Dental Care FAQs

1. Do I really have to go to the dentist every six months? Do I need x-rays at each visit?
How often you go for a check-up depends on your oral health needs. The goal is to catch small problems early. For many people, this means a check-up every six months. Your dentist may suggest that you visit more or less often depending on how well you care for your teeth and gums, problems you have that need to be checked or treated, how fast tartar builds up on your teeth, and so on.

Ask yourself the following questions:

� Do I floss every day?
� Do I brush twice a day with a fluoride toothpaste and follow my dentist’s instructions on how to brush properly?
� Do I eat a well-balanced diet, including food from all food groups, and limit sweets and sticky foods?
� Do I smoke?
� Do I have a history of cavities or gum disease?
� Is my overall health good?

The answers to these questions are all factors that affect your oral health. They will help you and your dentist decide how often you need to visit for check-ups. It’s worth noting that you should not determine your need for dental care on what your dental plan covers.

Do I need x-rays at each visit?

How often you need to have x-rays also depends on your oral health. A healthy adult who has not had cavities or other problems for a couple of years probably won’t need x-rays at every appointment. If your dental situation is less stable and your dentist is monitoring your progress, you may require more frequent x-rays.
If you are not sure why a particular x-ray is being taken, ask your dentist. Remember that dental x-rays deliver very little radiation; they are a vital tool for your dentist to ensure that small problems don’t develop into bigger ones.

Related Resources

� The Check Up
� CDA Positon on X-Radiation in Dentistry

2. I want to find a new dentist. How can I find one, and how can I get my records transferred?

The first step in choosing a new dentist is to list your needs, which might include:

� Location
� Hours of practice
� Language(s) spoken
� Generalist or specialist practice
� Ask your family and friends if they can recommend a dentist. Other members of your community, such as your doctor, may be able to offer suggestions. Some provincial dental associations have Web sites that allow you to search for a dentist in your area (see “Other Resources” below).

Yellow Pages advertising may also prove helpful. It will list each dentist’s location, and may include other details that will help you in your search.

Once you have narrowed your list to two or three names, call the dentists to see if they are accepting new patients. This initial call may also give you some sense of the office environment, but there’s nothing like the first visit to help you decide if it’s a good match for you.

How can I get my records transferred?

Original dental records belong to the dentist who provided the treatment, and not the patient, because dentists have to keep all of their records for a period of time, as set out by their provincial dental regulatory body. Once you have selected a new dentist, you can request that a copy of your records be transferred from your former dentist.
You may be required to sign a release form from your former dental office and you may also be charged an administrative fee for having your records copied and sent to another dental office. If you have questions about the records transfer process in your province, ask your dentist or contact the provincial dental regulatory body.
Other Resources

Provincial Regulatory Authorities and Provincial Associations

3. Does my dentist need to wear gloves and a mask, and how do I know he or she is using clean tools?

Your health is very important to your dentist. One of the ways that your dentist helps you stay healthy is by preventing the spread of germs. One of the best ways to do this is to use barrier protection such as gloves and masks.
Your dentist and other dental team members also wash their hands regularly. In addition, they sterilize equipment used in the dental office and clean the furniture and fixtures in the examining rooms. This system is referred to as “standard precautions.” It means that every patient is treated in the same way because patients don’t always know if they’re sick. It’s always better to be safe than sorry.

If you would like to know how this system is carried out in your dentist’s office, ask to be shown how it’s done. Dentists welcome the opportunity to ease their patients’ concerns, rather than have them leave the office with unanswered questions. Once you see the work that goes into making the dental office a clean and safe environment, you will feel reassured.

It is worth noting that even though standard precautions are used, it is still important to tell your dentist of changes in your health. This will help your dentist suggest the right choices of treatment for you.

4. When should I take my child to the dentist for the first time?

It’s important to get an early start on dental care, so that your child will learn that visiting the dentist is a regular part of health care. The first step is to choose a dentist for your child.

It may be your own dentist or one who specializes in treating children (called a pediatric dentist). Once you have selected a dentist, call the office to find out at what age he or she prefers to see child patients for the first time. CDA encourages the assessment of infants, by a dentist, within 6 months of the eruption of the first tooth or by one year of age.

It’s important to make the first visit a positive experience for your child – one reason why it’s best to visit before a problem develops. If you think there is a problem, however, take your child to the dentist right away, no matter what age.

If you are a nervous dental patient, ask your spouse or another family member to take the child for the appointment. If your child senses that you are nervous, he or she may feel nervous too. When you talk to your child about going to the dentist, explain what will happen without adding things like “it won’t hurt” or “don’t be scared.”
Be sure to get an early start on regular dental care at home. Start cleaning your child’s mouth with a soft damp cloth before teeth come in and continue with a soft toothbrush once he or she has a first tooth. Limit the number of sugary treats you give your child, and focus on healthy food choices from the very beginning.
Other Resources

� Your Child’s First Visit
� CDA’s Position on First Visit

5. Why doesn’t my dentist just accept payment from my insurance company? I don’t have dental insurance and can’t afford to go to the dentist. What can I do and why does dentistry cost so much anyway?

Dental plans, offered by many employers, are a means to help you pay for your dental treatment. Most Canadians enjoy dental plans and the insurance companies that provide them are actually benefit carriers. Carriers reimburse patients based on the level of coverage decided by the patient’s employer.

When you visit the dentist, it’s the dentist’s role to make a treatment plan based on your oral health needs. Your needs may be different from what is covered by your dental plan. It is your right to decide whether or not to go ahead with any treatment.

You should not decide based on what your plan covers. If you agree to have the treatment, it’s your responsibility to pay for it. It is the responsibility of the benefits carrier’s to reimburse you for the amount covered by your dental plan.
Many dentists are willing to contact a patient’s benefits carrier, on a patient’s behalf, to find out if a treatment is covered. The patient has to pay the portion that’s not covered and the dentist may offer a payment plan to help.

I don’t have dental insurance and can’t afford to go to the dentist. What can I do and why does dentistry cost so much anyway?

If you do not have a dental plan and cannot afford to pay your entire bill at once, ask your dentist about a payment plan. If you cannot afford care, even with a payment plan, contact the nearest:

� Social services agency to see if you qualify for government-funded dental care
� Dental school where senior dental students provide treatment at a reduced cost

Dental services may seem expensive. In Canada, we don’t have to pay directly when we visit a doctor or hospital, so we may not realize the high cost of providing health services. Overhead costs are high for dentists. They have staff, equipment and other operating costs.

The good news is that you can avoid costly dental treatment by brushing, flossing and visiting your dentist regularly for a check-up. Regular check-ups cost money, but they are less expensive than fixing serious dental problems that stem from neglect.
6. What’s the difference between the bleaching I can do at home with a kit from the store and the bleaching that my dentist does?

Dentists have been doing what’s called “non-vital” bleaching for many years. Non-vital bleaching is done on a damaged, darkened tooth that has had root canal treatment. “Vital” bleaching is done on healthy teeth and has become more popular in recent years.

Vital bleaching, also called whitening, may be carried out in the dental office or the dentist may instruct the patient on how to do the bleaching at home. There is also a wide variety of products for sale in stores. Not all products are the same and not all give you the same results.

Different products, including those used by dentists, may also have different risks and side effects.

Here is an overview:

Whitening toothpastes with abrasive ingredients are really not bleaching products at all, but work on surface stain only. These products are sold in many stores.

Some whitening toothpastes do contain a chemical ingredient (or “bleach”) that causes a chemical reaction to lighten teeth. Generally, they have the lowest amount of “bleach.” They may not whiten as well as stronger products, but they have less chance of side effects. These pastes are brushed onto teeth and rinsed off, like regular toothpaste.
Bleaching kits sold in stores stay on your teeth longer than toothpaste and contain stronger bleach.” These store-bought products do not come with the added safety of having your dentist monitor any side effects. They also come with a one-size-fits-all tray that holds the “bleach” and is more likely to leak the chemical into your mouth.
Dentists may use products with stronger “bleach”, but they give patients careful instructions to follow. They are also trained to spot and treat the side effects that patients sometimes report during bleaching. In addition, if a tray is needed to apply the “bleach”, dentists supply custom-made trays. Because products used by dentists are strong, they tend to produce the best results.

Patients should be aware that the long-term use of whitening or bleaching products may cause tooth sensitivity or tooth abrasion. Please consult with your dentist before using a whitening or bleaching product.

7. My dentist is recommending treatment (I know nothing about). What should I do?
Ask questions. It sounds simple enough, but sometimes we feel embarrassed to ask simple questions. There is no need to feel that way.

You will feel much better, and be able to make a better decision, if you understand the dental procedure that is recommended to you. If you don’t say anything, your dentist may think that you already understand.

Here are some tips when asking questions. Ask:

� If you can see any pictures of the procedure or what it looks like when it is done;
� How many times your dentist has done this procedure in the past;
� How much it will cost;
� How long it will take;
� If it will need to be redone in the future;
� If there are alternatives to the procedure and if so, what are the pros and cons of each option.

The final decision about how and when to proceed with any treatment is yours. To help you understand what is involved in the treatment, your dentist may give you some printed material to read.
If you have already left the dental office without asking questions, call back later. Be careful about getting information from unknown sources, including sources on the Internet. Some of this information may not be reliable.
If, after all of your questions have been answered you are still uncertain, you may wish to get a second opinion from another dentist. Often, a second opinion will give you confidence that your dentist has planned the right treatment for you.

Source- http://www.dentalcareuniverse.com

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You will never get a second chance to give someone a first impression of yourself!”

In today’s society, presentation is critical. The media dictates our lifestyles: workout, hairstyles and fashion. When these alone are not enough, we look to plastic surgery to enhance and modify what nature has given us.

In the last few years, the field of esthetic dentistry has grown providing patients with a wide range of procedures. Dentistry has evolved to the point where patients do not merely accept function anymore as was the ’70s and ’80s. Esthetics is now the motivation for many treatments.

Many patients visit a dentist not concerned with the health problems they may have but with “that little yellow spot that you can see near the gingiva of that lateral! Doctor: don’t you see it? It’s so huge!”

On a daily basis, dentists propose to their patients options to enhance their smile ranging from tooth whitening, composite bonding, porcelain veneers and advanced multi disciplinary procedures.

This article focuses on esthetic solutions using “minimal invasive dentistry”. That is that the less that is done, the better it is.

CASE PRESENTATION

A 24-year-old girl presented due to a trauma she received at age 12 that caused a class A fracture, according to Spinas and Altana’s classification,1 to teeth #11 and #21. The right central incisor displayed discoloration although it pulp tested vital.

The initial desire of the patient was only to have tooth #21 whiter, however this tooth did not respond to a previous attempt to external bleaching.

The options I considered were:

1. porcelain veneer to change the colour,

2. jacket crown,

3. all-ceramic crown,

4. porcelain fused to metal crown.

Following the “minimal invasive” principle, I believed that endodontics was the most aggressive treatment for this case and we opted only for a porcelain veneer. However, considering the total esthetic situation of our patient, I did not believe this to be a complete solution. Looking at the patient’s face and smile, I believed that other aspects could be corrected to enhance her beauty.

After further discussion with then patient, she described other aspects of her smile that bothered her. She found her two centrals to be too large and inclined and desired that the diastemas between her teeth be closed.

When we analysed her desires, we realise that by making tooth #21 brighter and by closing the diastemas, we will make the teeth appear larger. However, she already feels that her teeth are too large. One option could be to fabricate two veneers, reshaping the centrals in order to close the diastemas and changing the length to width ratio and have them appear smaller. This can be easily done by grinding the distal part of the teeth and moving the distal line angle mesially. As the patient did not like the divergence of the central incisors, the two proposed veneers could easily change their inclination.

Closing the diastemas presented a more complicated problem as by placing two veneers on #11 and #21 we could close the diastemas but be left with centrals that would be too large. Our patient would never accept this.

SOLUTION AND SMILE DESIGN

The only way to resolve all of her esthetic problems is to treatment plan the teeth from lateral to lateral in order to create a better esthetic ratio. Before beginning treatment, we first perform a direct composite mock-up (Figs. 3 & 4) to have the possibility of visualizing the tooth esthetics with the patient’s smile and face.

As a result of the diagnostic mock-up, our final treatment plan was determined to be four feldspathic porcelain (Creation Dental Porcelain, Klema) veneers on the anterior teeth.2

To give our ceramist a template for our desired final result, an alginate impression of the direct mock-up was taken. Using this as a guide, the ceramist can create a wax-up and silicone preparation guides.

We first perform 1.5mm of incisal reduction with a but margin (Fig. 5).4,5

The but-margin gives us the possibility to create a preparation that goes deep in the interproximal areas allowing a horizontal axis of insertion without undercuts.

We next prepare the tooth facially using depth cuts of 0.6mm as our reference to not go beyond enamel (Fig. 6). We reduce the depth of preparation at the cervical to 0.3 mm which allows us to keep the preparation in the enamel.3-6

This technique was first shown by Dr. Pascal Magne, using a cylindrical burr. His aim was to obtain a preparation guide in order to give his ceramist enough space for the porcelain veneer. This procedure minimizes cutting sound tooth structure and allows us to be much more conservative as opposed to freehand preparation or even by using calibrated burs.7

I prefer using a round bur because I can better manage the depth because I use more points and my prep burr does not jump over my depth marks. With cylindrical depth marks, we risk having the preparation bur jump from mark to mark leaving an uneven surface preparation.

Depth-burs do not give us the possibility of controlling the depth at each point. Furthermore, there is a much higher risk to expose dentin, from a 50.1% of dentin exposed with depth-burs to a 77.5% with a dimple technique.7

It is essential that enamel be conserved as much as possible, and the literature states that there is a higher risk of detachments and micro-infiltration if the enamel-ceramic criteria is not followed.8

I prefer to perform the initial buccal reduction without using retraction cord (Fig. 6). This allows me to visualize how the tissue will be displaced by the cord, and I can judge how deep to prep into the sulcus, especially if there is a need to slightly modify the gingival parabula with the emergence profile of the veneer.

After the first non-imbibed retraction cord (Ultrapak, Ultradent) is in place, the preparation is then refined (Fig. 7). This initial cord is not imbibed with astringents so as to not alter the marginal tissue.

A second cord imbibed with aluminium chloride-6-hydrate 21.3% (Hemodent, Premier), is then inserted into the sulcus and left in place for 4 mins. The impression is now taken.

For the additional micro veneers, I use only one cord. As there is no preparation, there is really no need to have the sulcus wide open (Fig. 8).

Using the silicon template that has been created from the initial wax-up. A provisional restoration is made using acrylic resin and luted with a spot-etch bonding technique.

At the insertion appointment, the provisionals are removed, the preparations cleaned with a non-fluoride paste, and the single full veneer is tried. It is difficult and risky to attempt to try the additional veneers because of the ultra-thin thickness of the ceramic (Fig. 9).

After the rubber dam is in place, the teeth are cleaned and washed with Chlorhexidine 0.2%. The ceramics have been pre-treated with hydrofluoric acid 9.7% for 90 seconds, rinsed, put in a ultrasonic bath with alcohol for five minutes and silanized. After the single veneer has been tried in,it is re-etched for 60 seconds with phosphoric acid 37%, rinsed with tap water and resilanited. Using this method, the bond strength of the ceramic increases approximately 50% over simple silanation.9

The hydrofluoric acid eliminates the superficial micro-fractures and enhances the mechanical properties of the ceramic as it allows a deeper penetration for the bonding agent.

The teeth are treated with 37% phosphoric acid (30 seconds on enamel),10-11 thouroughly rinsed with water for 30 seconds12 and bonding agent (Optibond Solo Plus, Kerr) is then layered both on tooth and the ceramic with a Microbrush rubbing for 30 seconds while thinning of the adhesive with lightly blowing oil-free air.

Luteing cement is then placed on the ceramic and the veneers placed on the teeth delicately pressed to allow the excess resin to flow out. After cleaning the excess, we light cure for 60 seconds on each side simultaneously in order to prevent undesired thickness of the adhesive layer.13 Further polymerization is done under glycerine to eliminate oxygen from the surface (oxygen inhibits the polymerization of resins).

The final restoration is then polished with rubbers (Brown and Green, Shofu) and then with brushes (Occlubrush, Have Neos) (Fig. 10).

The veneers were cemented one at a time. I find this the easiest way to control the entire procedure, as I don’t risk splinting the teeth together with composite or displacing the veneers. Once the cement is set, it is extremely difficult to remove the excess

After the veneers had been cemented and polished, the rubber dam is removed and the occlusion checked. The veneers act just like teeth, so they must play an active role in incisal guidance (the occlusal scheme is normal and correct).

DISCUSSION

It has been demonstrated that if the removed enamel layer is reconstructed with feldspatic porcelain veneers, the tooth entirely regains the structural flexibility of a natural tooth.14 In fact, the tooth is further reinforced with a variable resistance of 100% to 120%. When veneering with composite resin, the resistance to stress is consideralbly lower values (?80-90%).15

Tissue response to the presence of feldspatic porcelain veneers is optimal:16-17 as the presence of bacterial colonisation on a polished porcelain surface is minimal compared to that of a composite resin surface.

Porcelain bio-compatibility is confirmed by the absence of cytotoxicity in vitro, and cases reporting bio-compatibility problems linked to porcelain are very rare. There are no reports of known toxic effects of breakdown products of dental porcelain.18

The use of bond techniques with porcelain gives an excellent fracture resistance, when compared to that of porcelain fused to metal crowns.11-19 The translucency of the porcelain gives a natural effect the restoration and the clinician can regain form and colour of the tooth that were esthetically compromised.20

The only disadvantage in this technique is that it is operator-sensitive and requires a skilled dental technician. Following an exacting protocole can have a significant influence on the final restoration.21,22,23

It is very important that the technician’s attention during layering work, in particular, during porcelain preparation, leaves few surface gaps on the internal and external aspects of the porcelain.2 The advantage of the technique I have explained is the long-term esthetics and optimal restoration bio-compatibility.25,26,27

The long-term success rate of porcelain veneering has been reported in the literature to be: 98.8% at 6 years (83 veneers at 21 pz),28 89% at 5 years for undergraduate students (62 veneers on 29 patients).23

Conclusion

As the population of all ages has greater esthetic demands in order to prevent the high incidents of dental fractures, the clinician must have a clear understanding of treatment materials and options.

The goal of modern esthetic dentistry is to achieve the best possible results with minimal loss of tooth structure giving a patient a good looking, long-lasting result without damaging the integrity of their teeth.

Each time, we grind the tooth, we leave permanent damage. The use of ultra-thin veneers, (whenever possible), gives our patients the possibility of enhancing esthetics without seriously damaging their teeth. Furthermore, if something happens to the porcelain addition (ie. fractures or etc.) or if the patient doesn’t like the final esthetics, there is the possibility to remove the veneer and leave the teeth as they were before the treatment.

The final result of this case appears in harmony with her smile and face . It illustrates that when a smile has to be redesigned, the clinician must have the ability to evaluate the entire composition of the face.

Source-http://www.dentalcareuniverse.com/Cosmetic-Dentistry-Articles-97.html

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