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Services Offered at Bramalea Dentistry
Oral Examination
Check teeth, gums, bone supporting the teeth, all soft tissues in
the mouth, and odour.
Extra-oral Examination
Check muscles of mastication and temperomandibular joint (TMJ).
Cosmetic Examination
Assess appearance of smile -- lips, teeth, gums.
Assess smile in relation to whole face.
See Empress Procelain Veneers
in the Gallery for sample Cosmetic
work and EasyShade technology used for
colour matching.
Bite-Guard
Many people have a habit of clenching or grinding their
teeth (when not eating or chewing gum) often at night when sleeping.
This can cause a variety of problems. Teeth may wear excessively.
Teeth may become loose. Muscles may ache from overactivity. Temperomandibular
joint (in front of the ear) may develop symptoms.
Wearing a bite-guard appliance to separate the upper and lower
teeth has been a recognized form of therapy for many years. However,
the design of the bite-guard can vary. It may fit onto all the upper
teeth or onto all the lower teeth.
Since 2000, Dr. Perlmutter has chosen to use the NTI-tss
bite-guard for most of his patients who need this service. It
fits onto the upper central incisors, with only the lower central
incisors contacting it. Dr. Perlmutter has found a high rate of
success and patient satisfaction with this appliance.
See www.nti-tss.com
for more information about how and why this works; you can also
see the appliance in Case #9
Bridges
A fixed bridge involves at least one false tooth attached to one
or more adjacent teeth. A removable bridge is also called a partial
denture.
Teeth Cleaning
This is done by our Dental Hygienists, Cathy and Laura,
for most patients. For young children,
our Preventive Dental Assistant, Nancy, helps them with their cleaning,
providing a learning experience, not just a cleaning. See Children's
Programme - Polaroid 'Wall of Fame'. For adults with significant
periodontal disease, gum surgery is needed to allow the roots to
be seen for thorough cleaning. Dr. Perlmutter will do the gum surgery
or refer to a specialist.
Crowns
These cover a tooth like a thimble covers a finger. They
can be made of metal, or porcelain, or metal covered with porcelain.
Temporary crowns can be made of acrylic and/or metal. (See Eight
Gold Crowns, Three Porcelain Crowns and One Porcelain on Metal Crown)
Dentures
These are removable appliances that replace all teeth or some teeth.
Mr. Michael Litvack is the denture therapist who does most of the
denture work here, usually on Thursdays after 4:00 p.m. For emergency
denture work at other times, Dr. Perlmutter and Talisman Dental
Laboratory will provide the service.
Gum Treatment
Unhealthy gums (gingivitis or periodontitis) can usually be made
healthy by thoroughly cleaning the teeth, in the dental office and
at home. Sometimes, a thorough cleaning can not be accomplished
unless surgery is done to make the roots visible (see Periodontal
Treatment, Gingival Plastic
Surgery and Cleaning).
Removing the adjacent tooth (teeth) is also effective in allowing
the gum to heal, but then replacing the tooth (teeth) may be necessary
(see Replace Teeth). Without treatment,
gum disease may result in much loss of the bone supporting the teeth,
with teeth then being lost.
Implants
Titanium metal implants
are placed into the bone by a periodontist or an oral surgeon. Dr.
Perlmutter will then do the prosthetic work to attach something
to the implants. Crowns and/or bridges
can be attached so they are not removable by the patient. Removable
dentures can be attached to implants, making the dentures very secure.
(see Two Dental Implants Support
a 3-Unit Bridge)
Lumineers by Cerinate
Lumineers are thin porcelain veneers made with patented Cerinate
porcelain. (See www.Cerinate.com.)
Because they can be made so thin, the teeth may need little or no
cutting before they are placed. This may mean no local anaesthetic
injections and no pain during or after treatment. They can be used
to permanently whiten teeth, straighten crooked teeth, improve the
shape of teeth, repair damaged teeth, or resurface previous porcelain
crowns or bridges. See the gallery
for a number of cases where Lumineers were used.
Ozone Therapy
HealOzone® is a new machine that creates ozone from the oxygen
in the air, delivers it to the tooth or soft tissue site, sucks
the ozone back into the machine, and decomposes it to oxygen for
release into the environment. This recently appoved procedure was
first used in Brampton by Bramalea Dentistry December 7th, 2004.
The use and benefits of Ozone Therapy are plentiful:
- Ozone kills bacteria and viruses, with
no harm to the teeth or oral soft tissues.
- When used on a tooth to kill the bacteria
that causes tooth decay, the tooth is then given a chance to remineralize
and heal itself. The tooth becomes less sensitive. This allows
the dentist to not only avoid having to remove all tooth decay,
but also to do less drilling and maybe avoid local anaesthetic
injections.
- Ozone can be used on a healthy tooth that
has exposed, sensitive dentin to desensitize it.
- Ozone can be used on the lip or inside
the mouth on soft tissue to kill viruses that cause cold sores
or ulcerations. The ozone also promotes faster healing and the
patient usually notices instant reduction in discomfort.
More information about HealOzone and
other uses of Ozone therapy in medicine are available at www.scican.com
(Canadian section) and www.the-o-zone.cc.
Remove Teeth
Extract teeth if diseased, if painful, if unrestorable, if unesthetic,
if space needed, if likely to become future problems. Dr. Perlmutter
will do the surgery, or sometimes refer to a specialist.
Repair Teeth
Composite-resin tooth-coloured
fillings are used (Dr. Perlmutter stopped using silver-mercury
amalgam many years ago)(see Repair
of Back Teeth, and Cracked
Tooth Syndrome in the Gallery).
For more difficult restorations, or where more strength or better
esthetics is needed, crowns are used (see Crowns).
Lumineers can also be used to repair teeth (see Lumineers).
Replace Teeth
Artificial teeth can be attached to a removable denture, or can
be attached to adjacent natural teeth as a fixed bridge, or can
be attached to dental implants.
Root Canal Treatment
The centre of every tooth is a hollow space, filled with nerve and
blood vessels. If this is not healthy, or if it is likely to develop
a problem, the root canal is cleaned out, medicated, dried, and
filled. The tooth can then not feel temperature, but can still feel
pressure. There remain nerves in the periodontal ligament surrounding
the root that sense touch and pressure. Dr. Perlmutter does most
of the root canal treatment himself, and accepts referrals from
other dentists who don't want to do the root canal treatment. Occasionally,
Dr. Perlmutter will refer this to a specialist.
Orthodontic Treatment
Teeth will move, according to the forces applied (The bone remodels
itself in response to these forces). Teeth that are out of proper
position, can be treated and corrected. Dr. Perlmutter refers most
of the orthodontic work to orthodontists with offices in the same
building as Bramalea Dentistry.
Non-orthodontic Treatment
Sometimes, crooked teeth can be made to appear straight by changing
the shape of these teeth, without actually moving the teeth. This
is Cosmetic Dentistry that Dr. Perlmutter does. See examples in
the Photo Gallery.
Periodontal
Treatment
The gums (gingiva) and bone surrounding the teeth (periodontium)
can usually be made healthy by thorough cleaning in the dental office
and at home. However, where the infection has gone deeper than 4
mm., a thorough cleaning is not always possible unless surgery is
done to make the roots of the teeth visible. Then we can see what
needs to be removed, and not just rely on touch to detect debris.
After the surgery, the gum will heal closer to the bone, making
subsequent cleaning in the dental office and at home, easier and
more effective. Dr. Perlmutter may do the gum surgery or refer to
a periodontist.
Whitening Teeth
After teeth are cleaned, if you want them to be whiter,
we provide a variety of options:
- Bleaching
– take home products –
These can provide significant improvement in one to three weeks
of daily use, with hydrogen peroxide as the active ingredient.
e.g. Crest Whitestrips, Professional version
DayWhite2 bleaching gel with custom-fitted upper and lower trays
- One-hour* tooth whitening in the office, using the Oral-B Rembrandt
Professional Chairside Whitening Kit (see www.denmat.com,
products, whitening), augmented by the Sapphire PAC light, is
available, along with a variety of take-home bleaching products.
This enhanced whitening service is an important adjunct to Lumineers,
and other cosmetic restorative services. (*Note that the appointment
will be 1½ hours, requiring some preparation before and
during the 1 hour of light shining on the teeth.) For best long-term
results, this should be followed up by occasional use of a take-home
product.
Note: Bleaching changes the colour of natural
teeth. It does NOT change the colour of existing dental restorations.
If existing fillings, crowns, bridges, or denture teeth are discoloured,
they can be replaced.
- Replace Discoloured Restorations with a whiter
shade. We have many shades of composite-resin restorative material,
many shades of porcelain, and many shades of denture teeth to
choose from. The patient can participate in the colour selection
process. Just ask us.
- Lumineers can permanently whiten natural teeth or previous
restorations (see Lumineers)
New Patients are always welcome - call us
for an appointment or send us email.
Examination Tools & Techniques
The following is a list of Tools and Techniques
that may be used as part of the examinations noted above:
Medical and Dental History
Review past problems and treatments.
Direct Examination
Using sight, touch, pressure, ruler, smell.
X-Ray pictures
Intra-oral radiographs are made using Schick CDR computerized system,
involving significantly less radiation than traditional film (see
www.schicktech.com).
Diagnodent
This painless, red laser light may find chewing-surface caries (tooth
decay) more effectively than clinical exam or X-Ray (see www.kavousa.com/prophylaxe/diagnodent.htm).
Diagnostic Study Casts
Impressions are made that are converted into stone casts showing
the exact shape of the teeth, and the bite relationship.
Photographs
We have digital and film cameras. We may photograph the whole face,
the smile, many teeth, or just one tooth. See Children's
Programme - Polaroid 'Wall of Fame' as well.
Acucam III is an intraoral digital camera that allows patients
to see their own mouth instantly on the computer monitor; especially
useful for the back teeth. (Acucam III is the 1996 version of what
has since become Acucam concept IV (see www.gendexxray.com/concept_IV.htm).
See Case #8 for some interesting
photos using the Acucam.
Diagnostic Wax-up
Talisman Dental Laboratory modifies the Study Casts to show the
improvements that can be made to the teeth. Wax is applied where
new restorations or replacement teeth are needed. The patient can
then appreciate what can be done.
Cosmetic Preview
In the mouth, Dr. Perlmutter applies unbonded white filling directly
to the teeth, with no drilling and no pain, to show what new restorations
could look like, and how the smile could be improved. This unbonded
filling is then easily removed. Sometimes the patient can take this
material home and reapply it to show family and friends what is
possible.
Cosmetic Imaging
Talisman Dental Laboratory, using a digital photo of the whole face
or just the smile, can alter the appearance on the computer. Without
having anyone touch the mouth, the patient can see what cosmetic
dentistry could do for them.
Colour Matching
EasyShade technology makes
the goal of perfect colour matching more achievable than ever before.
We want the cosmetic restorations to be indistinguishable from natural
teeth.
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