The Dentist's Blog
Posted by Dr. Shirley Cheong
Trip to San Diego, California – IACA Meeting 2011
Our Smiling Star Team headed to San Diego, California to attend the International Association of Comprehensive Aesthetics (IACA) in July, 2011.
We had a great time enjoying nice sunshine and cool breeze. The three-day conference gathered 900 attendees coming from Australia, Canada, and USA. We learned a lot of new information including Sleep Apnoea, new filling materials, History of Neuromuscular Dentistry Battle and Nutrition/Anti-aging just to name a few.
Dr. Norman Thomas, pictured above with the Smilingstar Team, was the final speaker of the day. We had a lot of “AHA” moments when we listened to his 90 minute presentation about the negative impact of sugar to our aging body and crosslinking of collagens and connective tissues resulting from Advanced Glycation End Products (AGEs).
This is an important breakthrough in the understanding of difficult TMJ/TMD symptoms of tinnitus. The inelastic and inflexibilty of aging connective tissues caused many problems to the neuromuscular symptoms. So our knowledge has been expanded once again.
Posted by Dr. Kenny Chan
Healthy Or Just Not Sick?
As a dentist I have been asking myself “why is seeing a dentist different from seeing a medical doctor?” To answer this question, we need to know our body and our health care system.
Our health care system recognizes the complicated organization of the human body. In the case of a crisis, people go to the emergency room. Doctors in ER deal with vital functions such as restoring blood pressure, heart rate, breathing and circulation. When people are sick, they go to family doctors or specialists for treating symptoms such as a raised temperature, pain in different parts of the body, diarrhea, dizziness, and loss of appetite among many others. At this level of health, people feel sick and unable to carry out daily work. However, beyond sickness there are a wide range of conditions in which people are still functioning-though at a sub-optimal level. We are not sick but we are not healthy either. There are no symptoms to make us feel really bad, but our bodies’ signals show that the machine is not running at its best. Depending on the adaptive capacity of our bodies, we function at a wide range of sub-par levels.
Teeth are designed for a specific function: grinding down food. They are designed differently from other parts of body. Enamel, being the hardest body material, has to be on the outside to do the job. Enamel has no nerve innervations which is why we can eat hot, cold, spicy, or sour food without PAIN. Without nerves on the outside, there is no pain ever felt - even a tooth is getting sick. Early cavities, gum disease, wisdom teeth, and bite problems will cause no pain. People equate pain symptoms with sickness and apply the concept to their dental health. When people are not alarmed and not debilitated, they often choose to ignore the annoying signs of bleeding gums, dark shadows on teeth, and occasional clicking of the jaw. Does no toothache mean no problem?
When pain has been felt and people come to see dentists complaining of toothaches, 9 out of 10 times the problem has reached the deepest part of the tooth called the pulp. Pulp contains nerves and blood vessels and is a vital part of the tooth. It has a limited reparative capacity and when it is in trouble, the pulp has to be removed in a root canal treatment. At worst, the structure of tooth may have been damaged so much that the entire tooth needs to be removed.
And so why do people go to see dentist even though they are not feeling sick? I think there are three main reasons:
- Dental Health
No pain or being not sick is not good enough; we all need healthy teeth for lifelong use. - Preventing Emergencies
Toothache or infections in the mouth are debilitating causing work hours to be lost and incurring costly, complicated treatment. - Improving General Health
Our teeth and mouths are closely related to our overall physical health. They are inseparable from our general well-being.
One does not have to fall ill to become a patient. In dictionary, a patient is defined as one who receives medical attention, care, or treatment. Our dental patients come to us to seek health care or just maintain their health status. They are respectable people who truly understand the value of health.
Posted by Dr. Kenny Chan
We Practice Occlusion Dentistry
The way that your upper and lower teeth come together is called occlusion and is a vital part of a system which includes your teeth, muscles and joints. If you have a misaligned bite, your teeth do not fit together properly. The muscles and joints must work together to accommodate for the misalignment. A misaligned bite often leads to muscles that are overworked when they should be relaxed, leading to various painful conditions.
Most people don’t think to mention headaches to their dentists. Yet, tension headaches caused by muscle contraction is the most common form of headache. It typically results in pain on both sides of the forehead and can include pain and tightness in the neck as well. The temporalis muscle, located on the side of your head from the temple to just behind your ear, is the muscle group that is responsible for positioning your jaw. Simply stated, if your temporalis muscles have to work overtime to properly align your bite, they often go into spasm which in turn leads to pain.
Every part of your body works together to achieve a state of harmony. When one muscle group is having difficulties, others will work together to try to compensate to correct the problem. To demonstrate this, a group of scientists inserted a plastic filling in the tooth of a healthy rat and deliberately made it too thick to bite. X-rays of the rat before the filling showed the rat had a straight back and healthy limbs. A week after the insertion of filling, x-rays showed the rat’s back had curled up and the limbs were not functioning properly. The filling was then trimmed and balanced. After a week passed, the final x-ray showed the back and limbs had returned to normal. They concluded that the filling had caused the muscles and joints of the whole animal to accommodate. Once the filling was removed the accommodation was reversed.
When our jaw is closed, pressure sensors, located in gum tissue, can detect the presence of a foreign object the width of a human hair. Changes in the bite are not just limited to fillings. Improper bite can result from all kinds of dental interventions including removing teeth, getting braces, replacing teeth in a fixed bridge, having removable dentures. Natural wear due to grinding or clenching can also change the bite. When these things happen and change the occlusion, muscles and joints start to accommodate for the change. When the muscles overwork themselves the result is either cracked teeth or muscle ache.
Because improper occlusion is such a large issue in dentistry, Dr. Shirley Cheong and I spent lots of time studying Neuromuscular Dentistry. We are members of the International College of Cranio-Mandibular Orthopedics, a society of health care professionals who have a common interest in the anatomy and physiology of occlusion, jaw function and orthopedics dysfunction which result in symptoms in the head and neck.
We practice the Total Patient Care approach. As dentists, we are not just treating teeth. we take care of the total well being of your whole body. We look for signs that your body is not accommodating well and recommend treatment to rectify it. So don’t be surprised next time if we are taking photos of you standing or turning your head.
Posted by Dr. Shirley Cheong
Natural Beauty and Function: Is It Forever?
How we wish our bodies would last forever, but we are dynamic beings and age related changes are inevitable. Our teeth and jaw function as a biomechanical device which follows the natural law of aging and attrition. However, thanks to advancements in aesthetic dentistry with neuromuscular principles, we are able to turn back the clock. Without knowing it, people who have a poor bite, rapidly wear down their teeth. The front teeth starting to chip is the first sign of aging.
With the help of Smile Design, we are able to recreate your youthful smile and colour. Minor rotations and crowding can also be fixed instantly without going through lengthy orthodontic treatment. In addition, the ceramic material we use is very close to enamel in appearance and can reproduce the natural beauty of your teeth. You will never need to worry about your teeth staining and changing colour because of the stain resistant properties of ceramics. The material is called IPS Empress from Ivoclar and for 20 years has proven to be the best material to replace poor looking enamel, giving your smile a second chance.
Due to the advancements in materials, ceramic restorations to the front teeth can be durable and function well. Because of neuromuscular dentistry we understand how the jaw and musculature works. We follow the principles of happy muscles that allow the jaw to move smoothly to create a functional bite. When the bite is right, the teeth will last longer.
Your teeth may have suffered from wear and tear, losing their support at the back, which makes the front teeth become overloaded. When your bite is properly aligned, your teeth will last. However, when the bite shows signs of wear and tear, the muscles fight against your teeth, rapidly breaking them down. In some cases we may need to correct the bite along with restoring your smile.
Next time, when you are getting your teeth cleaned, make sure your teeth are being assessed for the amount of wear and tear. This should be documented by your dental practitioner with clinical digital photos. With proper diagnosis and treatment, your natural jaw function can be restored.
Posted by Dr. Kenny Chan
Dr. Kenny on Fairchild TV
Fairchild TV is a specialty Chinese language television station which broadcasts nationally in Canada. Dr, Kenny was on recently to talk about CEREC.
Posted by Dr. Shirley Cheong
The Joy of being a Dentist
Recently, a woman came to my office and asked to speak to me. When I met her I thought that her face was familiar but I could not recall who she was. She took my hand sincerely and told me that she was the daughter of one of my patients who I had seen in my office a week earlier. No wonder I saw the resemblance.
She told me that her mother had passed away peacefully a few days after I had seen her. She was 92. I immediately burst into tears. Her name was Santina and was my very first patient when I started my new practice In Canada in 1994.
In 15 years Santina came to my office religiously every 6 months for a regular check-up and cleaning. She never missed a visit.
Her daughter wanted to come in and thank me in person. She told me that up to her passing, Santina was happy and proud of her healthy teeth and that it had helped her live a quality life. It was Santina’s love of life and her total trust that made me enjoy being her dentist and helping people like her. She valued herself and put time and resources into her teeth.
I remember when she was 80, she asked me if I could restore her missing molar on one side. Honestly, there was a split second when I wondered if it would really be worth it to restore the only missing tooth in a person her age. But my conscience told me that I was not the one to judge whether it’s worth it or not for another person.
Santina had been very positive in her outlook on life and always gave her signature smile. To her this procedure was important. I told her it was possible for her to receive a fixed bridge which would restore her bite and chewing function on both sides. She later told me that the bridge was so comfortable that she felt that it was a part of her mouth. The bridge served her well for 12 years before her last day on earth.
The appreciation of the care I had given to Santina over 15 years brought her daughter and son-in-law to become my patients after that day. I attended Santina’s funeral, paying tribute to my very first patient in Canada, promising that I will continue to do what I have been doing all along, to give my best and to take care of every patient who treasures their teeth. To me, Santina’s example shows me that everyone deserves a healthy set of teeth for their whole life.
Posted by Dr. Shirley Cheong
Lifelong learning as a Generalist
Twenty-one years ago, after graduating from Dental School, I was unsure in which area to specialize. The Oral Surgery department wanted me to enroll in their Masters program while the Orthodontics Professor invited me to have a talk with him about pursuing his specialty, but I felt that the right move would be to step back and not make any hasty decisions which I might one day regret. To keep my options open, I took a position with the Government of Hongkong as a Dental Officer for a 5 year commitment to hone my skills in General Dentistry.
It was not until I moved to Toronto in 1994, however, that my eyes were opened to the fascinating world of North American Dentistry. Here learning was not restricted to a privileged few. Anyone with the desire to learn had opportunities to access resources and to be trained in advanced dentistry. I was among the first class of general dentists trained to do implant surgery at the University of Toronto. Starting in 1998 I began taking courses and mentorships in advanced orthodontics, and later, Dr. Kenny and I were fortunate to attend the Specialist Conference Program at Damon System Orthodontics.
By 2004 I had begun to see that there was something missing in the field of occlusion/bite, especially in prosthodontics, the branch of dentistry dealing with the replacement of teeth and related mouth or jaw structures by artificial devices. It was then that I started my journey to search for the truth about the human bite. This decision ultimately led to the development of our unique, holistic approach to dentistry through a greater understanding of neuromuscular physiology. We call this approach Total Patient Care.
From cosmetics to orthodontics, single tooth implant prosthodontics to full mouth reconstruction, we now have a wide selection of advanced tools to help our patients achieve optimal oral health. At this point in my life and career, I am happy to say that I am pleased with my decision to be a general dentist. As a generalist, I can use various combinations of treatment tools to achieve a better result with my patients, which is something that no individual specialist can do.
Peace of Mind
Posted by Dr. Kenny Chan
I have known James for 5 years. Today this young man brought his mother to my office. He has been staying with his parents and caring for them since graduation probably because of the high cost of moving out alone.
“How are you, James? Thanks for your trust in us and bringing your mother here. Is there anything I can help you with today?” James looked uneasy and uttered “My mom needs implants.”
This was no surprise to me. When Anna walked into my consultation room, her facial profile already told me how much bone support she had lost from the number of teeth she has lost. As a result she has a prominent nose and chin which is not the norm in her ethnic group.
Anna has been wearing dentures for 20 years. As her teeth deteriorated over the years she got more and more frustrated with loose and unsteady dentures. She was referred to a specialist and was told to have 17 implants. The mere thought of the price of implants created a lot of stress in the young man and his mom.
I examined Anna’s dental condition and discovered that she has a severe amount of bone loss and that she just does not have the bone to carry 17 implants without going through extensive surgery. Knowing her unwillingness to have major surgery, I formulated a treatment plan to improve her denture function with just 2 implants at strategic locations in her mouth. James and Anna agreed to the proposal and left with big smiles on their faces.
Did I lose a big case? Did I just flush out 15 implants into the drain? What was I thinking when I saw Anna in my dental chair?
I saw an older woman looking for the way to improve her chewing function. I saw in her mouth the necessary tissues that I could work with. And I saw a friend’s mom who has other concerns in life, that the best treatment may not be feasible at this time. I offered her the best solution which would be appropriate for her given her age and financial abilities. I am grateful that I have the clarity of mind to think of alternative treatments which take into consideration the patient’s real needs when I am challenged with clinical problems . It means that I feel great every day when I go home , I have peace of mind.
Only Better And Faster
Posted by Dr. Kenny Chan
Dentistry is an exciting profession. Technology advancement has allowed dentistry to be done better and faster.
When Dr. Shirley and I were in dental school, we were told not to use white fillings for the back teeth. Today, every filling we put in the mouth, whether it is for front teeth or back teeth, we use white filling (composite resin) material impregnated with nano particle fillers.
We used to write lengthy notes on treatment record after seeing a whole day of patients. No matter how hard you try, there are days you are not to write legibly and sometimes miss out important details of the procedures performed during the day. Today, we can type our notes on computer software which link up patient records with appointment schedule. The notes are neat and tidy, easy to read and most importantly accurate records of the happenings in dental operatories. A picture is better than a thousand words; we take clinical digital photos of oral condition and upload them into digital files of patient records. Insurance papers, consent forms, lab prescriptions can also be scanned and stored in digital files. Going paperless seems a very sensible way to protect and save the world we are living.
If you still are not convinced that dentistry is exciting, take a look at One-Visit Crown CAD/CAM dentistry. We are able to shorten your crown making into one appointment. Using CAD (Computer Assisted Design) and database library of the software program, your crown is designed with a click of a few buttons. The data is then transferred wirelessly to an in-office milling machine using CAM (Computer Assisted Milling). In just a few minutes a ceramic crown is ready to be bonded to your tooth. Isn’t that nice to have your tooth restored on the same day and not to worry about wearing a temporary tooth in your mouth? Have you heard of Instant Orthodontics? What about Implant-in-a-day? The air is heating up here.
How Can I Help You?
Posted by Dr. Kenny Chan
July 2, 2002 was the first day of operation of Yonge & Steeles Dental Care. We can still remember the fresh smell of the office and the first day was not as chaotic as we had thought, thanks to the help from our staff and the professional manner of our dental supplier and contractor.
In our 21 years of practicing dentistry, this is our third office. For the first six years we worked in Hong Kong, still a British colony, where we worked in clinics run by the government. Life was good. We took our time to work on our skills and accumulate our experience still fresh from learning at dental school. By 1992 we moved to Toronto where we established offices separately with Dr. Shirley in North York and myself, Dr. Kenny, practicing in Markham. These two offices had very different practice philosophies. Dr. Shirley worked hard using her skills and built a client base slowly. She treated every patient like a family friend, a philosophy she maintains to this day. My location served mostly new comers and the practice grew very quickly. Both offices were highly praised by patients and were very successful.
Deep inside our hearts, however, both Dr. Shirley and I dreamed of working together like we had done before in Hong Kong. We wanted to create a new kind of practice system that can help more people and at the same time help people more. That was how the idea for Yonge & Steeles Dental Care was born.
Yonge & Steeles Dental Care is all about helping each other. We help our patients to attain better total body health every day. In return our patients help us to become better dental professionals. They tell us how they feel after a long dental procedure. They tell us what they like about us and what we need to improve on. Our team members help us with the smooth running of the office. We give each other the support we need at work and in dealing with families at home. Our dental suppliers help us with the latest technological advancements. When we help others, we become more useful and bear more purposes in lives. Life is good again.
When you come to Yonge & Steeles Dental Care, please tell us how we can help you.
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