Our Services
Apex Dental Clinic offers the full array of dental services, from basic to comprehensive, always with the goal of achieving the healthiest smile and function for our patients.
Dental care is really a collaborative effort by both the patient and dental team to achieve optimal oral health, which in turn plays a significant role in total body health and longevity.
The earlier you engage in oral health maintenance, the greater the probability of success. We encourage initiating healthy habits for persons as young as 6 months old.
As we passionately believe education is the key to prevention, this page will be used to present general dental facts. If you have unique dental concerns not addressed here, please contact us.
Diagnostic
A good diagnosis is essential for treatment planning and treatment implementation. It is based on collecting accurate data starting with a medical & dental history, examination, imaging, models or scans and vitality tests where appropriate.
It is essential the patient informs us of all dental concerns so treatment can be effectively coordinated.
A dental examination allows the dentist an opportunity to assess the oral status of the patient. It is also a good opportunity to report to the dentist all your dental issues.
Imaging reveals dental conditions in the underlying tissues not visible or accessible by the dental examination.
Digital optical scans allow the dentist to analyze your case for the purpose of diagnosis and treatment planning. They can also be sent to the lab with a prescription for the fabrication of a prosthesis or of clear aligners for orthodontic treatment.
Vitality testing assesses the degree of vitality of a tooth and is important for diagnosis. It is not routinely done for all teeth. Usually, it is performed on specific symptomatic tooth/teeth.
Emergency
Life happens and if an unexpected accident occurs, timely treatment can make a big difference. We can respond to dental emergencies by teledentistry, adjusting our schedule to accommodate you during business hours or coming into the clinic after hours if necessary.
What to do in an emergency?
Call or Contact Us first to provide details so arrangements can be made for your treatment.
Preventive
Prevention is key in our modern health concept. Preventing a disease is always better than treating it after it has occurred. Prevention involves a daily hygiene regimen, periodic dental examinations with hygiene treatments, sealants, mouthguards or sports guards when appropriate.
The earlier you start, the better!
The Canadian Dental Association recommends brushing twice a day with a soft-bristled toothbrush. Floss at least once a day, usually at bedtime. Floss before brushing for best results.
Recall dental examinations assess your present oral status, monitor ongoing issues as well as assess possible dental issues which may arise in the near future, such as wisdom teeth impactions.
Recommended recall examinations range from 1-2+ times per year, depending on your oral status.
Dental hygiene treatments are essential in reducing the soft (plaque) and hard (calculus) bacterial burden on the teeth capable of causing dental decay, gingivitis, periodontitis and tooth loss, if severe.
Once periodontal bone (bone surrounding tooth) loss occurs, it is irreversible. Even after treatment by scaling and root planing to remove plaque and calculus (tartar) and subsequent healing, the periodontal bone cannot regenerate and would remain low, resulting in reduced support and tooth mobility thereafter. If periodontitis is significant, grafting by a periodontist should be considered to save the tooth/teeth.
Appropriate recall hygiene or periodontal treatments can range from 1-4+ times per year, depending on your oral health status.
Sealants involve coating the natural pits and fissures of the occlusal (biting) surfaces of bicuspids and molars with a thin composite resin to protect against dental decay.
This procedure can only be performed on teeth with no prior cavities. Therefore, it is ideal for young patients with newly erupted permanent teeth.
However, it cannot protect against interproximal (side) dental decay. So please do not skip flossing or brushing after sealant application.
Mouth/night guards protect against attrition (wear) on occlusal (biting) surfaces due to bruxism (clenching/grinding habit). It is usually worn at night time to manage bruxism during sleep.
Sports guards protect against traumatic injury to teeth, especially in the anterior (front) segments, while playing sports.
Sports guards can be purchased from drugstores, sports stores or custom fabricated by the dental clinic. They need to be replaced periodically due to growth, distortion or bacterial deposits.
Pedodontics
Pedodontics relates to the treatment of young patients from 6 months to 18 years of age.
Primary (Baby) Teeth Eruption Pattern
As baby's first teeth are expected as early as 6-8 months of age, it is important to start the conversation upon eruption with your dentist regarding baby's dental care.
Permanent (Adult) Teeth Eruption Pattern
First molars begin erupting at 6-7 years of age, so it is essential the child receives support from both the parents on a daily basis and the dentist regularly to achieve optimal oral health.
Daily Hygiene Regimen
It is best to start establishing healthy habits upon eruption of first teeth within the first year. One can begin by gently cleansing with a damp cloth, progressing to brushing, then adding flossing to the regimen when teeth start forming interproximal (side) contacts. This early investment in time and effort will lead to lifelong rewards.
Periodic Recall Regimen
Biannual recall dental examinations with hygiene treatments are recommended for all children. Thus, the dentist can monitor dental status, catch any condition that arose early and treat when minor. Furthermore, dental development can be assessed so concerns that may arise in the near future can be addressed even before any symptoms occur. The accompanying hygiene treatment reduces plaque and calculus build up to minimize risk of dental decay and periodontal disease.
Early Childhood Caries: Baby/Milk Bottle Syndrome
Answer: Milk, juice and/or other sweetened liquids ingested via a baby bottle over prolonged periods of time.
It is extremely important not to put the baby to sleep with a bottle once first teeth have erupted. A feeding should be completed while awake. Remove the bottle when the baby falls asleep. Prolonged exposure to milk allows bacteria to use the lactose (milk sugar) for extended periods, causing extensive decay of primary teeth.
Likewise, the same applies to a juice bottle/cup. Bacteria loves fructose (fruit sugar) just as much and sipping it all day, even when awake can do similar damage. So juice should be given with specific limits. The same applies to other sweetened liquids (ie, honey water).
It is heartbreaking for us to see multiple cavities in an infant or toddler because we know the child has been suffering from sensitivity to temperature changes (hot/cold), acute and/or chronic pain and difficulty chewing. Consequently, the child’s overall growth would also be compromised because chewing solids is uncomfortable or painful, and he/she will prefer the bottle for longer than normal.
Crowding due to Premature Loss of Baby/Primary Teeth.
Extensive decay of primary teeth leads to premature loss of those teeth. This in turn leads to loss of space in the dental arch because posterior teeth are inclined to move forward into open spaces created by prematurely lost baby/primary teeth, called mesial drift.
Additionally, absence of primary teeth reduces function which are natural triggers for growth of bone and tissues in those areas. The consequences include crowding, cross bites, and impaction (new tooth being unable to erupt due to blocked eruption path).
Myth: Loss of baby teeth is not a problem because the child will get replacement permanent/adult teeth soon.
Fact: Primary teeth not only function to chew food, but also to reserve space for and guide eruption of their permanent replacements. Some permanent teeth (canines and bicuspids) are not scheduled to erupt until 10-12 years of age. They do not erupt earlier just because the baby teeth are prematurely lost. The eruption of permanent teeth is based on their own natural crown and root development, which occurs in an eruption pattern per the Permanent (Adult) Teeth Eruption chart aforementioned.
Thus we advise that it is best to maintain primary teeth in optimal health for a natural, esthetic and timely transition.
Restorative
Restorative procedures primarily treat cavities and minor fractures with a filling of tooth coloured composite material.
Dental decay (cavity) occurs due to prolonged bacterial activity on a tooth. The decayed tooth structure needs to be removed before the tooth can be restored using a restorative material to replace the lost natural tooth structure, called a filling.
As the thickness of the tooth is naturally thinner on the side (interproximal) than on the the occlusal (biting) surfaces, interproximal (smooth surface & root) decay progresses much faster, requiring vigilant monitoring. Flossing is essential to prevent this.
Minor Dental Decay
Our preferred restorative materials are Dentsply TPH Spectra or 3M Filtek for best esthetic results, comfortable function and attrition resistance.
It is important to note that a tooth with decay cannot heal by itself. Dental decay increases in severity with time. Only proper instrumentation for removal of the decayed/damaged tooth structure followed with a filling by a dentist can properly treat this dental condition.
Extensive Dental Decay.
In these cases, patients may experience sensitivity to temperature changes (hot/cold) even after the restoration is placed due to prior prolonged bacterial activity. In most cases, with time and healing, the symptoms should subside with care and maintenance.
However, if the sensitivity increases in severity with time, the tooth may be suffering from irreversible pulpitis (inflammation of the pulp or vascular tissues) and may require root canal therapy.
Minor Fracture
Here the loss of tooth structure was restored with a white composite filling. Please do not bite on non food items. Avoid using your teeth to open bags, pop cans, beer bottles or chew on bones, shells and such.
Then after the treatment, please remember if some thing can fracture a tooth, it can also fracture the composite filling material which is designed to mimic the natural tooth structure.
With regards to larger fractures, bonding alone may be inadequate. Such cases may require veneers, crowns or root canal therapy before restoration if the fracture extended into the pulp.
Always be kind to your teeth.
Major Fracture
A major fracture is usually due to trauma and is a complicated situation. Here the fracture extended to the pulpal center of the tooth where the bleeding is visible, thus devitalizing it. This case will require root canal therapy followed by post and core with crown restoration.
Again, be kind to your teeth. Use common sense and proper protective equipment when engaging in sports or any high risk activity.
Endodontics
Endodontics is the field of root canal therapy. This is necessitated by dental decay that has progressed into the pulp where vascular tissues (blood vessels and nerves) reside, rendering the tooth hypersensitive or devitalized.
A progressively painful hypersensitive situation is called irreversible pulpitis. Symptoms include high sensitivity to temperature changes (hot/cold), spontaneous acute pain, chronic unrelenting pain, inflammation, abscess (infection draining into the periodontal tissues below) and pustulent fistula (pus draining into the oral cavity).
Root canal therapy involves clearing the overlying decayed tooth structure, accessing the pulp cavity, instrumenting to clean the root canal system, then subsequent closure with gutta percha, followed by a filling or filling with crown if there is extensive loss of tooth structure.
Root canal therapy is prescribed when dental decay has progressed through the enamel and dentin into the pulp (heart of the tooth) where blood vessels and nerves keeping the tooth vital reside.
Bacterial activity may cause pulpitis (pain & inflammation), abscess (infection draining into the bone below), fistula (infection draining into the mouth) or devitalization (death of tooth).
Thorough instrumentation to clear the decay and pus may require 2 or more appointments, especially when a significant abscess exists.
A devitalized (dead) tooth becomes progressively brittle (due to dehydration) and dark with time.
Gutta percha is a special filling material used to fill the root canals, visible on imaging.
Thereafter, the lost upper tooth structure is replaced by a filling or core buildup with crown. A crown also protects the now devitalized tooth from future fractures, prolonging the existence and function of this tooth by years if used and maintained with care.
Following successful root canal therapy and crown restoration, the patient still needs to be considerate of this tooth. Though the upper part is protected with a crown, please keep in mind the core and roots are still natural but devitalized.
Prosthodontics
Prosthodontics involves the replacement of one or several missing teeth with a fabricated prosthesis (man made replacement). It may be removable, as in dentures, or fixed as in crowns, bridges and implants.
Materials include dental alloys, ceramics, zirconium and various hybrids thereof.
Removable Denture
This is a good option to replace one or more missing teeth in several places in the dental arch. It is affordable, easy to clean and maintain.
Crown
When a significant portion of the natural tooth structure is lost due to decay or trauma, a crown protects the remaining weakened portion. It offers great esthetics and function, prolonging the function of a damaged tooth by years.
Bridge
One or several missing teeth are replaced along with crowns for the abutments (teeth adjacent to the gap). This is a good option when the abutments also need crown restorations or significant color change.
Implant
An implant replaces the entire root structure, root plus crown, using titanium metal with overlying ceramics for esthetics. It is an ideal option when the adjacent teeth are healthy and do not need to be involved.
More details are available in the Implants section below.
Cosmetic
Cosmetic procedures include whitening, restorative (bonding) and prosthodontic treatments for the purpose of improving esthetics.
Whitening (Bleaching)
Whitening formulations use either hydrogen peroxide or carbamide peroxide to remove yellow chromophores from foods, drinks, or smoking. Patients may select from drugstore kits, clinic's take home kits or in clinic treatment accompanied by bleaching light activation (eg. Zoom WhiteSpeed). The latter options offer shade improvements ranging from 2 to 8 shades, depending on individual variation.
Note whitening may not be as effective with tooth colour of intrinsic origin such as devitalization or tetracycline deposits during development. For these cases, other options may be more suitable.
As well, whitening effect is not permanent. Subsequent persistent intake of strongly coloured foods (beets, curries, soy sauce, etc.), drinks (coffee, tea, grape juice, dark sodas, red wines, etc.) and smoking can lead to recurrence of tooth coloration.
For a longer term effect, repeated or booster whitening cycles may be necessary.
Bonding
Bonding is a restorative procedure to correct localized discolorations or minor fractures on one or several teeth. Here, a single right central incisor was treated.
For situations of greater severity, veneers or crowns may be more appropriate. Please discuss your concern with your dentist.
Veneers: Preparation
Veneers are thin porcelain laminates cemented on teeth after appropriate preparation has been performed. Veneer preparation involves enameloplasty, removal of front surface enamel of up to 2 mm. Thereafter, an impression is made and the veneers are custom fabricated.
Veneers: No Preparation
It is also possible to get veneers without preparation. The resulting effect may appear a bit more protrusive and long.
In either case, the patient needs to take great care not to use excessive biting force.
Veneers (Cont’d)
Veneers are ideal for those who want significant permanent colour and teeth shape change and usually involve 6-10 maxillary (upper) teeth.
However veneers for mandibular (lower) teeth are less common as they are vulnerable to fractures due to being on the receiving end of your daily chewing and biting functions. Either no treatment or crowns may be a more appropriate option.
Please discuss your options with your dentist.
Implants
An implant replaces the whole missing tooth, both root and crown structures.
The root segment is constructed of titanium metal capable of osseoingration, a process where the metal can physically integrate with the periodontal (surrounding) bone.
The core is fabricated with a dental alloy and crown is constructed of porcelain fused to metal alloy or of zirconium.
With regards to preparation, a referral to an oral surgeon will be made for preparation and installation of the titanium implant structure. Then a period of time for healing is allowed to ensure acceptable osseointegration. Next is an appointment for impressions for the fabrication of the core and crown at the dental laboratory. The final appointment is for the placement of core and crown at our clinic.
Implant surgical placement by an oral maxillofacial surgeon.
Osseointegration: physical integration of titanium implant with periodontal (surrounding bone) tissues.
Placement of core and crown by dentist following an impression at the clinic and fabrication at the dental laboratory.
Finished crown is cemented or screw retained.
The longevity of the finished restoration depends on good oral hygiene habits and regular recall dental care to maintain the periodontal bone health.
There are factors such as periodontitis or unhealthy habits (grinding, smoking) which negatively impact the longevity of implant restorations by compromising periodontal bone health.
*This photo is not continuous with previous photos, meaning it is not the same case.
Implant Supported Bridge
An implant supported bridge replaces several missing teeth. In this case, two implants with an overlying bridge can replace four teeth. This reduces surgery and costs.
Implant Retained Prosthesis/Denture
Complete/full dentures may be retained by 4 implants per arch thereby providing better anchorage and support for each denture.
Oral Surgery
Dental surgeries involve either the soft tissues (gingiva) or hard tissues (teeth and/or bone).
Gingival Surgery
Soft tissue surgery includes the following.
- Frenuloplasty: to release a tongue tied condition causing speech problems or a high frenum attachment causing gingival recession.
- Crown lengthening: to reduce excessive gingival tissue display for a more cosmetic, balanced smile.
For complex grafting surgeries, a referral will be made to a periodontist for treatment and management.
Extractions
Extractions may be prescribed for the following situations.
Primary (baby) teeth:
- Due to traumatic injury, extensive decay or presence of pus affecting the development of erupting permanent teeth.
*Normally, it is preferred to maintain the primary teeth until natural transition to avoid subsequent crowding issues.
Permanent (adult) teeth:
-Bicuspids to facilitate orthodontic (braces) treatment.
- Extensive dental decay beyond saving.
- Extensive traumatic injury causing major fractures or avulsion (tooth displaced from socket).
- Third molar (wisdom tooth) impactions.
Third Molar Impactions
If a developing third molar (wisdom tooth) has a straight eruption path and will be a contributory, functional member of the dental arch, no treatment is necessary.
However, if it is impacted, angulated in such a manner that makes it not possible to erupt properly causing inflammation, infection, pain erosion cavities in adjacent tooth and crowding of the anterior segment, it needs to be extracted before irreversible harm occurs.
It is always sad to see erosion cavities in second molars to the point where they are beyond saving.
Imaging of Third Molar Impactions
A panoramic image is ideal for assessing the status of erupting teeth. Here, prevention is key.
For complex surgical cases, a referral to an oral maxillofacial surgeon will be made where IV sedation can be offered.
Orthodontics
Orthodontics involves the alignment of teeth for a more harmonious functional occlusion (bite) and aesthetic presentation.
Various systems are used including removable appliances and fixed brackets.
Removable Appliances
Some conditions such as anterior crossbite can be effectively treated with early intervention by a removable appliance with features designed to move specific teeth in the desired direction.
Braces
Full bracketing with or without bicuspid extractions can effectively align teeth in crowded, rotated, spaced, protrusive, retrusive, asymmetric and crossbite situations with precision, capable of correcting both dental and mild skeletal issues.
Clear Aligners
Orthodontic treatment by using a series of clear aligners, as prescribed and directed by a dentist, may be ideal for you. At times, 'buttons' (attachments) of various sizes and shapes may be used for specific alignments. The aligners need to be worn minimum 22h/d, except for meal times, to be maximally effective.
Invisalign
Invisalign is a brand of clear aligners with excellent proven results. See what Invisalign can do for you by scanning the QR provided. Take a selfie then check out the possible treatment outcome for you in seconds.
For more definitive treatment planning, please book a consultation appointment.
Retainers
Retention following orthodontic treatment is essential to maintain the ideal dental alignment achieved.
Depending on the situation, removable wire and acrylic retainers (Hawley) or clear resilient plastic (Essix/Vivera) retainers may be used.
It is important to wear your retainers 24/7 immediately following completion for 9-12 months to avoid relapse. Thereafter, your dentist will assess your stability and transition you to night time retainer wear for an appropriate period of time, per each unique case.
Myofunctional Therapy
Myofunctional therapy in dentistry involves treatment of pain and paranormal function via dental appliances and/or neuromodulators (Botox, Dysport).