Treatments

This is where every treatment starts, and the first thing we do with a new patient. The dentist examines your teeth, your existing fillings and crowns, your gums, your bite, your jaw joints and the soft tissues of your mouth. We also review your medical history and any medication you take.

Then we explain what we found, in plain terms, and the options available. Nothing is done before you have had a chance to ask your questions and decide with us.

Between comprehensive exams, a recall exam checks that all is well and catches a cavity, a gum problem or a wearing filling early, when it is simpler to treat. It is usually done at the same appointment as your cleaning.

We generally recommend a recall exam every six months. Depending on your situation, your dentist may suggest a different interval.

A sensitive tooth, gums that bleed in one spot, a small bump that worries you: a focused exam looks at one area of the mouth, for one particular problem. The dentist examines the area, takes a radiograph if needed, then explains what is going on and what is recommended.

Radiographs (X-rays) show what the eye cannot see: a cavity between two teeth, the bone around the roots, an infection at the tip of a root, a tooth that has not come in yet. At the clinic we take intra-oral radiographs (small images of a few teeth), panoramic radiographs (the whole mouth in one image, useful for wisdom teeth and implants) and cephalometric radiographs (a profile of the face, for orthodontics).

We also have a cone beam computed tomography (CBCT) machine on site, which produces a three-dimensional image of the teeth and jaw bones. Not everyone needs one, but some cases do, for example to plan an implant, to assess a wisdom tooth close to a nerve, or to find the cause of an infection that is hard to see. We only take the images your diagnosis needs.

Plaque is the soft, sticky film that forms on teeth every day. When it is not removed, it hardens into tartar, which a toothbrush cannot take off. During a cleaning, the hygienist removes the tartar above and below the gumline (scaling), then polishes the teeth to remove plaque and stain.

It is also a good time to talk about your routine: the hygienist checks your gums and can show you how to clean the spots that are harder to reach. Clean teeth are also a matter of health, since an unhealthy mouth can affect your general health.

In most cases, a cleaning is recommended every six months. If your gums need more care, we may suggest more frequent cleanings or root planing (see Gum care).

When you are in pain, it is good to know you can call us. We do our best to fit our patients, and new patients too, into our schedule, to find the cause of the problem and relieve it.

The emergency exam focuses on what brings you in: the dentist examines the area, takes the radiographs needed and explains what is going on. Depending on the case, we take care of the problem during the visit, or do a temporary treatment until the appointment for the definitive one. It is always best to call before coming in, and to tell us what happened and since when.

A dental infection can show up as throbbing pain, a tooth that hurts when you bite, a small bump on the gum, a bad taste in the mouth or swelling. Treatment depends on where the infection started:

• when it comes from inside the tooth (the nerve), it is treated with a root canal or, if the tooth cannot be kept, an extraction
• when it comes from the gum around the root, the dentist cleans the root deep below the gumline (root planing)
• around a wisdom tooth that is not coming in properly, the area is cleaned and, depending on the case, removing the tooth may be recommended

Antibiotics do not treat the cause of an infection on their own. They are prescribed when the infection is spreading, for example with swelling or fever, in addition to treating the tooth.

If swelling makes it hard to breathe or swallow, or spreads towards the eye or the neck, go to a hospital emergency department.

A chipped or cracked tooth, a filling that falls out, a crown that comes off: it does not always hurt, but it is best not to wait, so the tooth does not weaken further. If you have the crown, keep it and bring it to your appointment.

Depending on the tooth, we repair it during the visit or protect it temporarily until the definitive treatment.

If a tooth has been knocked out in an accident, call us right away: time matters, and we will tell you what to do over the phone. In the meantime, hold the tooth by the crown (the white part), without touching the root. If it is dirty, rinse it briefly without scrubbing, and keep it in milk until you get here. Do not try to put a baby tooth back in place.

A cavity is an area of the tooth damaged by the bacteria in plaque. In the early stages it often does not hurt, which is why it is usually found at an exam or on a radiograph. The earlier it is treated, the simpler the repair.

For a filling, the dentist freezes the tooth with a local anaesthetic, removes the damaged part, then replaces it with a material that restores the tooth’s shape. We most often use tooth-coloured composite resin. Depending on the situation, we also offer other materials, such as glass ionomer, amalgam, or a sedative (temporary) filling, used to settle an irritated tooth before the definitive treatment. We choose the material with you, based on what the tooth needs and your preferences. When too little tooth is left for a filling, a crown may be recommended.

Inside each tooth is the pulp, the soft tissue that holds the nerve and blood vessels. It can become inflamed or infected after deep decay, a crack or a blow. Signs can include pain that lingers after hot or cold, pain when biting, or swelling, but sometimes there are no symptoms at all.

During treatment, the tooth is frozen. The dentist removes the pulp, cleans the canals inside the root, then seals them. The goal is to clear the infection and keep your natural tooth. Afterwards, a crown is often recommended to protect the tooth, especially for back teeth.

A crown covers the whole visible part of a tooth, like a cap. It is recommended when a tooth is too damaged for a filling: a large filling that leaves too little tooth, a cracked tooth, or a tooth weakened after a root canal. A crown can also cover an implant.

The tooth is first prepared and an impression is taken. You leave with a temporary crown, and the final crown is cemented at a later appointment. Crowns can be made of porcelain, ceramic, metal or a combination, and we choose with you the one that suits the tooth and your bite. A crown is cared for like a natural tooth.

An implant is an artificial root, most often titanium, placed in the jawbone to replace the root of a missing tooth. Once the implant is in place and has bonded with the bone, usually after a few months of healing, our dentists take the impressions and attach the replacement tooth: a crown, or a bridge when several teeth are missing.

An implant is cared for like a natural tooth: daily brushing and flossing, and regular exams and cleanings.

A bridge replaces one or more missing teeth. The replacement tooth or teeth are held by crowns on the neighbouring teeth or on implants. The bridge is cemented in place and can only be removed by a dentist.

Replacing a missing tooth helps keep the neighbouring teeth from slowly drifting into the gap, which can change your bite. Under a bridge, you floss with a floss threader: we will show you how.

A removable denture replaces several teeth, or all the teeth in a jaw, and comes out for cleaning. A partial denture clips onto the remaining teeth. A complete denture rests on the gums.

We take impressions and do try-ins before the final denture, to check how it looks and how it fits your bite. It usually takes a few weeks to get used to speaking and eating with a new denture, and a few adjustments are often needed at first: just come back and see us.

When plaque and tartar build up below the gumline, the gums become inflamed and can pull away from the teeth, forming pockets where bacteria settle. This is periodontal (gum) disease. The most common signs are gums that bleed when brushing, receding gums, persistent bad breath or loose teeth.

Root planing, often called a deep cleaning, cleans below the gumline: the roots are cleaned and smoothed to help the gums heal. The area is frozen if needed, and treatment is often done over a few visits. More frequent cleanings afterwards help keep things stable.

There are several types of gum graft, depending on the goal. When gums recede, the root of the tooth is exposed. It can become sensitive to cold and more prone to decay, and the tooth can look longer. A graft can then be used to cover the root. But a graft is not always about recession: it can also be used to thicken thin gums and make them stronger.

Dr. Karim Chalaby assesses your gums, looks for the cause of any recession (brushing too hard, the position of the tooth, gum disease) and explains which type of graft suits your case, if any.

Crown lengthening reshapes the gum, and sometimes a little bone, to expose more of the tooth. It is most often done when a tooth is broken or decayed below the gumline, so a crown or filling can be fitted properly. It can also be considered when the gums cover a large part of the teeth and make them look short.

Frenums are small folds of tissue that connect the lip or cheek to the gum. When one is too short or attaches too close to the teeth, it can pull on the gum and contribute to gum recession or a gap between the front teeth. A frenectomy releases or removes it. It is a short procedure done under local anaesthetic.

At the clinic, we do lip and cheek frenectomies. We do not do tongue frenectomies.

Dr. Karim Chalaby places implants at the clinic. Treatment starts with an assessment, with 3D imaging (CBCT) taken on site when needed, to measure the bone, check the health of your gums and plan exactly where the implant goes. Not everyone is a candidate right away: the amount of bone and your general health matter, and we will explain your options.

The implant is placed under local anaesthetic, then needs a few months to heal and bond with the bone. Your dentist then attaches the replacement tooth (see Replacing teeth).

Straighter teeth are not just about looks: they are easier to clean and can improve your bite. Invisalign uses a series of clear, removable, custom-made trays, changed at regular intervals, that move the teeth in small steps.

Treatment starts with an exam and diagnostic records (photos, radiographs, impressions) used to plan how the teeth will move. The aligners come out to eat and brush, and are worn most of the day. How long treatment takes depends on the case. When it is done, a retainer keeps the teeth in place.

When the upper jaw is too narrow, the teeth can run short of space, or the upper and lower teeth do not meet properly (a crossbite). A palatal expander is an appliance attached to the upper teeth that gradually widens the palate.

It is mainly used in children and young teens, while the jaw bones are still growing. Depending on the appliance, we show you how to activate it at home, and we follow progress at regular visits.

The Carriere appliance (Carriere Motion) is a small appliance bonded to the back teeth, on one or both sides, that helps improve how the upper and lower jaws relate, for example when the upper teeth sit too far forward compared to the lower ones. It is worn with elastics, often at the start of treatment, before aligners.

There is no minimum age for a first visit: the earlier your child comes, the better. Early visits let them discover the clinic, the chair and the instruments at their own pace, before they ever need treatment.

These visits are for parents too. We give you advice on brushing, diet, pacifiers and thumb-sucking, and we check jaw growth, how the teeth are coming in, and the small folds of tissue under the tongue and lip (frenums).

Back teeth have deep grooves where plaque and food collect easily and that a toothbrush struggles to reach. A sealant is a thin coat of resin applied into these grooves to help protect them from decay. It is quick to apply, with no freezing or drilling, and is usually done soon after the permanent molars come in.

When a baby tooth is lost too early, from decay or an accident, the neighbouring teeth can drift into the gap and block the way for the permanent tooth growing underneath. A space maintainer is a small appliance, most often attached to a neighbouring tooth, that keeps the space open until the permanent tooth comes in.

During growth, some bite problems can be addressed early by guiding how the jaws develop. Functional appliances, removable or fixed, are used for example to encourage the growth of a lower jaw that sits too far back. The palatal expander, which widens the upper jaw, is part of this too (see Orthodontics).

We look at the right timing during your child’s exams: some cases benefit from early treatment, others can wait until the permanent teeth are in.

Sometimes your mouth is healthy, but you are just not happy with your smile: the colour, shape or position of the teeth, a gap, a chipped tooth. The causes vary, some simple to fix, others more complex.

The consultation is where it starts. We look together at what bothers you, explain where it comes from, and see whether you are a candidate for whitening, veneers, Invisalign or composite bonding. You leave with a clear idea of the options, their advantages and their limits.

We offer in-office whitening (Zoom), done in one appointment, and at-home whitening, which you do over a few days following our instructions.

Not everyone’s teeth respond the same way, and some need precautions (sensitive, worn or eroded teeth). Whitening does not change the colour of existing fillings, crowns or veneers, and temporary sensitivity is possible during treatment. We discuss with you the results you can expect in your case.

A veneer is a thin shell of ceramic or composite resin bonded to the front of a tooth. It can change a tooth’s colour, shape or length, close a small gap, or cover a chipped or stained tooth.

Our dentists place veneers here at the clinic. Depending on the case, the surface of the tooth needs to be lightly prepared. Before starting, we plan the shape and shade with you. Like a natural tooth, a veneer can wear or chip over time: we explain how to care for it.

Tooth-coloured composite resin can be added directly to the tooth to change its shape, repair a chip, close a gap or fill the small dark triangles between teeth near the gums. The Bioclear method uses clear matrices that let the resin be moulded around the tooth.

Bonding is usually done in one appointment and needs little or no preparation of the tooth. Composite can stain or chip over time, and can be touched up when needed.

Botox® is a neuromodulator that relaxes the muscles it is injected into. In cosmetic treatment, it is used to soften expression lines on the face.

Every treatment starts with an assessment by the dentist. Most people feel only a few small pinches, and we give you a few simple instructions for the hours that follow. The effect appears in 3 to 7 days and usually lasts 3 to 4 months.

Many people clench or grind their teeth at night without knowing it. Signs include worn or chipped teeth, a tight or sore jaw on waking, and morning headaches. A night guard is a rigid, custom-made appliance worn at night that protects the teeth from wear and can help ease tension in the jaw muscles.

It is made from impressions of your teeth, then adjusted at the clinic so your bite is balanced on it. We check it at your recall exams.

When the jaw muscles overwork, clenching or grinding, they can become tight and sore and contribute to pain in the temporomandibular joint (TMJ). Injected into these muscles, Botox® relaxes them, which can reduce the tension and discomfort.

Every treatment starts with an assessment by the dentist. The effect appears in 3 to 7 days and usually lasts 3 to 4 months. Depending on your situation, Botox® can be used on its own or with a night guard.

Obstructive sleep apnea is a disorder in which the airway repeatedly narrows or closes during sleep. Loud snoring, pauses in breathing noticed by a partner, and daytime tiredness are common signs.

If we suspect sleep apnea, we can give you a testing device to use at home, in your own bed, overnight. The results are then interpreted by a respirologist, a physician specializing in breathing, who makes the diagnosis and recommends treatment options.

A mandibular advancement appliance is custom-made and worn at night. It holds the lower jaw slightly forward to help keep the airway open during sleep. Depending on the diagnosis, it can be an option for snoring and for some people with obstructive sleep apnea.

It is made after an exam of your teeth, gums and jaw joints. Dr. Gabriel Kakon then titrates it: over follow-up visits, the appliance is advanced in small steps until the right position is reached. A follow-up sleep test then checks the effect. Some temporary tenderness in the teeth or jaw is possible while you get used to it.

We look at keeping a tooth first, whenever that is possible. An extraction may still be needed when a tooth is too damaged to repair, badly infected, very loose because of gum disease, or when space is needed for orthodontic treatment.

The area is frozen before the procedure. We then give you clear instructions for the following days (eating, brushing, bleeding, pain medication) and, if the tooth needs replacing, we go over the options with you.

Wisdom teeth are the last molars. They usually come in between the late teens and early twenties, and often lack the room to come in properly. They can then cause pain, gum infections or decay on the tooth next to them.

A panoramic radiograph, and 3D imaging (CBCT) when needed, shows their position and how close they sit to the nerve. Wisdom teeth that have come in can be removed at the clinic.

A dental laser is a concentrated beam of light that works precisely on the soft tissues of the mouth. We use it in particular to:

• relieve mouth ulcers (canker sores) and cold sores, and help them heal
• remove or reshape a small amount of gum (gingivectomy), for example to uncover a tooth properly before a crown impression

Not every situation is suited to the laser: your dentist will tell you whether it is an option for you.