Dr. Brian Saby's Dental Blog

Since graduating in 1981 I have seen some incredible changes in the delivery of dental services.  I thought it would be a good idea to share some of the changes with you, as a lot of the changes in dentistry are not readily apparent to the general public.

When we were in dental school, esthetic dentistry was not even discussed except when we were setting up a denture.  When we were restoring teeth, the goal was to make the front teeth acceptable in appearance, and little or no consideration was given to the appearance of the back teeth.

At that time, it wasn’t that dentists were unconcerned about the appearance of our patients; it was that the materials and techniques available to us were limited.  Back fillings were either silver amalgam or gold.  Front fillings were available in tooth coloured material, however, the material was not that great and a limited number of tooth shades were manufactured. 

The goal when placing a restoration in a tooth is to have a seal that will prevent leakage of the oral fluids.  Gold restorations could be constructed to have a mechanical seal; gold is malleable and can be burnished to obtain the excellent fit required.  Silver amalgam restorations seal the filling by corroding.  The corrosion layer between the filling and the tooth has enough thickness to seal the cavity.  Both of these restorations have a great track record and still function as acceptable restorative materials, however they are not always acceptable in appearance especially in front teeth.

White fillings were made of composite resins filled with finely ground glass particles.  The problem with these fillings was that they did not stick to the tooth, therefore there was limited usage and the fillings did not last very long.

Things were changing quickly.

To create a long lasting restoration that did not leak and create sensitivity, there needed to be a way to glue the filling to the tooth.  It is very difficult to glue to a tooth.  This is good for you as this keeps things from sticking to your teeth (except spinach), but creates a problem for a dentist who wants to stick a dental restoration on your tooth.  While it was discovered as early as 1955, that application of a mild acid solution to a tooth created a surface that could be bonded etching and bonding of teeth did not become routine until the late 70’s.  In the 80’s great advances were made in the science of bonding to tooth structure.   With these advances came new tooth coloured resins with greater colour matching and strength.  Light cured resins were developed to allow for greater control of placement by allowing the dentist to cure the resin on demand.  (That is what the blue light does, for those of you who have had bonded restorations.)  The advances in dental bonding are ongoing.  We are currently in the seventh generation of dental bonding resins.

Today, we can predictably bond to tooth material.  This allows for placement of restorations that are not only acceptable, but also invisible.  The modern dentist can make front and back tooth restorations out of composite resin or bonded porcelain, that not only look great but also function like a normal tooth.

Dental bonding has dramatically changed the way dentists practice dentistry.  It has opened a whole new field of esthetic or cosmetic dentistry.  Today, if you would like to change your smile to make it look better you have that option.  A dentist trained in smile design and current in the state of the art esthetic procedures can easily create for you a smile that you love.

For more information about esthetic dental restorations ask Dr. Saby 

Previously, I have discussed dental goals, for the most part everyone has the same goals:  teeth that look good, feel good, chew well and last a long time. 

The first phase of treatment is phase one treatment, where the object is to stabilize the existing teeth and gums.  This is achieved by placing fillings where there is decay, treating gum disease and stabilizing the bite.

After phase one treatment, it is time to move to phase two treatment.  This is where, missing teeth are replaced, damaged teeth are restored to optimum function and any esthetic improvements are made. 

To maintain proper function and stability, it is important to replace any teeth that are missing.   While it is true that many people are missing teeth and get along quite fine, this is more to do with the adaptive nature of the human body than the fact that the teeth are not necessary.  The teeth are arranged in an arch, disruption of the continuity of the arch results in aberrant biting which must be compensated for.  Loss of an opposing tooth will result in the opposite tooth drifting down.  If you have a tooth that has lost the tooth in front of it, this will result in tipping forward of the back tooth.  Over time this changes the bite and may result in excessive wear, TMJ symptoms or further tooth loss.

Teeth can be replaced with either dental implant supported crowns, fixed bridgework or removable bridgework.  The rule is, fixed is better than removable, an implant is better than a bridge.

Teeth that have been badly broken down by decay or wear, or teeth that have excessively large fillings can be restored with crowns.  A crown is much like an outside filling.  It is cast and becomes a solid unit that fits over the damaged tooth, it is shaped and acts like a tooth.  A crown can be either gold, porcelain fused to gold, milled ceramic or cast ceramic.  What material is used depends upon the situation.

Esthetics can be improved by using whitening, bonding, veneers or crowns, again depending on the situation.

While sometimes simple and sometimes complex, there are very few dental conditions that modern dentistry cannot improve.  If you want to enjoy a comfortable, functional mouth that also looks great, ask your dentist for more information.

Once a dentist has finished a comprehensive dental examination, he must come up with a treatment plan to help meet the patient’s dental goals.  These usually are:  Comfort, function, stability and esthetics.  More plainly: Look good, feel good, chew well and last a long time. 

To reach these goals, we often divide dental treatment in to two phases.  Phase one treatment involves the treatment of active disease.  Phase two treatment involves repair of damage caused by the previous disease.  In some cases, phase one treatment will be all that is required, in other situations, phase one and phase two treatment can be accomplished at the same time.  Sometimes, phase one treatment must be completed prior to phase two treatment.

Phase one treatment…stopping disease.

Creating healthy gums.  This usually involves gum treatment.  The goal is to have healthy gums that do not bleed.  This usually means a trip to the dental hygienist for a deep cleaning.  If the gums are still inflamed after initial gum therapy, laser gum therapy, chemical gum therapy or surgical gum therapy may be needed.

After the disease is halted phase one treatment is either completed, or the final part of the phase one treatment may be to move the teeth.  This is done to allow the bite to be as good as it can be.  Teeth are moved with braces.

Following phase one dentistry, the teeth and gums should be in a state where they are not infected or inflamed and the teeth are where they need to be. At this point, all treatment is either completed and only regular check ups and maintenance is required or it is time to start restoring the teeth to their ideal form and function…phase two treatment.

I will discuss more about phase two dentistry in our next segment.

What do dentists mean when they talk about comprehensive treatment?

Once you have had your thorough complete dental exam, which includes examination of the teeth, the gums and other soft tissue, occlusion—how the teeth fit together in function, the jaw joint and the muscles used for chewing and support of your jaw, your dentist will review all pertinent findings and make an evaluation of the overall health of you chewing system.

A comprehensive treatment plan should address not only current issues such as active decay, and gum problems but also potential problems.

The comprehensive treatment plan will be devised to obtain the optimum functional and esthetic result. 

It is the dentist’s responsibility to present an optimal treatment plan.  This discussion should include benefits of ideal treatment, potential risks of treatment and potential risks if the treatment is not done.  This allows you, the patient to make an informed decision regarding their dental treatment.

Today, I’m going to talk about occlusal or bite disease.

Teeth are negatively affected by three diseases, decay (cavities), periodontal (gum) and occlusal (bite) disease.  Most of us are aware of the signs and symptoms of the first two, probably from personal experience.

Occlusal disease does not always present itself so obviously.  Wear, sensitivity, cracks, loose teeth, fractured teeth, painful jaw joints, headaches —these can be the effects of occlusal disease.

As you chew, your upper and lower teeth come together pushing against the skull.  If you have an uneven bite, missing teeth or improperly aligned teeth, your muscles have to work harder to bring your teeth together.  If you clench or grind your teeth the strain is even greater. 

Your dentist will have the skills to recognize signs of occlusal disease and provide appropriate treatment to halt and often reverse its effects.  Recognizing occlusal disease as early as possible increases the probability that you will have young teeth at an elderly age…and possibly require less dental treatment through your life.

Your doctor knows that looking into the future means providing you with all the information about what’s happening today and how it will impact your teeth five, ten, twenty and more years from now.

You may have a poor bite if you experience any of the following:

You clench your jaw muscles for long periods of time.

When you wake up in the morning your jaw muscles are tiered and sore

You experience pain behind your eyes

You grind your teeth while sleeping

Your jaw clicks and pops

Your head or scalp feels painful when you touch it

Your ears ache or you hear ringing

You have neck shoulder or back pain

You feel dizzy.

If you have any of these symptoms, we can evaluate your bite to determine if it is a probable contributing factor.  If so, we will recommend an effective plan of treatment.

This summer I had to replace some outdoor stairs at my home.  When these stairs were built about 12 years ago, we did not use treated lumber, as a result, there were signs of rot.  The stairs were still functional, but I had some concern that they could break.  Not wanting to have a stair failure as Aunt Tilley was climbing down, I decided to tear out the old stairs and build new ones.

Many readers are now saying: “Brian, did you whack your head while windsurfing on Friday?  This is a dental column.  While we find your stair story fascinating, what has it got to do with teeth?”  Let me explain.

Many times after examining someone’s teeth and going over treatment options, I hear the line “If it ain’t broke, why fix it?”  While it may be true that there are no clinical symptoms at the present time, there may be advantages to treating some teeth before they cause problems.  Much the way we replaced the stairs before an accident occurred.

We can often predict which teeth will eventually fail.  By taking action before failure we are able to prevent dental emergencies and restorative complications and treatment of the affected teeth can be scheduled at a convenient time. Read the rest of this entry »

The following article was published in the Boise Beauty Examiner:

A smile is the universal form of communication. With a smile we can portray happiness, excitement, approval, energy, and love. Smiling is sexy- and if we smile with confidence, it’s one of the most beautiful things we can do!

The color, shape, and alignment of the teeth all contribute to a beautiful smile. Tooth whitening or bleaching has become one of the most popular beauty treatments, and thanks to our Idaho cosmetic dentists, we can have straight teeth without even needing braces! The first step to getting the smile of your dreams is to consult a cosmetic dentist specializing in aesthetics.

Choosing the right cosmetic dentist, one with extensive training, substantial experience and a gentle approach that understands clients’ needs, is the key to achieving a successful outcome through whitening or bleaching your teeth, or for achieving straight teeth and a beautiful smile! Below are some guidelines for successfully choosing a cosmetic dentist.
Does the dentist have credentials in cosmetic dentistry?
Many dentists perform some sort of cosmetic work as part of their services, but how do you know if you are paying someone who is qualified to perform tooth whitening, bleaching, or give you straight teeth and a beautiful smile? In cosmetic dentistry, as in medicine, specialties exist that are indications of a high level of education and training. Presently, however, no specialty in cosmetic dentistry recognized by the American Dental Association exists. In 1984, however, the American Academy of Cosmetic Dentistry (AACD) was formed and has the filled the need for credentials in the area of cosmetic dentistry. The organization currently has 7,000 members in the U.S. and in 40 countries around the world. It is the largest international dental organization dedicated specifically to the art and science of cosmetic dentistry, and it administers the leading accreditation program for cosmetic dentists. This accreditation process requires dentists to attend many continuing education courses in cosmetic dentistry, to be tested and to submit a number of cosmetic cases to be judged by a panel of cosmetic dentistry experts.

Read the rest of this entry »

Have you ever wondered what dentists do to keep up and get ahead in the wonderful world of dental science?

When most dentists get out of dental school, they are ready to start practice and save the world’s teeth.  It seems almost universal that a new graduate feels that they are up to date on all there is to know about teeth and that everyone else is behind the times.  “You are better off seeing a new graduate, who knows everything, rather than one of those old timers who must be behind.” is a common thought often expressed by the new dentist.

Of course it only takes about a week or two in practice to realize that maybe you don’t know everything.  In a few more weeks, you quickly discover that your dental school education prepared you for private practice in only the very basic sense.  Actually, your dental school training gave you a very good foundation on which to grow, learn and eventually become a very good dentist.  What it cannot give a young dentist is experience.

To learn more and to keep current, dentists take continuing education courses.  Local dental societies and universities traditionally gave these courses. Over time there has evolved a large business of supplying dental courses to dentists and dental staff. These are either through private businesses or non-profit organizations.

Another way for a dentist to learn and improve is to pursue a fellowship or accreditation by a recognized organization.

An example is the American Academy of General Dentistry.  This organization is dedicated to dental continuing education and has set a standard for quality in this area.  The AGD has set up a system to track and record the courses taken by a dentist member.  When the dentist has taken 500 hours of course study, they are then eligible to write the fellowship exam.  After successfully writing and passing the 400-question examination the dentist would be awarded a Fellowship in the Academy of General Dentistry.

Another organization is the American Academy of Cosmetic Dentistry.  The AACD is an organization dedicated to appearance related dentistry.  This organization has a credentialing procedure that recognizes achievement in the art and science of esthetic dental care.  A written examination, clinical case presentation and an oral examination are required to achieve accreditation.  

While it is kind of cool to be awarded a fellowship or an accreditation status, the real benefit of pursuing these is the education and professional development that occurs in the process.  The true benefactor is the patient of dentists who go through these processes.

If you are in the process of choosing a dentist, be sure to ask your dentist about the continuing education he or she pursues.

If you were to take a survey of the “over 40” crowd.  You would find that the majority of people over 40 have had numerous fillings in their teeth, especially the back teeth.  You would also find that most of the old fillings are silver amalgam and likely quite large. (Feel free to try this at your next summer barbeque; it will make you the topic of conversation for months.)

The prevalence of dental restoration in that demographic group is largely due to the fact that this group missed some important dental developments during their formative years.  Fluoridation, dental sealants and the importance of flossing and brushing in the pre-teen years being the main advances in protection against tooth decay that were advanced shortly after this age group got their first cavities.

Fortunately, dentists have been very successful in the treatment of dental decay.  For many years now we have been proficient in placing fillings teeth that have been affected by decay.   Unfortunately, fillings have a limited life span and fail over time.  Each time a filling fails the next filling needs to be bigger.  At a certain point, there may be too much filling and not enough tooth to produce a good result.

Dental fillings were designed to fill a hole in the tooth using the remaining tooth to support the filling.  When the filling exceeds a certain size the remaining tooth structure is too brittle to hold the filling without fracturing under the strain of chewing.  This results in fracture of the remaining tooth.  To prevent tooth fracture or to repair a tooth that has fractured the dentist will recommend that the tooth have a crown.

A crown (also called a cap) is a restoration that covers the outside of the tooth.  The crown acts to hold the tooth together and replace the missing tooth material.  Think of it as a casing for the tooth.

To produce a crown, a thin veneer of tooth material is milled from the outside and the top of the tooth.  This produces enough space for the restorative material and allows for the crown to be shaped so it can function like a tooth.  Usually, 1 to 1.5 mm of tooth is removed around the tooth and 1 to 2mm removed from the biting surface.  A very accurate rubber-like impression is taken of the tooth and a plaster model is produced that is exactly like the prepared tooth.  A dental lab technician will then construct the crown that fits the model, and therefore the tooth precisely.  The crown is then cemented over the tooth preparation, any you are on your way to years of happy chewing.

Crowns can be made of a number of materials.  The most conservative, longest lasting material is still gold.  The malleable nature of gold allows for final finishing in the mouth that makes for best seal.  The main drawback of the gold crown is the colour. 

If esthetics is a concern, a veneer of porcelain can be made over the gold of a crown.  With modern, porcelain technology, these teeth can be made to be indistinguishable from natural teeth.  New technology even allows for all porcelain crowns that fit well, are strong and have the maximum esthetic potential.  This is especially helpful when the tooth to be crowned is near the front of the mouth.

Dr. Saby can help you decide if it is best for you to have crowns on some of your teeth and if so, what type you should have.

It appears that there are still many people out there who are slightly misguided when it comes to complete loss of teeth.  I would like to spend this week’s column discussing dentures and the common misconceptions surrounding these artificial body part replacements.

First and foremost, you do not naturally lose your teeth when you get older.  In the past, when dental care was not generally available, it became very common for people to eventually have all their teeth out.  As it takes a while for dental disease to eventually claim all the teeth, tooth loss became associated with aging. 

In reality, there is no reason to lose your teeth, as you get older, today it is generally accepted that most people will have their teeth for their entire life and the necessity to have complete dentures is most often the result of conscious decisions.

Dentures are not a substitute for natural teeth; they are a substitute for NO teeth.  It is widely believed that removable complete dentures will give the same function as natural teeth, but even the best-made dentures cannot come close to providing the function of natural teeth.  It has been shown that the biting forces generated by dentures approach only 10 – 20% of that of fixed teeth.  Dentures are by their very nature, are loose.  Even a properly fitting upper denture is not fixed in place, but held in by suction.  Lower dentures, with 1/6 the surface area for suction and a tongue moving around are even worse.

Dentures are not factory original parts but after-market add-ons.  The gums remaining after teeth have been removed were never intended to support acrylic bases and denture teeth.  As a matter of fact, immediately following tooth extraction, the bone that was there to support the teeth, starts to disappear.  The additional load from the denture hastens this shrinkage.   As this bone loss progresses, the fit of the denture will change.  The denture wearer may adapt to this change as it happens slowly so they may not notice the subtle degradation of the fit and function.

So, yes, even though you have dentures, you should see your dentist at least once a year.  At this appointment your dentist will do an oral cancer exam and soft tissue check.  He will also evaluate and clean your denture.  If the fit is not adequate, he may suggest a reline.  If the teeth are worn out he may suggest a new denture.  We recommend that a denture be relined every two years and that they be replaced every five years.

At your regular denture and gum check, your dentist will also be able to discuss with you some of the possibilities available today where you can have a fixed solution to your problem using dental implants.