Yes. Just like in your natural teeth bacterial plaque can accumulate at the gum line and under it, around the restoration (crown or bridge) and the base of your implant causing inflammation of the gums, this is called peri-implant mucositis. This condition, like gingivitis can be reversible if treated on time.

If left untreated it will progress to peri-implantitis, where the bony structure that supports the implant will be affected, putting at risk the longevity of your implant and generally requiring surgical treatment. 

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Yes. Just like adults, children can have gum disease. Children can suffer from different types of gum disease or periodontal disease. It is also, generally caused by the accumulation of bacterial plaque on teeth due to poor oral hygiene.

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There are different forms of gum disease in children:

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Chronic Gingivitis: 

Gingivitis is the most common form of gum disease in children. Just like in adults the gums become swollen, red and can bleed easily. They might or might not be painful. If not treated it can also progress to periodontitis. 

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Aggressive Periodontitis

This is type of gum disease is found in teenagers and young adults. It affects the first set of adult molars and the front teeth or incisors. In this case patients present with severe bone loss and usually do not have an amount of plaque that justifies the extent of the disease.

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Generalized Aggressive Periodontitis 

In this case the patient presents with heavy plaque and calculus, gums are very swollen and all or most teeth are affected. It can begin around puberty.

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Certain risk factors might make your child more prone to gum disease:

- Poor oral hygiene

- A family history of gum disease

- Mouth breathing.

- Malocclusions or problems with the bite, crowding, etc. 

- Poor diet lacking nutrients. 

- Certain medications, like phenytoin and cyclosporine can cause inflammation and overgrowth of the gums. 

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Your dentist will be able to assess, diagnose and recommend the appropriate treatment for your child. 

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Yes. Now a days research shows that gum disease is related to your overall health. Initially it was thought that the bacteria in gum disease was related to other diseases but more recently it seems that it is the inflammation. However, more research is still needed to establish a specific causal association.

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Diabetes:

Diabetic patients are at higher risk of having gum disease. At the same time it has been suggested that diabetic patients with gum disease have more difficulty controlling their blood sugar levels than diabetic patients with healthy gums. The American Academy of Peirodontolgoy states that severe periodontal disease elevates blood sugar levels, which puts diabetic patients at a higher risk of having complications from diabetes.

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Heart Disease:

Research shows that gum disease increases the risk of heart disease and might make it worst. It has shown to increase in the risk of atherosclerosis or clogged arteries. Again, the inflammation that comes with periodontal disease seems to be the risk factor.

Gum disease can also but patients with preexisting heart conditions at risk for infective endocarditis. Your dentist will let you know if you require antibiotics prior to certain dental procedures. 

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Stroke:

Studies also point at gum disease as a risk factor for a certain type of stroke caused by blocked arteries.

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Lung disease:

Research points to gum disease as a possible cause of lung infections and making lung conditions worst when pathologic bacteria from the mouth reach the lungs. 

Gum disease can be prevented and if it is active, it can be stopped and controlled.

The following are some recommendations to prevent gum disease:

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1. Brush your teeth after each meal or at least twice a day and floss daily. This will remove most of the food debris and plaque on all surfaces of the teeth and along the gumline.

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2. Clean or brush your tongue daily as it also harbours bacteria.

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3. Visit your dentist and dental hygienist. They will be able to:

    -  Discuss and educate you regarding risk factors. You might be at a higher risk of having gum disease or it progressing more aggressively.

     - Recommend specific oral hygiene strategies that will help you improve plaque removal at home.

     - Do a thorough periodontal or gum assessment to be able to diagnose the presence or not and type of gum disease.

     - Based on this assessment your dental practitioner will be able to recommend the treatment and maintenance protocol that adjusts to your needs. 

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Gum disease or periodontal disease starts with inflammation of the gums (gingivitis). If left untreated it can progress to the loss of tissues and bone that supports your teeth (periodontitis). Uncontrolled periodontal disease will lead to tooth loss.

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What causes gum disease?

Gum disease is caused by bacteria in dental plaque. Dental plaque is a biofilm that builds up on teeth and contains disease causing bacteria.

Gum disease starts with gingivitis , which is generally caused by poor oral hygiene habits. It is your body 's response to these bacteria that causes the problem. At the begining you might not notice it. Gums can become red and swollen, and can bleed easily.  These are signs that your gums are infected with bacteria. Gingivitis is reversible if treated on time.

Untreated, gingivitis can advance to periodontitis. With time, plaque spreads below the gum line and the bacteria produce toxins. These toxins stimulate a chronic inflammatory response in your body and the tissues and bone that support the teeth are broken down and destroyed. The gums separate from the teeth forming pockets that become infected. As the disease progresses, more tissue and bone is destroyed and the pockets deepen.  

Patients might not have symptoms of  this disease and are surprised when informed of it's existence and severity. Periodontal disease can be stopped and controlled but lost tissue and bone cannot be regained. Left untreated, teeth can become loose and may have to be removed.

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Factors that increase your chance of having gum disease are: systemic diseases and conditions, diabetes, hormonal changes, puberty, pregnancy, smoking, aging, genetic predisposition stress, inadequate nutrition, substance abuse, HIV infection, and some medications.

The Canadian Dental Association recommends bringing your child to the dentist within 6 months of the eruption of the first tooth or by one year of age. Bringing your child for regular check ups will also help him or her adapt in a positive way to the dental environment.

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The dentist will assess your child. The main idea is to prevent any future problems.  They will discuss important information to prevent cavities and gum disease, like nutrition and proper oral hygiene; oral habits (them sucking, soothers, etc) and dental development, among other things.

1. Role playing: try playing dentist. Count your childs teeth and switch rolls.

2. The library has several books to introduce your child to the dental office: What to expect when you go to the dentist, ABC Dentist by Harriet Ziefert, Dentist trip from Peppa Pig colection, Open Wide! My first trip to the dentist by Jen Green, among many others.

3. Explain what others things can happen in the visit: a ride on the chair, you can say “ the dentist might take some pictures of your teeth with a special camera”, "he will use a mirror to look in your mouth", etc.

4. If you or one of your family members has a routine exam coming up, this is a good opportunity to take your child to observe and get familiar with the dental office.

5. Be sure to advise your dentist about any special needs or medical problems like allergies or previous surgeries.

6. Let your child bring his o her favorite stuffed toy.

Some people need to visit their hygienist more often that others. It all depends on your oral health The dentist and the hygienist will recommend visits every 3, 4, 6 or 12 months. Care and recommendations are individualized to each patient's needs. 

Regular dental visits are important because they prevent many problems from developing and help maintain oral health. They help identify problems early on, making treatments simpler and more affordable. 

Dental visit are also important because some diseases or medical condition have symptoms that can appear in the mouth.

Visiting your dentist during your pregnancy is safe and very important. Changes that occur in your body during pregnancy can affect your oral health and increase your risk for oral disease (pregnancy gingivitis, dental erosion, cavities, etc.).  The American Academy of Periodontology  recommends a periodontal evaluation if you're considering pregnancy or are pregnant.

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Routine general dentistry can be performed. Unless urgent, it should usually be done during the second and third trimester of pregnancy. If you are high risk patient or if you have any specific medical condition your dentist or your physician may recommend to postpone elective dental treatments. X-rays are safe as long as the usual protective measure are in place (lead aprons with thyroid collars and low exposure, such as digital x-rays). In most cases, unless it's an emergency situation,  we postpone them until after the pregnancy.

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Optimal oral health is very important during pregnancy. Remember that any infection can affect the health of your baby. The Canadian Academy of Periodontology  states that "...mothers with periodontal disease may be at a 7 times greater risk for having a premature or low birthweight baby". Routine 3-4 months dental hygiene visits are ideal to maintain gingival health. Your dentist and dental hygienist can help you with any pregnancy related dental symptoms you might experience.

If any emergency treatment is required during pregnancy, such as  a filling, a root canal or an extraction, you do not have to worry. Local anesthetics are safe for both you and your baby.

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1. Brush at least 2 times a day with a fluoride or calcium based toothpaste.

2. Floss at least once a day.

3. You can use mouthwash as long as it is alcohol free, e.g. listerine zero.

4. Eat a balance diet.

5. Visit your dentist on a regular basis. Cleanings are recommended every 3-4 months.

6. If you experience morning sickness or frequent vomiting rinse with a teaspoon of baking soda mixed in a glass of water. This will neutralize the acid and minimize it's erosive effect on your teeth.

It is very important to maintain good oral habits during your pregnancy. Periodontal disease during pregnancy is a risk factor for premature delivery, gestational diabetes and preeclampsia.

Yes, you can. We avoid taking x-rays during pregnancy, but if required due to pain or any other emergency, x-rays can be taken using a lead apron with a thyroid collar and minimizing radiation exposure, which we do, with the use of digital radiography.

Brushing is an essential part of the home care routine. It removes bacterial plaque from all the surfaces of the teeth, except between the teeth. 

Teeth should be brushed ideally after each meal or a minimum of twice a day. The toothbrush should be soft-bristled and fit the size and shape of your mouth. It should be replaced every 3 months or as soon as it looses it's shape. 

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Floss should be used once a day to remove plaque that sits between the teeth.

Even when people have been brushing and flossing a certain way for many years, they're amazed when the dentist or the hygienist teaches them the proper technique.

• Follow the  rule of 2's: brush at least 2 times a day for 2 minutes.

• Avoid scrubbing and applying to much pressure.

• Hold your toothbrush at 45 degree angle where the gums and the teeth meet. Gently brush in short back, and forth strokes to clean the area at the junction between the gum and the tooth. Finish with a rolling stroke from where the tooth and the gum meet to the end of the tooth

• Brush all the outer and inner surfaces. Then brush the chewing surfaces, scrubbing with a back and forth motion. 

• Brush your tongue or clean it with a tongue scrubber. Bacteria also hid on your tongue.

• Your dentist or dental hygienist will review this technique with you or find an alternative that works for you.

Cleaning between your teeth will remove food particles and a sticky film called plaque that contains the bacteria that cause cavities and gum disease. Unremoved plaque will harden and turn into calculus (tartar).

Calculus cannot be removed with brushing or flossing and will harbour more plaque and more bacteria increasing the risk of periodontal disease and cavities.

1. Dispense about one-and-a-half feet (18 inches) of floss.

2. Hold a short amount of floss between your thumb and fingers, and insert it gently between your teeth. Never snap the gum with the floss.

3. Curve the floss around each tooth making a "C" shape.

4. Gently move the floss using a slow back-and-forth motion and up and down, going gently under the gumline. Avoid applying too much pressure.

5. Use a new section of floss for each tooth.

Root canal treatments are also known as endodontic treatments. The purpose of this procedure is to remove the infected, injured or dead pulp from your tooth, clean the space and fill and seal it with a special material.

The procedure can be performed by your dentist or he could refer you to a specialist. After the procedure is completed a final restoration has to be place, most of the times a crown is recommended. 

A similar procedures is done on primary teeth (baby teeth) either by your general dentist or a paediatric dentist. 

1. The dentist will give you local anaesthetic (numbing)

2. The dentist will place a rubber dam around the tooth to isolate it and prevent saliva and bacteria from coming in contact with the tooth being treated.

3. The dentist will make an opening to reach the infected pulp and prepare the root canal.

4. With special instruments the dentist removes the pulp, cleans an enlarges the root canal.

5. After the canal has been prepared, the dentist fills and seals the canal(s)

6. The opening of the tooth is sealed with a temporary or permanent filling.

​Once the root canal is done, the look and function of your tooth needs to be restored. If a specialist performed the root canal he will seal the opening with a temporary filling and send you back to your dentist for the permanent restoration.

The permanent filling could be done with a composite or white filling, an amalgam or silver filling, a crown, a bridge, an overlay, etc. The choice of the restoration will depend on the type of tooth and the coverage required to strengthen the tooth. 

1. May be done in 1 or 2 appointments

2. After a root canal treatment your tooth could be sore/tender for a week or two. It is uncommon to have bad pain or swelling.

3. The root canal does not protect your tooth from getting a cavity or gum disease.

4. A root canal is a way to preserve the tooth. However, there are cases in which the tooth ends up being extracted after your dentist has done everything to try to save it.

5. Sometimes a  root canal treatment needs to be redone. This is called retreatment.

6. Sometimes a root canal surgery is needed, in this case the approach is from the root. This procedure is indicated when a regular root canal can not be performed or when the initial treatment has failed.

The common term for caries is cavities or tooth decay. Cavities form when acid produced by specific bacteria destroy the enamel and the underlying layer, the dentin.  

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Teeth can have decay on different surfaces, the biting surfaces (most common in children), between the teeth (this area is only cleaned adequately with flossing) and on the root surfaces (common in adult patients that have gum recession). It can also form around dental fillings and at the margins of crowns and bridges.

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Bacteria turn sugar and starches into acids that dissolve the enamel (outer surface of the tooth). At first the enamel looks like it is eroded or changed colour (generally looks whiter and more opaque), this is called demineralization, early or incipient decay, and can be visible clinically or on some radiographs. At this stage with the use of certain products and changes in habits the tooth surfaces have a chance to remineralize. A filling will not be required if remineralization is achieved. If the cavity progresses it will reach the dentin or soft inner layer, here it advances much quicker and you could experience sensitivity or pain to sweet, hot or cold. A filling is required once the cavity has gone through the enamel or most of it.

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Having caries increases your risk or chance of having more in the future. Your dentist and dental hygienist will guide you regarding your nutritional and homecare habits that can help you prevent and remineralize decay. 

There are many ways you can prevent cavities:  

1. Brush after each meal or at least twice a day.

2. Floss at least once a day to remove the plaque between your teeth

3. Use toothpaste or mouthwash with fluoride, calcium or phosphate. 

4. Follow a healthy diet and limit processed foods, sugary and starchy foods and drinks like pop, energy drinks and juice. Remember that is not only what you eat and drink, but  how often.

5. Antibacterial, acid neutralizing rinses or remineralizing rinses can also be recommended b your dentist or dental hygienist.

6. Chewing gum sweetened only with xylitol.  

7. Visit your dentist regularly.

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Your dentist and dental hygienist will be able to recommend a personalized protocol to prevent and/or remineralize caries or decay.

Please contact us for your questions or comments