The dental sub-department of RVH is comprised of a small group of surgeons (of which we are one) that offer a very important dental service to the wider local community. We see patients under general anesthesia that could not be safely treated in a community setting, and includes patients with special needs, major medical compromise, significant oral and maxillofacial surgery needs, and of course, children who are too young to cooperate for dental treatment. It is great that RVH has such a programme, and it is important that it continues to operate. Thanks for your support and we will be pleased to do the same thing this year!

(This post is not describing bite planes, which are hard appliances meant for nighttime wear, often to prevent damage to teeth from grinding or clenching.)

You may have heard from some people who do not believe in mouthguards, saying things like: “I knew someone who got hit in the mouth while wearing a mouthguard, and he still had his teeth broken”.  This may have been true, but still is not an argument for not wearing mouthguards.  Kindly ask these people if they also do not wear seatbelts because they ”knew someone who got into a car accident while wearing a seatbelt, and he still got hurt”.  Mouthguards are not a guarantee, but they are better than nothing.  And since they are quite cheap and easy to wear, there is little reason not to wear them.

The big misconception about mouthguards is that they protect the teeth mainly from frontal impacts.  Obviously this is true, but an equally (if not more) important use is to absorb the impact of lower teeth crashing into upper teeth.  Tooth-to-tooth contact is a huge source of dental injury, and since teeth are often not clenched together perfectly during an impact, some sort of shock absorber will be helpful in taking the load.

Mouthguards can often be found in sports-supply stores in the form of a one-size-fits-all mould that is boiled until softened.  When soft, the wearer is supposed to bite into the material and mould it to the teeth.  These “boil-and-bite” mouthguards are typically cheap and not too difficult to manipulate.  However, these offer poorer protection and are not usually recommended.  In fact, there are only two situations where we will recommend these types of mouthguards:

1) The wearer is also undergoing orthodontic treatment, where the position of the teeth is constantly changing.  Boil-and-bite mouthguards are typically quite cost-efficient, so it’s not a big deal to buy a new one when the old one no longer fits.

2) The wearer is growing and actively losing baby teeth.  For the same reason, as teeth fall out and others come in, mouthguards no longer fit as well.  Simply for cost reasons, a boil-and bite guard will probably make more sense.

Note that in neither of the above situations do we feel that a boil-and-bite mouthguard is actually better, it’s just cheaper if you have to replace them frequently.  It the cost is not a concern, then definitely the custom mouthguards are your preferred choice.

Custom mouthguards are what we as a dental office would provide for the wearer.  These are made using a plaster mould of the patient’s teeth, where a sheet of mouthguard rubber (ethylene vinyl acetate) is vacuum-formed to fit that mould.  Not only is the end product better-fitting and therefore more comfortable (less likely to be dislodged during impact and easier to breathe with it in place), it will offer better protection because the thickness is more controlled.  Remember what we said about tooth-to-tooth impact?  Sometimes in the boil-and-bite process, too much pressure is used to bite down on the guard, thereby thinning it out so it no longer offers adequate protection.

Here are some tips on mouthguards:

1) These are typically worn on upper teeth, unless the wearer has a very prognathic (protrusive) lower jaw.  In those cases, it may be wiser to opt for a lower mouthguard.

2) You do not need two mouthguards, one on the top and one on the bottom.  Breathing and comfort would be much poorer.

3) The colour is important – select a colour that contrasts well with the playing surface of your sport.  So, for ice hockey avoid clear or white mouthguards.  For soccer, avoid green.  (If you play on some weird rainbow tie-dyed surface, you’re out of luck – take your pick).  This will help you find it if for some reason it flies out of your mouth.  Also, it is likely wise to avoid red – if there is injury that causes bleeding, you want to be able to identify bleeding quickly.

4) Replace them regularly.  No surprise if it doesn’t fit anymore on a growing child, but sometimes superstitions or habits or just plain laziness will prevent someone from getting a new one.  If a mouthguard thins out too much, it is no longer effective.  In general, mouthguards should be 3mm thick between the teeth and also 3mm in front of the teeth.

That’s all for this time!  Hope it was helpful.  If you would like to ask about sports/mouthguards or have a complete oral evaluation, please contact us!  We love to be your dentist in Barrie.

When enamel is forming, it should be a perfectly clear crystal structure with little, if any colouration.  Sometimes, this does not happen and the result is brown or white stains on the teeth that are intrinsic (i.e.: not acquired over time extrinsic stains like food stains).  These discoloured areas cannot be brushed clean and will also not respond to whitening.  Often they lead to a lifetime of dissatisfaction with the appearance of the teeth.  If severe, they can cause significant embarrassment to the point that someone may not wish to smile.

These teeth are not more susceptible to decay; they are just discoloured.  Because there is not a structural concern, dentists are loathe to treat them invasively with resins or veneers; the teeth would be compromised for what is merely an esthetic problem.  Enter microabrasion.  This process is a painless, one-appointment procedure that requires no anesthetic.  Akin to microdermabrasion, it involves using a dedicated slurry that gently and slowly removes the offending poorly-formed superficial enamel (about 1 hair’s thickness, so not a lot).  By removing the stained enamel and uncovering the underlying properly-formed enamel, the enamel can then rebuild itself properly.  Remember, enamel is a crystal, and like other crystals, can rebuild without biologic influence.  Typically, the darker, browner stains will respond better than white staining.

The result is an instant improvement in appearance after about an hour’s worth of treatment, and an appearance that improves over time as the tooth rebuilds.  A quick, simple albeit underused treatment that does not compromise the tooth.  The cost is calculated based on the amount of time required to remove the stains, and is comparable to (if not less than) in-office whitening of teeth.

What is microabrasion not effective on?  If there are very white and deep formation defects that extend the full thickness of enamel, it will obviously not work completely.  Also, teeth with formation defects (genetic) such as amelogenesis imperfecta, dentinogenesis imperfecta, or tetracycline staining.  These problems are not superficial, so a superficial treatment would not be expected to improve them.

Below is a recent case of a 35-year old female patient who had been dissatisfied with the streaked, discoloured front of her upper front four teeth.  She had been told by several other dentists that there was no good treatment for the stain other than veneers, but that veneers would be overaggressive treatment for such a small problem.  We suggested microabrasion as a possible solution, and when you look at the following photographs, we think the results speak for themselves.

Right canine view before microabrasion

Front view before microabrasion. Note the brown horizontal streaking of the upper four front teeth.

Left canine view before microabrasion.

Total treatment time: 1h treatment, followed by 20-30 minutes of 1.1% Neutral sodium fluoride gel applied to teeth.  All treatment done with rubber dam in place.  The cost was less than the typical cost for in-office whitening.

Right canine view after microabrasion.

Frontal view after microabrasion – brown stains are gone!

Left canine view after microabrasion.

If you’d like to explore microabrasion as a treatment option, or wish to have an overall oral / dental health evaluation, please contact us!  We’d love to be your Barrie dentist.

Today’s installment is about Cassity, a tattoo artist and fire spinner.  Yup, playing with fire and not only not getting burned, playing with fire and makin’ it look awesome!  Kids, do not try this at home.  However, with careful supervision and training, adults certainly can try it out in the open where uncontrolled fire is not a risk!

Check out the following photos; Cassity’s fire spinning is fearsome (especially that belt-mounted cell phone – watch out!) as is her tattooing (Tatooine?)

Sample of tattoo work by Cassity

Fire spinning at night – awesome!

If interested, she can be found at www.fyretoys.com (fyretoys@hotmail.com) or www.cameltrails.ca (cameltrails@hotmail.ca).

Please note that these posts do not endorse any particular business or individual and are published for general interest only.

And as always, for a complete evaluation of your oral health and treatment options for what ails you (orally), please Contact Us!  We’d love to be your Barrie dentist.

Here is a link by the Journal of the Canadian Dental Association about an article that was published by the Canadian Agency for Drugs and Technology in Health. It finds that key concepts of neuromuscular dentistry are not supported by the available evidence, in both the diagnosis and the treatment of TMDs (temporo-mandibular disorders).

(Pro tip: if you want to avoid eye rolls when talking about your jaw pain, don’t say “I have TMJ”. TMJ (temporomandibular joint) refers to the actual jaw joint (the one involving temporal bone and the mandible.) Saying “I have TMJ” is like saying “I have knee”. Just say you have had jaw pain issues or the like.)

It is worthwhile to note that we do not wholeheartedly embrace the actual article’s contents, nor do we completely agree with some of the comments made at the bottom of the article.

If you have jaw pain issues, and that would include things like pain on chewing, easy fatigue of jaws when eating tough foods, or even a sensation that you have “more than one bite”, please contact us! Our view is that although these things may not cause you constant pain, they are worth investigating and treating before they do. We’d love to be your dentist in Barrie.

Roger Federer’s tennis racquet. Now take it and go play Rafael Nadal.

K3 Rotary endodontic files. Now take these and go do a molar root canal.

We’ve all seen advertisements from all sorts of businesses, dental and non-dental, promoting themselves as having “state of the art” equipment of one sort or another.  While this is a very appealing carrot to dangle in front of potential clients/patients, it also infuriates us because it devalues the role of the operator.  In dentistry, like in so many other disciplines, the quality of the work  is more dependent on the knowledge and skill of the operator, and less on the technology.

From our perspective, one can perform excellent dentistry with 20-year-old equipment, provided that the knowledge and technique is state-of-the-art.

Our focus is on keeping up on our knowledge, and being aware of new technology is only one facet of this.  Dentistry is changing towards a more customized form of management, with decision-making guided more and more by scientific evidence rather than by personal opinion (often masqueraded as “clinical experience”.)  Even individual procedures change as new data emerges.  Continuing Dental Education (CDE) is a pillar of good dentistry, and our efforts are geared towards exceeding minimum requirements.

Our commitment to you is to implement strategies that have been shown to provide a better result over the long run.  We look at clinical long-term data.  We read articles about new understanding of human disease and wellness.  We practice techniques over and over.  And we understand that everything is subject to change.

If new technology does develop that allows us to practice better dentistry, we will incorporate it if we can.  But, the bulk of the changes in dentistry are of the type that do not come with a shiny new gadget, and those are more fundamental.

We will leave you with a final scenario, plus a scene from one of Dr. Wong’s all-time favourite movies (youth has that effect on you).

Below is a photo of the steering wheel of a Formula 1 race car.  If you sit behind this wheel, will you be a better driver?

It’s not the car, it’s the driver.

The point of this article, dumbed down a bit more, and also for all those closet Spaceballs fans out there – best parody ever.

Contact us for a personalized assessment of your oral health.  We’d love to be your dentist in Barrie.

There are different reasons for a gummy smile, and it is important to distinguish between them in order to find the correct treatment.  If one applies an across-the-board treatment for all smiles, one will encounter catastrophic failure. Just because one has a laser, does not always mean that it should be used.

In general, gummy smiles can be due to three factors: an upper jaw that is placed too far down in the face, an upper lip that is very mobile, or (simplest of all), there is just too much gum tissue.  Of course, there can be combinations of the three, but it is very important to determine the cause.  The treatment must address the cause.  If treatment is undertaken that does not address the cause, it will not be totally successful.  Diagnosis is key here.

Here are two examples from our office:

This case of “gummy smile” is truly an excess of gum tissue and not a problem of “small teeth” or an underlying skeletal anomaly.

The treatment for this should be simple: removal of excess gum tissue (or if necessary), some of the underlying bone as well.  There are well-established parameters that need to be followed in order to achieve predictable healing, but it appears to be quite straightforward.  If you haven’t guessed, yes, this is our own Keshia.  She has not had this treatment because of a major health issue that has plagued her for about 8 months now.  At the time of writing, we figure she should be cured in about one more month.

When you inspect the amount of visible tooth structure, you will see that the teeth are totally exposed. The problem here is not with the gums, it is with the placement of the entire upper jaw bone, where it sits too low for the upper lip to cover the teeth.

This is an altogether different case.  Here, the treatment actually needs to involve surgical repositioning of the upper jaw (maxilla) to a more upwards position.   There is nothing wrong with the amount of gum tissue, nor is there any excess lip movement.  For some reason (hereditary, likely), the jaws developed in this way, and trying to mask it by trimming gums would end up with a disastrous, or at least odd-looking result.  Treatment needs to be targeted at the problem area, and this would warrant a trip to the local friendly oral and maxillofacial surgeon in conjunction with an orthodontist.

The final basic reason for a gummy smile would be a lip that just rides higher than normal when smiling.  On average, one should expect something in the range of 6-9mm of lip movement when going from rest to full smile.  If it is more than normal, it can be corrected in one of two ways: Botox (easiest, but needs refreshing every 6 months or so) in the lip to reduce the amount of lip rise, or surgery by a specialized practitioner to permanently alter the mobility.

What about cases where gum levels are just a bit uneven from one tooth to the next?  In the case of excess gums, it is easy to just remove the offending portion.  A laser can make quick painless work of that, with great long-term stability.

If there is insufficient gums on a tooth, it will be necessary to attempt to add some gum tissue, by way of grafting.  This can be evaluated and done at your local friendly periodontist’s office.

Contact us if you would like an assessment of your gummy smile or uneven gumlines!  There may be a solution to your problems beyond “not smiling too much”.  We’d love to be your dentist in Barrie.

First of all, we will NOT be on the bandwagon of offices who say “Great!  Let’s use up those benefits!”  As we have stated many times before, dental needs are determined by your teeth, and not by your benefits.  And your teeth did not read the benefits booklet.

It is important to realize that dental fees are not determined by a random pick of a number from the reading of cloud formations, farmer’s almanacs or the flight speed of African swallows (which are non-migratory).  There is a formula that goes into calculating the fee for most dental procedures, and it takes into account the technical difficulty of the procedure, the usual time required, the materials cost, as well as other factors.  Each year, there is a recalculation of these procedure costs that is then compiled into the yearly Ontario Dental Association Suggested Fee Guide.  This is not a fee schedule (ie: it is not mandatory for dental offices to follow it), but it is the most commonly used tool to determine dental costs in the province.

This determines the clinical fee, and the additional laboratory or expense fees are simply the costs of laboratory work or extra materials.  Think of fees as parts and labour.  For those who gripe about the high cost of dentistry, consider this:  we are not giving you a mass-produced product that is pulled off an assembly line, each one the same as the last like the hottest Apple, Android, or even Microsoft product.  Every bit of dentistry that is done in your mouth is a custom procedure done in an unforgiving, moving, dark, wet, bacteria-laden and cramped environment to a precision of fractions of a millimetre and is expected to last for over a decade with punishing daily use.  Furthermore, the training required to legally provide a full scope of dentistry takes not only four years of dental school, but a lifetime of continuing education hours in order to stay current.  Think of dentistry as a made-to-measure garment that has to keep changing with science and technology that you wear everyday and chew on, with a pressure of 200 pounds per square inch.  And it has to work.  Every time.  For years.  What would you pay now?  We are unapologetic about the fees, but understand the confusion.  It is a consumer society, after all, and people are looking for the best bang for their buck.

Dental fees are one thing.  Insurance benefits, are unfortunately quite another.  It is common for dental benefits not to cover the entire cost of a procedure, or perhaps not to cover any of it at all.  This leads many to feel that the procedure is unncessary, or perhaps an extravagance that they can do without.   To that, consider this:  what you need and what is covered are two different things.  When somebody has a root canal performed on a back tooth, it will usually need a crown in order to maximize its lifespan.  Many insurance benefits will cover only a portion (say 50%) of a crown.  Does this mean that only 50% of the crown was necessary?  If that person’s insurance happens not to cover crowns at all, does it mean that the crown is then totally unnecessary?  Of course not.  The crown is necessary, but insurance just won’t pay for all of it.  The answer is simpler.  The well-trained actuaries who work for insurance carriers know that if they require the insured to pay for a portion of the treatment out of their own pockets, a certain percentage of those people will be unwilling to do so.  By covering only a portion of the cost, they may instead save themselves from paying out any at all!  Keep in mind:  100% of insurance companies are in business to make a profit.  0% of insurance companies are in it for your health.  Whether you have healthy teeth or not is not their concern.

By looking after your own needs first, and that would mean a thoughtful discussion with your dentist and no questions left unanswered, you should arrive at a treatment plan that you agree with.  Then, if insurance happens to cover some of the treatment, treat it as a discount.  Determining your treatment plan based on insurance benefits is literally going about matters in backwards order.

Finally, to those who have avoided going to any dentist because “they don’t have dental insurance”, it is often cheaper and better to find a problem early on, than to find out about them when they hurt.  We’re willing to bet that one would rather pay for blood pressure medications even if they are out-of-pocket, rather than have the heart attack (OHIP covered visits to the cardiologist!  If you survive!)

Cost of a simple 1-surface white filling on a molar: in 2012, $134 and a bit of tooth.

Cost of a four-canal root canal, core, and crown on the same molar because the cavity was allowed to get too deep: in 2012, $2170 and a lot more tooth material, leaving a tooth that is weakened for life.  And if you’re thinking what would have been the cost of an extraction?  Minimum $153 for an x-ray and extraction.

So does dentistry in Barrie cost a lot?  Compared to a pair of socks, yes it does.  Compared to a house, no it doesn’t.  Compared to other artificial body parts and health care, it’s right in line.  We hope this provides you a new perspective or better clarity on things.

Of course, we won’t know how much or how little dentistry you need until we have a look at your mouth!  For a customized overall assessment and treatment plan, please contact us!  We’d love to be your dentist in Barrie.

Elston Wong

Dentistry has evolved from basically a technical exercise with relatively few options, to a dream-it-and-you-can-have-it proposition. What does this mean in reality? Allow us to illustrate:

In the 1950′s dentistry was mainly a tooth-by-tooth affair that followed a break-and-fix mentality. If you had a problem with a tooth, you filled it. If you had a big problem with a tooth, you pulled it. If you wanted to replace teeth, you put in a denture. And that was about it! Pretty simple, and unfortunately that is all too often the extent of people’s understanding of dentistry. There was little talk of prevention, or aesthetics.

Just as you would never ask your physician nowadays to practice 1950′s-style medicine, we should not be limiting or relegating ourselves to 1950′s-style dentistry. Our understanding of teeth and the oral-facial complex is so much better now. The technology is so much better. And most importantly, our approach to oral health management is so much more holistic (not in the airy-fairy sense) and sophisticated now. Here is a taste:

Start with the end in mind. We can now provide you with simulations of what we think we can do with your teeth. This lets you “test drive” things as best as possible before you proceed with treatment, and shows you what is achievable.

Prevent problems before they start. The world has moved on from a break-and-fix reactive model to a more proactive model of care. This means that we can identify potential problems and take steps to prevent them, rather than dealing with things after they get worse. This can mean single-tooth problems such as fractures, all the way to bite problems that can cause future TMJ pain. It’s all a part of the risk assessment that we perform, and is the future of dentistry.

You’re the star, and we’re the director. When there were few options available for teeth, there wasn’t much room for input. Now that we can pretty much do anything, there is much more of a role to be played by you! Just tell us what you don’t like. Do you think you have crooked teeth? We can do some orthodontics to fix that. Do you think you show too much gums when you smile? We can fix that.

A gummy smile – is this the result of too much gums? Maybe the whole upper jaw is too far down? Or, maybe it’s just a lip that moves too high and reveals too much tooth. Whatever the problem, we can fix it to make smiles look natural.

Don’t be nervous. There are more civilized ways of doing dentistry for the dentally fearful than just white-knuckling it. There are sedation options for you that can make you relaxed, or really relaxed. It never pays off to put things off.

Dentistry is only going to get better. Is there a catch? Sort of. When we started, we said you would never ask to have 1950′s-style medicine performed on you. Dental insurance is pretty much that – 1950′s style dentistry with slight modifications for this decade. Unfortunately, much of the mentality of dentistry is still dictated by an insurance plan, which we’ve said before is the wrong way to think about things. Free yourself from the constraints of dental insurance, and you will enjoy your teeth for longer.

Of course, none of this is possible without a thorough assessment of the state of things in your mouth. Please contact us for a customized examination and diagnosis. We’d love to be your dentist in Barrie.