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White filling resin with no Bisphenol-A

Like Affinity Dental Care, most dentists nowadays do not use silver amalgam fillings anymore because of the mercury content in this material.

We only use composite resin for the fillings in both anterior and molar teeth to avoid mercury alloy. We like composite resin because of other advantages as well – tooth coloured, translucency that makes it more life-like, less drilling and removal of sound tooth structure before filling with this material, and ease of repair.

However, there are many different brands of composite resin by several manufacturers. They are not all the same in terms of chemistry and their properties.

Unfortunately, many different brands use BPA (bisphenol-A) or Bis-GMA (Bisphenol-A-Glycidyl-Methacrylate). BPA is an endocrine-disrupting chemical that affects your health in a large quantity. Considerable exposure can cause problems in the brain and prostate of fetuses and children. It can also cause behavioural issues in children. Other studies also link this chemical to early puberty, metabolic disorders such as obesity and diabetes, heart disease, high blood pressure, infertility, thyroid dysfunction, and some cancers.

Spermatogenesis impairment and male reproductive abnormalities are related to excessive exposure to this chemical.

Bisphenol-A is a commonly used chemical for plastic materials such as polycarbonate bottles, containers, or coatings of cans. Bis-GMA is not the same as BPA; it comprises only the BPA structure in a tightly bonded ether form. There are traces of BPA in those composites, however.

Suffice it to say. It is a good idea to minimize the amount we are exposed to. In Affinity Dental Care, we use a non-BPA or GMA-containing composite resin made by Kulzer Dental called Venus Pearl. Venus Pearl does not contain any of the two chemicals.

Besides this advantage, there are other benefits of this composite material as it is:

  • easy to be used to fill the cavities – it is not sticky and has a creamy consistency that makes the material easy to be applied to the cleaned cavities,
  • durable – the material’s matrix is a nano-hybrid complex (the filler is from 5 nanometres to 5 micrometres) that resists wear, erosion and crack propagation,
  • strong – It combines high flexural strength with minimal shrinkage stress. The results are long-lasting, and
  • good looking – it offers a wide range of shades and can be applied in single- and multi-shade layering techniques. The material adapts perfectly to the colour of the surrounding teeth, creating an outstandingly natural look.

We do not introduce chemicals that are known to cause harm to our patients at Affinity Dental Care cause we like to consider wellness and health for our patients.

Non-BPA Fillings

Non-BPA Fillings

Top – a molar with a silver amalgam filling. Bottom – the same molar with a white composite resin filling. Dr. Wong at Affinity Dental Care did the filling.

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New Dental Implant

Modern dental implants are almost all made of titanium metal inserted into the jaw bone to support artificial teeth made with tooth-like materials. The material could be porcelain, lithium disilicate, composite resin, acrylic or zirconia. There are a few implants made with zirconium oxide, however. The titanium implants are usually greyish metallic, and the zirconium oxide ones are white. Titanium implants have a long history of success. The first titanium dental implant was placed in a human volunteer in 1965 by an orthopedic surgeon named Dr. Branemark. The white Zirconium oxide implant has a shorter history; it was first introduced in 2005.

Dental implants function like roots in the jaw bone to solidly support structures like crowns, bridges and dentures in the mouth that the patients would otherwise could not have. In order to place the implant in the bone, several surgical procedures may involve. After the implant is placed in the bone, a few months is needed for the bone to heal tightly around the implants before the implants can support functional teeth.

There are many other benefits of having the implants besides having new teeth that do not move:

  • Maintain jaw bone by reducing bone resorption of the jaw bone where the implants are located. Without the implants in the bone, the bone will gradually become smaller in dimension and density.
  • Can confidently chew more solid food without pain from the otherwise sliding, painful and unstable dentures.
  • Improved appearance and smile because implant-supported teeth can look and feel like your own teeth, having the appearance of pink gums around the teeth naturally.
  • Improved speech with the spaces having teeth and no more unstable, loose dentures
  • Improved comfort because the implants become part of you; implants eliminate the discomfort of removable dentures.
  • Improved self-esteem because dental implants can give you back your smile and help you feel better about yourself.
  • Improved oral health because implants can be placed in the bone where the teeth are missing, either immediately or after extractions. Implants do not involve other teeth as a tooth-supported bridge does. Individual implants also allow easier access between teeth, improving oral hygiene.
  • Implants are very durable and will last many years. With good care, many implants last a lifetime.
  • Convenience because implants eliminate the embarrassing inconvenience of removing dentures and the need for messy adhesives to keep them in place.

There are many shapes and sizes of implants. Conventional implants usually have a width between 3.3 mm to 6 mm. Mini-implants are long and narrow and have a width of between 2.2 to 3.00.

Lately, Keystone Dental has developed wide-body implants ranging from 7 mm to 9 mm. The wide-body implants are for immediate replacement of a molar tooth in the same sitting after a tooth is removed. A conventional implant is often not suited for immediate placement in the molar extraction socket because the smaller size cannot effectively fill up the wide of the socket of the molar after extraction. On the other hand, a wide-body one can fill up the space of the molar socket much better and, therefore, have more stability. Better stability means a better outcome in the healing process.

Wide body dental implant
Wide-body implant
Conventional dental implant
Conventional dental implant
Mini-implant
Mini-implant

Another nice feature of these wide-body implants is the shorter lengths than conventional implants. They only need shorter lengths because they have much wider diameters that provide more surface area for bone to heal into them. Frequently, there is not enough bone depth for a conventional implant to be inserted before it encroaches into vital structures like the sinuses, inferior alveolar nerve, lingual nerve, and blood vessels. A shorter wide-body implant can be a good option in cases like these.

The other benefits of the broad platform of the wide-body implant allow for an emergence profile suitable for a molar restoration, less food trap and more aesthetic. Because they are ideal for immediate placement in a multi-rooted molar extraction socket, therefore they require a less surgical procedure, shorter treatment time and maximized bone preservation.

At Affinity Dental Care, we provide implant treatments using conventional implants and the new wide-body implant to restore teeth with crowns, bridges and secured dentures for our patients.

Image courtesy of Keystone Dental
Courtesy of Keystone Dental
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Kids’ teeth grinding during sleep

Sleep bruxism in children is characterized by grinding and involuntary teeth clenching. It is natural to be concerned if you hear your child grinding their teeth in their sleep. Bruxism in children lasts about four seconds and can occur up to six times per hour. Typically, the parents notice the condition first because they can hear the grinding noises at night.

Many kids have it, but most outgrow it without lasting problems.

If your child is around 3 to 5 years old, I would not be overly concerned about it because some scholars have indicated that sleep grinding at that age could produce physiological wear to allow the growth and development of the jaw. It can become more of a concern if you hear or notice your older children grinding their teeth at least three times per week for two months because repetitive masticatory muscle activity can cause serious health complications. Typically, the incidence of sleep grinding decreases from ten years old onwards.

Causes of Sleep Bruxism in Children

Kids grind their teeth for a few reasons:

  • pain, such as from an earache or teething
  • temporomandibular joint disorder (TMD)
  • erupting adult teeth in the mixed dentition period, typically between 6 to 12 years old
  • misaligned teeth
  • stress (worry about a test or a change in routine) and social anxiety disorder (arguing with parents and siblings can cause enough stress to prompt teeth grinding or jaw clenching)
  • medical reasons like hyperactivity, cerebral palsy, attention-deficit disorder, gastroesophageal reflux, sleep apnea or hypoxia secondary to airway obstruction
  • taking some types of medicines like antidepressants and psychotropic drugs for anxiety
  • frequent snoring and mouth breathing, which could be a sign of upper airway obstruction
  • daytime bad habits and parafunction like lip, pen and nail-biting
  • frequent nightmare
  • second-hand smoke
  • genetic reason and personality trait (it runs in families). Studies have indicated a positive correlation between the concentration of catecholamines in the urine and sleep bruxism. Disturbances in the GABAergic and glutamatergic systems of the brain also have a positive correlation with sleep bruxism

Many times, bruxism is not noticed and does not cause problems. Often, it’s more bothersome to other family members because of the grinding sound.

But sometimes, it can cause:

  • headaches
  • worn down tooth enamel or chipped teeth
  • sensitive teeth
  • face, ear, or jaw pain
  • sleep disturbance that can cause behavioural problems and medical issues because they are not getting the rest children need

It can be challenging to pinpoint the cause of bruxism. I may use a method of elimination to determine the cause. I need to examine the patient systematically to determine the causes and risks, then provide treatment to the patient accordingly if the reasons are a concern.

Treatment for Bruxism

Most kids will outgrow sleep bruxism, but they still need to be monitored by the dentist. Grinding can damage both primary and secondary teeth and affect current and future oral health. The treatment approach can include monitoring and

  • a nighttime mouthguard
  • an examination by a pediatrician if medical reasons like tonsilitis and airway obstruction are suspected
  • reduction of the stressors – parents’ roles are vital because they could be the ones who can help to eliminate the stressors like high expectations and excessive extracurricular activities like piano lessons or sports
  • referral for mental health counselling
  • improve your child’s sleep hygiene by making sure their room is dark and quiet, limiting their time on cell phone and computer
  • Soothing bedtime activities like brushing teeth, taking a warm bath, cuddling together with your child, reading stories and soft music
  • provision of nutritious diet low in added sugars but avoid hard snacks like corn chips, popcorn and chewing gum
  • stretching exercises and facial massage techniques
  • orthodontic treatment to align the teeth and create proper arch forms that can help healthy orofacial development
  • elimination of parafunction and bad habits like nail and pen biting
  • acupuncture and photomodulation of the (acupoint) trigger points
  • Stop using a pacifier if the kid is still using it after 2.5 years
  • Hydroxyzine medication before bed for two months for older children

Combining the above treatment modalities is often needed if the condition is severe. We love to see children at Affinity Dental Care.

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Safe Mercury Fillings Removal

Dental silver filling is a filling material used to fill cavities. It is also called dental silver amalgam filling.

Dental amalgam is a mixture of metals consisting of liquid mercury (about 50%) and a powdered alloy composed of silver (about 25%), tin (about 14%), zinc (about 8%) and copper. The liquid mercury reacts with the three metals to form a paste. Before the chemical reaction is completed, dentists can pack the paste into a cleaned cavity, then carve out the shape and anatomy before the paste becomes hard.

It is a strong, cheap, and durable material for cavity filling. It has been in use since the early 1800s. The silver amalgam has an antibacterial effect with a self-sealing property that contributes to its longevity. However, there are potential risks with mercury fillings.

Potential Risks:

  1. It contains elemental mercury that can release in the form of a vapour that can be inhaled. Exposure to high levels of mercury vapour, which may occur in some occupational settings, has been associated with adverse effects on the brain and the kidney.
  2. Fetuses and young children whose developing neurological systems are more sensitive to the neurotoxic effects of mercury vapour. In light of this, there are concerns about using mercury fillings in pregnant women with their developing fetuses, women planning to become pregnant, nursing women, and young children.
  3. People with pre-existing neurological diseases and people with impaired kidney function.
  4. People with known heightened sensitivity (allergy) to mercury or other dental amalgam components (silver, copper, tin).

In July 2018, the European Union prohibited amalgam for the dental treatment of children under 15 years and pregnant or breastfeeding women.

Due to the “potential risks” and the poor cosmetic results, I have not been doing silver amalgam fillings for over two decades. In fact, my office does not have mercury amalgam materials at all.

Suppose you fall into any of the greater risk groups listed above; both Health Canada and the Food and Drug Administration (FDA) recommend not to use mercury amalgam filling in those groups mentioned earlier in this blog.

I do not recommend anyone remove or replace existing amalgam fillings in good condition unless necessary – patients with medical conditions mentioned, physiological reactions to this material, or holistic propensity. Removing intact amalgam fillings can result in unnecessary loss of healthy tooth structure and a temporary increase in exposure due to additional mercury vapour during the removal process.

The International Academy of Oral Medicine and Toxicology (IAOMT) has provided guidelines on a safe amalgam removal protocol dubbed Safe Mercury Amalgam Removal Technique (SMART). At Affinity Dental Care, we closely follow the guidelines and have the following equipment and protocols.

  • An amalgam separator filters all the wastewater from our dental high volume suction to collect mercury waste such that no mercury is released in our effluent into the public sewer system. A certified medical waste disposal company safely disposes of the amalgam separator once full.
  • The operatory is equipped with a MedEVAC Airflow chairside unit that can remove mercury vapour from the air during amalgam filling removal. The nozzle is placed close to the operating field.
  • A non-latex rubber dam isolates the teeth from the rest of the oral space to keep the amalgam pieces from entering the mouth before a high-volume waste suction removes them.
  • The patient’s face and head are covered with a disposable sheet to prevent accidental contact with the mercury alloy during the removal.
  • A high-volume evacuation suction is used thorough the removal and cleanup procedure. After completely removing the amalgam filling, the area will be thoroughly washed with water and then with a slurry of charcoal before removing the rubber isolation dam and head/face cover.
  • A saliva ejector is placed under the dental dam to reduce mercury exposure to the patient.
  • The amalgam is to be sectioned into chunks and removed in as large pieces as possible, using a small diameter carbide drill under a copious amount of water.
  • We avoid any amalgam filling removal for women who are pregnant or breastfeeding.

We do not stock any mercury materials and restore teeth with composite white fillings to avoid mercury exposure. We use porcelain, lithium disilicate (Emax), and Zirconia materials for crowns and bridges.

If you are interested in having the silver amalgam fillings removed safely and holistically, please call our office to book a consultation appointment.

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Airway Dentistry

I recently heard the term airway dentistry, and I was curious about what that exactly is. I have been researching and noticed that it is just another term for dentistry that focuses on the mouth’s structure and how those impacts breathing. It involves looking for signs of sleep breathing disorder like tooth wear, the position of the tongue and the condition of the soft tissue. The goal is to recognize signs and symptoms of breathing disorders that could lead to obstructive sleep apnea.

I have been practicing dental sleep medicine emphasizing sleep-related disorders like obstructive sleep apnea. I have also been looking for potential developmental issues in children who show signs and symptoms of craniofacial discrepancy that can cause nasal obstruction and mouth breathing habits.

Essentially, wellness and holistic dentistry encompass airway dentistry. I practice my dentistry by looking beyond the teeth, nose, throat, muscles of the tongue, face, neck, and rest of the body. Our entire system and organs are interconnected. I mentioned in my previous blog about the effects and the subsequent diseases that can arise from a single disorder – a breathing disorder. The compromised airway should be treated rigorously and as soon as it is diagnosed, as it can lead to many other conditions. The list of the conditions is long, ranging from poor facial aesthetics and hunched posture to debilitating congestive heart failure. Please see my previous blogs on Nurturing, Sleep Apnea, Tongue-tie and Lip-tie.

Sleepiness and narcolepsy during the day despite 7 to 8 hours of the sleeping time the night before can be the sign of obstructive sleep apnea or hypoxia for adults. Snoring, teeth grinding, and excessive enamel wear are signs of sleep-related breathing disorder. Infants who have trouble breastfeeding could have tongue and lip ties or even upper nasal airway obstruction. Tongue and lip ties can themselves lead to the craniofacial discrepancy that, in turn, causes a narrow upper airway.

There are many reasons you should breathe in through your nose instead of the mouth. You can take deeper breaths, which provides more oxygen to the body. Chronic mouth breathing causes teeth to crowd and narrow, long faces. Mouth breathers are more likely to have sleep-related breathing disorders, dry mouth, swollen gums and other gum diseases.

Airway enhancement is part of holistic wellness dentistry. The recognition and referral to medical colleagues to make the diagnosis of the underlying diseases and related treatments could be the first step in helping patients. Besides the recognition and proper referrals, dentists can provide treatments like palatal expansion, mandibular advancement, oral myofunctional therapy, air-centric orthodontic treatment etc. Dentists can help lactating mothers understand the importance of breastfeeding and proper unprocessed diets for their infants to enhance airway development and immune system development. If the infants have tongue and/or lip tie problems that affect breastfeeding, frenectomy or frenotomy should be done.

Integrative Dental Medicine is a term to describe the modern-day dentistry that dentists should be practicing to provide the best outcomes to our patients. It comprises airway dentistry, air-centric orthodontics, wellness and holistic dentistry.

At Affinity Dental Care, we practice dentistry the way I blog.

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An Implant Case

My patient had a tooth in his lower right side, the first molar, that was very mobile due to advanced gum disease with severe bone loss. The tooth was deemed hopeless in prognosis, so I recommended the patient have the tooth extracted. The patient has presented the different options with the would-be space left behind in detail: leaving the space empty, replacing it with a removable partial denture, fixing a three-unit-dental bridge, and placing a crown supporting by an implant. After all the fees, procedures and other questions were answered, the patient elected to have the tooth removed and replaced with an implant-supported crown.

Severe bone loss in the first molar
1. Severe bone loss in the first molar

After having a cone-beam computed tomography taken (CBCT) to determine the adequacy of bone volume and quality for an implant, treatment plans were made to place a tissue level Biohorizons implant immediately after the extraction using a surgical template to guide the placement of the implant.

Treatment planning using 3D imaging
2. Treatment planning using 3D imaging

The patient was instructed to take an antibiotic and rinse his mouth with an antiseptic for a few days before the surgery.

On the day of surgery, a local anesthetic was first administered, and when the numbing was profound enough, the tooth was atraumatically extracted. The inflamed tissues inside the socket were cleaned out carefully and meticulously. Immediately, an implant was placed inside the prepared socket. Due to severe bone loss from his advanced gum disease, ground bone particles from a human donor were grafted and packed around the implant. A special collagen membrane was placed over the bone graft to ensure that the patient’s bone cells migrated among the bone graft particles to form new natural solid bone around the implant.

Immediately implant and bone graft placement after the extraction.
3. Immediately implant and bone graft placement after the extraction.
An implant case
4. The implant with a cover after six months of healing.

After six months of healing, a resonance test, a device that gives out a measurement in number, was done to determine how well the implant had been embedded in the jaw bone. The measurement indicated a well-integrated implant with the bone; therefore, the implant was ready to support a crown. A Trois digital scanner was used to take an impression of the teeth and implant. The digital data were sent to a dental laboratory. A digital model was printed with the implant analogue embedded in it in the same way as the actual implant in the month.

A crown made with Zirconia material was made that fit onto the implant. The crown was then secured to the implant with a screw in the mouth that must be tightened with a torque wrench.

After the crown was securely screwed onto the implant, a composite resin was used to fill in the screw hole. In this case, it is a screw-retained crown. A screw-retained crown is desirable because of its ability to be removed easily from the implant if the crown is chipped and requires removal for repairs. If there is periimplantitis (bone loss around the implant due to infection), the crown must be removed for proper treatments.

The implant without the cover.
5. The implant without the cover.
The crown was made on the digitally printed model.
6. The crown was made on the digitally printed model.
The crown was tightened onto the implant with a special wrench.
7. The crown was tightened onto the implant with a special wrench.
The crown was secured onto the implant and became functional.
8. The crown was secured onto the implant and became functional.
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Lip Tie

About lip-tie: In my last blog, I mentioned seven frena (also called frenula) in the mouth, found in the top, bottom, sides of the mouth, underneath the upper and lower lips, and below the tongue. The primary function of the frena is to keep the different structures together with flexible but restricted movements. The flexible and yet controlled movement of the organs (lips, cheeks, tongues etc.) allows proper food capturing, swallowing, speech, and mouth movement.

Babies born with lip-tie can have Issues with breastfeeding, inadequate weight gain, colic, sore mother’s nipples. If untreated, it will affect speech, instrument playing, kissing, etc., in adulthood. It will further generate space between the two upper front teeth (diastema), gum recession, painful dentures etc.

What is a lip tie?

A lip-tie occurs when a baby born with the frenulum attaching the lip, upper or lower lip, to the gums, is very short and tight. The lip-tie may make it difficult to move the lips. Lip ties are less common than a similar (sometimes co-occurring) condition: tongue tie. There is reason to believe that lip ties and tongue ties are genetic.

Lip tie has not been studied as much as tongue-tie, but treatments are similar.

Common symptoms

Related symptoms in babies may include:

  • Struggling to latch on to the breast. The baby may make clicking or smacking sounds while nursing because of poor latching or constant losing the nipple.
  • Difficulty breathing during feeding.
  • Falling asleep often during nursing and prolonged feeding time.
  • Acting extremely fatigued by nursing.
  • Slow or lack of weight gain.
  • Colic.
  • Failure to thrive.
  • Breast milk leaking from the mouth as a result of a poor seal.

Related symptoms in mothers may include:

  • Pain during or after breastfeeding – blocked milk ducts or mastitis.
  • Breasts that feel engorged even right after nursing
  • Fatigue from constantly breastfeeding even though your child never seems to be full

Lip tie complications

Babies with a severe condition may have trouble gaining weight. They may have an easier time drinking from a bottle, so you may need to supplement breastfeeding with formula or breast milk-fed from a bottle if that makes it easier for your baby to get nourishment. They will keep your baby on the right track, growth-wise, while you figure out if your child needs a lip tie revision.

Babies who have a severe lip or tongue-tie may have difficulty eating from a spoon or eating finger foods. Some pediatricians believe that an untreated lip tie can lead to a higher likelihood of tooth decay for toddlers.

How is it Treated?

It all depends on the severity of the tie: a small, string-like appearance on one end of the spectrum, a broad, fanlike band of connective tissue on the other. Babies with the severe condition can develop a callus on their upper lip.

The Kotlow classification system uses four grades to rate the frenulum based on appearance. With this system, the higher the grade, the higher the ‘severity’ of lip-tie, and the greater the likelihood of breastfeeding problems.

Level 1 and Level 2 lip ties are typically left alone and do not require revision. If there’s a tongue tie as well as a lip tie restricting your baby’s ability to feed, a pediatrician may advise you to “revise” or “release” them both, even if the lip tie is considered to be Level 1 or Level 2.

Level 3 or Level 4 lip ties may require a frenotomy procedure. However, most people equate frenotomy to frenectomy as they are two different procedures.

A frenotomy neatly severs the membrane connecting the lip to the gums. It can be performed using a laser or a sterilized surgical scissor. In comparison, a frenectomy involves total removal of the frena, including its attachment to the underlying bone, which requires more surgery than a simple frenotomy incision.

Besides frenotomy or frenectomy, the mother can try a therapy technique to loosen a lip tie and make it easier for babies to breastfeed. Sliding your finger along the top of your baby’s lip and practicing lessening the gap between the lip and gumline can gradually improve the mobility of your child’s lip.

Lip-tie with gum recession
Lip-tie with gum recession
Frenotomy using diode laser – minimal bleeding and pain right after
Frenotomy using diode laser – minimal bleeding and pain right after
Healing after a week – fast healing
Healing after a week – fast healing
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Tongue Tie

Tongue Tie

Tongue Tie: There are seven frena (also called frenula) in the mouth, found in the top, bottom, sides of the mouth, underneath the upper and lower lips, and below the tongue.

A frenum (singular for frena) is a fleshy piece of soft tissue comprised of elastic and striated muscle fibres attached between the gums and the other tissue structures like the lips, cheeks, tongue etc. The primary function of frena is to keep the different structures together with flexible but restricted movements. The flexible and yet controlled movement of the organs (lips, cheeks, tongues etc.) allows proper food capturing, swallowing, speech, and mouth movement.

What is a Tongue Tie?

A tongue-tie is a condition someone is born with that the frenum is too tight that the tongue has limited, overly restricted movements, resulting in ankyloglossia – the frenum is too short, too thick or too broad. Boys have more prevalence for tongue ties than girls.

In neonates, tongue-tie causes the infant to have trouble drinking breast milk because the tongue cannot latch on the nipples. When the infant cries, the tongue appears to have a V shape or a heart shape. Because of not drinking adequate breast milk, the growth and development are impaired and slow.

If gone undiagnosed and untreated, tongue ties can cause many issues to children like small body size, Intellectual disability, ADHD, teeth grinding, dental malocclusion, restricted airway development, dental malocclusion, chronic mouth breathing, speech difficulties, snoring, problems with swallowing, elongated face, small lower jaw, frequent upper respiratory infections. The list can go on and on further.

Adults who have not had the issues corrected before suffer from the signs and symptoms listed in the previous paragraph. Moreover, they also can be experiencing craniofacial deformity, lower self-esteem, lisping and difficult speech, laud snoring, sleep apnea, tongue and cheek biting, soreness in the jaw, TMJ pain, lethargy, gum recession at the site of the frenum attachment (the frenum pulls the gums away), difficult kissing, painful denture (the denture irritating the frenum constantly) etc.

How is it Treated?

A frenotomy is a procedure that releases the tight ligament in the tongue tie by making an incision in the frena. Most laypeople use the term frenectomy, which means the total removal of the frena. Frenectomy is not indicated in most cases.

Frenotomy is simple and adequate for most tongue-tie cases. Since there are few blood vessels or nerve endings, it can be done without any numbing or anesthesia. We just cut the frenum so that the tongue can move normally. After the procedure, the baby can feed without discomfort.

We apply topical numbing gel first for adults and then a bit of local anesthetic around the site. Diode laser is then used to severe the ligament in the frenum with minimal to no bleeding. The laser seals the cut surfaces, so the pain level is usually minimum after the local anesthetic is gone.

Recognition of tongue-tie in babies is essential. The best outcomes from a frenotomy treatment are usually within the first three months after birth. After three months, the infant will take a pregressively longer time to readapt their tongue position during latching after the treatment. Most cases are recognized by a lactation consultation or a nurse at the maternity ward. The mother should look out for it if she is experiencing:

  • pain during or after breastfeeding
  • breasts that feel engorged even right after nursing
  • blocked milk ducts or mastitis
  • fatigue from constantly breastfeeding even though your child never seems to be full
  • colic baby

Should the mothers experience the above symptoms, they should consult with their pediatricians to find out if some issues with the babies affect the feeding.

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Moderate Sedation with Nitrous Oxide and Benzodiazepine

Moderate Sedation with Nitrous Oxide and Benzodiazepine

Moderate sedation: Dentistry has long been associated with pain, fear and anxiety. Fortunately, most of the general population in North America are slightly to somewhat afraid of dentistry, but over 5.5% are highly phobic about dental treatments. 15% of the people are interested in having sedation during a dental visit.

We all know that anxiety affects pain perception, decreasing the pain threshold. The bottom line is that we try to make our patients at Affinity Dental Care feel more comfortable and painless.

How we make our patients more comfortable

The first step is to ensure our patients do not wait too long in our waiting area before seeing them in the treatment area. Our policy is that we do not make our patients wait longer than 10 minutes once they are in the clinic. In fact, 95% of our patients do not need to wait longer than 5 minutes. Besides valuing our patients’ times, we also know that the long wait in a dental office can increase anxiety during the waiting period due to the prolonged activation of the hypothalamic-pituitary-adrenal (HPA) axis in an increase in stress hormone like cortisol release. The longer the patient waits, the more cortisol is circulating in the body, further increasing the signs of anxiety like fast heart rate and heavy breathing.

The colour tone of our walls is calm and soothing. We have windows in all our treatment areas that allow natural light to come in and a nice view of the outside.

We like to tune in to lovely scenery of different countries or videos of fish swimming in the coral reef on our TV while playing soothing music instead of radio stations playing loud music.

Having patients take pain killers right before the appointment can positively reduce pain and soreness. We always apply a topical numbing gel to the injection site before freezing. The freezing technique is crucial, giving the freezing steadily, slowly with acupuncture/vibration, reducing or eliminating the pain from the needles.

We help our patients understand the process

Patients not knowing the treatment process and what to expect can add more anxiety to an already stressful situation. In light of this, a preoperatory consultation can help assess the patient’s medical conditions, previous history of dental treatments tolerance, and psychological conditions. The proposed treatment process can be shown and explained during the exact consultation. When the patients understand the process and feel confident about the dentist, they feel more comfortable and less anxious. It is equivalent to sitting in the dark versus in a well-lit environment.

Our office has no experience with and does not offer other anxiety-reducing modalities like acupuncture and hypnosis. According to our research, both are unpredictable in achieving the end goal – only works sometimes.

Notwithstanding the earlier armamentarium, certain patients may need moderate sedation either because they are petrifying with dentistry or have cardiovascular disease that cannot be stressed further during the dental procedure.

The cornerstone of moderate sedation

The use of benzodiazepine and nitrous oxide is the cornerstone of moderate sedation. We use one of those agents or both together to help to calm and sedate our anxious patients. Nitrous oxide, also called laughing gas, can be used alone to reduce stress and analgesic effect during the treatment.

The gas is non-irritating, sweet-smelling, colourless. It has a high margin of safety, and it is safe for patients who have impaired liver or kidney functions. The gas is delivered via a nose piece sitting on the patient’s nose. Despite its high safety level, there are specific contraindications for using the gas on some patients who are:

  • Inability to tolerate a nasal hood for an extended time
  • Un-cooperative children
  • Claustrophobic patients
  • Inability to breathe through the nose
  • Patients with severe COPD (Chronic obstructive pulmonary disease)
  • Pregnancy in the first trimester
  • Bleomycin chemotherapy within the last past year

Oral sedation with a benzodiazepine can be used alone or in conjunction with nitrous oxide gas. The drug of choice in Affinity Dental Care is Triazolam (Halcion) for adults and Midazolam (Versed) for children. Both are sedative and anxiolytic (anti-anxiety). They both have a short effect and are relatively safe to be used in patients with compromised liver function.

The patients cannot eat or drink anything eight hours before the oral sedation. Because of that, we usually book the patients in the morning for sedation. The patient cannot drive or engage with activities with attention and sobriety for at least 24 hours after.

When both oral sedation and nitrous oxide are combined, the patients become very relaxed and can fall asleep. However, we only administer the medications to the level that the patients remain conscious when they are in the office. Besides following all the conscious sedation protocols closely, other safety measures like vital sign monitoring of the patients are on when the patient is under treatment.

At Affinity Dental Care, we want to ensure our patients are safe and have the least amount of anxiety during dental treatments.

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Gum Disease Treatment

Gum Disease Treatment

The goal of gum disease treatment is to control the infection and restore the health of the gums and bones. There are two approaches to it – allopathic and holistic. The two approaches are not mutually exclusive and can be employed together to achieve “wholistic” results.

When I say holistic approach, I do not narrowly mean detoxification or using natural products to fight gum disease in toothpaste, rinse, capsules or ointment. I am more referring to treating the underlying causes or exacerbating factors of gum disease.

Examples of how treatment should be dealt with

In my previous blog talking about the risk factors, there is a factor of nutritional deficiency in Vitamin C or D. We need to make sure the patient is getting the proper nutrient for the building and maintenance of the supporting tissues. If you are a smoker or social drug user, it makes sense to stop smoking and substance abuse to achieve better oral health.

Stress can be a factor that decreases the immune system and increases the amount of chemo messengers for inflammation in our bodies. This factor needed to be recognized, and appropriate professional help should be initiated.

Diabetes-induced gum disease can be severe. It is usually caused by poorly controlled diabetes – either no knowledge of having diabetes, noncompliance with the medications, indulging in sweet consumption, and simply inadequate or wrong medications. Once the diabetes is under control, allopathic and other holistic treatments can be effectively employed to manage the disease.

Those are just a few examples of how gum disease should be dealt with. A good medical history is essential in guiding the treatment modalities of gum disease.

The importance of patient’s education on gum disease

The patient’s education on gum disease processes (causes and results) is the epitome of the whole treatment. Knowing the importance of brushing and flossing, brushing the teeth properly, the frequency of brushing, etc., is the first stage in helping us have better oral health.

The allopathic approach, comprising biomechanical scraping and chemotherapeutic treatments, eliminates the direct causes of gum disease – the oral pathogenic bacteria and their products, including plaque and tartar.

The biomechanical scraping includes scaling and root planing. It involves physically removing the obnoxious toxin and bacteria embedded in the plaque and tartar sticking on the teeth and roots using fine instruments that dentists and hygienists used to scale the substances out. In some cases, for the patients to feel comfortable during the procedure, local anesthetics can numb the gums and teeth. When the gums and teeth are frozen, cleaning can be done to the root underneath the sensitive and inflamed gums without feeling pain by the patients.

In some cases, gum flaps are raised (gums covering the diseased roots are detached away from the roots with the surgical procedure) to have good visualization of the tartar and disease. The scraping can be performed more effortlessly and more thoroughly. After the thorough cleaning is done, the gums are sutured back onto the roots to heal and seal.

Removal of the redundant, inflamed and frail gums covering the deep gum pocket (space between the teeth and the surrounding gums) can be performed as such that the depth of the pocket can be reduced for easier home care/brushing. This procedure is called gingivectomy or gingivoplasty.

Grafting sound healthy gums to cover the exposed root with receding gums can be performed to enhance the healthiness of the area.

The dentist can prescribe antibiotics like amoxicillin for chemotherapy treatments to fight acute gum infection. If the disease is chronic, low dose doxycycline like periostat can help the body regulate the inflammatory mediators.

Place antibiotics into the deep pockets underneath the gums releasing medication slowly over time can help avoid having the other system exposed to the drug.

Emdogain (a natural protein growth factor) that promotes the healing process of soft and hard tissues is one of the chemo agents that dentists can use to battle gum disease. It is used locally in the defect after the area has been cleaned and disinfected.

Using a dental laser to target and kill the harmful bacteria in the infected gum pockets can be an effective choice of treatment in conjunction with other therapies.

Besides killing the harmful germs, the photons emitted by a particular dental laser can be a biomodulation agent (photobiomodulation) that stimulates the mitochondria (the powerhouse) in our good body cells. The energized cells, in turn, make the healing process a lot faster.

The use of natural botanical products like turmeric, cinnamon, Beswick, etc., in mouth rinse or toothpaste, can help suppress bacterial counts and modulate our inflammatory mediators.

Like I said before in my previous blog. The practice of mindfulness of our body and our health status is quintessential to maintaining our well-being. Periodic checkups with our family doctors and dentists are essential to stop any disease processes from progressing. Prevention is the best medicine. Early detection will ensure the disease is curable and health and wellness can be maintained and last for a lifetime.