General Dental Procedures

Tooth Extractions

A dental extraction is the procedure to remove a tooth from your mouth. A dental extraction is most commonly required if one of your teeth is damaged beyond practical repair. The most common reasons for tooth extractions include:

  • Severe tooth decay or infection may make it impossible or too costly to repair a tooth
  • Advanced gum disease may required a tooth to be pulled so it doesn’t affect the supporting tissues and bone structures of your mouth
  • A tooth may be extracted if it is blocking other teeth from coming in
  • During orthodontic work, teeth may need to be extracted to create room for the teeth that are being moved into place
  • Wisdom teeth are often extracted either before or after they come in

What to expect

Your dentist will first administer anesthetic to numb the area and reduce discomfort. During the extraction, you will feel the pressure of the tooth being removed, but will not feel any pain. Typically, the dentist is able to remove your tooth within a matter of minutes.

Immediately after the tooth extraction, a small amount of bleeding is normal and patch of gauze will be placed in the affected area. The area may bleed minimally for the next 24 hours or so and taper off after that. Follow your dentist’s instructions on how often to change the gauze, and what other post-procedure steps to follow.

It is important to decide if you want to replace the tooth being removed. There are several different options of tooth replacement and depending on the situation, your dentist will be able to discuss the best long term option for you.

Root Canal Therapy

Root canal therapy is treatment used to repair and save a tooth that has been infected due to a deep cavity or cracked tooth. The treatment involves removing the pulp and the nerves in the middle of the tooth, and cleaning the infected area. A tooth’s pulp and nerve is not important to a tooth’s health and function after the tooth has fully emerged from the gums. If the treatment is not performed, infection of the nerve can spread into the surrounding bone which may spread for years unnoticed. However, it is more likely that an acute infection will develop, which will probably require removal of the tooth.

What are the signs that a root canal is needed?

  • Severe tooth pain while chewing
  • Your tooth pain wakes you up at night
  • Teeth that are highly sensitive to hot or cold, with the sensitivity lingering for some time.
  • Discolouration or darkening of the tooth
  • Swollen gums in the area of the infected tooth

What does the treatment involve?

First, an opening is made into the pulp chamber (middle of the tooth) through the crown of the tooth.. Once the pulp is removed, the root system is thoroughly cleaned. If the dentist decides to complete the root canal therapy in multiple visits, a temporary filling will be placed to protect the tooth. When you return, the dentist will remove the temporary filling, re-clean the root canal and pulp chamber, fill the root canal system with a plastic like filling material, and place a permanent filling and / or crown over the tooth.

Root canal therapy has a high rate of success (>95%) and many teeth undergoing the procedure can be saved to last a lifetime. However, root canal treated teeth are more brittle and they are more susceptible to fracture. As a result, it is highly recommended that root canal treated teeth are protected with crowns to prevent future breakage.

Composite Fillings

When treating a cavity, the dentist will remove the decayed portion of your tooth and fill it with another substance. This procedure is called a filling. There are multiple options for the material to be used in the filling, the most common of which are composite fillings and amalgam fillings.

A composite filling is also known as a tooth coloured filling, since the material used in the filling can be closely matched to the colour of your teeth. Composite fillings provide good durability for small to medium cavities, and the procedure typically involves removing less of a tooth than you would during an amalgam filling. They are also particularly well suited for treating front or highly visible teeth because of their natural look.

When can a composite filling be used for?

  • Decayed tooth (i.e. cavity)
  • Chipped or broken teeth
  • Decreasing the gap between teeth

How its done

After the dentist numbs the area where the filling is to be placed, he/she will remove any decayed portion of the tooth. A bonding agent is applied, and hardened and cured with a special light. Once this is complete, the filling is applied in thin layers to slowly form the complete filling. After the composite has hardened, using the curing light, the filling will be smoothened and polished to be comfortable and fit your bite.

Dental Exams and X-Rays

Routine dental exams are important to maintaining healthy teeth and gums. Additionally, they can help to avoid the financial costs associated with large treatment plans later on. The Academy of General Dentistry recommends checkups twice a year for people of all ages. At this frequency, most problems can be caught while they remain in an early stage.

How it’s done

The dentist first examines your mouth visually, using dental equipment such as mouth mirrors, dental picks, and high intensity lights. They will look for cracked and decayed teeth, as well as review other important items such as:

  • Medical history review: The dentist will assess how any new medical conditions or illnesses may affect your dental health.
  • Examination of tooth decay: with the help of xrays, we are able to assess the presence of decay in between your teeth and under existing fillings. Our instruments will also aid in detecting cavities starting in the pits of teeth and around the margins of existing restorations.
  • Oral cancer screening: The face, neck, lips, tongue, throat, tissues, and gums will be checked for any signs of oral cancer.
  • Gum disease evaluation: Your gums and bone around the teeth will be checked for any evidence of periodontal disease.
  • Examination of existing restorations: Current fillings, crowns, and other restorations are made sure to be in good order.

Additionally, your dentist will take diagnostic x-rays to reveal any other hidden problems, especially in the areas below the gums. Bitewing x-rays are typically taken every 12-24 months (to detect the presence of cavities in between teeth and under existing fillings) and a panographic x-ray, which revolves around the head, is taken every 3-5 years (too assess the location and eruption pattern of adult teeth and to assess the entire head for possible lesions).

Dental Cleanings

Routine dental cleanings are important in maintaining good oral hygiene. Professional cleaning by a hygienist can remove mineralized plaque (called calculus or tartar) that may develop even with careful brushing and flossing, particularly in areas that are difficult to reach. The overall health of the gums (based on clinical pocket depths) and the amount of calculus present will dictate how often it is recommended that you go in for a cleaning. Your dentist and hygienist will recommended what interval is right for you, whether it is to come in every 3 months, 4 months, 6 months or 9 months.

How it’s done

You can expect your dental cleaning to last between 30 minutes and an hour. Typically, a trained hygienist will do the cleaning, and a dentist may come in for an exam at the end. Most people find that dental cleanings are painless, and do not cause any discomfort.

There are two important steps to a dental cleaning. The first step is scaling or root planing the teeth, whereby the hygienist will remove the plaque and tartar from the tooth surfaces both above and more importantly, below the gum line. This is performed by hand and/or electric scalers depending on the hygienist’s preference.

The second step is polishing to remove any final plaque and stains from the teeth.

The health of the teeth and gums is dependent not only by regular maintenance with your hygienist, but with continual home care as well.

Cosmetic Dentistry

Dental Inlays and Onlays

Dental inlays and onlays are a more conservative approach to tooth restoration than full crowns. The are used to repair premolar and molar teeth that have mild to moderate tooth decay, or for cracked teeth where the damage does not warrant a dental crown. Porcelain, composite resin and sometimes gold are used to create inlays and onlays. Inlays refer to those procedures where the bonded material limited to the center of the tooth, while onlays refer to those procedures where the bonded material can extend further to one or more cusps of the tooth.

What are the benefits of inlays and onlays? Natural look: Inlays and onlays have a natural tooth color that makes them virtually invisible compared to metal fillings. Great fit: Inlays and onlys will not expand or contract based on temperature like metal fillings. Longevity: Inlays and onlays can last up to thirty years, longer than any other type of filling. Minimal tooth structure removed: Inlays and onlays require the minimal removal of a tooth’s surface, helping to preserve the maximum amount of healthy tooth structure while restoring decayed or damaged areas.

How it’s done

Typically, two visits are required for the placements of inlays and onlays. In the first visit, your dentist will take an impression of your tooth, which will be sent to a lab to create the permanent inlay or onlay. Before you leave, he will fit your tooth with a temporary inlay / onlay to keep the tooth protected between visits. During your second visit, the dentist will remove the temporary protective material and fit your tooth with the permanent inlay or onlay received from the lab.

Dental Bonding

Dental Bonding is a restoration procedure in which a tooth-colored resin is bonded to a tooth and cured with ultraviolet light. Bonding is faster and cheaper than veneers or crowns, and can thus be a good option to make small cosmetic improvements to your teeth. Unlike veneers and crowns, bonding can be done within one office visit since nothing has to be custom made by a dental laboratory. Additionally, the procedure typically requires removing less the tooth enamel compared to veneers and crowns. However, since bonding typically doesn’t last as long as other forms of restoration and is less resistant to stains, it is used more often for small cosmetic touchups rather than major restorations.

How its done

First the dentist determines exactly what colour shade your teeth are to select a resin that will blend in naturally. Once this is done, the dentist will prepare the tooth so that the bonding material will adhere easier. This involves roughening the surface of the affected tooth and applying a liquid conditioner. Once this is complete, the dentist will apply the resin to the tooth, and cure it in place using an ultraviolet light. Finally, the dentist will apply the finishing touches by shaping and polishing the resin for a good fit.

Dental Veneers

Dental veneers are thin custom made shells that cover the front surface of your tooth to improve their appearance. They are made of tooth colored materials and can be used to improve the color of teeth that have been worn down or stained. Alternatively, they can be used to improve the shape or size of the tooth.

Types of veneers

There are two types of veneers that are commonly used. Porcelain veneers are more durable, and resist stains better. The properties of the material also helps to create a very natural tooth look. Unlike porcelain veneers, composite resin veneers are not made in a laboratory, but instead directly applied to the teeth. They typically have a shorter life span, and are less expensive.

When should you consider dental veneers? You talk to you dentist about dental veneers if

  • Your teeth are stained or discolored teeth
  • Your teeth are crooked or misshaped teeth
  • Your teeth have spaces between them
  • Your teeth are broken or chipped

How its done

Two visits to your dentist are typically required for porcelain veneers. At the first visit, three important steps are completed. Firstly, the your teeth is prepared to be fitted with a veneer, which will involve trimming a portion of the tooth so the veneer can be bonded on top. Secondly, an impression is taken of your tooth which will be sent to a laboratory to prepare the veneer. Finally, you may receive a temporary veneer depending on how much of your tooth structure was removed. This temporary veneer will protect your tooth while the permanent veneer is prepared at the laboratory.

At the second visit, the temporary veneer, if you received one, will be removed. Then, the new veneer received from the laboratory will be checked to see if it fits well. It’s best not to adjust porcelain veneers after they are bonded to your teeth, so any adjustments will be made beforehand. Once you and the dentist are satisfied with the look and feel of the veneer, it will be bonded to your tooth.

Dental Bridges

A dental bridge is a false tooth that is used to fill the gap created by missing tooth or teeth. A gap between your teeth can be potentially dangerous to your dental health, as it can cause your teeth to shift resulting in a change in your bite that could be painful. Dental bridges help alleviate this problem by using the two surrounding teeth as anchors to hold a false tooth in the place where the gap is. Typically, porcelain crowns are placed over the surrounding teeth, and the false tooth, known as a pontic, is fused between them.

Types of dental bridges

There are three types of dental bridges that are commonly used today:

  1. Traditional fixed bridge – This is the most common type of dental bridge, in which porcelain crowns are placed over the two surrounding teeth and used as anchors to hold the fale tooth in place. The false tooth is usually made of either porcelain fused to metal or ceramics.
  2. Cantilever bridge – A cantilever bridge is used when teeth are present on only one side of the gap. These are used typically in areas of your mouth that doesn’t experience an intense chewing load, such as your front teeth.
  3. Resin-bonded bridge – In a resin-bonded bridge, metal bands are bonded to the surrounding teeth with resin and used to hold a plastic false tooth in place. This type of bridge is typically used in areas of the mouth that undergo less stress, such as the front teeth.

How it’s done

A minimum of two visits are required for placing a dental bridge. At the first visit, three important steps are completed. Firstly, the surrounding teeth are prepared to be fitted with a crown. This may including filing down the tooth so that the crown can fit over it. Secondly, an impression is taken of your teeth which will be sent to a laboratory to prepare the bridge and crown. Finally, the dentist fits your teeth with a temporary bridge to protect them while the bridge is prepared at the laboratory.

At the second visit, the temporary bridge is removed and the new bridge received from the laboratory is fitted and adjusted. Multiple visits may be necessary to check and adjust the fit.

Teeth Whitening

Our teeth can discolour through the years as our enamel wears down. The wearing down of enamel allows dentin, a yellow color substance that makes the core of our teeth, to show through. This is what gives our teeth a yellowish tint. Teeth whitening helps restore teeth to a shiny white colour through the use of bleach.

Teeth whitening methods

The best method, involves the use of take home whitening kits. These professional whitening kits are purchased from your doctor for use at home. The strength of the gel used in these kits is lower than that used for in-office bleaching, and thus the gel can be applied for longer periods of time. Usually the custom made trays are worn a couple hours a day or overnight for a few days or weeks depending on the product. The beauty about this system is that if specific teeth are darker than others, you can selectively whiten those teeth until they become the same shade as the rest of the teeth, at which time all of the teeth are whitened together. The other advantage of this system is that if patients wish to whiten their teeth in the future, additional whitening product can be purchased for a fraction of the cost since the bleaching trays can be used indefinitely (as long as they still fit). We do not recommend in-office whitening for a few reasons. First and foremost is the risk for increased sensitivity, as the strength of the solution used is much higher than the at home solutions. Economically, the cost of in-office bleaching is about 3X that of professional at home kits. Finally, in-office bleaching does not offer predictable shade results and you may end up needing a second appointment to achieve the result you are wanting.

Porcelain Crowns

Compared to fillings which just cover a small portion of a tooth, a crown (or cap) encases the entire visible portion of a tooth. In effect, the crown acts as the tooth’s new outer surface. A dental crown is used when a tooth is broken or decayed to such an extent that fillings aren’t able to repair the problem. The crown is able to provide a protective shell around the damaged or decayed tooth to strengthen it, as well as to improve the appearance of the tooth. They can also help restore a tooth to it’s original shape and are used commonly for teeth that have been broken. While crowns come in different materials, the most common crowns typically have some mixture of porcelain in them to give them a look and feel similar to a natural tooth.

How it’s done

The first visit to your dentist involves reshaping the tooth and taking impressions to create the crown. Typically a portion of you tooth will have to be removed for the crown to fit properly. After the dentist reshapes your tooth, he will use a special material to create an impression of it. This impression will be sent to a dental laboratory to be made into a permanent crown. Before sending you home, the dentist will provide you with a temporary crown to cover your tooth in between visits.

When you return to you dentist, he will have received the permanent crown from the laboratory. He will remove the temporary crown and fit the new permanent one. Before cementing the permanent crown in place, he will ensure that it fits comfortably and matches the colour of your teeth.

Specialty Dentistry

Orthodontics

How Orthodontic Treatment Works

Orthodontic appliances can be made of metal, ceramic, or plastic. They may be removable or they may be brackets bonded to the teeth. By placing a constant, gentle force in a carefully controlled direction, braces slowly move teeth to a corrected position. In this generation it is a great time to wear braces! Gone are the days when a metal band with a bracket was placed around each tooth. You can choose brackets that are clear or metallic in color. You can choose the color of the elastics that hold the wire into the brackets. Wires are also less noticeable than they used to be and the latest materials move teeth faster with less discomfort to patients. We also offer Invisalign orthodontic treatment of teeth which involves aligning teeth with clear tray aligners without the use of brackets. Once again the viability and ability to use these aligners to straighten teeth is determined on an individual basis. Invisalign may be on option to straighten your teeth or they may not be an option. Our dental team can assess your teeth to determine whether you are a candidate for Invisalign. For more information about Invisalign please refer to the Invisalign website.

Duration of Treatment

Treatment time typically ranges from one to three years, depending on the growth of the patient’s mouth and face and the severity of the problem. Patients grow at different rates and will respond individually to orthodontic treatment, so the time to case completion may differ from the original estimate. The patient’s diligent use of any prescribed rubber bands or headgear is an important factor in achieving the most efficient treatment. Interceptive, or early treatment procedures, may take as few as six months. More complex cases can take up to 3 years.

Orthodontics for Children

It is recommended that your child is seen by age 7 in order to advise you if orthodontic treatment is required and when is the best time to start treatment. Every child is assessed on an invidual basis by our dental team. The first permanent molars and incisors have usually come in by that time and crossbites, crowding, and other problems can be evaluated. Early treatment and monitoring is highly recommended and can prevent future complications. Dr. Mang will evaluate the oral situation and recommend treatment. Often we will take care of most orthodontic treatment. Conditions which are too complex are referred to an Orthodontic specialist. Rest assured you are getting excellent care with your family and child’s best interest of utmost importance all the time.

Often, when treatment is begun early, we can guide the growth of the jaws and guide incoming permanent teeth. Early treatment can also regulate the width of the upper and lower dental arch shapes, gain space for permanent teeth, avoid the need for permanent tooth extractions, reduce likelihood of impacted permanent teeth, correct thumb-sucking, and eliminate abnormal swallowing or speech problems. In other words, early treatment may simplify later treatment.

Orthodontics for Adults

Orthodontic treatment can be successful at any age and adults especially appreciate the benefits of a beautiful smile. It improves confidence, self esteem. One of every five patients in orthodontic treatment is over the age of 21. Jaw surgery may be required for adult orthodontic patients because their jaws are not growing but in the majority of cases this is not required. Once again this is assessed based on individual needs. Adults also may have experienced some breakdown or loss of their teeth and bone that supports the teeth and may require periodontal treatment before, during, and/or after orthodontic treatment. Bone loss can also limit the amount and direction of tooth movement that is advisable. For most people, a beautiful smile is the most obvious benefit of orthodontics. After your braces come off, you’ll feel more self-confident. During your treatment, we want you to feel as comfortable as possible.

Dental Implants

Dental implants are becoming an increasingly popular method for replacing missing teeth. In this procedure, titanium supports are precisely placed into the bone where the tooth used to be, and act as an anchor for naturally looking porcelain crowns. Dental implants are not only used for individual tooth replacement, but can also be used when replacing multiple teeth as an alternative to dentures. In addition, patients who currently wear dentures can have the stability and retention significantly improved by having their dentures ‘snap and lock’ onto dental implants.

Dental implants require adequate height and width of bone in order for them to work. If the bone levels are inadequate, additional bone (bone graft) needs to be placed at the site prior to placing an implant. The best time to place bone in the site is at the time of the extraction. Once this new bone gets incorporated into the patient’s own bone (after 4-6 months), an implant can be placed successfully.

Advantages of dental implants

  • Implants are extremely natural looking unlike bridges where adjacent teeth are being used to hold the missing tooth in place, implants are totally independent of other teeth, making it easier to clean and maintain
  • Fusion of the implants into your jaw make them very stable and comfortable compared to traditional dentures
  • They last a lifetime
  • Implant costs are close to that of a bridge

Disadvantages of dental implants

  • Implants are more costly than dentures
  • The process of getting implants can be time consuming and requires multiple visits to the dentist
  • There is a chance the surgery fails (less than 5% of the time)

For more information about whether or not you are a candidate for dental implants, please don’t hesitate to come in for a complimentary consultation.