Dr. Brian Saby's Dental Blog

Like everything else in the world, technological breakthroughs have changed dentistry.  Today, the modern dentist is doing things, which were technically impossible even five years ago and unimaginable twenty years ago.  With all this change, the average perception of a dental visit has not changed.  When most people go for a dental check up, they expect the dentist to tell them what is wrong, and what “needs to be done”.   This attitude is still shared by many dentists as well.  The dentist will look for problems and disease and fix these.  This “patch and fill” approach has served us well for many years, however, there is another approach which is better.  Give the patient some choices!

One of the first things you and your dentist should do when deciding you get together is determine your long-term objectives concerning your teeth.  Do you want to have your teeth for the rest of your life?  If you want to keep your teeth (most people do, and most should have no problem in this regard) is there anything you would change about the appearance, or function?  Would you like to prevent any future dental problems?   Once you have determined these goals, your dentist should perform a very thorough examination and give you some treatment options to help you achieve the desired results.  It is morally and ethically imperative that your dentist present to you a treatment plan which outlines the best treatment that is available in 1999 style dentistry.  This treatment plan should achieve your dental goals; cost, time of treatment, complexity or other factors should not be part of this planning phase.  You have the right to know what is the best available, and the dentist is morally and ethically obligated to let you know what you could have, if you so choose.  Now that you have an idea what could be done, you can now look at the other factors involved in making the decision: How many appointments would it take?  Would braces be required?  How much would it cost?  Would there be any discomfort?  Your dentist should be able to answer all of your questions or concerns.  If the treatment plan is not to your liking, it may be possible that there are other treatment modalities available which would be acceptable to you.  The dentist’s job is to let you know what treatment is available, your job is to determine if this is something you would like, is this the right dentist to perform the treatment, and what time frame you would like to do the treatment.       

Today, a person can have almost anything they want when it comes to how they would like their mouth and smile.  People without teeth can now have teeth implanted so they no longer require dentures.  Those unhappy with the appearance of their teeth can have their smile changed to give them a perfect smile.  Dental restoration can be constructed which will last a very long time, and broken teeth can be avoided.  Fillings can be made that look just like natural teeth, giving the appearance of having no fillings.  Unfilled teeth can be sealed to prevent cavities.  Missing teeth can be replaced easily.  Worn and aged appearing teeth can be restored to give a more youthful appearance.  All you have to do is decide what you want.

For the most part, we do some pretty neat things in dentistry today.  We can help people by drastically improving their smiles; we can restore function, and provide the peace of mind that comes with having ideally restored teeth.  This is rather fulfilling for the dentist, but every now and then we treat a patient where we make a dramatic difference and are able to change their lives.  Last week was such a time.

We had been treating a lady in my practice (we will call her Mary) for the last several years.   When we first saw her, her main complaint was her poor fitting upper and lower dentures.  For you to fully understand her problem, we must first go over some things that happen when a person loses their teeth.

Traditionally, when most people lose all their teeth, they initially have a set of dentures made.  These are made of an acrylic base with either porcelain or plastic teeth.  The acrylic base rests on the gums.  The dentures are held in by the suction created by an accurate fit.  The upper dentures, with six times the surface area, suck in well, while the lower denture with less area and a tongue and cheeks to dislodge it, fits adequately. 

Most people can get by with their dentures after sufficient learning and adapting.  Even though the best dentures offer only 25% of the biting ability of natural teeth, the adaptability of people makes this a workable solution to their problem.  However, things get worse.

In the jaws, there are two types of bone, the base bone and the bone that goes around the teeth (basal and alveolar bone for you jargon junkies).  When the teeth are removed, the bone that goes around the teeth immediately begin to dissolve since the stimulus for maintaining the bone, namely the teeth is gone.  Initially, there is usually enough gum-covered bone, to form a ridge.  Over time as the bone shrinks, the dentures fit becomes poorer and poorer.  Every couple of years, a new base needs to be placed on the denture, this is called a reline.  Owing to wear of the teeth and shrinking gums, the dentures need to be replaced every 6 – 8 years.

The amount of bone shrinkage is the biggest problems facing denture wearers.  In most people, the total amount of bone loss is such that they will still be able to function with a denture. In others the bone loss is so great that they have a difficult time with their dentures.  At a certain point, it becomes impossible to construct an adequate denture. Usually, this is seen in the lower jaw since there is no palate to take some of the load.   No one can make a functional, comfortable denture when the foundation has been destroyed due to bone loss. 

Mary was such a person.  She had lost her teeth in her early 20’s.  Over time she had lost almost all the supporting bone in the upper and lower jaws.  Where there is usually a ridge on the lower jaw, she had a ditch.  She  had lost so much lower bone, that the nerve which normally runs in the middle of the jaw, was laying just under the gums causing pain when pressed upon by the denture.  Her upper gums were not anchored to much bone and were loose and flabby.

We initially made a very accurate denture for Mary.  Painstaking attention to detail with regards to fit and the bite ensured that she had the very best denture that could be constructed.  Even with this we had to use a rubbery base on the lower denture to cushion the gums.  This denture served Mary well for about 5 years but was barely adequate.

The solution to Mary’s problem was to place dental implants in her lower jaw.  Ideally we would have constructed fixed lower teeth, but financial considerations did not allow this extensive treatment.  Instead, Mary had two implants placed in lower jaw.  To these we secured a special bar.  Clips in her lower denture allow her to snap her lower denture in place so it is stable. 

The implant placement is a simple procedure that is done under local anesthetic.  The implants are simply screwed into place and left to fuse to the bone.  There is surprisingly little pain following and no pain during placement.

After a three-month period during which Mary was still able to wear her lower denture, we made the bar.  This procedure involves no pain or discomfort for the patient. 

I knew Mary would have considerably more comfort and function with her new dentures, but how much more was not evident until I talked to her sister a few days later.  She mentioned how happy she was and how she was able to eat better with no pain or discomfort.  The most telling indication, however, was when she walked into the kitchen and heard Mary for the first time in 35 years proudly say: “Hey, look at me, I’m eating an apple!”

It is often the simple things in life that we most often take for granted yet miss the most when they are taken away.  If you would like more information about how dental implants may help you improve your life, ask Dr. Saby.

The world is full of people who suffer from headaches.  Drug companies make billions of dollars with headache remedies.  If you have never had a tension headache, you probably know someone who has.  These headaches can range from mild to debilitating.

There may be a dental reason for your headache.  That pulsing pain behind your eyes or in your temples may be coming from your teeth.  Of course, there are many causes of headaches, but a common cause for tension headaches is related to how the teeth come together.

It is fairly common for people to have “tension” headaches.  These are often more frequent during times of stress.  You know the type.  Your daughter just introduces you to “Snake” her new boyfriend, and shows you his impressive collection of tattoos he got last time he was in jail.  This, the same day your boss suggests that you should do that important project next week even though you have holidays scheduled.  Meanwhile, you discovered that someone thought your new car would look better with pinstripes done with a key.  Wow, Excedrine headache number 4.

What causes the tension in a “tension” headache?  Each tooth has a very sensitive pressure receptor around the root, which help you to chew your food without clashing your teeth.  If your top teeth do not line up perfectly with your bottom teeth, the slight misalignment may cause your jaw muscles to clench.  This can happen during the day, but more frequently occurs at night while you are asleep.  The excessive use of the jaw muscles can make them tense and sore.  The biggest chewing muscles connect to the temple region and that is why your teeth can be a cause of pain in that area.  Other muscles that may be involved are in the cheeks and neck.  You should be able to press firmly on all of these muscles without pain.  There are some smaller muscles which may be affected as well.  Some of these are inside in the jaw area.  Tension in these muscles may produce a pulling sensation behind the eyes. It is not uncommon for a person to have constant pain in these muscles, the background pain would be considered normal and periods of extra pain would be a headache. Read the rest of this entry »

As we suffer through this cold snap, my mind sometimes drifts back to days past where the weather was a bit nicer.  Last spring, I was fortunate enough to attend a performance windsurfing clinic in Florida.  One of the best sailors in our class was a fellow from New York who invented toys for a living.  He was unfortunate to have lost one of his legs just below the knee.

One day at lunch I mentioned to him that I found it amazing that he could sail so well with a prosthetic limb.  He told me that he actually designed and constructed his own attachments for his leg to allow him to utilize the foot straps on the board.

He then mentioned that the most critical part of a prosthetic limb is the interface between the prosthetic and the limb.  He had many different prosthetic legs made and was not able to participate in sports.  Apparently the fit is so crucial that any errors or distortions create extreme discomfort when extra stress is placed on the prosthesis.  Eventually he was able to find someone who could make an interface that worked for him.  He had to travel over 300 miles to see this man and the cost of the prosthesis was 5 times that of his previous legs.  Before he had experienced the better artificial leg, he was okay with the leg that he had and was adapting; he thought that he would just have to learn to live with the limitations imposed by his disability.  Now that he has the new limb, he could never go back to the other.

Now you are saying, “Brian has the cold weather frozen your brain, what has this to do with dentistry?”

I found that in some respects, the situation described above is very similar to the full and partial dentures.  There are millions of people who are using dentures as a replacement for their natural teeth.  Most of these dental prosthesis, while functional, are not optimal.

Those wearing these appliances may not even know that there could be a substantial improvement in comfort, esthetics and the ability to speak. 

The common perception about dentures is that they are equal replacements to natural teeth.  This is far from the truth.  Teeth are anchored in the gums and jawbones, dentures sit on top of the gums.  Dentures are held in place by suction.  Of course the upper dentures with six times the surface area suck in better. 

For dentures to function at the maximum efficiency, they must be made in a very precise manner.  The interface between the denture and the gums must be very carefully constructed.  The extensions of the edges of the denture have to be exact to prevent sores yet allow maximum suction with minimal movement.  The way the teeth hit in function (occlusion) has to be made in a way that maximizes the chewing ability yet minimizes the dislodgment of the dentures.  Of course, the teeth must look good and be set up to allow for proper speech.

Since the bone that supported the teeth is no longer required for teeth, it slowly disappears.  This means that the fit of a denture is constantly degrading.  It is important that dentures be relined every two years.

The best way to minimize the problems associated with dentures is to have dental implants placed.  This moves the load bearing responsibility from the gums back to the bone where it belongs.  Implant supported dentures are the ultimate in dental prosthetics.

If you have dentures and feel that you are not ready to have implant-supported teeth, you should get the best dentures that you can.  A high quality set of dentures may cost you 2-3 times as much as a bargain denture, but you will appreciate the difference.

If you have any questions about dentures and the options available to you ask Dr. Saby.

Despite the publics increasing attention to improving their oral health, the thought of going to the dentist still evokes overwhelming fear in many patients.  In some people, the fear of going to the dentist is so great that they will put up with discomfort and even severe pain, rather than seek dental care.  Some will only seek dental help when the pain becomes intolerable.  They then choose to have their teeth amputated rather than fixed.

Why is it that dental fear is so prevalent?  Nearly everyone knows a person who has an exaggerated negative dental experience.  Of course the entertainment industry has not helped quell the fears of dental patients and even Blue Cross the dental insurance company uses a subtle reference to dental fear to help keep you from using your dental benefits.

Almost every dentist has heard the story of the “old horse doctor who put his knee on my chest to get the tooth out!”  Yet no dentist I know of has ever had to put a knee on a chest to extract a tooth, nor would this ever help get a tooth out. 

To some dental fear may arise from the belief that the procedure will be uncomfortable, while others fear the feeling that they have no control over the situation.  Some people associate the sterile smell of a dental office with medical facilities that may trigger associative fears. 

In the early years of dentistry, good pain management was unavailable and there was pain associated with dental procedures.  As science progressed, the effectiveness of dental procedures and local anesthetics became better and better resulting in more comfortable dental appointments.  Today, it is possible to perform dental procedures in a totally comfortable manner.  Excellent topical anesthetics and computer controlled local anesthetic systems allow for comfortable delivery of local anesthetics with profound effects.

In the modern caring dental office, the dentist must make every effort to make the patient feel relaxed.  It is important to establish a relationship with your dentist prior to having your work done.  You should feel comfortable with your treatment plan and be confident that this is the right treatment for you.  You should also have a signal worked out with your dentist to ensure that he or she will stop the procedure should you feel any discomfort or simply need a break.

Should you need a little more that TLC to help you with your dental appointment, there are other avenues that could be explored.  Today, many dental practices are marketing “Sleep Dentistry” to aid nervous patients.  Sleep dentistry is simply the utilization of medications to help a patient through the appointment.  A medication such as Atavan, or Halcion produce a sleeplike state but still allows enough alertness for response to verbal or physical commands.  In some patients, there is also an amnesic effect that results in little or no memory of the appointment.  The utilization of these medications has allowed for even very nervous dental patients to have great dental appointments.

If you have a fear of dentists and would like to find more information about techniques to help you get the dental care you desire, contact Dr. Saby.

If you are missing one or more teeth and wish to replace them, dental implants are the first treatment choice.  This innovative technique replaces the root of missing teeth with a titanium appliance that actually fuses to your bone and becomes part of your body.  The single tooth or tooth replacement appliance is then screwed to the implant and acts in a manner similar to natural teeth.

Traditionally, missing teeth were replaced by fixed bridgework, where crowns on teeth adjacent to a space support an artificial tooth.  This works very well for short spans such as one missing tooth.  If more than one tooth is missing or if the missing teeth do not have sound teeth on either side, fixed bridgework becomes more complex.  If the spans are too long or all the teeth are missing, removable appliances such as partial or full dentures were constructed to replace the teeth. 

Anyone who has experienced partial dentures or complete dentures knows that there are all sorts of problems associated with these devices. 

Over 30 years ago, an accidental discovery by Dr. Branemark in Sweden led to the modern dental implants.  Dr. Branemark , an orthopedic surgeon, discovered that titanium screws used to hold bone plates in place were extremely difficult to remove.  Study of this phenomenon revealed that the titanium had fused to the bone and become part of the bone.  This process was called osteointegration.  He postulated that osteointegration of titanium could be used to replace missing teeth. Read the rest of this entry »

Most people are familiar with a dental check up, either having had one themselves or knowing someone who has had one.  While almost everyone is aware that the dentist is looking for cavities in the teeth, there is more to a dental examination than merely looking for holes.

 Today, I would like to walk you through a typical complete dental examination.  Hopefully, this will help you to understand what is going on at your next dental check up.

The first part of the examination involves an interview with the patient, either by the doctor or one of the staff members.  In this interview, we hope to discover what your long term plans are regarding your teeth.  What do you want your teeth to be like in the future, are there any changes you want to make regarding the appearance or function?  Are you currently having any dental problems, and if not, what brought you to the dental office today?  What are your concerns regarding dental treatment?  These are the types of questions that help your dentist establish a treatment plan that custom fits your desires. Read the rest of this entry »

We are very fortunate to live in Canada where our standard of living is amongst the highest in the world.  Our consumer driven economy allows us to have choices in almost every aspect of our life.  We get to decide on what level of service and quality of consumer products we would like to obtain.

Let’s say that you decided you wanted a larger television for the family room.  Not many of us would be happy if the salesperson were to inform us that they had looked at our old television and decided that it was still pretty good and they would not sell us a new television until it quit working completely. 

If you decided to get a new car, you would be shocked if the sales representative told you that you didn’t need a new car right now.  “Your old car is fine, you can probably get another 100,000 km out of it, come back and see me in a few years.” Is something you will not likely hear at your auto dealer.

In dentistry, you also have choices.  Read the rest of this entry »

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