental Care is a family dental clinic that provides dental wellness care to all family members- from infants through children to adults of all ages.

Besides treating oral diseases, we provide cosmetic dentistry to patients in Burlington and its vicinities to enhance self-esteem and elevate happiness and overall wellness.

As a cosmetic dentist, Dr. Wong provides the following treatments for complete smile makeovers. The treatments can be a combination of dental techniques to achieve a great smile. The cosmetic treatments comprise dental bonding, veneers, crowns, enamel shaping, orthodontics (clear aligners and braces), teeth whitening, composite fillings, gum reshaping, implants, dentures, bridges, and gum grafts.

Let’s see what dental bonding, veneers, braces, crowns, veneers, teeth whitening, bridges, implants, gum reshaping or even a complete dental makeover can do for your smile.

Teeth Whitening

An assortment of teeth-whitening systems is available, including over-the-counter toothpaste and rinses, gels, strips and trays, and whitening procedures provided by Affinity Dental Care, at-home whitening under a dentist’s care and in-office whitening.

But whitening isn’t for everyone. It works better for people who have healthy, unrestored teeth and gums. Individuals with yellow tones to their teeth, as opposed to gray tones, respond best.

Dental Bonding

Bonding is used to repair teeth that are decayed, chipped, fractured or discoloured. It can even reduce gaps between teeth and change the shape of teeth. Tooth-coloured resin is applied and hardened with a special blue light, ultimately “bonding” the material to the tooth to improve a person’s smile.

It is an option for all ages, including children. It is a relatively conservative and cost-effective procedure to restore the natural appearance of a beautiful smile.


Veneers are made with wafer-thin porcelain that covers the front surface of teeth. They can change the colour, shape, size, or length of the front teeth. Veneers offer a conservative approach to changing a tooth’s colour or form compared to crowns.


A crown is also known as a cap that is tooth-shaped and coloured. It is placed over a weak, badly stained, misshaped, broken or damaged tooth to improve its shape, size, strength, or appearance. Crowns can be made of metal, porcelain fused to metal, resin, or ceramic, but the materials used in cosmetic dentistry are ceramic like porcelain, zirconium, and lithium disilicate. Crowns cover the entire visible portion of a tooth, but onlays and three-quarter crowns cover the underlying tooth to a lesser extent.

The crowns, onlays and three-quarter crowns can closely match the colour and shape of your natural teeth.


A fixed bridge replaces one or more teeth by placing crowns on the teeth on either side of the gap and attaching artificial teeth (false teeth) to them. The dental bridge is then cemented into place.

The bridges can be tooth coloured and shaped like teeth to provide both functions and beauty.

Enamel Shaping

Enamel shaping or contouring is a quick and painless process of shaping natural teeth to improve their appearance. It is used to correct minor imperfections such as uneven teeth or slightly chipped teeth. Results can be seen immediately. Enamel shaping is often combined with whitening, veneers, or bonding.

Orthodontics (Clear Aligners and Braces)

Orthodontics can correct crooked or misaligned teeth. They work by applying steady pressure, either by braces and wires or a series of invisible clear plastic trays, over time to move teeth into alignment slowly. As the teeth move into alignment, the bony tooth socket changes shape as pressure is applied.

Composite Fillings

Composite resins are tooth cosmetically much more pleasing than any other metallic fillings like silver amalgam and gold. At Affinity Dental Care, we only provide fillings using composite resins to fill teeth. When existing silver amalgam fillings need to be replaced due to wear, chipping, or cracking, we will replace them with natural, tooth-coloured composites.

Gum Reshaping

Gum reshaping can improve a “gummy” smile in which teeth appear too short, too much gums are showing or where the gum line seems uneven. A small amount of gum tissues, and excess bone tissues, if necessary, are removed and contoured to expose more of the teeth. This procedure can be done on one tooth to even the gum line or several teeth to create a natural, broad smile.


Dental implants are tooth roots embedded in the jawbone, made of titanium that provides a strong foundation for attaching permanent or removable artificial teeth (crowns). Instead of individual crowns, some patients may have attachments on their implants that support a fixed bridge or removable denture.


A denture is a removable prosthesis with natural-looking teeth made of acrylic for missing teeth and surrounding tissue. There are two types of dentures – complete and partial. Full dentures are used when all the teeth are missing, while partial dentures are used when some natural teeth remain.

Dentures are secured by attaching to or fitting over any remaining natural teeth or implants.

They can restore smiles, give a more youthful look to the face, and allow people to eat, swallow, and speak with ease.

Gum Grafts

Tooth roots exposed due to gum recession may be sensitive to hot and cold foods or liquids, making teeth appear long. Gum recession can put you at risk of developing a cavity on the tooth root and may lead to bone loss, eventually resulting in tooth loss. Soft tissue grafts, harvested from cadavers or from one part of the mouth to another, can stop gum recession and bone loss and improve the esthetics of the gum line.

Key Takeaways

The cosmetic procedures can improve the appearance and, in some cases, the function of the teeth. Our primary focuses are on colour, position, shape, size, alignment and overall smile appearance. If you are near our dental clinic in Burlington, you need to come in to meet Dr. Wong for an examination to see your teeth are healthy enough for cosmetic procedures and what kind of results you can expect.


Where did the certified dental assistants (CDA) and registered dental hygienists (RDH) go?

There has been a country-wide dental staff shortage for many years. Hiring experienced, and personable receptionists and administrative personnel has been a challenge for as long as my 31 years as a dentist and practice owner. Then for the last 15 years, there has been a shortage of certified dental assistants. Recently, after the Covid hit at the beginning of 2020, the lack of quality hygienists has become an additional problem for dental clinics.

In dental healthcare, staffing shortages seriously affect the dental team’s ability to deliver quality care to patients.
The majority of the staff in a dental team are females. Generally, female workers work fewer hours per week as compared to their male counterparts. Additionally, women disproportionately shoulder more caregiving responsibilities that they are much more likely to work part-time than men. Among women, childcare as a reason for working part-time is being cited in a lot of cases. To make the situation worse is the COVID-19 pandemic that makes women are more likely than men to fall out of the workforce.

The Health Policy Institute (HPI) (American Dental Association) survey points to a voluntary reduction according to 59.1% of hygienists. Today’s RDH posted results of their COVID-19 survey revealing that 9% of hygienists left the field for the following reasons:

  • Retired early due to the pandemic (24%)
  • Did not feel safe working clinically “at this time” (21%)
  • Laid off or fired due to the pandemic (10%)
  • The employer did not provide PPE or a safe work environment (4%)
  • Needed to stay home with children (3%)

Pregnancies and the subsequent childcare responsibilities for infants and toddlers tend to interrupt their availabilities for joining the workforce.
The talented and ambitious administrative staff would likely seek other opportunities outside a dental clinic because of the lack of promotion prospects and challenges. In general, wages and benefits from dental clinics are also not as competitive compared to larger institutions and companies.

Yonge female certified dental assistants aspire to become registered dental hygienists who can provide better wages and more responsibilities. Some of them even decided to pursue other professionals, realizing that a career in dental health care was not for them after working in this field.
The availability of The Canada Recovery Benefit (CRB), Canada Recovery Caregiving Benefit, and the Canada Recovery Sickness Benefit remove some of the incentives for the dental health care workers to work. The CRB replaced the initial $2,000-per-month Canada Emergency Response Benefit (CERB) in September 2020.

To counter the issues facing dentists, we should address the issues with changes. We need to make sure our staff feel safe in the environment, with robust infection control and prevention policy in place and adequate supplies with PPE.

We need to improve our leadership skills and address other staff issues, including flexible working hours, ergonomic issues and recognition of the team’s hard work and contributions. We need to have an open channel of communications with our staff to ensure that the workload, work satisfaction, incentives, concerns and staff spirit are being addressed regularly
The shortage of PPE supplies was real at the beginning of the lockdown, but the scarcities have been eased a lot in the last few months. Dental clinics should adhere to and practice stringent Infection Prevention and Control protocols to ensure both the patients and team are safe and confident.

Dentists should support continuing education and training to team members to enhance their professional knowledge and skills. We can hire receptionists and administrative staff who have no previous experience in dental health care but have the desirable personalities and attitudes. As long as they are trainable and want to make it their profession, they can be valuable team members for years to come.

At Affinity Dental Care, I am thankful that I have a star team to deliver high-quality and timely dental treatments to my patients.