Dental Web Letter

I have wanted to write a newsletter for some time to share important information regarding your dental health and dental care and some services that our office provides.

We have expanded our facilities

Some of you may not know that we have added a third treatment room to our office.   This has made it much easier to fit brief adjustments, exams and

emergencies into our day, meaning less waiting times and more efficient scheduling.  Our third room features an extra comfortable  patient chair for longer procedures. 

     We have also added an additional x-ray room that allow us to take panoramic  x-rays, which are wide x-rays of the jaw, similar like  panoramic pictures your camera might take. These x-rays are used to assess wisdom teeth and help us plan implant cases.

Dr. Shnall places Dental Implants

Dental implants have become a very common way to replace one or more missing teeth.  I have taken advanced training in this exciting field of dentistry and have placed dental implants for many of our patients over the past few years.

What is an implant?

  Nature has given us humans two sets of teeth, our baby (primary) teeth and our adult or permanent teeth.  Implants are as closest thing to a third set of teeth.

 An implant is essentially an artificial tooth root.  It resembles a screw.  They are commonly about  half an inch long (12 millimetres).  They are made of titanium which is the same material that artificial hip and knee joints are made from.  Titanium is a unique metal in that when it placed in our jaws, hips or knees our bone attaches itself directly to the titanium and accepts it as if it were part of our body.

Dental implants are placed in a very straight forward procedure with  same kind of freezing that we typically give patients for routine fillings.   After an implant is placed  we usually recommend our patients take Advil or Motrin tablets  as needed that day (2 tablets every 4-6 hours) and by the next day  the medication is  often no longer required. 

Dental implants can be used in many different situations:

• They can be used to permanently replace one or more teeth.  Before implants were available, if a patient lost a single tooth and wanted a permanent replacement that stayed in the mouth and looked and felt like  a natural tooth, the neighbouring  teeth had to be drilled/reshaped to create a dental appliance  known as a bridge. 
• An implant allows tooth replacement while  leaving the neighbouring teeth untouched.

What is the advantage of using an implant to replace a missing tooth rather than using a bridge?

• Research shows that the average lifespan of a bridge is only approximately ten years, while an implant can last a lifetime.
•  Teeth replaced with traditional bridges can develop cavities, gum disease and  root fractures, which all may result in loss of the bridge. As well. a  tooth that has to be cut down in size in order to make a bridge can later require root canal treatment.
• A dental implant never decays, is resistant to gum disease and is virtually unbreakable

For Patients who are missing all of their own teeth :

Complete removable dentures use to be the only option available.  However, full upper dentures cover the entire roof of the mouth, which can diminish the enjoyment of food;  full lower dentures can frequently be loose fitting due to the lack of available  bone in the lower jaw to support the denture.

Dental implants can help patients who are missing all their teeth in one or both jaws  in two ways: 

(i)  a permanent set of  teeth can be placed in  the lower jaw attached to  five or six implants;  six or eight upper jaw implants can anchor a permanent set of upper teeth.  Thus implants can eliminate the need for removable dentures.

(ii)  alternatively, loose lower dentures can be anchored to two implants making them very stable and retentive;   Four upper jaw implants allow us to make a secure upper removable denture that does not cover the roof of mouth the way that traditional full upper dentures must.

   Advantages of Having Dr. Shnall  Place Your Implant(s) (as compared to an oral surgeon or gum  specialist

When dental implants were introduced to North America about twenty years ago, only oral surgeons or gum specialists were placing them. 

     Currently, a growing number of general dentists are placing dental implants.  In North America, 10 percent of general dentists are placing implants.  In the years to come this number will definitely increase, as placing dental implants is not unlike many other procedures general dentists perform on a daily basis.  As well, there are a number of advantages to having your Dr. Shnall place your implant as compared to a specialist:

• fewer appointments requiredsaving you time and expense
• Dr. Shnall can place temporary crowns or bridges directly onto your implants on the day of implant placement, something that may be difficult to coordinate with a specialist.
• cost…The price of excellent implant components have fallen dramatically as competition increases amongst implant manufactures.  General dentist fees for implant related procedures tend be lower than specialist fees.

While I enjoy placing implants, I am selective in the cases that I do treat and when necessary, do refer my patients to an excellent specialist that I have completed many implants cases with for many years.

If you would like to discuss how implants can benefit you please do give us a call.

Two Big Mistakes that many patients make that can Seriously Affect their Dental Health, or the Dental Health of their Children:

1.  Giving their children bottled water or filtered water instead of tap  water that is fluoridated:

 Bottled water generally is lacking in fluoride.  Children (and pregnant/nursing mothers) need a proper amount of fluoride in their diet to ensure the optimum development of baby and permanent teeth.  Fluoride, when consumed in proper amounts becomes part of the enamel in developing teeth and hardens the enamel, making it more decay/cavity resistant.  People drinking filtered water at home should check with the manufacturer to see if their filter removes fluoride from  water or not.  Too much fluoride is not good either.  Parents should never give their child fluoride tablets or drops without first checking with their dentist or pediatrician.  There is no need for these supplements for the typical child. Ingesting too much fluoride can result in a condition known as fluorosis, which results in soft, pitted discoloured teeth.      

      As for the safety of Toronto drinking water, public health experts say it is perfectly safe to drink unfiltered, and research has shown that not all bottled water is necessary pure or “safer” than tap water

2.  Drinking too much pop (regular or diet) and/or fruit juice or sipping these drinks over a few hours at a time on a regular basis:

    The perils of soft drinks (yes, even diet pop) and fruit juice consumption:

When these beverages are consumed with a meal they do no harm to your teeth.  However they can do serious damage if misused: 

There are a few key ingredients in pop and fruit juice that can harm our teeth.  Sugar is the most obvious culprit.   Sugar, in the form of sucrose in regular pop and fructose in fruit juices feed the bacteria that live on our teeth (especially in the deep grooves, along the gum line and in between the teeth).  Thisbacteria, or plaque converts these sugars to acid, which can soften the outer layers of our teeth causing a cavity.

     The lesser known ingredient in both regular and diet soft drinks that can harm our teeth is citric and/ or phosphoric acid.

I recently visited the soft drink section of a local supermarket and checked the labels of popular soft drinks.  Every one of them listed at least one of these two acids as an ingredient.  Either of these  acids has the potential to gradually wear down the protective enamel surface of our teeth, producing teeth that look worn or thin.

     The key factors in whether these drinks are going to harm your teeth is frequency and exposure time, that is how often and for how long are these drinks are in contact with your teeth.

If you drink pop or fruit juice with a meal or snack that is fine.  -  The surface of our teeth may become acidic during this fairly brief sugar or acid attack and even start to break down. 

-  However after the meal the calcium in  our saliva can recoat the surface of the tooth and repair the microscopic damage that was done during the acid or sugar attack. 

-  This process of wear and repair goes on all day long in our mouths.

 - People run into problems when they overwhelm this delicate repair system.   Problems arise if you do the following:

-  you drink even little sips of pop or juice over a several hours while at work or while watching television (or in the case of students, studying) in the evening for example.   

-  The problems are made worse if you’re a drinking large volumes of pop or fruit juice throughout the day or night.

-  If your teeth are be bathed in sugar or acid for long periods of time there is less opportunity for the natural repair process to occur. 

-  I have seen patients of all ages with extensive decay or wear because of this destructive habit.

The solution:

-  If you feel that you need to have a drink by your side when you work or relax, make it water, coffee or tea (without sugar)  or sugar free juice (even these drinks should be taken in moderation.

-  Or perhaps chew on veggie sticks (cucumber, carrots, celery) or simply take a drink of your favourite beverage with a meal or snack over a short period of time…not hours on end.

A Snoring Appliance That Really Works

Okay, I admit it.  I used to snore.  According to my wife, loudly.  While this snoring did not disturb my sleep it did keep my wife up at night.

     This year I finally made myself a snoring appliance.  It completely eliminated my snoring!    This dental appliance moves your lower jaw forward into a comfortable position, and in so doing  moves your tongue  away from the back of your throat while you sleep, which is the cause of snoring.  This appliance also is an effective treatment for a condition known as sleep apnea, which is a serious condition where your body does not receive enough oxygen during sleep.  This condition is often found in people who snore.

Signs of Sleep Apnea:

 -  choking or stopping breathing  during sleep

-  excessive daytime sleepiness

-  morning headaches

-  irresistible urge to nap or sleep during the day

-  limbs jerk during sleep

-  waking up tired or thirsty

-  snoring

The snoring appliance is comfortable, effective and easy to make.  Only two short appointments are required.

If you or your partner snore and you are interested in finding a solution, you will need to call your family doctor first and request a sleep study.  This study is done at a sleep clinic.  It is necessary to determine whether you simply snore or whether you suffer from sleep apnea.

If you have mild or moderate apnea you can get effective treatment with the dental sleep appliance.  If you have severe sleep apnea you will require a different treatment approach with a machine called a CPAP, which is a device that blows a stream of air through your mouth or nose keeping your airway open.

If you would like information on the treatment of snoring please give our office a call.                                                                                                                                                                

Tooth Whitening Fact and Fiction

Tooth whitening has become a very popular way to enhance your smile.  Here are some interesting things that you should know about tooth whitening:

•        the safest and most effective way to whiten your teeth is a home whitening technique that our office uses.

•        we make a set of trays that comfortably fit on your teeth;  you place a small amount of whitening gel in the trays and can either sleep with the trays or wear them three hours a day.

•        in-office whitening or “laser whitening” is done while you sit in the dental chair.  It uses stronger whiteners than the home method and it can be painful for some patients.  It only works well for about half the patients that it is used on.  If it doesn’t work then you need to have the home whitening trays made or you have to repeat the in office procedure another day.

• in-office or laser whitening is  double the cost of home whitening.

• regardless of how you whiten your teeth the colour of your teeth will fade or stain over time and you will require a touch up.  If you have home whitening trays already you can simply put them in one or two nights once every nine months or so.  If you use a laser whitening system you will have to go to the expense of making home whitening trays or go through another expensive in office whitening procedure.

• most interesting of all, research has shown that the whitening achieved with in office or laser whitening is completely due to the strong whitening gel that is placed on the teeth only!  It has nothing to do with the laser.  The strong whitening gels are what can make the laser whitening system painful...they will burn the gums if they touch them and can irritate the nerve of the tooth.

• home whitening uses a gentle whitening gel and has years of research showing that it does not weaken the teeth or change the structure of the teeth in  any way.

If you have any questions about tooth whitening please give our office a call!

Other Office News

• Leah, one of our receptionists has been volunteering in Honduras since January of this year, but is due to return to our office January 2008.
• Rose, one of our other receptionsts has recently married and has moved out of the city.
• Lexi and Susan are our front desk people.
• Lucy  is our full time dental assistant and Donna is our full time dental hygienist. 

Dr.  Shnall’s Family Update

• this summer I  ran several 25 km trail races and even one 32km race .    I have been running regularly for about  six years now and if any of you have ever wanted to become a runner please feel free to email me or ask me for tips at your next check-up. 
• My running accomplishments pale in comparison to my wife Adi, who has run several 50km trail races this spring and who is setting her sites on running an 80 km race (I have no idea how she does it!) 

I hope that you found this newsletter informative.

Looking forward to seeing your smile!!!

 Warmest regards,

 Dr. Jeff Shnall