Temporomandibular joint and muscle disorders (TMJ) explained

Temporomandibular joint and muscle disorders, commonly called “TMJ,” are a group of conditions that cause pain and dysfunction in the jaw joint and muscles that control jaw movement.

Researchers generally agree that the conditions fall into three main categories:

  1. Myofascial pain involves discomfort or pain in the muscles that control jaw function.
  2. Internal derangement of the joint involves a displaced disc, dislocated jaw, or injury to the condyle.
  3. Arthritis refers to a group of degenerative/inflammatory joint disorders that can affect the temporomandibular joint.

A person may have one or more of these conditions at the same time.

Some estimates suggest that TMJ disorders affect over 10 million Americans. These conditions appear to be more common in women than men.


Trauma to the jaw or temporomandibular joint plays a role in some TMJ disorders, but in most cases, the exact cause of the condition is not clear. For many people, symptoms seem to start without obvious reason.

Because TMJ is more common in women than in men, scientists are exploring a possible link between female hormones and TMJ disorders.


A variety of symptoms may be linked to TMJ disorders. The most common symptom is pain in the chewing muscles and/or jaw joint. Other symptoms include:

  • radiating pain in the face, jaw, or neck,
  • jaw muscle stiffness,
  • limited movement or locking of the jaw,
  • painful clicking, popping or grating in the jaw joint when opening or closing the mouth,
  • a change in the way the upper and lower teeth fit together.


There is no widely accepted, standard test now available to correctly diagnose TMJ disorders. Because the exact causes and symptoms are not clear, identifying these disorders can be difficult and confusing.

Your doctor will note your symptoms, take a detailed medical history, and examine problem areas, including the head, neck, face, and jaw for tenderness, clicking, popping, or difficulty with movement. The doctor might also suggest imaging studies such as an x-ray.

You may want to ask your doctor about other causes of pain. Facial pain can be a symptom of many conditions, such as sinus or ear infections, various types of headaches, and facial neuralgias (nerve-related facial pain). Ruling out these problems first helps in identifying TMJ disorders.


Because more studies are needed on the safety and effectiveness of most treatments for jaw joint and muscle disorders, experts strongly recommend using the most conservative, reversible treatments possible. Conservative treatments do not invade the tissues of the face, jaw, or joint, or involve surgery. Reversible treatments do not cause permanent changes in the structure or position of the jaw or teeth. Even when TMJ disorders have become persistent, most patients still do not need aggressive types of treatment.

Conservative Treatments

Because the most common jaw joint and muscle problems are temporary and do not get worse, simple treatment may be all that is necessary to relieve discomfort. Short term use of over-the-counter pain medicines or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen; the use of a stabilization splint, or bite guard, that fits over upper or lower teeth may provide relief. If a stabilization splint is recommended, it should be used only for a short time and should not cause permanent changes in bite. Studies of their effectiveness in providing pain relief have been inconclusive.

Irreversible Treatments

Surgical treatments are controversial, often irreversible, and should be avoided where possible. There have been no long-term clinical trials to study the safety and effectiveness of surgical treatments for TMJ disorders. Additionally, surgical replacement of jaw joints with artificial implants may cause severe pain and permanent jaw damage. Some of these devices may fail to function properly or may break apart in the jaw over time.

Helpful Tips

Self-care practices that may help ease symptoms of TMJ:

  • eating soft foods,
  • applying an ice pack,
  • avoiding extreme jaw movements like wide yawning, loud singing, and gum chewing,
  • learning techniques to relax and reduce stress,
  • practicing gentle jaw stretching and relaxing exercises that may help increase jaw movement. Your health care provider or a physical therapist can recommend exercises if appropriate for your particular condition.


Source: National Institute of Dental and Craniofacial Research

What’s the difference between the bleaching I can do at home with a kit from the store and the bleaching that my dentist does?

Dentists have been doing what’s called “non-vital” bleaching for many years. Non-vital bleaching is done on a damaged, darkened tooth that has had root canal treatment. “Vital” bleaching is done on healthy teeth and has become more popular in recent years.

Vital bleaching, also called whitening, may be carried out in the dental office or the dentist may instruct the patient on how to do the bleaching at home. There is also a wide variety of products for sale in stores. Not all products are the same and not all give you the same results.

Different products, including those used by dentists, may also have different risks and side effects.

Here is an overview:

Whitening toothpastes with abrasive ingredients are really not bleaching products at all, but work on surface stain only. These products are sold in many stores.

Some whitening toothpastes do contain a chemical ingredient (or “bleach”) that causes a chemical reaction to lighten teeth. Generally, they have the lowest amount of “bleach.” They may not whiten as well as stronger products, but they have less chance of side effects. These pastes are brushed onto teeth and rinsed off, like regular toothpaste.

Bleaching kits sold in stores stay on your teeth longer than toothpaste and contain stronger “bleach”. These store-bought products do not come with the added safety of having your dentist monitor any side effects. They also come with a one-size-fits-all tray that holds the “bleach” and is more likely to leak the chemical into your mouth.

Dentists may use products with stronger “bleach”, but they give patients careful instructions to follow. They are also trained to spot and treat the side effects that patients sometimes report during bleaching. In addition, if a tray is needed to apply the “bleach”, dentists supply custom-made trays. Because products used by dentists are strong, they tend to produce the best results.

Patients should be aware that the long-term use of whitening or bleaching products may cause tooth sensitivity or tooth abrasion. Please consult with your dentist before using a whitening or bleaching product.


Source: Canadian Dental Association

Minimally Invasive Dentistry (MID)

Nothing is as valuable as your natural tooth structure. So when it comes time to removing a small cavity, why use a large drill when you can use air abrasion.

Minimally Invasive Dentistry comes into play here. At Langford Dental, for really small cavities or for dental sealants, air-abrasion particles (aluminum oxide) can safely and very effectively remove the decay without drilling away good solid tooth structure.

Instead of using a conventional rotary drill, aluminum oxide particles under pressure are blown out of an extremely small nozzle tip. These particles abrade away cavities and also prepare the tooth structure for a strong bond.

In the end, the strength of the filling/tooth bond is greatly enhanced, less tooth structure is removed, typically creating a longer-lasting restoration.

Wine, Fruit Juice, Soda — Which Drinks Can Harm Your Teeth?

Much of what you drink, including diet drinks and sports drinks, can damage your teeth. To keep your mouth healthy, try these strategies for choosing drinks.

Aside from what you eat, what you drink has a big impact on your oral health. When you drink a liquid, you’re essentially bathing your teeth in that beverage. And many drinks pose a hazard to your dental health similar to that of sweet treats such as candy and chocolate.

When it comes to your diet, there are two chief threats to the health of your teeth: sugar, which promotes the growth of bacteria in your mouth and damages enamel, and acid, which also harms enamel. Both are found in a variety of popular foods and drinks.

Top Beverages That Can Harm Your Teeth

Edmond R. Hewlett, DDS, a professor at the UCLA School of Dentistry and a consumer adviser for the American Dental Association, says he won’t touch fruit juice — it’s high in sugar and can also be quite acidic. This category of drink includes smoothies, since many are made with citrus fruits, which are acidic, and fruits that are high in sugar.

“Once sugar hits the mouth,” says Dr. Hewlett, “bacteria are very effective and quick.”

Another thing to consider is the sugar you add to your coffee or tea. This sugar does more harm than the coffee or tea itself, which isn’t acidic enough to cause as much damage as many people believe.

“However,” says Hewlett, “do keep in mind that coffee and tea will stain your teeth.” To help prevent staining, he recommends that you run a wet toothbrush over your teeth or at least rinse your mouth out with water after drinking these beverages. This can help slow the amount of staining over time.

Wine also contains acid, but Hewlett says only excessive wine consumption puts your tooth enamel at risk. However, like coffee and tea, it can stain your teeth, and drinkers might want to consider rinsing with water after imbibing to reduce the amount of staining over time.

Many people rightly believe that regular soda is bad for the teeth because of its high sugar content. But sodas, as well as diet sodas and diet sports drinks, can also cause significant harm to tooth enamel because of the acid they contain.

“These drinks often contain phosphoric or citric acid to make them tangy and taste good,” says Hewlett. “Soda actually contains an acid that dentists use to rough up enamel before administering bonding treatment.”

It’s Not Just What You Drink But How You Drink It

Keeping your teeth healthy while you drink involves more than just making the right choices of what to drink.

If you drink slowly, you allow the liquid to have more contact with your teeth. If you nurse a diet soda throughout the day, for example, or sip a sugary latte during your hour-long commute, the damage to your teeth can be much greater than if you finish your beverage quickly.

Drinking with a straw can help reduce damage to tooth enamel — it seems to help by allowing harmful substances to bypass the teeth, Hewlett says. Still, he advises that it’s better to avoid harmful drinks altogether.

Also, if you tend to chew ice that’s in your beverage, Hewlett advises that you break the habit. Over time, chewing ice can cause tiny cracks in your teeth, weakening them; and eventually, “a chunk of your tooth can even break off when you least expect it,” he explains.

Drink Tips to Promote Healthy Teeth

When it comes to choosing what to drink, you can take steps to keep your teeth strong and healthy. Start with these strategies:

  • Drink fruit juices and smoothies with a straw and aim to finish them in one sitting as opposed to sipping them slowly.
  • Put little or no sugar in your coffee, particularly if you tend to nurse it.
  • Drink regular and diet sodas and sports drinks sparingly, and don’t allow yourself to sip them for prolonged periods.
  • Use a straw when it makes sense, to help avoid bathing your teeth in harmful sugary or acidic liquids.
  • Use a wet toothbrush or rinse your mouth out with water after you drink acidic beverages or anything that might stain your teeth, such as wine, coffee, and tea.
  • Don’t chew ice.
  • When in doubt, choose water.


Source: Tami Swartz of

CBCT: Cone Beam Computed Tomography

We are very excited to add this is new technology to Langford Dental. A CBCT is a very low dose dental CAT scan of a small or large area of interest. The image created is an incredibly precise 3-D rendering of the jaw bone. The image used is cutting edge technology for many dental procedures such as:

  • planning and placing dental implants
  • planning for bone grafting
  • treating or retreating root canals
  • planning orthodontics
  • planning for complicated dental extractions
  • visualizing TMJ anatomy
  • visualizing oral pathologies

Dry Mouth (Also Known As Xerostomia)

Dry mouth occurs when there is not enough saliva, or spit to keep your mouth moist and comfortable. Dry mouth is not a disease. It is a side effect of taking medications or can be a symptom of certain diseases or conditions.

Dry mouth is a common complaint amongst older adults but can occur at any age. It is not a normal sign of aging.


The most common cause of dry mouth is prescribed and over-the counter medications, such as:

Amphetamines Antihypertensives Bronchodilators
Antianxiety drugs Antiparkinsonians Decongestants
Antidepressants (tricyclics) Antipsychotics Diuretics
Anticholinergics (atropine) Antispasmodics Hypnotics
Anticonvulsants Appetite suppressants Muscle relaxants
Antihistamines Barbiturates Opioid (narcotic) analgesics


  • A sticky, dry or burning feeling in the mouth, throat or nasal passages
  • Lips or corners of mouth are cracked
  • Lips may stick to teeth or dentures
  • Saliva is thick and stringy
  • Trouble chewing, swallowing, tasting or speaking

Affect on oral health

Saliva helps to protect teeth by neutralizing the acid caused by plaque that leads to tooth decay. In addition, decreased saliva leads to:

  • plaque buildup
  • gingivitis and gum disease
  • dentures being less comfortable to wear
  • bad breath

Tips to manage dry mouth

  • Daily mouth care: clean teeth, gums and dentures
  • Brush teeth with a high fluoride toothpaste
  • Use a high fluoride mouth rinse
  • Take frequent sips of water to keep the mouth moist
  • Chew sugar-free gum or candy to stimulate saliva
  • Avoid tobacco, alcohol, caffeinated beverages and sugary drinks
  • Speak to your dentist about products that can help keep your mouth moist
  • Have regular dental and professional cleanings


Source: British Columbia Dental Association

Can My Teeth Erode Away?

Canadian dentists are seeing more and more patients with dental erosion. Dental erosion occurs when the hard part of the tooth wears away from direct contact with acid. Dental erosion can be caused by certain health conditions such as stomach acid problems and eating disorders, but eating and drinking foods high in acid such as sport drinks and soft drinks can also cause teeth to erode.

To learn more about dental erosion and other oral health concerns, talk to your dentist and visit the Canadian Dental Association website at

Three steps to preventing dental erosion

  1. Choose drinks that are low in acid. Carbonated soft drinks are high in acid, which can harm your teeth
  2. Do not swish or hold high acid drinks in your mouth for long periods of time or suck on citrus fruits
  3. It is best to consume foods and drinks high in acid at the end of mealtime while there is still plenty of saliva in your mouth to wash away sugars and acids.

As always please remember… ‘floss and brush today, so you can smile tomorrow!’


Source: California Dental Association

Do I Have Receding Gums?

Gums that recede to expose the root surfaces of teeth is a common condition in adults over the age of 40. Many consider it to be just a sign of aging, and in some cases it is essentially that – often the result of wear and tear or years of aggressive tooth brushing. However, sometimes receding gums can be a sign of something more.

In many cases, receding gums are caused by periodontal disease (gum disease). Three out of four adults have some form of it, and in most cases, it doesn’t cause any pain and goes unnoticed.

Common in adults, gum disease starts when bacteria containing plaque builds up on the teeth and gums. When the plaque is not removed daily, it produces toxins that irritate and inflame the gums. Eventually the inflammatory process destroys the gum tissues, causing them to separate from the tooth and form spaces called pockets. The pockets hold more bacteria, which only compounds the problem. In the early stages, gum disease (gingivitis), marked by red or swollen gums that bleed easily, is reversible and can be detected and treated by your dentist or dental hygienist during regular check-ups. As the disease progresses (periodontitis), it can destroy the bone and soft tissues that support the teeth. In advanced stages of periodontitis, teeth can become loose, fall out or have to be removed by a dentist. In fact, periodontitis is the culprit in 70 percent of tooth loss in adults over 40.

The good news is these gum conditions can be prevented by good daily oral hygiene habits. Receding gums are best prevented by brushing with a soft toothbrush, using mild- to-moderate pressure and small circular or very short back and forth motions. Avoid hard toothbrush bristles and long horizontal brush strokes with excessive pressure on your toothbrush.

If your gums have receded, it is sometimes possible to graft tissue to cover a portion of the exposed root surface and to reinforce the fragile, receding gum tissue to protect from further recession. Also common to receded gums is sensitivity that results from the exposed root surface. Your dentist can apply medications in the office, and/or recommend products for you to use at home that will help reduce sensitivity of these root surfaces and help protect the now vulnerable root surface from decay. Remember, with daily brushing and flossing and regular visits to your dentist, adults can look forward to keeping their natural teeth throughout their life.

As always please remember… ‘floss and brush today, so you can smile tomorrow!’


Source: California Dental Association

Are Cavities Contagious?

In short, yes! Cavity causing bacteria can be transferred from parents to children by many different ways. A few examples are: sharing utensils, cleaning a soother by putting it into your own mouth and then giving it to the baby, kissing etc.

For the most part babies mouths are free from bacteria that cause dental decay. The cavity causing bacteria are introduced into their mouths usually from external sources. If you can minimize these sources, that child may have a lower propensity for developing cavities in the future.

Of course good oral hygiene like brushing and flossing and a healthy, low sugar, low acid diet go a long long way.

As always please remember… ‘floss and brush today, so you can smile tomorrow!’

Why is being honest about my medical history important to the dentist?

Filling out any medical form can be a very simple thing for some and a long complex process for others depending on their health.
Some questions on medical forms may not seem relevant to dentistry. For example, questions asking about previous surgeries, prosthetic joints, heart conditions etc. It may not seem obvious at first, but many of these can have a direct impact on how your dentist approaches treating you.
For instance, if you have high blood pressure not controlled with medication and you choose not to inform your dentist, bleeding complications may arise at time of surgery.
Another example is if you are taking or have a history of taking a specific type of osteoporosis medication or chemotherapy medication. Some of these medications have a direct impact on how well and how fast the jaw bone heals, especially after surgery. Healing from a simple dental procedure may sometimes take months and can be potentially disfiguring to the jaw. Having prior knowledge of this medication can change the approach your dentist takes to ensure a likely better outcome.
Dentists are here that help you. Please do not feel embarrassed about having certain health conditions or taking certain medications. Disclosing complete and accurate medical information is for your best interest and can ultimately only help you in the long run.
As always please remember… ‘floss and brush today, so you can smile tomorrow!’

What are ‘soft teeth’? Do I have them?

Over the years I’ve heard many patients say, “I seem to have really soft teeth. Ever since I was a child I would come out of every dental visit with a cavity. No matter how much I flossed and brushed it didn’t help!!”

Or worse yet, “my brother never brushes, never flosses, eats sugar all the time, and he doesn’t have one filling. It’s not fair!”

So, how can this be possible?

While we know for certain that genetics plays a role in our oral health, it doesn’t play the only role. Yes, some people are more prone to cavities (soft teeth) or gum disease. Some people inherit their ‘crooked teeth’ or gummy smile from their parents. However, what we don’t inherit are habits (hygiene, diet, smoking etc).

Ultimately the biggest factor in determining your susceptibility for decay or gum disease is you. Regular brushing and flossing (with proper technique), and regularly scheduled dental cleanings are paramount in achieving a healthy mouth.

While it is true that some people neglect their teeth with no consequence, they are in the minority. The vast majority of people cannot sustain these poor habits long-term without aquiring some form of oral disease.

3 simple things you can do to prevent cavities

Aside from the obvious things your dentist tells you like flossing and brushing your teeth, there are other simple everyday things you can do to fight cavities.

  1. Eat and drink your food/liquids in one sitting. In other words, don’t graze! If you’re constantly snacking and drinking (coffee, pop, juice) throughout the day you are replenishing the sugars and starches bacteria need to create the acids that form cavities.
  2. Don’t swish your sugar drinks…especially carbonated drinks. It sounds simple…but most of us have this habit of savoring the flavor of our drinks by swishing them through our teeth before we swallow them. By doing this you’re allowing the sugars to be dispersed all over the mouth and in between teeth.
  3. Do swish water when you drink it; and especially try to swish thoroughly with water after every meal. This allows the water to flush out any sugary residue and food debris from between your teeth. This not only will hydrate you but also clean your mouth in the process!

There you have it. Three simple, no cost, common-sense ideas that should go a long way in keeping your mouth healthy and you happy.

Keep smiling!

My dentist has found that I have a dead tooth and need a root canal. What exactly is a root canal and why is it necessary?

Most people have heard of the term “root canal” but there are a lot of misconceptions about what this procedure actually entails.

A person’s tooth has many layers with the innermost being the pulp – commonly referred to as the nerve.  In a healthy tooth this is a narrow chamber and canals filled with blood vessels and nerves that keep the tooth “alive”.

Several problems can lead to the disease or death of these tissues.  Most commonly a very deep cavity or deep crack lines in the tooth are to blame, both of which can cause inflammation in this tissue and bacterial contamination. Dental trauma can also result in damage to the pulp tissue that can require a root canal treatment.

A tooth ache often follows though not always. In some cases the tooth hurts…only much later… or not at all. An abscess(infection) is seen only much later on an x-ray (radiograph) or when a person develops swelling in the area.

Root canal therapy involves first getting the tooth numb, then cleaning out the canals with special file systems to remove the diseased or dead tissues.  Once this is complete, the canals are filled to help prevent bacteria from growing in them and the tooth needs to be repaired where damaged.

Most commonly a crown is placed over the tooth to strengthen it and help reduce the chance of breakage in the future.

It is very important to address infection in a tooth as it can lead to serious and even occasionally fatal consequences.  Antibiotics are often needed in the short term but are not a permanent solution due to the internal anatomy of a tooth.  A root canal or the removal of the tooth is required to allow the body to heal.

It should be noted that any swelling or pain in the mouth or face must be examined as soon as possible by a dentist or a medical doctor to evaluate the cause and initiate antibiotics or definitive treatment as needed.

What can I do if I witness someone losing a tooth (getting it knocked out)?

Most of us are fortunate enough not to have witnessed or experienced an accident such as this. Luckily these situations rarely occur; however, if they do, it is important to know what to do. An encouraging fact is that many ‘lost’ teeth can be replanted with a good long term prognosis. Some of the factors that will help this prognosis are under our control.

The first and most important thing to remember is DO NOT touch the root. If your tooth is laying on the ground, pick it up by the crown (typically the crown is the whiter, shorter part of the tooth; the root is normally long, and yellowish in color).

If clean cold water is available, rinse soil or debris off the tooth. Place the tooth back into its socket. If unable to manage this, place the tooth in your mouth in the pouch by the cheek. If you have access to milk, place your tooth into a jar full of white milk and cover the lid.

  • Do not rub any debris off the tooth.
  • If the tooth is still partly in the socket, keep it there.
  • Immediately proceed to your dentist with your tooth (it would be a good idea to phone the office before arriving so they can prepare as time is of the essence).

The dentist will make every effort to reposition, and immobilize the tooth into the socket. There will be follow up appointments made to evaluate, and further treat this tooth.

Why should I replace a tooth that has been removed?

This is a very common question that we are asked when a tooth needs to be taken out. It is definitely possible to leave the space with no replacement. For some people there will be no major issues aside from a decrease in chewing ability or aesthetic concerns, but there are some problems that can also arise over time.

The main issue at play is the natural tendency of teeth to drift towards an open space, particularly forward and outwards. Over time this can lead to a situation in which the teeth no longer line up properly between the upper and lower jaw. Problems with chewing can follow and in some cases even TMJ (jaw joint) issues can arise.

Also, surrounding and opposing teeth that have tipped and moved can be much harder to keep clean. Tipping quite often leads to areas of the roots which become exposed. These teeth are at higher risk for cavities and gum disease over time.

When a tooth has been removed, there is a window of time that is ideal if a replacement is planned. Waiting too long can make treatment much more complicated. Options such as dental implants, fixed bridges, or removable tooth replacements are all possibilities for replacing missing teeth.

Your dentist is the best person to discuss this with and will be able to advise you as to the pros and cons of different options for your particular circumstance.

Why do my gums bleed?

This is a very common question that dentists hear on a daily basis. Although this can be a painless phenomenon, it can be uncomfortable and worrisome. Luckily, for the majority of cases this can be easily corrected.

The most common cause of bleeding gums is a condition called gingivitis. This refers to the inflammation of the gums in response to local factors ie) plaque, tartar, cavities, old fillings etc. Gingivitis can progress to a more advanced condition called periodontitis which involves not only the gums, but the bone anchoring the teeth in place. In both these situations, the gums are very fragile and do not need much force on them to make them bleed (brushing/flossing).  The good news is gingivitis is reversible. Proper home care and regular dental visits should resolve this issue.

Other factors that can make gums bleed easily:

• Brushing too hard
• Using a toothbrush with medium or hard bristles
• Bleeding disorders
• Medications
• Hormones (especially sensitive during pregnancy)

If you are concerned about this or any other dental issue, please contact us and we will be more than happy to answer any of your questions.

Is there a dental device that can be used to prevent snoring?

Snoring and sleep apnea (a condition that involves periods during which a person stops breathing while asleep) afflicts many people. A large portion of people with sleep apnea are not even aware that they have it. The most common cause of both involves the throat becoming closed off by the tongue as the body relaxes during sleep. Snoring often causes poor rest for the person’s partner, and apnea can be a life threatening condition.

The first step in evaluating a person for either condition is to have a sleep study done. This is undertaken by a medical doctor with training in sleep medicine. A sleep study allows the doctor to evaluate how severe the sleep apnea is by noting the number of times that he or she stops breathing as well as the level of blood oxygenation.

To treat sleep apnea, the gold standard and best treatment is called a CPAP machine. This is a device that helps to push air in during breathing to help maintain the person’s airway and, therefore, oxygen supply. This device is prescribed and fitted by a medical doctor.

Some people are not able to tolerate a CPAP machine. For these individuals and those with very mild apnea or simple snoring, a dental appliance can be a great alternative. This plastic device fits inside the mouth and gently guides the lower jaw into a more forward position. In this position apnea and snoring generally improve as the tongue is also pulled forward. Many dentists are trained to provide this service.

If you or a loved one snore or may have sleep apnea, please talk to your medical doctor or your dentist to get further information.

Why do dentist recommend coming in every 6 months for check ups and cleanings?

There are many factors that go in to the recommended time frame between dental examinations and cleanings; the average person is seen at least on a 6 month recall schedule.

There are several reasons that a person should be seen by a dentist on a regular basis.

The first, is this allows for the dentist to regularly examine your mouth.  Cavities and other issues with the teeth and gums can be detected at an early stage.  Many people think that as long as nothing is hurting, there is no issue with their mouth, but in reality by the time something is painful there is often significant disease or even infection. In some cases treatments such as root canals, crowns or extractions could be required where a filling may have been sufficient at an earlier stage.

A second reason for regular visits is to help to ensure your gums remain healthy.  Your hygienist is an expert at cleaning your teeth and gums, as well as at offering advise on home care.  Many people are not aware that you can lose teeth to gum disease, and there is growing research on the relationship between periodontal (gum) disease and cardiovascular disease.  The early detection of gum disease is crucial, and some people with gum disease require further interventions as well as more frequent care to help maintain their teeth.

Finally, regular dental care and examinations allow for earlier detection of oral diseases or other pathology such as oral cancer.  This offers far better outcomes in the event that these are present.

Your dentist can examine your mouth and offer suggestions on the best recall schedule for your specific needs.

Please visit the public website of the B.C. Dental Association at

What are dental veneers?

Dental veneers are custom made, extremely thin porcelain or resin composite restorations permanently bonded to natural teeth. They are most often placed on front teeth, and sometimes on premolar teeth (side teeth) to improve/enhance your appearance.  Dental veneers are considered very durable, aesthetic restorations; however, they also in many cases can serve to restore an ideal bite relationship and function.

What type of dental situations can dental veneers treat?

  • Stained/discolored teeth
  • Uneven, crowded teeth
  • Worn, chipping teeth
  • Gaps/spaces in teeth
  • Improper bite relationship (bad bite)

The process of fabricating dental veneers involves at the minimum 4 appointments, and sometimes more. The first appointment includes digital photos of the patient’s teeth, dental impressions where precise copies of teeth are made, and a bite registration is taken. This allows the dentist to examine the teeth, smile, and bite after the patient leaves the office. It is on these models that a veneer wax-up is created mimicking the final look of the veneers.

The second appointment is a consultation with the dentist to go over the proposed treatment plan i.e.) estimated length of treatment, teeth involved, fees involved. It is at this appointment where the patient examines her proposed new veneers made of wax. Feedback is given to the dentist to see if any changes need to be made to enhance/change the look.

If there is mutual agreement with the wax-up, then the next appointment involves preparing the teeth for veneers. Teeth are minimally reduced (0.3-0.5 millimeters), impressions taken, and temporary veneers are fabricated. Patients leave this appointment with new temporary teeth to try out. During this temporary phase the patient gets to evaluate the comfort, look and feel of the new teeth. If there are any adjustments, they are performed on the temporaries. Once there is mutual satisfaction with the temporaries, a dental lab custom fabricates permanent veneers to match the temporaries as close as possible.

The next appointment involves taking off the temporaries, and bonding on the new veneers. Slight adjustments are made to the bite, and photos are taken!

Dental veneers are a great choice for many people; however, they are not for everyone. Dr. Malinowski will be able to answer all your questions and together you can decide on the best course of treatment.


What??? A sugar that is good for your teeth???

XYLITOL – The Decay-Preventive Sweetener

What is xylitol?

Xylitol is a natural sugar alcohol that helps prevents cavities. You may recognize other sugar alcohols used in sugarless products, such as mannitol and sorbitol. Xylitol is the sugar alcohol that shows the greatest promise for cavity prevention. It is equal in sweetness and volume to sugar and the granular form can be used in many of the ways that sugar is used, including to sweeten cereals and hot
beverages and for baking (except when sugar is needed for yeast to rise).

How does xylitol prevent cavities?

Xylitol inhibits the growth of the bacteria that cause cavities. It does this because these bacteria (Streptococcus mutans) cannot utilize xylitol to grow. Over time with xylitol use, the quality of the bacteria in the mouth changes and fewer and fewer decay-causing bacteria survive on tooth surfaces. Less plaque forms and the level of acids attacking the tooth surface is lowered.

Studies show that Streptococcus mutans is passed from parents to their newborn children, thus beginning the growth of these decay-producing bacteria in the child. Regular use of xylitol by mothers has been demonstrated to significantly reduce this bacterial transmission, resulting in fewer cavities for the child.

What products contain xylitol and how do I find them?

Xylitol is found most often in chewing gum and mints. You must look at the list of ingredients to know if a product contains xylitol.

Generally, for the amount of xylitol to be at decay-preventing levels, it must be listed as the first ingredient. Health food stores can be a good resource for xylitol containing products. Additionally, several companies provide xylitol products for distribution over the Internet.

How often must I use xylitol for it to be effective?

Xylitol gum or mints used 3-5 times daily, for a total intake of 5 grams, is considered optimal. Because frequency and duration of exposure is important, gum should be chewed for approximately 5 minutes and mints should be allowed to dissolve. As xylitol is digested slowly in the large intestine, it acts much like fiber and large amounts can lead to
soft stools or have a laxative effect. However, the amounts suggested for cavity reduction are far lower than those typically producing unwelcome results.

Has xylitol been evaluated for safety?

Xylitol has been approved for safety by a number of agencies, including the U.S. Food and Drug Administration, the World Health Organization’s Joint Expert Committee on Food Additives and the European Union’s Scientific Committee for Food.

Xylitol has been shown to have decay-preventive qualities, especially for people at moderate to high risk for decay, when used as part of an overall strategy for decay reduction that also includes a healthy diet and good home care.

Consult your dentist to help you determine if xylitol use would be beneficial for you.

Source: California Dental Association

How can I stop my child from sucking his/her thumb?

Thumb or finger sucking is very common and in early years it is not a major cause for concern. If this habit continues or is severe, it can cause changes in the position of the teeth and the shape of the upper jaw bone (the palate).
Thumb sucking is a soothing activity that serves to help alleviate anxiety and is thought to stem from the rooting impulse of infants seeking comfort.
Many children who suck their thumb will stop on their own with no intervention (often by 2-4 years of age), though some do require assistance to break the habit.
It is generally best to avoid making a big deal of the behaviour as this tends to make children dig in their heals. In social situations, a secret hand signal or some other subtle reminder can help to remind the child without embarrassing him or her.
An important point to be made with any intervention is to try to keep to positive reinforcement – scolding or other negative attention can actually worsen the problem as it makes the child more prone to self-soothing. A reward system such as a sticker chart can work very well to help the child change their behaviour and let them feel a sense of pride in having done so.
There are products on the market such as nail varnishes which have a bad taste but these serve more as a reminder for the child to stop sucking their thumb – a determined child will still suck, regardless of these products.
A dentist can be of some assistance. Sometimes a conversation with the dentist stressing the importance of stopping the habit can enhance parental efforts. If the habit is causing problems and previous attempts at curbing it are not successful, an oral appliance can be fitted for the child that makes thumb sucking very difficult. This is can serve a useful role in helping him or her to break the habit.
Dr. Malinowski can examine your child for any signs of changes in his (or her) mouth and answer any further questions that you may have.

What toothbrush and toothpaste should I use?

With the variety of toothpastes and toothbrushes that are available, choosing one can be overwhelming for some people. There are toothpastes for sensitive teeth, whitening toothpastes, ‘enamel strengthening’ toothpastes and the list goes on. There are soft/medium/hard bristled toothbrushes, angled, raised bristled toothbrushes, and electric as well. With all that, what is the right choice?

The Canadian and American dental associations recommend using fluoride-containing toothpastes. The fluoride helps make your teeth more resistant to forming ‘cavities’. If your teeth are sensitive try using one that addresses this; however, to rule out other reasons for this sensitivity make sure you ask your dentist why your teeth are sensitive.

Soft bristled brushes are preferred for a number of reasons. They are gentler on the gums, and on the roots. With improper technique, it is easier to wear away gum tissue and exposed root surfaces if you are using a hard or medium bristled brush versus a soft. So, it is the technique you brush with, not the toothbrush that determines how well you clean your teeth. For people with poor manual dexterity electric brushes may offer a better result than a manual brush. It may be easier and more fun to get your child to brush with an electric brush than a manual.

If you are not sure whether you have the ‘proper technique’, next time you are at your dentist ask him/her to watch you brush and floss your teeth and give you feedback. If you want to evaluate your own brushing/flossing efficiency, there are plaque disclosing dyes/tablets you can purchase that will temporarily stain areas on your teeth you missed while brushing and flossing. Make sure you brush 2-3 times a day for at least 2 minutes per brushing episode. Remember, it is not the force you brush with but the length of time you brush that is important.

Speaking of flossing…yes flossing! How many times has your dentist asked you if you floss? The reason we are so concerned is because flossing is as important as brushing, yet most people do not floss regularly. Cavities we see forming between teeth are largely due to inadequate flossing. Toothbrush bristles will not reach between your teeth. By not flossing, you are missing close to half of your tooth structure.

What is a night guard, and why should I wear one?

A night guard or an occlusal splint is an acrylic oral appliance prescribed by your dentist to be worn for a specific reason(s). There are many types of guards that exist with each type serving a specific purpose.

It is important to distinguish between sport guards and occlusal guards. Sport guards are soft, flexible rubber-like appliances that are designed to help protect your teeth from injury incurred during a sporting event. Occlusal guards are worn to help protect teeth and jaw joints from trauma due to some kind of oral habit or dysfunction i.e.) grinding, clenching, poor bite, TMD (temporo-mandibular disease/dysfunction) etc.

Signs you may need an occlusal guard:

  • Clicking jaw joints
  • Pain/discomfort in jaw joints
  • Tired chewing muscles
  • Clenching/grinding habits
  • Headaches
  • Sensitive teeth
  • Many porcelain restorations

What’s involved in getting a guard?

The process is quite simple and quick. It involves two appointments, both requiring no freezing! The first visit is to take impressions (mold) of your teeth; the second to insert and adjust the guard to ensure it is comfortable. The two appointments are usually 30 minutes long and between 1-2 weeks apart. During this time a dental lab custom fabricates the guard for a very precise fit.

There are other reasons that an occlusal guard may be recommended. Dr. Malinowski can diagnose whether you could benefit from a guard and explain the pros and cons for your particular situation.

Why should I have my child’s baby teeth filled when they will fall out eventually?

It is true that baby teeth will fall out, yet there are very good reasons to have them filled when caries (cavities) are present.

Any tooth which has a cavity that is not properly fixed can eventually cause a tooth ache.  It can also cause infection in the surrounding gums or bone.  The earlier that a cavity is detected and a restoration (filling) placed, the lower the likelihood that this will happen.  Infection can be dangerous and can also, in certain circumstances, cause problems with the adult tooth that is developing in the jaw bone.

Also, having untreated cavities increases the amount of cavity forming bacteria in the mouth.  This makes it more likely that the adult teeth coming into the mouth could develop cavities as well.

So why do we not just pull the tooth?  Baby teeth fall out at different times – some of the back ones may not come out until 11 or 12 years of age.  These teeth function in chewing but also keep space for the adult teeth to come into place in the proper position.

Your child should be evaluated by a dentist to assess his or her teeth, as well as risk factors for developing cavities or other problems.  Your dentist can answer any further questions that you may have.

When should a child see a dentist for the first time?

As parents tending to many of our children’s needs, dental check-ups often end up at the bottom of the list. In fact most children do not see a dentist for the first time until they are well over a year old. The American Dental Association and Canadian Dental Association recommend a child be seen by a dentist for the first time by one year of age or when their first tooth comes in (whichever comes first).

The first visit includes a dental exam on the child, but it is also an educational visit for the parents. The child’s diet, their oral hygiene, and overall health are assessed. Parents are typically in the room holding their child, and are encouraged to ask any questions. The appointment is very brief, and positive in nature so as the child can get accustomed to a new ‘dental’ environment. The dentist will recommend the frequency of examinations following this appointment.

Instilling proper oral care from an early age will create good oral habits that should last a lifetime. Early education, and early visits to the dentist may also help in reducing dental anxiety seen in adults.


  • Wash baby’s gums with a wash cloth twice daily (if no teeth)
  • Brush teeth with a rice-grain sized amount of children’s toothpaste with fluoride twice daily
  • Do not put babies to bed with milk, juice or anything other than water
  • Do not let a fussy baby discourage you; the key is to be consistent every day and a habit will form

 Note: the above information serves as a guide to routine oral care. For more information please refer to the BC Dental Association public website

What is pregnancy gingivitis?

Besides the very obvious physical exterior changes a woman goes through during pregnancy, there are other more subtle changes that occur in the mouth. Many pregnant women ask “why do my gums bleed all of a sudden when I brush and floss my teeth? Why are my gums so sensitive when I brush and floss?”.

The constant hormonal changes that occur during pregnancy can play havoc on the gums. Research shows the gums are much more sensitive and prone to inflammation from the bacteria in your mouth during pregnancy. This increase in inflammation can make the gums more delicate and prone to bleeding when normal brushing and flossing forces are applied.

In addition, growths called pyogenic granulomas (pregnancy tumours) can occur. These benign growths are usually raised, red, bleed very easily, and can range in size from a few millimeters to a few centimeters. They can grow on many parts of the body not only in the mouth. If small enough they resolve on their own with good hygiene, but if they grow large enough your dentist may have to remove them.

Research shows a strong association between gingivitis and preeclampsia, premature birth, and low birth weight infants. This does occur more in severe forms of gingivitis and periodontitis. As a result, pregnant woman should make sure they are educated on, and practice proper oral hygiene care. Regular checkups with dentists and hygienists are very important during pregnancy and even pre-pregnancy (to eliminate any existing gingival/periodontal conditions).

Should I change my silver (amalgam) fillings to white (composite) fillings?

This is a very popular question in dentistry today; one which does not have a simple answer.
Silver fillings are composed of a variety of metals including: mercury, silver, tin, and copper. Composite fillings are made of a combination of dimethacrylate monomers(acrylic) and silica fillers (glass). Both options have their indications and limitations depending on the circumstance.

Amalgam fillings have been around since the early 1800’s. It’s quite amazing that for the most part it’s composition is relatively unchanged. The most controversial aspect of the amalgam filling is the mercury component. Even though there is no scientific consensus to date linking any ill-health effect to the mercury release in dental amalgam restorations, some individuals choose to remove these fillings and replace them with non-amalgam like materials.

Generally, removing a sound filling for the sole purpose of replacing it with a white filling is not recommended.

Any time a tooth is drilled on certain inherent risks need to be understood. Irritation to the tooth can create sensitivity(transient or long term which can potentially lead to the need for root canal treatment). Small craze lines can develop in teeth which overtime can lead to crack formation. This may then require crown treatment, which again may create a sensitive tooth!

However, if a situation exists like decay or a poor seal around an amalgam, then replacing it with a white filling is at this time possible.

Placing a white filling for the first time on a tooth is preferable(especially if it is small) because the amount of tooth structure removed will be less than it would be for a silver filling. It is the bonding of the composite to tooth structure that allows a more conservative drilling approach. Silver fillings are ‘wedged’ into a space in the tooth that is created by drilling. This space has to be of a certain size for the material to be durable; this space is usually larger than for a composite restoration.

If you have a concern regarding the amalgam filings in your mouth it is best to speak with your dentist to see what the best approach would be for you.

What role does fluoride serve in oral health? Do we really need it?

Fluoride is a naturally occurring mineral found in our environment. We are exposed to it on a daily basis from the foods we eat, the water we drink, and the ground we walk on. Unfortunately for most people, these extremely low levels are not sufficient to help reduce dental decay. Fluoride is also added to most toothpastes and some mouthwashes. In the dental office setting it can be administered by a varnish painted on to teeth, or by gels in trays or rinses. In certain municipalities, fluoride is added to city water; Victoria and surrounding areas do not have this service.

Fluoride plays an extremely important role in decreasing the risk of developing tooth decay. It can be incorporated into the enamel matrix as the tooth develops in a small child. This incorporation can serve as a life long benefit, especially when combined with good oral hygiene.

Fluoride can also be very useful when used topically (toothpastes, vanishes etc.) If a tooth is starting to develop a cavity, fluoride in the mouth can help strengthen the tooth, stop and sometimes reverse the cavity.

Since Victoria does not add fluoride to their water supply, we are reliant on the above mentioned sources. For most people with good oral hygiene, good health and a healthy diet, this is sufficient. However, there are some people who need the extra fluoride. This extra fluoride can come in various forms, from different sources. It is recommended you speak to your dentist if you have a concern regarding your dental decay susceptibility.

The Canadian Dental Association recommends children by the age of 1 be seen by a dentist. Children under 3 will be assessed to see if they are at risk to develop tooth decay. If yes, parents should use toothpastes with fluoride in small amounts. If no, water and a tooth brush is enough. From ages 3 to 6 supervised toothbrushing with fluoride toothpaste is recommended.

It is important to mention dental fluorosis. Dental fluorosis is a change in the appearance of the enamel. This is a result of over-exposure to fluoride before the age of 8 (while the adult teeth are developing). Usually this over-exposure results from swallowing too much toothpaste, or improper fluoride supplement use. The enamel’s appearance can vary from a mild form (small white spots barely noticeable), to more severe forms (large white spots; pitting of enamel). For this reason it is important to supervise your child while brushing, and if you are using supplements make sure you are measuring correctly.

Finally, it is important to educate yourself on your or your child’s specific oral situation. No one will be better able to this than your dentist or hygienist who has examined your mouth and spoken to you directly.

Why do I have bad breath?

Having bad breath or ‘halitosis’ can be an embarrassing and frustrating issue to deal with. We all at some point in time have experienced our own bad breath, or someone else’s. Sometimes no matter how much we brush, floss or rinse we cannot escape that lingering odour, or metallic taste. So, what are the most common causes of bad breath, and how do we deal with them?

Oral infections are a major source of foul odours. They can be deep inside the jaw bone around the root or more superficial around the gum line. They can sometimes drain pus into the mouth, and enter the bloodstream circulating to vital organs like the heart. These infections can actually affect a person’s ability to properly control their blood sugar levels as well.

Old fillings with poor seals around the teeth and decay around the fillings can also affect bad breath. If there are rough areas around older fillings bacteria will start to reside there in larger numbers. These bacteria will eventually be the reason decay develops around these fillings. The gases they produce as a byproduct are very foul smelling. So the more old fillings, and the more decay present, the higher the likelihood you will have bad breath.

Other sources for bad breath include having a dry mouth, gases coming from the stomach, a diet high in sulfur containing foods i.e.) onion, garlic. Not brushing the tongue, and food stuck between teeth are two more common reasons bad breath exists. Certain medical conditions and medications can contribute to halitosis as well.

If you suspect you have a bad taste coming from your mouth, or just bad breath it would be a good idea to ask your dentist to examine your mouth for the potential causes. Some of the causes can be dealt with by brushing and flossing your teeth and tongue more regularly. Some of the causes may mean replacing old fillings. Certain infections may require antibiotics as well as root canals or extractions of teeth. Whatever the cause, it is important to rule out specific ones that can potentially have more serious systemic health risks.

My dentist has recommended that I get a crown on my tooth after I had a root canal. Why is this needed?

There are many circumstances in which it may be recommended that a tooth receive root canal therapy (commonly called a “root canal”).  Some common reasons are trauma, very deep cavities or infections of the tooth or surrounding bone.

Once a root canal has been completed on a tooth it becomes more brittle and prone to cracking or breaking over time as it is no longer alive inside.  This is similar to a tree branch – while it is attached to a tree it is quite strong and has some flexibility but once it is no longer attached to the tree it becomes weaker and easier to break.

Also, the majority of teeth that require a root canal are quite broken down and/or have a significant portion missing.  This structure needs to be replaced in a way that will stand up to the demands of chewing over many years.

A crown is often recommended to cover teeth that have had root canal therapy.  Placing a crown helps to protect the remaining tooth and reduce the chance that it will break in the future.  This is particularly important in the case of back teeth as they sustain the majority of the forces of chewing.

The decision to crown a tooth involves many clinical factors.  Your dentist can review the pros and cons of placing a crown on your tooth given it’s particular condition.

My dentist has found that I have a dead tooth and need a root canal. What exactly is a root canal and why is it necessary?

Most people have heard of the term “root canal” but there are a lot of misconceptions about what this procedure actually entails.

A person’s tooth has many layers with the innermost being the pulp – commonly referred to as the nerve.  In a healthy tooth this is a narrow chamber and canals filled with blood vessels and nerves that keep the tooth “alive”.  Several problems can lead to the disease or death of these tissues.  Most commonly a very deep cavity or deep crack lines in the tooth are to blame, both of which can cause inflammation in this tissue and bacterial invasion.  A tooth ache often follows though not always.  In some cases the tooth hurts only much later or not at all and an abscess is seen only much later on an x-ray (radiograph) or when a person develops swelling in the area.  Dental trauma can also result in damage to the pulp tissue that can require a root canal treatment.

Root canal therapy involves first getting the tooth numb, then cleaning out the canals with special file systems to remove the diseased or dead tissues.  Once this is complete, the canals are filled to help prevent bacteria from growing in them and the tooth needs to be repaired where damaged.  Most commonly a crown is placed over the tooth to strengthen it and help reduce the chance of breakage in the future.

It is very important to address infection in a tooth as it can lead to serious and even occasionally fatal consequences.  Antibiotics are often needed in the short term but are not a permanent solution due to the internal anatomy of a tooth.  A root canal or the removal of the tooth is required to allow the body to heal.

It should be noted that any swelling or pain in the mouth or face must be examined as soon as possible by a dentist or a medical doctor to evaluate the cause and initiate antibiotics or definitive treatment as needed.