How do I go about home teeth whitening?

Our dental hygienist Dulene Swanepoel talks about home teeth whitening and shares tips on how to prevent tooth sensitivity.

Immediately-loaded Dental Implants: What You Need To Know

Dr. Michael’s Dental Clinic’s Oral Maxillofacial Surgeon Dr. Walter Goriwoda, MD, DMD answers the most commonly asked questions about immediately-loaded dental implants.

1. What are immediately loaded implants? Are same day implants the same as immediately loaded implants?

In modern dentistry, missing teeth should be ideally restored by insertion of dental implants. In many cases and specifically in the aesthetic regions, where patient would show gaps after tooth extraction, a single dental implant can be placed immediately after tooth extraction into the fresh extraction socket. In most cases, the implant is stable enough to be loaded with an immediate implant crown. To allow for osseointegration of the implant, the surrounding bone has to grow right onto the implants surface without being disturbed by any movements of the implant. This is why the immediate crown on a newly inserted single dental single implant should not be subjected to any masticatory forces for several weeks.

In cases where rehabilitation of all teeth in upper or lower jaws is necessary, at least 4 implants (better more) should be inserted into one jaw. The whole dentition can then be attached to these implants as a suprastructure. Due to different biomechanics, minor masticatory (chewing) forces can be tolerated immediately.

The term same day implants is mainly used for advertising purposes, but indeed comprises immediate loading of the newly placed dental implant.

2. Who are the best candidates for immediately loaded implants?

Ideally the best candidates are young, healthy, nonsmoking patients without any periodontal disease and sufficient amount of bone, which of course is almost never the case! There is always a specific reason for the necessity to remove a tooth/teeth and each case has to be investigated individually for the suitability of extraction with immediate implant placement and loading. In general, there is very few absolute contraindications.

3. What are the benefits of immediately loaded implants?

Following a conservative treatment modality means to wait 3-6 months after tooth extraction. Then the implant is placed and another 3 months for osseointegration are awaited before the restoration with a crown takes place. This is an almost unacceptable long period of time for our modern society! But more importantly, another negative side effect might occur during this waiting periods which is resorption of bone and recession of gums.

Insertion of a dental implant right after tooth extraction with immediate placement of a crown has a superior outcome when it comes to the long term aesthetics of the surrounding tissues. The alveolar bone surrounding the newly placed immediately restored implant and its surrounding gums will be preserved to its maximum degree. It should be the treatment modality of choice for aesthetic areas where the patient shows gums when smiling!

And of course it is a nice side effect for the patient to get a complete dental rehabilitation in a day and not to suffer from a socially unacceptable tooth gap for several months neither to struggle with some temporary removable denture.

4. What is the success rate of immediately loaded implants?

The success rates of extraction with immediate implant placement and immediate loading of primary stable implants do not differ from the conservative treatment modality, when the suitability is clinically assessed prior to surgery. Prognosis can be compromised due to periodontal disease, insufficient oral hygiene, or systemic disease but then all dental surgical procedures are more prone to complications independent of which implant insertion concept was followed.

5. What is the procedure like? How many appointments will it take to get the implants and crowns done?

The removal of the tooth is the more invasive surgical part. Inserting the dental implant into the fresh extraction socket is easily practicable. In most cases the implant is stable enough in the anterior jaw and can be immediately restored with a chairside custom made temporary crown. The whole procedure of dental rehabilitation is done in one session only and takes approximately 2 hours.

6. What can patients expect after receiving their implants?

Depending on each patient individually and the location of extraction and implant placement, some amount of swelling and pain, must be expected for about 3-5 days and even bruising might occur.

7. How often should patients come to visit their oral surgeon after the implants are done?

It is advisable to have a follow-up with the surgeon approximately a week after implant placement and again prior to restoration with the permanent crown. In the long term, the implant maintenance constitutes of regular sessions with the dental hygienist and normal follow-ups with the dentist.

5 Things You Should Know About Fluoride & Your Child’s Teeth

By  Dr. Carol Onyango, DMD, MPH

1. What is fluoride?

Fluoride is a compound that contains the natural element known as fluorine. Routinely using small amounts of fluoride can help prevent tooth decay. Studies have shown that in places with community water fluoridation, decay rates have reduced by over 50 per cent and children grow up with fewer cavities. Where fluoride is not available in the community water, the use of toothpaste, mouth rinses and professionally applied gels and varnishes containing fluoride as the active ingredient is highly recommended to help reduce tooth decay.

Dr. Carol Onyango, DMD, MPH 
Specialist Pediatric Dentis

2. How does fluoride prevent cavities?

When sugar is broken down, it forms an acid which attacks and weakens the tooth enamel by causing the loss of minerals and creating cavities. Fluoride helps prevent this loss of minerals and encourages strengthening of the enamel in areas where cavities are just beginning to develop. Fluoride also affects the bacteria that help in causing the acid attacks on the teeth. When the use of fluoride is combined with a healthy diet and good oral hygiene, the risk for decay is reduced even further.

3. Is fluoride safe?

There is confirmation from clinical studies that fluoride use in the appropriate quantities for the prevention and control of tooth decay is both safe and highly effective. However, products containing fluoride should be stored out of reach of young children.

4. What happens if my child swallows fluoridated toothpaste while brushing?

To avoid ingesting excessive amounts of fluoride, always monitor children to make sure that they are using the correct amount of fluoride toothpaste for their age. This should be a smear amount for children less than three years of age and a pea-size amount for children aged 3-8 twice daily.

5. My child’s dentist suggests fluoride varnish? What is it for?

Topical fluoride is used and applied by a dental professional to prevent tooth decay. It comes in the form of gels, foams and varnish. Gels or foams are placed in trays and held against the teeth for up to 4 minutes while fluoride varnish is “painted” on teeth.

Image: American Academy of Pediatric Dentistry
Comparison of a smear (left) with a pea-sized (right) amount

World Oral Health Day 2016

It’s never too early or too late to start looking after your oral health. 

Sunday 20 March is World Oral Health Day. 

#WOHD16 #ItAllStartsHere

What Are the Potential Causes of Toothaches?

By Dr. Marwan Al-Obeidi, Clinical Head at Dr, Michael's Dental Clinic

There are many causes for toothaches. Carries could be primary, where the tooth has never been filled before (new decay) or it could be secondary, where it occurs below the fillings. It could also be caused by fractures or cracks of the teeth (patients who are grinding). Pain could also come from an impacted tooth. There are some case where the pain does not come from the tooth itself but from the gums around the tooth. Sometimes even nerve pain can manifest itself as toothache. That's why the dental checkups and visits are very important.

What You Need to Know About White Spots and Braces

Written by: Dr. Argiro Kechagia, Specialist Orthodontist

A very common problem that can occur while a patient has braces is the formation of white spots during treatment and it is always a bit disappointing to find that your teeth are marked with chalky white patches after your braces are removed.

But why?

Many believe that braces can cause these spots to appear, but in reality they are the result of plaque build-up just like any other form of tooth decay. These chalky patches, or dental decalcification, affect 24% of all teenagers without braces. That number jumps up to 50% in teenagers with braces. Although braces are not directly responsible for causing these white spots to form on your teeth, they can complicate the process of plaque removal. The white, chalky marks on the teeth appear when acids created by the plaque, remove minerals from the tooth surface and change the way it reflects light. Decalcification, most commonly affects the region between the gums and the brackets where plaque is most difficult to remove. So, braces do not cause white spots, bad oral hygiene does!

Can I prevent it?

Of course you can; and it is very simple, brush your teeth. Keep the plaque to a minimum. When you brush, be sure to focus on the areas that are obstructed by your brackets and wires, place the bristles of your brush underneath the wire. Finally, try to avoid having sodas and other foods that are high in sugar and acid, as these build plaque fast.

What if I have them already? Can I make them disappear?

1. The first step is to improve your oral hygiene with meticulous brushing in order to give some time (around 6 months) to the enamel to re-mineralize the affected tooth surfaces. All white spots improve some with time and minor ones may disappear altogether.
2. After 6 months our dentist can give you low concentration fluoride rinses and remineralization pastes that can be used in order to improve further the appearance of white spots.
3. Alternatively, bleaching, as it lightens the enamel, can make white spots to blend in better and actually improve as the effects of the bleaching wear off.
4. A newer technique, known as “caries infiltration,” involves injecting a liquid tooth-colored resin, which has optical properties closer to natural enamel, beneath the surface enamel in the area of the white spot. This makes the spot less opaque and more translucent like normal enamel.
5. For more severe problems, your dentist may perform microabrasion (removing superficial white spots), cosmetic bonding (replacing damaged enamel), or place porcelain veneers (covering badly damaged surfaces).

 Always remember that the best treatment is prevention.

5 Most Common Questions on Brushing Kid's Teeth

Written by Dr. Carol Onyango, Specialist Pediatric Dentist

Moms and dads, here are five things you need to know about brushing your little one’s teeth.

1. When should I start brushing my child's teeth?

You should start brushing your child's teeth when the first baby tooth erupts (grows in the mouth).

2. What's the right way to brush my child's teeth?

The best way to brush your child's teeth is in a circular motion with a soft toothbrush of age-appropriate size. All surfaces of all teeth should be brushed to help dislodge food and reduce bacteria plaque levels.

3. How much toothpaste should my child use? Should I use a fluoride toothpaste?

Fluoride in the right amount is safe and effective in preventing and controlling tooth decay; and fluoride toothpaste is recommended twice daily.

A smear amount of fluoride toothpaste should be used for children under age 3, while children 3-8 years old should use a pea-sized amount.

4. When can my child start brushing on his/her own?

Your child can start brushing their own teeth when they can hold a brush well. However, this does not mean that they will brush well and there is no specific age when a child will do this. Supervision and assistance is needed for all children and can in some instances, continue into adolescence.

5. What can I do if my child refuse to brush his/her teeth?

Many young children will give parents a hard time with brushing but it's important to persevere through the process because a healthy mouth is much better than the consequences of tooth decay and gum disease. While visiting your pediatric dentist, they can demonstrate how this can be done to make the process quicker while still efficient.