Frequently Asked Questions
Dr. Gibrayel Answers Your Questions About Dentistry
We have identified the most common questions about various treatments you can get at the dentist.
Select the type of treatment you are curious about from the list below and have a look at our answers.
If you can’t find your question, please visit the contact page, send us a web form and Dr. Gibrayel will be glad to give you accurate answers and direct you to the right resources, if necessary.
Why do I need to have my teeth cleaned?
The most important factor affecting your gums’ health is how clean they are. This is why brushing and flossing are very important. Over time, plaque can start to accumulate in areas under the gum line that are hard for you to reach and gradually calcify into tartar, in other words become hard and stick to the surface of your teeth. This tartar hides a lot of bacteria which can cause constant inflammation in your gums (gingivitis). This inflammation can eventually spread deeper and destroy the bone supporting the teeth. Also, it has been recently proven that constant gum inflammation can lead to more widespread health hazards, including heart disease.
How often do I need to get my teeth cleaned?
That depends on your gums’ health. For people with healthy gums or mild gingivitis, we usually recommend a cleaning every 6 months. If you have gum disease (periodontal disease) and several deep pockets, we recommend that you get a cleaning done more frequently, such as every 3 or 4 months.
My dentist/hygienist told me I have gingivitis. Is it a serious disease?
If you don’t brush your teeth for a few days, your gums will respond to the bacteria in the plaque on your teeth by recruiting more blood cells, so they become inflamed. This is called gingivitis. The best treatment is to keep your teeth clean from plaque by regular brushing and flossing. Gingivitis could, at any point, turn into periodontitis, which is more serious. At that stage, you could start losing your tooth-supporting bone. This is a slow process, but if left untreated, you could end up losing your teeth.
Could my bad breath be related to my teeth?
Bad breath can have many different causes. Poor oral hygiene, dental decay, and tooth infections are all common reasons for bad breath. However, other general health problems could also cause bad breath, including respiratory or digestive problems. If you suffer from bad breath, your dentist will often be the first to confirm whether it is related to your teeth or not.
Are cleanings the only way to treat gum disease?
The first step in treating gum disease is to chart all the pockets in your mouth to have a baseline of the stage of the disease. You should then have your teeth cleaned. A re-evaluation is usually carried out 4 to 6 weeks after to assess the healing of the gum tissues. At that stage, further treatment recommendations are usually suggested, if required, including scaling, laser gum-therapy, or surgical procedures.
Do my gums need to be frozen/numb for my cleaning?
Most people can have their cleaning done comfortably without any freezing. However, freezing will be recommended for patients who have very sensitive teeth or for those who need deeper root debridement (scaling) therapy or surgery. Recently, a needle-free anesthetic that can be used for cleaning was introduced to make the whole experience painless.
I had my teeth cleaned a few days ago and they became very sensitive afterwards. Why?
Many times after teeth cleaning, and especially if you haven’t had a cleaning in a long time, the cleaning process will expose the root surface of the tooth (which was covered by tartar,) causing temporary sensitivity. This doesn’t mean that your teeth or gums are getting any weaker. Over time, the exposed tooth surface becomes desensitized by absorbing fluoride and other minerals from toothpaste, saliva, food, etc., which is why it is important to keep your teeth clean. You can also use toothpaste for sensitive teeth to speed up the desensitizing process.
What is the advantage of digital X -rays over regular X-rays?
Digital X-rays offer many benefits for dentists and patients. One of their major advantages is that they reduce the X-ray dose that patients are exposed to. Their digital sensors use a fraction of the X-rays needed for regular X-ray films to produce an image with superior quality. They also allow for more accurate diagnosis of early dental problems, which are easier to fix, and can help you maintain healthy teeth for life.
How often do I need to get X-rays?
X-rays are an integral part of your checkup. Without X-rays, many problems could go undetected until they become serious. Cavity-detection X-rays should be updated once a year to allow us to see cavities that start in-between the teeth. They also show the bone level between the teeth, as well as any problems starting around existing fillings or crowns.
Are dental X-rays harmful to my health?
There are two main types of X-rays: therapeutic X-rays, which are sometimes used for cancer treatment, and diagnostic X-rays, which are used for X -ray imaging. Diagnostic X-rays are far less harmful than therapeutic ones. In addition, the dose of radiation you’ll receive from digital X-rays is very minimal, which makes its effect on your health rather insignificant.
Can I get dental X-rays when I am pregnant?
Generally speaking, routine dental X-rays are best avoided during pregnancy. However, in certain emergency situations like a toothache or dental trauma, they might become necessary. In this case, we weigh the risks against the benefits. It’s important to know that you would roughly need to have 100 000 dental X-rays to have an X-ray dose that is high enough to harm your fetus.
Sealants and Fillings
Are silver fillings better than tooth-colored fillings?
Currently, there are two main types of filling materials commonly used in dentistry: silver (amalgam) fillings and white (composite) fillings. In addition to their natural look, composite fillings offer several advantages over silver fillings. They don’t require as much healthy tooth structure to be removed, making the cavities smaller and mainly limited to the area affected by decay. Removing less tooth helps reduce its sensitivity and keep it stronger. Composite fillings can also be bonded or glued to teeth. Having a solid tooth-filling margin helps prevent the recurrence of decay which can happen around or underneath a filling. Silver fillings are still sometimes used in certain situations, for example when composite fillings may be impossible to bond to the tooth in certain areas of the mouth that are very difficult to keep completely dry while the filling is placed.
I have many old silver fillings. Should I have them replaced with white fillings?
Silver fillings have been used for decades, but their effects on general health are controversial. Some believe that mercury in amalgam fillings can be gradually released and become deposited in various organs in the body, causing symptoms like chronic fatigue, confusion, etc. The majority of dentists believe that, unless a silver filling is defective, it doesn’t need to be replaced, especially since replacing a fillings can cause sensitivity in the tooth afterward, to the point that a root canal treatment might become necessary to save the tooth.
What are cavities, and how are they caused?
Plaque on a tooth’s surface contains bacteria that transforms any sugar you ingest into acid. Cavities develop when that acid dissolves a hole into one of your teeth.
How are cavities detected?
There are two types of cavities. The first type occurs in the grooves of the teeth (rough surface cavity) where bacteria can hide and cause cavities deep in the groove. A common example is when cavities appear on the chewing surface of the teeth. When those cavities are big enough, a hole or a dark spot can be seen on the surface of the tooth. At that point, the cavity is cleaned and all the decay removed, and a filling is placed to restore the tooth to its original shape and function.
The second type of cavity is the one that starts on the smooth surface of the tooth (smooth surface cavity.) These can happen either between the teeth, or on the cheek or tongue side of the teeth, commonly close to the gum-line. Cavities between the teeth can only be detected using X-rays, unless they are big enough to weaken the surface of the tooth to the point that the tooth breaks. Smooth surface cavities that occur on the cheek side of the tooth can sometimes be seen as a white spot in the early stages and then as a hole that starts to appear on the tooth’s surface.
How can I have a cavity if my tooth doesn’t hurt?
The crown of the tooth (the part of the tooth that shows in the mouth) is made up of an outer enamel layer, an inner layer of dentin, and a core of dental pulp (nerves and the tissues that supply the tooth with blood.) The enamel of the tooth has no nerve endings, so a cavity restricted only to the enamel is not going to cause any pain. Once the cavity spreads to the underlying, softer dentin, the tooth could start showing some sweet sensitivity or temperature sensitivity; however, many people still don’t notice any pain until the cavity reaches the pulp (nerve) of the tooth. Once decay reaches the nerve, sensitivity usually gets worse, and the tooth could become extremely painful. At that stage, fillings on their own will not solve the problem. A root canal treatment will then be required to remove the affected pulp in addition to the filling to save the tooth. In most cases, a crown will also be recommended after a root canal treatment is performed.
What is the difference between sealant and fillings?
When the grooves on the surface of a tooth are still healthy with no signs of decay, sealants are the only proven method to prevent cavities. Those grooves may or may not be prepared first, and then a very runny filling material is placed in those grooves to seal them and prevent bacteria and food from accumulating deep in the grooves and causing a cavity.
When a cavity forms within the grooves, which might become apparent when the tooth is prepared to receive sealants, the decay will need to be removed first, and the space has to be filled with a filling material. In this case, the sealant will not be strong enough to fill the space and restore the tooth to its full function.
Does my mouth have to be frozen/numb to get a filling?
As a rule, freezing your mouth will guarantee that you can get your fillings done without any pain. However, what you will feel depends on two factors: your individual tolerance to pain and the size of the cavity. Some patients have very high pain tolerance and they never get freezing for fillings. Also, if the cavity is restricted to the outer enamel layer of the tooth, the filling can also be done painlessly without any freezing.
Why did my dentist tell me that he is watching my cavity instead of fixing it?
Dental decay is an evolving process. Between the acid attacks on your tooth, the tooth tries to heal by absorbing minerals from saliva, toothpaste, etc. Small cavities can heal on their own and hence don’t require any treatment. If you keep away from sugar and keep your teeth clean, those cavities could harden over time. On the other hand, if you consume sweets frequently and don’t keep your teeth clean, chances are those cavities will get bigger and will require treatment.
How can I avoid getting cavities?
Cavities only develop when you have a combination of three factors: tooth, plaque, and sugar. To prevent cavities, you have to work on minimizing the plaque by regularly flossing and brushing and minimizing your sugar intake. How much sugar you ingest is not as important as how often you ingest it. Remember that every time your mouth is sticky, your teeth are under attack. In addition to this, sealants are used to prevent cavities on the grooves of the teeth (rough surface cavities,) and fluoride is used to strengthen the tooth surface and make it more resistant to acid attacks.
Can I still need fillings if I have no cavities?
Fillings can be used to build up a worn-down tooth or to fix a chipped tooth. However, cavities are still the number one reason why you would need a filling.
My tooth hurts more now that I’ve had a filling. Why?
The procedure of cleaning decay from a tooth often results in some degree of inflammation to the nerve of the tooth. The bigger the cavity, the worse the inflammation. Inflammation usually manifests itself as temperature sensitivity, particularly with cold. Most of the time, the nerve of the tooth will recover and the tooth will settle down. In some cases, however, especially if the decay was very close to the nerve, the inflammation can persist or become worse. At that stage, the tooth might require a root canal treatment to relieve the pain. That doesn’t mean that the tooth required the root canal treatment because of the filling: if the decay was left untreated, the tooth would have still eventually required a root canal treatment.
Root Canal Treatment
What is a dead nerve, and why do I still need a root canal treatment if the nerve in my tooth is dead and I am not feeling any pain?
The pulp tissue (nerve) of a tooth can die after severe inflammation or due to trauma to the tooth (for example a blow to a front tooth.) Once the nerve tissues die, they start to decompose, resulting in an infection around the tooth. This infection can be either an acute infection or abscess, where the face can become swollen and feel severe pain and pressure sensitivity in the teeth, or it can be a chronic infection, where pain is mild and there is little or no swelling. In both cases, the bone supporting the tooth starts to dissolve, which may lead to loss of the tooth. In this situation, a root canal treatment is performed to remove the decomposing nerve from the nerve canals. After being cleaned and sterilized, the canals are filled to prevent future accumulation of bacteria and allow for the healing of the supporting bone.
What happens if I do not undergo a root canal treatment?
The only other alternative to a root canal treatment is removing the tooth. The damage caused by losing the tooth and the shifting of the opposing and adjacent teeth into the space is irreversible. The only way to avoid this damage is to replace the tooth, with a bridge or an implant, which are much more complex and costly compared to having a root canal treatment done.
I had a root canal treatment done a while ago, and the tooth still bothers me sometimes. What can I do?
After a root canal treatment is performed, it is normal to feel moderate to severe discomfort for a few days after the procedure. Sometimes, mild discomfort can last until the tooth heals completely, which could take up to one year. In rare cases, a root canal treatment may not work successfully because of a hidden inaccessible nerve canal, a crack in the tooth or some other reasons. In these rare instances, you will need to discuss other options with your dentist.
My dentist told me that I need to have a cap (crown) on the tooth after my root canal treatment is done. Why?
After a root canal treatment is performed, the tooth becomes brittle and more prone to fracturing, which is the most common reason why people lose a tooth after having a root canal done. A cap (crown) will cover the entire tooth and help protect it from breaking down.
Crowns and Bridges
What is the difference between a crown and a bridge?
A crown is a restoration that is manufactured outside the mouth (usually in a dental lab) after your tooth has been prepared to create enough room for the crown and that covers your tooth when fitted. A bridge is made to replace a missing tooth or teeth and usually consists of two or more crowns with fake teeth attached to them to replace the missing teeth.
Why do I need a crown?
There are several reasons why a crown might be recommended, such as the following:
- Broken teeth
- Teeth weakened by decay to the point that there is not enough tooth to support a filling
- Root-canal-treated teeth
- For cosmetic reasons, to change the shape or colour of a tooth
What are the different types of crowns?
There are many types of crowns. Generally speaking, there are full metal crowns, full porcelain crowns, and combination crowns. Each type has its own advantages and disadvantages. Your dentist might recommend a certain type in a certain situation.
How long is a crown supposed to last?
It is hard to predict how long a crown will last since its durability will depend on many factors, including: the amount of tooth structure existing under the crown, stresses that the crown is subjected to (i.e. clenching, grinding, nail biting, hard food,) the decay activity in the mouth, etc.
Can I get a cavity under a crown?
Crowns sometimes need to be replaced because of a cavity at the edge where the crown meets the tooth, which is why getting a crown doesn’t mean that the tooth is immune to decay. Good oral hygiene, regular flossing, and brushing are the best way to prevent this from happening.
My dentist told me that I need gum surgery before having a crown fitted. Why?
In some cases, a tooth could be broken right at the gum line or the decay in a tooth could extend below the gum line. If we determine that a crown can be made to restore the tooth to its full function, gum surgery could be required first to expose more of the tooth under the gum line and allow the crown to be placed on solid tooth structure.
What is an implant?
An implant is used to restore one or more missing teeth. It is made of a metal rod that replaces the root of the tooth a crown (fake tooth) or special attachment that is used to hold a denture in place.
I have no teeth left, and I don’t like my dentures. Will implants help me?
In this case, implants are the best option. A review of the general health, amount, and quality of the existing bone is required first to determine what your options are and what would work best for you.
What is a bone graft?
When placing implants, enough bone has to be present to hold the implant. The problem is, after a tooth extraction, the bone that supported the tooth is gradually lost, leaving less bone to support an implant. Bone grafts can be done immediately after an extraction to maintain the maximum amount of bone or later to add more bone to the jaw in preparation for the implant.
I still have some teeth left. Do I have to get them removed to get a denture?
It all depends on the condition of the existing teeth. If the existing teeth are healthy, you can get a partial denture (partial plate) to restore only the missing teeth using some of the existing teeth as anchors.
I just got dentures, and I sound different when I talk. What should I do?
Dentures restrict the space of the tongue. It will take a few days until your tongue gets used to the new space so you can talk normally. A trick that could help is reading out-loud for a few minutes every day to help the tongue adapt faster.
I just got dentures and my bottom ones seem to be floating. What should I do?
It is very hard to get good retention for lower complete dentures. Many times, though, your tongue and cheek muscles will learn how to keep the denture in place while you are speaking or chewing. This can take some time. Ideally, implants should be used, if possible, to help keep the lower denture in place.
What are the different types of tooth whitening?
There are two main types of tooth whitening. In both types, a model of your teeth is made and a small transparent carrier (tray) is fabricated that fits your teeth. A special gel is then placed inside the carrier. In the first type, you wear the tray with the gel and then it is activated by a special light at the dentist’s office to help the whitening gel work faster. For the other type, you take the trays and gel home and follow our instructions on how to use them. The tray is usually worn overnight for about two weeks or until you reach the desired shade.
I heard that whitening makes the teeth softer and weaker. Is that true?
Research has shown that whitening using peroxide gels has no harmful effects on teeth. You might experience some cold sensitivity after whitening, but this is a reversible effect and will subside with time. Whitening toothpastes that contain abrasives to remove stains, however, can be too harsh on the teeth and can actually be harmful to the tooth enamel, especially with repeated use.
What are veneers?
Veneers are a very thin layer of tooth-colored material (composite or porcelain) that is bonded to the surface of the tooth to change its colour and shape.
Are there different types of veneers?
There are two main types of veneers:
- Composite veneers (bonding) are done directly by the dentist in the patient’s mouth by bonding, placing and shaping white filling material (composite) on the tooth surface.
- Porcelain veneers are made in the dental lab on a model of the teeth and then the dentist bonds them to the surface of the teeth.
Sedation | Nitrous Oxide / Laughing Gas
What is laughing gas?
Laughing gas was discovered many years ago. Breathing this gas helps one to feel more relaxed and less nervous.
Is it safe to use laughing gas with kids?
Laughing gas is very safe and very useful with children. It helps them relax during treatment, which makes them more cooperative and allows the treatment to be done better and faster.
Do I need to have fasted before I breathe in the laughing gas?
It is recommended that you don’t eat or drink anything 2 hours before your appointment.
Will I be able to drive myself home after I have the laughing gas?
One of the biggest advantages of the laughing gas is that it washes out of your body almost immediately after it is shut off. Once your treatment is completed, you will be breathing 100% oxygen for 5 minutes, which washes out the laughing gas from your system, allowing you to go back to your normal daily activities, including driving.
What should I expect when I breathe in laughing gas?
Every person has a slightly different experience with the laughing gas. In general, most people feel relaxed and sleepy.
What is oral sedation?
Oral sedation is performed by administering a sleeping pill that can be either swallowed or crushed and placed under the tongue. It offers a much higher level of sedation compared to laughing gas while still maintaining the patient’s ability to listen and respond.
What are the advantages of oral sedation?
Oral sedation is the treatment of choice if you have been avoiding the dentist for years and have lots of work to be done. Oral sedation offers several advantages including:
- The ability to do your treatment in fewer appointments. When you are sedated, you don’t notice the time passing and you become more cooperative. This allows your treatment to be performed quickly and efficiently and get more accomplished in a single session.
- One of the biggest advantages of oral sedatives is their amnesic effect. This means that you will have very little to no memory of noises or smells after your treatment.
Will I be able to drive after my appointment?
After your oral sedation appointment, you have to arrange a drive back home. You should spend the rest of the day relaxing at home. After 24 hours, you can resume all your normal activities.