Dental Care During Pregnancy

Hey everyone,

I was just reading some of the latest findings/summaries in the Ontario Dentist Journal about pregnancy and dental care. Some interesting points:

1. 50% of women experience gingivitis during pregnancy due to increased hormone production
2. Roughly half of those women do not seek dental care
3. A study of 823 women at 13-21 weeks did not show any adverse fetal outcomes when periodontal disease was treated by scaling and root planing using local anaesthetic
4. Local anaesthetics are generally safe during pregnancy. However proper aspiration is particularly important to prevent inadvertent intravascular injection
5. Health Canada recommends that amalgam fillings should not be placed or removed during pregnancy. This approach is conservative since studies have failed to show an increased incidence of birth defects, spontaneous abortions, neurologic or infertility problems.
6. Prenatal x-rays are a small dose of radiation that has not been shown to be associated with any adverse fetal abnormalities

Source: Feferman I, Ontario Dentist, OD Healthline, Sept 2009, Vol 86, No7, pg 16-17.

Hans Skariah, B.Sc., DMD
Promenade Court Dental Health Group in Mississauga
2233 Hurontario St., Mississauga, ON, Canada
(1/2 km north of the QEW in the Dome Building)
(905) 273-7100

Cosmetic Makeover in a few Pictures: Part I

Hi everyone,

I just wanted to give everyone a sample of how we do a nice cosmetic case. In this case, our patient had missing upper laterals that were replaced by some bonding a number of years ago. She was not confident in her smile, and therefore wanted her front 6 teeth redone with two bridges. Here's the before photo (and yes, those devices around her lips are just lip retractors...thanks to Deborah for the photos):

Notice the poor contour of the teeth, not to mention the lack of strength this type of restoration has. It will be much better with two bridges cemented in. After a consult with the patient, as well as getting all necessary hygiene appointments done beforehand, we had a few goals in mind with this case:

1. Improve the shape of the teeth to a more natural contour
2. Make the teeth larger for a more youthful look
3. Improve the colour so that the teeth look whiter
4. Improve the contacts so that we have a good chance at having the gingiva (gums) nicely fill in the space in between teeth.

So with the help of Krest Labs, we treatment planned the case.

Coming up in Part 2: The preparation of the teeth and the shape of temporary teeth.


Hans Skariah, B.Sc., DMD
Promenade Court Dental Health Group in Mississauga
2233 Hurontario St., Mississauga, ON, Canada
(1/2 km north of the QEW in the Dome Building)
(905) 273-7100

Unfortunate Terminology: CBC.ca article - Will face masks protect you from the flu?

Here's an unfortunately worded article in regards to dentistry (Will face masks protect you from the flu?). While I have no issue with the premise and conclusions of the article with regards to the H1N1 flu, I wonder what this statement is doing in the article:

"Not all masks are created equally, either. Surgical masks — the kind your dental hygienist might use while inflicting a cleaning on you — offer some help, but they won't filter out smaller particles and don't provide a good seal."

Huh? Inflicting a cleaning on you? So much for preventive dental care. C'mon CBC you can do better!

Source: Will face masks protect you from the flu? April 28th, 2009. Read Sep 1, 2009. http://www.cbc.ca/health/story/2009/04/28/f-flumasks.html

Hans Skariah, B.Sc., DMD
Promenade Court Dental Health Group in Mississauga
2233 Hurontario St., Mississauga, ON, Canada
(1/2 km north of the QEW in the Dome Building)
(905) 273-7100

Dental Did You Know: Oral Appliances

According to the latest RCDSO (Royal College of Dental Surgeons of Ontario) guideline publication, 40% of patients with myogenous (muscle-based) jaw issues who had a placebo oral appliance (guard) experienced remission or noticeable improvement.

Source: Klasser G and Greene C, Oral Appliances in the Management of Temporomandibular Disorders, Royal College of Dental Surgeons of Ontario PEAK Publication, Aug 2009.


Hans Skariah, B.Sc., DMD
Promenade Court Dental Health Group in Mississauga
2233 Hurontario St., Mississauga, ON, Canada
(1/2 km north of the QEW in the Dome Building)
(905) 273-7100

TWiD: This Week in Dentistry (Episode 2)

Hi everyone!

Sorry about the delay in posting. I was on vacation in Europe (it was *fantastic*). I just wanted to acknowledge everyone's patience while I was gone and especially thanks to Jodie and Gloria for keeping things together while I was away. Anyways, this week had a few items of dental interest:

1) Do Redheads Feel More Pain?
A new study has found that redheads are more than twice as likely to avoid a visit to the dentist - possibly because they are more sensitive to pain. But does hair colour really mean more discomfort in the dentist chair?

(Wow, this is news to me...apparently redheads may need as much as 20% more anesthesia for the same affect...I think I'll wait for corroborating studies before I take it as canon)

Source: BBC online, Aug 11, 2009, Do Redheads Really Feel More Pain? http://news.bbc.co.uk/2/hi/uk_news/magazine/8195177.stm
Read: Aug 18, 2009

2) Canadians Reducing Dental Visits During Recession

The economic downturn is delivering a beating to Canadians' health as well as their wealth, a new poll shows. 25 per cent said they have cancelled or delayed a dental appointment to save money

(This is not a surprising result given the recession, it is unfortunate though)

Source: The Globe and Mail Online, Aug 16, 2009, Poor economy hammers Canadians' health, http://www.theglobeandmail.com/news/national/poor-economy-hammers-canadians-health/article1254083/
Read on Aug 17, 2009



Hans Skariah, B.Sc., DMD
Promenade Court Dental Health Group in Mississauga
2233 Hurontario St., Mississauga, ON, Canada
(1/2 km north of the QEW in the Dome Building)
(905) 273-7100

TWiD: This Week in Dentistry

My weekly or so survey of dental stories from the internet:

Crest Pro-Enamel Shield May Stain Teeth (Miami Herald)
Sensational headline for something we've known for a while about stannous fluoride.

Dental Floss Still #1 Choice for Cleaning in Between Teeth (The Wealthy Dentist)
Not really a scientific survey but not a surprising result either.

Lawsuit: Dentist Dropped Tools Down Man's Throat (Associated Press)
Oh my...and he did it twice to a 90 year old.

Schulich Dentist Takes Bite out of Cold Cases (Western News)
Love it! A real life dental CSI (kinda).


Take care

Hans Skariah, B.Sc., DMD
Promenade Court Dental Health Group in Mississauga
2233 Hurontario St., Mississauga, ON, Canada
(1/2 km north of the QEW in the Dome Building)
(905) 273-7100

Hepatitis B Dental Facts

In general, all dental and medical professionals in Canada and the US are required to have documented proof of immunization against hepatitis B to prevent onset of the disease and to prevent transmission to patients.

Why is this needed and why are regulatory colleges so strict about it?

1. Worldwide, there were an estimated 350 million carriers of Hep B
2. 10-18% of surgeons worldwide have Hep B
3. The estimated risk of transmission from an infected worker is 240-1400 per 1 million procedures
4. The sero (blood) conversion rate from a potentially infected workers is 19-30%

Source: Anand R and Bowker C, RCDSO, The Legal and Human Rights Ramifications of Serology Testing for Dental Professionals, PEAK Bulletin May/June 2009


Hans Skariah, B.Sc., DMD
Promenade Court Dental Health Group in Mississauga
2233 Hurontario St., Mississauga, ON, Canada
(1/2 km north of the QEW in the Dome Building)
(905) 273-7100

Happy belated Father's Day and the "Principles of Waiting"

Hope everyone had a great Father's Day celebration. I'm on a reduced schedule in Mississauga because I'm covering the senior dentist's vacation time at the Tavistock location.

I was scanning some of the dental publications at the office and came upon this little gem from Dentaltown Magazine. The publisher, Howard Farran had a list of the "Eight Principles of Waiting" first created by Harvard Business School professor David Maister:

The Eight Principles of Waiting:

1. Unoccupied time feels longer than occupied time
2. Pre-process waits feel longer than in-process waits
3. Anxiety makes waits seem longer
4. Uncertain waits are longer than known, finite waits
5. Unexplained waits are longer than explained waits
6. Unfair waits are longer than equitable waits
7. The more valuable the service the longer I will wait
8. Solo waiting feels longer then group waiting

What a great list! Jodie, Gloria and myself will try to adjust our process flows so that any waiting time is perceived as short as possible.

Source: Farran H, The Waiting is the Hardest Part, Dentaltown Magazine, Vol 10, No 6 June 2009 pg 12-14.

Hans Skariah, B.Sc., DMD
Promenade Court Dental Health Group in Mississauga
2233 Hurontario St., Mississauga, ON, Canada
(1/2 km north of the QEW in the Dome Building)
(905) 273-7100

The Cochrane Library Available to All Canadians!

The Cochrane Library is universally considered the best source of high quality research studies and current evidence-based clinical treatments and guidelines. A partnership between the Canadian Cochrane Network and the Canadian Health Libraries Association has allowed Canadians free access to the library on a trial basis. You can access the library here: Cochrane Library.

Source: JCDA Vol 75, No 5, pg 323, June 2009 http://www.ccnc.cochrane.org/en/index.html

Hans Skariah, B.Sc., DMD
Promenade Court Dental Health Group in Mississauga
2233 Hurontario St., Mississauga, ON, Canada
(1/2 km north of the QEW in the Dome Building)
(905) 273-7100

Evidence Based Dentistry Website from the American Dental Association

The American Dental Association (ADA) has launched a new website dedicated to evidence based dentistry (EBD). The database, which will be updated 4 times a year started with over 1300 systematic reviews.

Source: http://ebd.ada.org

Hans Skariah, B.Sc., DMD
Promenade Court Dental Health Group in Mississauga
2233 Hurontario St., Mississauga, ON, Canada
(1/2 km north of the QEW in the Dome Building)
(905) 273-7100

The British Columbia Oral Cancer Prevention Program Website: Orcanet.ca

This is a fantastic oral cancer website with clinical guidelines for dentists and a nice question and answer section for patients and providers. Check it out!

Hans Skariah, B.Sc., DMD
Promenade Court Dental Health Group in Mississauga
2233 Hurontario St., Mississauga, ON, Canada
(1/2 km north of the QEW in the Dome Building)
(905) 273-7100

Pancreatic Cancer and Periodontal Disease

A Harvard study on 63 000 male health professionals showed a 62% increase in pancreatic cancer in patients who had periodontal (gum) disease.



Source: Kammer C, Gum Disease is Killing Our Patients (and Our Profession is About to be Busted)! Dentaltown, May 2009, Vol 10, No 5, pg 20-23.

Hans Skariah, B.Sc., DMD
Promenade Court Dental Health Group in Mississauga
2233 Hurontario St., Mississauga, ON, Canada
(1/2 km north of the QEW in the Dome Building)
(905) 273-7100

Demi Moore and the Missing Tooth

Well, this story has been making the rounds all over the internet and even a dental blog or two. Demi Moore's dental work on twitter. Here's the teaser quote:

When it comes to twittering, Demi Moore is known for really sinking her teeth into the latest communication craze. At least the ones she has left.

The 46-year-old actress hopped on her account over the weekend to post a couple of pictures in which she's smiling in a dentist's chair and revealing a gaping hole where a tooth used to be.

"I lost it and had to have it fixed! I personally thought this look went out after you were eight, didn't know I would be rocking it again!" she wrote. "Happy to share and always appreciate the opportunity to find humility!!! Or at least be able to laugh at myself!"

Read the rest of the story on E Online and see the pictures here: For Demi, Less is More

Source: E Online, Read on May 28/09 http://ca.eonline.com/uberblog/b125706_demi_sometimes_less_moore.html

Hans Skariah, B.Sc., DMD
Promenade Court Dental Health Group in Mississauga
2233 Hurontario St., Mississauga, ON, Canada
(1/2 km north of the QEW in the Dome Building)
(905) 273-7100

Smoking Related Deaths in Canada

As recently as 1998, nearly 22% of all deaths in Canada were attributable to smoking.

Source: Smoking Cessation Rounds Vol 2, No 9, 2009.

Hans Skariah, B.Sc., DMD
Promenade Court Dental Health Group in Mississauga
2233 Hurontario St., Mississauga, ON, Canada
(1/2 km north of the QEW in the Dome Building)
(905) 273-7100

Dental Did You Know: Breastfeeding Duration and Non-nutritive Sucking Habits

Children that were breastfed for fewer than six months developed non-nutritive sucking habits (e.g. thumb sucking) at a four-fold higher rate than children who were fed 6 months or longer.

Source: Am J Orthod Dentofacial Orthop 130:531-534, 2006

Hans Skariah, B.Sc., DMD
Promenade Court Dental Health Group in Mississauga
2233 Hurontario St., Mississauga, ON, Canada
(1/2 km north of the QEW in the Dome Building)
(905) 273-7100

Practice in Pictures: Part 3

More from Phi Le, the photographer/denturist we refer to.

Hans Skariah, B.Sc., DMD
Promenade Court Dental Health Group in Mississauga
2233 Hurontario St., Mississauga, ON, Canada
(1/2 km north of the QEW in the Dome Building)
(905) 273-7100

New Dental Blogs and Dental Characters in Movies

Just perusing around the 'net and found a couple of interesting blogs. The first is the University of Toronto Dental Library Blog by Amy Beaith and in particular the post from December 11, 2008 on dentists in movies (as characters). Here's the teaser:

A web list of movies from 1940s to 1979 with dentists http://www.classicfilmguide.com/index.php?s=essays&item=24

Ghost Town (2008) - Ricky Gervais, Greg Kinnear Bertram Pincus, is a man whose people skills leave much to be desired. When Pincus dies unexpectedly, but is miraculously revived after seven minutes, he wakes up to discover that he now has the annoying ability to see ghosts. Ricky Gervais a dentist who can talk to the dead.
Good Luck Chuck (2007) - Dane Cook and Jessica Alba Standup comedian Dane Cook stars in this romantic comedy as Charlie Logan, a successful dentist cursed with the affliction of having the women he dates fall in love with the next guy they meet.
The Whole Ten Yards (2004) - Bruce Willis, Matthew PerryJimmy the Tulip's (Willis) quiet new life is shaken up by his old pal Oz (Perry), whose wife (Henstridge) has been kidnapped by a Hungarian mob. The Tulip and his wife Jill (Peet) spring into action.
Finding Nemo (2003) - Bill Hunter voices the dentistA father-son underwater adventure featuring Nemo, a boy clownfish, stolen from his coral reef home. His timid father must then travel to Sydney, and search Sydney Harbour find Nemo. Little Nemo ends up in a dentist's aquarium.

You can read the rest of the post here: Dentist Films. I'll post the other blog in an upcoming post.

Source: http://uoftdentistrylibrary.blogspot.com/2008/12/dentist-films.html
and http://uoftdentistrylibrary.blogspot.com/


Hans Skariah, B.Sc., DMD
Promenade Court Dental Health Group in Mississauga
2233 Hurontario St., Mississauga, ON, Canada
(1/2 km north of the QEW in the Dome Building)
(905) 273-7100

Practice in Pictures: Part II

Another image from Phi Le (the denturist we refer to) of the very unique roof of our building.

Hans Skariah, B.Sc., DMD
Promenade Court Dental Health Group in Mississauga
2233 Hurontario St., Mississauga, ON, Canada
(1/2 km north of the QEW in the Dome Building)
(905) 273-7100

Practice in Pictures: Part I

The denturist we refer to is a hobby photographer and he decided to take a few pictures during one of his visits...here's the first in the series:

Hans Skariah, B.Sc., DMD
Promenade Court Dental Health Group in Mississauga
2233 Hurontario St., Mississauga, ON, Canada
(1/2 km north of the QEW in the Dome Building)
(905) 273-7100

April is Oral Health Month!

Yes, it's that time of the year....April is Oral Health Month. The Ontario Dental Association has taken a leadership role this year in enhancing Ontarians' understanding about the importance of oral health including:

1. downloadable patient fact sheets and an oral health month guide at http://www.youroralhealth.ca/
2. grants to local communities (via the local component societies of the ODA) during the month of April
3. Brush-a-mania, the annual program to educate our young students on proper dental care. This program has already reached over 230 000 students so far

I will try in the next couple of days to post some of the materials the ODA has regarding these great programs.

Source: Estevao R, April is Oral Health Month, Ontario Dentist, April 2009, Vol 86, No 3, pg 48-9.

Hans Skariah, B.Sc., DMD
Promenade Court Dental Health Group in Mississauga
2233 Hurontario St., Mississauga, ON, Canada
(1/2 km north of the QEW in the Dome Building)
(905) 273-7100