Articles by Dr. Wilson J. Kwong, DMD
Dr. Kwong shares his vast dental knowledge with his readers by writing his own articles. He has also been interviewed by Omni News and BeautyCosmopolite, a leading source for health and beauty information.
He is a contributing writer for Vancouver View Magazine with the monthly "Ask An Expert" column and answers a variety of questions giving advice on a range of dentistry topics from how to treat bad breath to addressing concerns regarding fillings and headaches.
Enjoy these articles and if you have a question you would like Dr. Kwong to answer please email:
info@smilesarebeautiful.com.
Vancouver View Magazine's 'Ask An Expert' Column
February 2010
January 2010
September 2009
August 2009
July 2009
March 2009
February 2009
January 2009
August 2008
July 2008
June 2008
Q and A with Dr. Kwong about teeth whitening:
http://www.beautycosmopolite.com/smiles/ I have worn dentures for most of my life and I am hearing from friends that I can now have an implant denture that will provide a better and more secure fit. Can you please tell me what’s involved? My own father wore upper and lower dentures, and as a child, I always thought it was funny to see him without his teeth. I also remember that he was always complaining about the looseness of his teeth. During meals, the sound of him chewing and the click-clacking of his false teeth told me something just wasn’t right.
The introduction of implants 30 years ago changed everything for denture wearers! No longer do patients have to endure what my father experienced, as implants have changed the lives of many people by relieving them of their loose or uncomfortable dentures.
Most people are concerned about the possible pain associated with implant surgery, but the majority of patients report little or no pain, and any discomfort they do experience can be easily controlled with mild analgesics like Advil or Tylenol.
If you are a candidate for implant-supported dentures, then your dentist will place the implants, allowing a few months for osseointegration, or “fusing” of the bone to the implant. The newer systems use computer-aided design and titanium materials as the scaffolding for the denture/implant interface. The actual teeth are made of plastic or porcelain, giving you a great look and natural feel. The fit and finish is superb and because it is so light, it feels very natural to the wearer.
My father is no longer alive but if he were, he would be 85 years old today. If he were healthy enough to accept implants, I would not hesitate to give him an implant-supported denture. The procedure is simple and in as little as a few months, his mouth would be transformed to one that is fully functional, allowing him to eat whatever he wanted. This would have vastly improved his quality of life and enjoyment of food.
Ask your dentist about implants today and see how he or she can help you get out of those loose dentures. In the meantime, keep smiling!
I have been diagnosed as having sleep apnea, and my doctor has prescribed a CPAP machine for me to wear, which I find to be quite bulky. I have heard that dentists can make a guard for me to wear that might help me with my sleep. Obstructive sleep apnea (OSA) is a potentially life-threatening sleep disorder where you stop breathing, sometimes up to several hundred times, during your sleep. It is commonly associated with loud snoring, and the condition is severely under-diagnosed. OSA is contributory to headaches, fatigue, strokes, and heart attacks. It is also believed to be one of the leading factors involved in car accidents.
OSA is caused by an obstruction of the airway, usually due to a collapse of the soft tissue around your throat during sleep. This results in reduced oxygen to your brain and vital organs. Other contributing factors include obesity, smoking, and alcohol use. OSA is usually a chronic condition, and over time, greatly affects your health and well-being.
The CPAP (Continuous Postive Airway Pressure) machine is worn over the face during sleep, but many find it cumbersome to use. An oral appliance (OA) can be made by your dentist if you get a prescription from your physician. The OA is made of a soft acrylic fitted over your upper and lower teeth. When the OA is worn, your lower jaw will be positioned slightly forward, thereby allowing your airway to remain open, similar to having your jaw pulled forward during artificial resuscitation.
During your treatment for OSA, try to think about the preventative steps you can take to help you with your situation, such as a healthy diet, exercise, and quitting smoking. The British Medical Journal reported in 2005 that toning of muscles around the throat by playing a wind instrument helped with OSA. Try it - you can have fun and learn a new skill, as well as improve your health! Keep smiling!
I’m 21 years old and I have pain in my wisdom teeth. My dentist said they’re impacted and has recommended extraction. What should I do? An impacted wisdom tooth is stuck behind the tooth in front of it, or under the bone that’s covering it, and is unable to fully emerge through the gums. The pain you are experiencing is likely due to infection caused by bacteria that has accumulated between the gums and the bone. Chronic infection and decay are quite common for teeth in this situation and can lead to serious health complications, which is why most dentists recommend extraction.
Removing wisdom teeth while you are young has its advantages as the roots are not as well-developed, and younger people tend to heal more quickly. Waiting until you are in your thirties or forties may make the process a little more difficult.
You may experience some pain and swelling afterward which can be managed with ibuprofen and ice packs. After a few days of a soft diet and gentle care, most patients are back to their normal activities. Keeping the extraction site clean is crucial for better healing.
Occasionally, complications may develop. The most common of these is dry socket, a temporary painful condition that occurs when the blood clot is dislodged, leaving behind uncovered bone. If this happens, your dentist can apply some medication that will give you almost immediate relief.
Another complication might be numbness of the lip or tongue due to the nerve being disturbed during the extraction. This is usually a temporary condition, but there is a very small chance that the numbness might be permanent. This will be discussed with you prior to your procedure and assessed with x-rays or a CT scan.
Most wisdom teeth extractions go according to plan and problems, if any, are minimal. Good luck and keep smiling!
"I have a sore in my mouth - how can I be sure whether it is a canker sore or oral cancer?"In addition to checking for cavities and gum disease, oral cancer is one of the things dentists look for when we do an examination during a check-up. We look at the most common areas where oral cancer is found: under the tongue and on the floor of the mouth, on and around the sides of the tongue, in the back of the throat, on the sides of the cheeks, on the roof of the mouth and around the lips. Sometimes an x-ray will reveal cancer in the bones of the upper or lower jaw, or in the spaces of the sinuses. Dentists will also examine the neck for unusual swellings or hardening of the lymph nodes, which may indicate cancer in the throat. One of my patients noticed an unusual change in his voice and later found that he had a tumour on his larynx. Fortunately, it was operable and he continues to sing in his band today.
Oral cancers look like red sores or white patches. They are often painful, irregularly shaped, and bleed easily. Unlike canker sores or cold sores, they do not improve or disappear over time. Teeth around the area may be loose or uncomfortable to chew on. Patients may also notice a lump or thickening in the mouth or throat.
A biopsy is the only certain way to determine if tissue is cancerous. Your dentist, or an oral medicine or surgical specialist, can perform one. The tissue sample is then sent for a histological test at a lab to determine if it is a cancer. Different levels of severity from benign to malignant will be assessed and treatment recommended. Complete removal of the cancerous tissue is recommended to prevent spread or metastasis. Treatment may also involve radiation and chemotherapy if it is suspected that the cancer has spread to other parts of the body. Unfortunately, if the cancer is advanced, radical surgery to remove large areas is often required in order to save a patient’s life. This type of surgery can be disfiguring and debilitating to the patient, who will often have difficulty with chewing and swallowing, and may require speech rehabilitation. As with all forms of cancer, early detection is crucial.
There are new instruments being used by some dentists than can aid in the early detection of oral cancer. The most common of these uses a special light that causes abnormal tissue to appear different from healthy tissue. While these tools cannot replace the judgement of an experienced clinician, they are a valuable adjunct to the screening process.
There is no absolute prevention of oral cancers. There are ways to reduce your risk such as minimizing drinking, quitting smoking or chewing tobacco, and eating healthy foods. The combination of alcohol and tobacco is particularly risky, as alcohol thins out or strips away the lining of the oral tissue, which then allows the carcinogens in tobacco to damage the cells. Limiting sun exposure and using a lip balm containing sunscreen will help to prevent cancer on the lips. Infection with the human papilloma virus (HPV) has been linked to several types of cancer including oral, so practicing safe sex can also help to reduce your risk.
Going to the dentist isn’t just about getting your teeth cleaned or your gums checked. It is an important part of your total wellness and should be done on a regular basis. Ask your dentist to evaluate your oral health with a thorough cancer screen.
Keep smiling!
“I’m a 56 year old mom and both of my kids had braces. I’m ready to have them for myself now, but I’m not sure I want to wear the wires. I have heard that there are clear braces that will do the trick. What are my options?”Orthodontic treatment is no longer just for kids. Many of my patients are looking for a more beautiful smile and they understand the health benefits of having straighter teeth. Having straight teeth and a stable bite is good for you because when your teeth fit well, they work better. Straighter teeth are easier to clean and, of course, they look better, too!
Traditional braces employ the use of brackets, which are glued onto the teeth and linked together by elastics and wire. The wire has a “memory” for a preset shape, which slowly moves the teeth to their ideal positions. Every few weeks, the wires are changed. You can ask for the wires and brackets to be placed on the tongue side of the teeth if you’re concerned about the “metal” look. It’s a little more complicated and the feel of the brackets against your tongue will take some getting used to.
One new way your dentist can straighten your teeth is by using clear braces. These are high-grade plastic “trays” which are worn over your teeth and replaced every few weeks. Each new tray slowly moves your teeth closer to their ideal position. The trays are created using a form of Computer Aided Design and Manufacturing (CAD/CAM). Using a virtual 3D model of your teeth, a computer creates a proposal for the series of movements required to straighten your teeth. Trays corresponding to each movement are then manufactured. The obvious advantage to this method is that the trays are clear and nobody can see your braces. Because you can remove them to eat and clean your teeth between meals, you can keep your teeth and gums healthier. Additionally, you won’t have to suffer the embarrassment of spinach or other foods caught in your brackets when having dinner with friends or business associates. The biggest drawback to clear braces is the need for patient compliance. You need to wear them all of the time, except during meals and for cleaning. This is why removable braces are not recommended for children or where compliance may be an issue.
Both treatment systems usually take an average of one to one and a half years, after which, you will wear retainers for another year, but usually just at night. The new thinking is “retention for life”, which means you will need to wear your retainers at least once a week to keep your teeth from relapsing back to their original position. Your dentist can also use fixed retention, which is a wire glued to the tongue side of your teeth. This may make it more a little more challenging to floss your teeth but with a little practice, it is doable.
The investment for a healthier and better-looking smile ranges from $5000 to $9,000. Many adults are now having their teeth straightened and are glad they did it. After all, you can’t let your kids have all of the fun! Keep smiling!
"I have always been embarrassed about my smile. After reading one of your earlier articles, I’ve decided on porcelain veneers to change the shape and colour of my teeth. How will my dentist determine my 'perfect smile'?"
A beautiful smile is more than just shiny, white teeth. A good cosmetic dentist will understand facial aesthetics and how your new smile should work with your overall facial form in a complementary fashion. A smile designed for someone with a very round face will likely not suit someone with a long, thin face. A woman’s smile will often be designed with “softer” features than a man’s. Like most patients, you probably want white teeth, but the shade of white must be chosen carefully to complement your skin tone. Your dentist will understand certain facial parameters and how to set up your smile so that it is in balance with your eyes, nose, lips and chin. Your perfect smile will work in harmony with your other facial features, promoting a sense of balance and symmetry.
With an ideal smile, the teeth should fit nicely within the boundaries of the lips. The midline of the two front teeth will be aligned with the filtrum, the little furrow in your upper lip under your nose, and there should be perfect symmetry between the teeth on the left and those on the right. The incisal edges of the teeth should follow the form of the lower lip all the way to the corners of the mouth, often mimicking the contour of a smile. When smiling gently, these incisal edges should just barely touch the lip and very little of the gumline should be visible. A smile that is too “gummy” or that has an uneven gumline can be improved through laser recontouring.
Cosmetic dentists work with talented lab ceramists who create the new teeth using mathematical parameters. In an ideal smile, the teeth actually relate to one another in size according to a mathematical formula called the Golden Proportion. Examples of this proportion abound in nature and can be seen in the design of the sunflower and spiral shells. We find this proportion to be pleasing to the eye, and we often attempt to replicate it in our art and architecture.
Some dentists talk about the “Social Six”, where only the central six front teeth are treated. However, I find that most people show a minimum of eight and sometimes up to twelve teeth when they smile, and therefore, the most beautiful effect is achieved when the proper number of veneers are placed to complement that particular smile.
When you are choosing to improve your smile with porcelain, it is important to ask the right questions of your dentist. There is not one “perfect smile” that suits everyone. Your new smile should be uniquely designed to complement your face and to enhance its features, allowing you to express your inner beauty. You will find that once you are no longer embarrassed to smile, you will smile more readily and more often. You will feel better and more confident - and isn’t feeling good about yourself the best reason to smile?
Keep smiling!
"I’m considering bleaching my teeth to whiten them for my daughter’s wedding this summer. What are the newest techniques?"
Teeth Whitening is a multi-million dollar industry in North America and growing. Stains from the food and drink we consume over a lifetime fill the micro pores in our teeth, causing discolouration. Baby boomers, unhappy seeing their teeth turn yellow with age, are fuelling the demand for bleaching in their quest for the whiter, healthier-looking teeth of their youth.
Tooth “bleach” is actually hydrogen peroxide, which was originally used in gum surgery to help with disinfection of a fresh surgical site. What the surgeon found was that the gums looked great after a week or so, but that the teeth also looked brighter!
You may find over-the-counter whiteners will lighten your teeth, but you will have to bleach more often, as the chemistry is much weaker than dentist-prescribed methods. They work best for people whose teeth are already fairly white and who are looking for a little brightening. Expect to pay about $50 to $80 for a week’s worth of strips or trays and the whitening to last for a few months.
If you’re like the majority of people over 40 who drink coffee, tea or red wine, then you’ll likely need something stronger as the stains in your teeth have been there longer. Your dentist can prescribe in-chair bleaching or a take-home kit, either of which can provide the whitening you desire and results that can last up to one year.
With the in-chair service, a hydrogen peroxide solution is carefully applied to your teeth after isolating your gums and soft tissue from the active ingredient. A bright light, sometimes ultraviolet, is used to activate the chemicals. The UV light is very safe but may not be suitable for some people who are under certain medications. The light and heat emitted accelerate the bleaching process, resulting in teeth up to 10 shades lighter after only one hour. Your dentist will probably provide a custom-made silicone tray with some bleach material so you can continue lightening your teeth at home.
The take-home system is probably the most popular technique as it is the easiest way to whiten your teeth. During the day or at night, you simply place the bleach material into a custom-made silicone tray and wear it, making sure the material does not overflow and irritate the gums. After 10 applications, you will notice a dramatic improvement in the brightness of your teeth.
The side effects of bleaching are usually sensitivity of teeth to cold and “zingers”, which some patients describe as spontaneous “electrical” zaps. Although annoying and sometimes painful, taking ibuprofen or filling the trays with desensitizing toothpaste usually keeps the sensitivity under control. Contrary to popular belief, repeated bleaching does not cause your teeth to weaken, although abuse or incorrect use can cause severe pain to the gums and hypersensitivity to the teeth so it’s important to follow the recommended instructions. During the bleaching phase, the teeth become more vulnerable to staining as the particles of stain are dissolved, opening the micro pores within the teeth. It’s best to avoid food & drink such as red wine or yellow curry at this time.
The range of costs for in-chair bleaching is $600 to 1200, while take home bleaching is from $250 to $600. If you’re in need of whiter teeth by this weekend, you might want to consider the in-chair technique, but if you have more time, then the take-home system might be more suited for you.
Bleaching is a wonderful and safe way to get a brighter and more youthful looking smile. Make sure you talk to your dentist about the different options available and keep smiling!
“My husband has bad breath and not just in the morning. He brushes and uses mouthwash, but the problem keeps coming back. What do you recommend?”The holiday season has come and gone, and many of you probably had the unpleasant experience of kissing someone with bad breath (halitosis) during that time. Even worse, some of you may have been an unknowing offender! The best way to check if you have halitosis is to ask an honest friend for feedback. While it’s common to have bad breath after eating certain foods such as garlic or onions, a chronic condition may indicate a more serious health concern.
Halitosis is most often due to bacteria in the mouth that produce foul smelling compounds, known as volatile sulphur compounds (VSC). A dry mouth, caused by medications, smoking, or otherwise decreased salivary gland activity, exacerbates the problem by allowing these bacteria to remain in the mouth and multiply. This is the reason for “morning breath”. Brushing, flossing, and using a mouthwash is your best course of action. If you are on the go, stimulating your saliva flow with sugarless gum or candy, particularly those with xylitol, will help to freshen your breath. Avoid sugar-filled candies or mints, as constantly sucking on them will lead to cavities.
If your halitosis is chronic, you will need to address the source of the bacteria in order to solve your breath problem. The VSC producing bacteria are most commonly found on the tongue. When brushing your teeth, be sure to include your tongue. You can also try using a tongue scraper, scraping as far back on the tongue as possible. This, of course, may elicit a gag reflex, so be careful! Other spots in the mouth that can harbour these bacteria are between the teeth, and under the gumline. These crevices can trap food and allow bacteria to proliferate. Regular visits to the dentist for a professional cleaning will help keep these problem areas clean. Your dentist will also check for tooth decay, tooth abscesses, poorly fitting restorations, or gum infections, any of which could be hiding those problem-causing bacteria.
It’s also a good idea to have a full medical checkup. Diabetes, chronic lung or sinus infections, kidney or liver problems, and other metabolic disorders can all cause halitosis.
If your New Year’s Eve date didn’t call you back … maybe now you know why! Valentine’s Day is fast approaching – get your breath in shape by visiting your dentist today. Keep smiling!
"I lost two of my front teeth in a biking accident last year and I have been wearing a denture ever since. I would like to replace it with something permanent. What are my options?”The loss of a permanent tooth can be traumatic because it affects the smile and oftentimes, a person’s self-esteem. Some patients find dentures to be a satisfactory solution, while others, unhappy with the maintenance procedures involved and difficulty chewing, long for a more “natural-feeling” option.
One alternative is to have a fixed bridge. A dental lab replicates the missing teeth, usually out of porcelain, and these new teeth are then attached to the existing adjacent teeth usually within two to three weeks. A well-made bridge can provide excellent esthetic results as well as the strength required for chewing. The disadvantages are that the adjacent teeth must be reduced and capped in order to affix the bridge and cleaning the bridge is not as straightforward as caring for natural teeth.
The best option for a natural look and feel is to have a dental implant. A titanium implant is inserted in the jaw where it integrates with the bone. Once integration is complete, the implant is used to anchor a crown. The result is the next best thing to a natural tooth - strong, esthetically pleasing and comfortable. Implants are more expensive than a bridge and not every patient is an immediate candidate. The entire process can take up to six months, but patients consider the result worth the wait.
If you’re trying to decide between an implant and a bridge, consider this advice from Dr. Frederick Li, Director of the BC Institute of Oral Implantology:
“Long-term studies have shown dental implants to last longer than a bridge, resulting in an overall less expensive dental bill. When a bridge fails, the most common cause is cavities around the capped teeth. With a bridge, you will also continue to lose bone in the area of the missing teeth resulting in further deterioration of your oral health. Dental implants are the only option that maintains jawbone”.
A smile is such an important social tool. Make sure to ask your dental professional for the best option for you. Keep smiling!
“I’m interested in having whiter teeth. What’s the difference between bonding and veneers?”Before you make a decision on bonding or veneers, ask your dentist about other options such as bleaching or orthodontics.
Direct composite bonding and Porcelain Veneers can give you whiter, straighter teeth very quickly, usually the same day or in the case of Veneers, two to three weeks.
Direct bonding uses plastic resin material to shape and sculpt your teeth to look very natural. It’s relatively inexpensive ($300 to $500 per tooth) and usually can be done for you by your dentist in a few hours. The downside is composite is generally not as strong as its cousin porcelain, and colour stability over time is not as good. Advances in composite materials now allow dentists to create very beautiful restorations.
Porcelain Veneers allow your dentist to give you the exact shape and colour that best fits your esthetic needs. Your teeth are minimally prepared, after which a temporary is used to cover the teeth. During the temporary phase, you can “test drive” your teeth and check out colour, shape and function. That information is then used to create your customized final smile. At the last stage, the Veneers and teeth are specially treated with adhesive agents and they are married to each other. The Veneers are super thin, acting like a contact lens, the seam between tooth and porcelain disappears, giving you very natural-looking teeth. The costs range from $800 to $1300 per tooth.
Whatever you decide, take care of your new smile with proper brushing, flossing and regular visits to your dentist for professional care. Keep smiling!
"I've heard that composite (tooth-coloured) fillings may contain Bisphenol A. How safe are they?”Bisphenol A (BPA), a chemical used in the production of plastics and epoxy resins, has had a lot of press lately about its potential danger when used in baby bottles and water bottles. BPA is also found in the lining of tin cans, sports helmets, and some dental composites and sealants.
Composite fillings and sealants contain a form of BPA which is different than that used to make plastic bottles. The BPA in dental materials is encased in a stable compound that does not degrade in the mouth.
Current scientific research indicates that human exposure to BPA from dental sealants and fillings is minimal and presents no known health risk. The risks of not treating cavities and preventing oral disease are far greater than the very small risks associated with exposure to BPA.
The best solution is to practice prevention. Floss and brush daily and schedule regular visits with your dental professional. Keep smiling!
