Archive for July 2016
What is a Dental or Rubber Dam?
This is the dental term for the small sheet of rubber we place over teeth when we do fillings. It is often referred to by children as a “raincoat” or a “trampoline” and these nicknames are fairly accurate. Just as with a raincoat, the rubber dam is designed to keep a tooth dry while we work on it, and similar to a trampoline, our dam is a stretchy piece of rubber!
Why do we use it?When working on teeth most of the filling materials we use must be placed into a tooth in a completely dry and clean work area. Saliva is not only moist, but it also contains certain materials that would contaminate the surface of the tooth to which we are gluing a filling. When we are bonding white fillings onto teeth, any contamination from either saliva or blood will result in the filling not lasting anywhere near as long as it is designed to.
Although the rubber dam was initially designed to help a dentist achieve excellent restorations, it is also there to make the patient’s experience in our chair more comfortable. Once the dam is in place, it stops water spray and little tooth bits or filling materials from falling into the back of a patient’s throat or being swallowed. It also blocks many of our bad tasting dental products from ever reaching the patient’s tongue.
One of the benefits for dentists is that it provides us with much better visibility to work on a tooth as it holds the tongue and cheeks out of the way and also eliminates the problem of having saliva bubbles cover the tooth and prevent us from seeing what we are doing. These are just some of the ways that we are able to ensure that dental procedures are done in a safe and effective way.
There is also an infection control aspect to using a rubber dam. Saliva contains a lot of bacteria. When we use a high-speed hand piece (a dental drill), aerosols containing bacteria are produced. These aerosols float into the air that everyone in the room breathes. By using the rubber dam, drilling takes place without any saliva contamination. The infectious component to these aerosols is reduced by over 95%. The use of a dental dam has been likened to wearing latex gloves during dental treatment with a similar impact on cross-infection. And, speaking of latex, for those that have sensitivity or an allergy to latex products, a ‘non-latex’ version of the rubber dam is available. Please advise us if you require a non-latex version.
Many patients that have not seen a rubber dam prior to arriving in our office will ask if this is something new. In fact, dental dams have been around in some form or another for over 150 years. It was first described in the dental literature in 1864 when a Dr. Barnum from upper New York State punched a hole in an oil-cloth and tied it around the tooth he was working on. This kept saliva out of the way and allowed him to place the filling.
The popularity of rubber dams has gone up and down based on current theories of dental practice. There was a resurgence in the 1950’s for doing root canals when it was understood that the bacterial contamination from saliva was causing infections during treatment and reducing the success rate of treatment. Its use for routine fillings became popular again in the 1970’s with the start of bonding procedures and the use of the white composite filling materials. Through trial and error it became understood that without proper isolation, fillings were falling out after just a few years unless they were placed in a dry and contamination free environment.
Over the years the quality of the rubber has improved until today we have very thin and easy to work with latex sheets.
In order to have the dam fit over teeth, we punch holes in it to match the teeth that need to be isolated. The dam is then held in place in the mouth by placing a small metal ring called a ‘clamp’ onto the back tooth and sliding one of the holes that we have punched in the dam over the clamp. The other holes are then flossed between the teeth until all that shows through on our side of the dam are the teeth that make up our work site.
One downside of having a rubber dam is that it is harder for a patient to speak to us while we are working on a tooth. But, through a variety of non-verbal noises and handsigns we are able to meet most of a patient’s requests. Also, based on our years of experience, you would be surprised as to just how much-garbled speech from underneath the dam we are able to understand!
Although there are other ways to keep a mouth dry while we are working, such as placing absorbent cotton rolls or gauze combinedwithvacuum like suction systems, none are as effective or as successful as using the rubber dam. The way that it provides us with a combination of a clean and dry work area with greatly improved visibility allows us to achieve excellent and long lasting results with the fillings that we take pride in placing in your mouth.
Achieving excellence with all of our dental procedures is our ultimate goal, and our use of the rubber dam makes this task much easier.
If you have any questions on the rubber dam or on any of our dental procedures, please feel free to contact us for an explanation.
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Are Whiter Teeth Possible?
Coffee. Tea. Red wine. Cranberry juice. Pasta sauce. Even blueberries. All of these common foods can stain your teeth. Brushing well will definitely help, but some of us are more prone to long term changes in the color of our teeth than others, even if we are good brushers. Also, as we age, the enamel of our teeth may get a little thinner allowing the darker colored dentin layer below to show through a little bit more giving our teeth a darker appearance.
What can we do about it?
First there are whitening toothpastes. You cannot go far in the toothpaste aisle at the pharmacy without being bombarded with all sorts of speciality tooth pastes offering you a dazzling white smile if you use their product. Many of these products do work well to help breakdown and remove many surface stains that build up from the things we eat and drink. They do have much success at removing the deeper stains within the tooth that are often the reason for seeking whiter teeth.
Whitening gels are the most common form of what is referred to as “take home” bleaching. These are either hydrogen peroxide or carbamide peroxide based products that penetrate into the enamel and break down the stain molecules to remove them leaving your teeth a brighter color. These gels can be applied to your teeth either on a special strip such as Crest White Strips, or in a customized tray much like a sports mouth guard. This allows the bleaching gel to stay in contact with the enamel for the desired amount of time to allow the gel to whiten the teeth. Depending on the brand of product, these trays or strips will be applied for 30 to 60 minutes or in some cases overnight while you sleep. The advantage of the customized tray system is that it allows for a more accurate delivery of the gel to the tooth surface with less of the gel being wasted or spreading up onto the gums where it may cause the gums to be irritated.
Will all teeth whiten with equal success? Unfortunately the answer to this question is “no”.
Certain colors of teeth will whiten more successfully than others: Yellow teeth will brighten the best. Brown based stain will improve to a lesser extent and bluish grey teeth will show the least improvement.
Any tooth which has darkened as a result of medication taken during childhood or which have darkened following a trauma will not likely change color to a desired level. Any tooth that has a restoration on it such as a crown, veneer or basic filling will not change color because these materials are not susceptible to the bleaching process. This does not stop you from whitening your teeth, it just means that, once you are finished whitening, you will have to replace the restorations on these teeth to match the new color of the rest of your teeth.
For these reasons it is always best to discuss your individual case with your dentist before you start just to be sure that you are indeed a good candidate for whitening.
“In office” whitening is another option in which a bright light or laser is used to activate a special whitening gel that is applied to the teeth. While this provides an initial “jump start” to your whitening process, in most cases a follow-up treatment with take-home trays is necessary to achieve successful long-term results.
The process of whitening is best done under the supervision of your dentist so that if issues such as sensitivity of either the gums or the teeth develop, you will be in good hands to solve the problem.
The process of “take-home” whitening involves two short office visits. The first visit is when we assess your individual condition and discuss your expectations. Once it is determined that you are a good candidate for the procedure, we will take impressions of your mouth so that we can build a set of custom-made trays. On the second visit, three or four days later, your dentist will ensure the trays fit perfectly and then show you how to apply the gel in a predictable and safe manner. It’s easy and fast to learn how to apply the gel and insert the trays. Before you leave, we want to ensure you’re comfortable with how the trays feel and we’ll answer any questions you have about the whitening process.
After a week or so of home whitening we invite you to drop in so we can assess your short term results and be sure that you are following the steps properly.
If you think you would like a whiter, brighter smile and want to know if you are a good candidate, we welcome you to call our office at 514-484-0521 and set up a consultation appointment so that we can discuss your individual case.
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