A mouthguard is a protective, thin, rubber-like appliance made from an exact mould of your teeth to protect your dentition from trauma during contact sports. We fabricate simple, vacuum-formed, custom mouthguards as a service to our patients. Because we want you to have this appliance to protect your teeth, we charge a nominal fee to cover only the cost of materials.
The teeth, jaw muscles and the jaw joint should all function in harmony. Over time, events occur which damage this system beyond its adaptive capabilities. This results in symptoms such as jaw muscle soreness and tenderness, popping/clicking complaints in the jaw joint itself, and difficulty opening.
If you are experiencing these symptoms we will do a complete assessment and provide therapeutic options that will return the system as close as possible to harmony. The assessment includes a detailed intra-oral exam of the joints, muscles, and bite. Our JVA/JT technology, which is a computerized 3-D jaw analysis system, is also used to diagnose Temporomandibular Joint (TMJ) diseas. The process includes a joint Vibrational Analysis (JVA) and Jaw Tracker (JT 3-D).
All new patients will benefit from JVA analysis during their complete exam to get base-line measurements which can always be referred to for future comparison. If you have jaw pain or discomfort of any kind then the full JVA/JT assessment will provide detailed analysis of the pathology of your joint, often without the aid of an MRI. Dr. Hunter can then provide specific treatment plans to decrease discomfort and stabilize the joint to prevent progression of disease.
To view an explanatory video on JVA, please click here.
Review Expanded Information on TMJ ▼
The Temporomandibular Joint, or TMJ, is a complex joint that contains a bony condyle, muscles, and ligaments. Just like other joints in the body, they can become displaced or experience degenerative and arthritic changes.
In a normal TMJ, the disc is properly aligned on the joint head, or condyle. Normal jaw function is the result of a healthy joint, where all the parts are properly aligned and working together.
An improperly aligned TMJ can result in many symptoms including:
- Sore Facial Muscles
- Locking Jaw
- Eye Pain
- Sore Teeth
- Ringing in the Ears
- Clicking Joints
- Sore or Painful Jaw
Like most medical conditions, TMJ dysfunction can be treated more successfully with early diagnosis.
What is Joint Vibration Analysis?
The Joint Vibration Analysis or “JVA” is a quick, non-invasive test to examine the health of the TMJs.
It works by measuring the vibrations in the joints and allows the clinician to detect the presence of TMJ disc problems as well as any presence of arthritic issues.
A normal, healthy joint will not produce any vibrations, whereas unhealthy joints will produce vibrations. The JVA test will tell the clinician both the severity and the type of problem within the joint.
How Does the JVA Work?
Taking the JVA Test is simple and painless. The procedure only takes about 1-2 minutes. Our staff will place 2 sensors in front of the ears. Then, you will simply open and close your jaw completely about 7-8 times. The JVA will record any joint noises and our staff will be able to identify any problem you may have with your TMJs.
Who Should Have a JVA Test?
Anyone may have a TMJ problem, and traditional methods make it very difficult to detect early on.
We perform a simple screening with a questionnaire to check for common TMJ dysfunction symptoms and to see if there may be a problem.
We will also do a routine screening for anyone undergoing any significant dental work.
Our team is thrilled about this TMJ screening procedure and the diagnostic capabilities now available to our patients. Your overall health is very important to us!
Snoring and Sleep Apnea Treatment
Medical research has shown that proper sleep patterns are crucial for day-to-day functioning and long-term health. Once a patient has had their sleep cycle analyzed with an overnight sleep test, an appliance will be fabricated. It is worn while sleeping in an attempt to curtail snoring and/or obstructive sleep apnea. The purpose of this appliance is to maintain an open airway passage which permits normal, quiet breathing during sleep.
What is Obstructive Sleep Apnea?
OSA occurs when the muscles and tissue surrounding the throat relax causing the airway to completely collapse and block airflow into the lungs. This blockage cuts off the oxygen supply to the body and brain. The airway obstruction persists until the brain partially awakens the person. The repeating cycle: falling asleep, muscles relaxing, airway collapsing, unconsciously awakening with a gasp, is the reason there is never a restful night of sleep. The lack of oxygen puts extra stress on the entire body, especially the heart. Sleep apnea is a serious chronic disease that may trigger other serious health problems.
- Chronic Sleepiness
- Heart Attack
- High Blood Pressure
- Morning Headaches
There are varying treatment options available to patients who want to solve their sleep-disordered breathing problems.
Review Expanded Information on Sleep Apnea ▼
About 70 million Americans suffer from a sleep problem; among them, nearly 60 percent have a chronic disorder. Sleep problems affect men and women of every age, race, and socioeconomic class. Despite this widespread prevalence, most cases remain undiagnosed and untreated. Research shows that 93% of middle-aged women and 83% of middle-aged men with moderate to severe OSA have not been clinically diagnosed.
Sleep disturbances are any condition that prohibits or affects sleep and may be medical or psychological. Sleep disorders include dyssomnias (excessive sleepiness, result of difficulty initiating or maintaining sleep), insomnia, arasomnia (disorder that intrudes into the normal sleep process), sleep-disordered breathing and sleep bruxism.
The Sleep Cycle
Sleep consists of two distinct states – non-REM sleep and REM sleep. These alternate in 90 to 110 minute cycles, with a normal sleep pattern consisting of 4-5 cycles. Normal sleep lasts for 4 to 10 hours. In the last one-third of the night, REM sleep dominates the sleep cycle. Non-REM sleep accounts for 75% of sleep and has four sequential phases. Delta sleep is the final phase of NREM sleep and is a deep sleep that is important for physical rest, restorative, and is characterized by large slow waves in the brain. Delta sleep accounts for a greater proportion of total sleep time in children and decreases by age 50-60. By age 60 it is almost completely absent.
REM Sleep (Rapid Eye Movement) accounts for 20-25% of total sleep time, and includes vivid dreams, problem solving, and limpness of the body. REM sleep improves the ability to sustain attention when awake and improves learning. In its absence, recollection of newly learned material is impaired. Hypotonia of the upper airway muscles in the presence of unchanged diaphragmatic contractions during REM sleep predisposes individuals to obstructive sleep apneas. Poor sleep causes headaches, pain, irritability and fatigue. In its turn, pain can lead to insomnia and daytime sleepiness.
Sleep Disordered Breathing
Sleep disordered breathing (SDB) is the result of an anatomical abnormality of either the oral airway or the nasal passages. It is of non-psychological origin. Oral airway problems associated with SDB include swollen adenoids and tonsils, a small airway (anatomical as opposed to pathological in origin), malocclusion, hormonal imbalances (such as menopause), obesity and pregnancy. Nasal obstructions include sinus problems and allergies that cause swelling of the nasal mucous membranes. In a person suffering from SDB, the airway collapses in on itself when the patient breathes in and out, shutting off the airway either completely or partially.
There are three categories of SDB: snoring, upper airway resistance syndrome and obstructive sleep apnea. Snoring is the mildest form of SDB and obstructive sleep apnea the most severe. Research has found that around 40% of adults snore, and that around 4% of women and 9% of men show evidence of sleep apnea. SDB’s are also recognized to affect approximately 1%-3% of children.
Types of Sleep Disorders and SDB’s:
Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) is a complete cessation of breathing during sleep for at least 10 seconds. It affects primarily those ages 40-60, and affects more males than females. Left untreated, OSA becomes more severe over time. The national Institute of Health considers OSA a common disorder, affecting 12 million Americans. During an episode of OSA the entire upper airway is blocked causing airflow to stop. This disrupts sleep as a lack of oxygen results (both hypoxia and hypercapnia). The patient awakens repeatedly as a result of making an effort to breathe in the presence of a lack of oxygen.
Patent Airway and Obstructed Airway
Clinical signs and symptoms include intermittent snoring, excessive daytime sleepiness, gasping or choking causing awakening, non-refreshing fragmented light sleep, poor memory, irritability and personality changes, morning headaches and GERD. Cardiovascular symptoms associated with OSA include systemic hypertensions, cardiac arrhythmias, cerebrovascular disease and pulmonary hypertension.
Other problems include the effect on the spouse, with relationships developing problems as a result of sleep-disordered breathing. Central Sleep Apnea (CSA) is defined as a period of 10 seconds without airflow due to lack of stimulus from higher levels of the brain (no ventilator effort), OSA can be longer periods of time.
Symptoms of OSA
It is important to note that insomnia and OSA, while both may result in reduced sleeping time, are not synonymous. Insomnia affects 25-35% of the adult population and can be defined as difficulty falling or staying asleep at least 3 times a week for longer than a month. Spontaneous wakenings, difficulty returning to sleep, and daytime sleepiness are common. Causes of insomnia include psychiatric and medical neurological conditions, use of medications and alcohol. Sleep disordered breathing is an intrinsic disorder that can also result in insomnia- the converse is not true.
Sleep bruxism has been defined by the American Sleep Disorders Association as “tooth grinding or clenching during sleep plus one of the following: wear, sounds or jaw muscle discomfort in the absence of medical disorder.” It occurs mainly in stage NREM and REM sleep and is classified as an oromotor movement disorder. Radin et al found that degenerative arthritic changes in synovial joints are the result of a fatigue mechanism, which is initiated by repetitive strain injury, such as due to sleep bruxism. Sleep bruxism results in micro-trauma, defined as overloading with moderate forces over a long period of time (parafunctional activity). Sleep Bruxism is most commonly the result of pain, airway obstruction and/or anxiety.
Risk Factors for Sleep Apnea
Risk factors for sleep apnea include obesity, increasing age, male gender, family history, alcohol or sedative use, smoking, hypertension, breathing disorders such as asthma, menopause (due to a change in sex hormone levels) and anatomic abnormalities of the upper airway. A further risk factor is malocclusion of the teeth and bruxism, which can affect the upper airway.
Skeletal morphometric risk factors are: high palate, narrow dental arch, and excessive over-jet. Breastfeeding is important in the proper development of airways. The palate of a newborn/ infant is quite malleable. During breastfeeding, and also during a young infant’s normal swallow, the tongue shapes the palate by placing pressure on it. If a person is breastfed and has a normal swallow, the palate will have…a normal height and a dental arch that has a nicely rounded ‘U’ shape.
Diagnosis of Sleep-Disordered Breathing
Sleep-disordered breathing is under-diagnosed. 76% of physicians who are not sleep specialists do not screen or evaluate patients for OSA alone – this number does not include screening for other SDB’s, which are less severe than OSA.
The differential diagnosis of SDB must include headaches of non-SDB origin. Morning headaches and headaches which awaken a patient in the middle of the night, as well as headaches that appear after a long afternoon nap, are common signs of SDB. Headaches may also be a result of TMD and simply a lack of sleep due to sleep disorders such as insomnia.
It is important to be able to differentiate between TMD and airway disorders. It has been found that 75% of the population has at least one sign of TMJ dysfunction, and 33% have at least one symptom. Signs include joint sounds, muscle tenderness, limited opening, capsulitis, and headache/facial pain. Signs and symptoms have been found to be equally common in men and women, with women seeking treatment nine times more often than men.
A definitive diagnosis must be made to rule out one or other before embarking on a treatment plan. A full patient examination will elicit information to make a tentative diagnosis. To confirm SDB, following initial evaluation (including completion of the Epworth Sleepiness Scale), the diagnosis can be made using an overnight sleep study called a polysomnogram (PSG). The patients sleep is monitored and measured throughout the night. Alternatively, a home diagnostic test can be performed – these range from measurements of the blood oxygen level (pulse oxymetry) to devices that measure everything that the laboratory polysomnogram measures.
Patients with SDBs must be triggered into those with problems of nasal origin and those with oral airway problems, and those that are suspected to be of nasal origin must be referred to an otolaryngologist for assessment.
Treating SDBs of Oral Airway Origin
The American Academy of Sleep Medicine (AASM) states that only a physician can make the diagnosis of OSA. However, dental professionals are in a unique position to screen patients for SDBs and refer patients for a definitive diagnosis.
In February 2006 the AASM published their “Practice Parameters” which states “oral appliances (OAs) are indicated for the use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP."
SDBs of oral airway origin can be successfully treated by dentists who are knowledgeable about temporomandibular pathology. It is important to understand during the triage process which patients to treat and which to refer. The three treatment options available for SDBs are CPAP, surgery and oral appliance therapy. CPAP uses a device that forms a pneumatic splint and is placed over the patient’s nose during sleep. It opens up the airway with positive pressure and has been found to be effective for moderate to severe OSA. According to the journal of Respiratory Therapy, compliance with CPAP is poor. Its use is also associated with a number of problems including laceration of the bridge of the nose (caused by the mask), rawness of the throat, bloating of the stomach, nasal congestion and ironically sleep deprivation. The device is also obtrusive and not mobile. Surgery is helpful where there is an anatomical obstruction such as enlarged tonsils or adenoids, an enlarged uvula or nasal anatomical problems. Surgery has only been found to be 30-50% effective. The third category of treatment is the use of oral appliances, which the dental professional is uniquely qualified to provide and treat patients with.
Oral Appliance Therapy
Oral appliance therapy is non-invasive, less obtrusive than CPAP, and effective in the treatment of mild to moderate cases of SDB. Oral appliances may be worn overnight or during the day or both, depending on the individual patient’s treatment. Oral appliances are used to achieve TMJ/mandibular repositioning or tongue retention, or both. Appliances are also available that additionally create a pneumatic splint. Success rates have been found to be as high as 76%. Oral appliances can sometimes cause mild discomfort and temporary minor occlusal shifts that are easily corrected by removing the appliance and opening and closing the mouth a few times, while using a leaf gauge to measure the opening. The patient can gently clench the molars and hold them together for two to three seconds, repeating this every 15 seconds for 10 minutes or until the bite returns to normal.
Patient compliance with oral appliances is significantly higher than for CPAP, and has been found to be between 60-70% after three years of use. Mandibular repositioning appliances advance the mandible, changing the shape of the airway. A number of oral appliance devices have been cleared by the food and drug administration (FDA) as safe and effective. Mandibular repositioning devices may be intended to permanently adjust the patient into a more protrusive position, altering the rest position of the condyles.
Source: Steven R. Olmos, D.D.S. "Dental Sleep Medicine & TMD, A System for Dx and Tx Mini Residency." TMJ & Sleep Therapy Research Centre.
If you would like to do a simple analysis to determine your need for a sleep study, click here
Digital and Panoramic Radiographic Usage and Interpretation
At Hunter Dental, we are dedicated to providing our patients with the safest and most up-to-date treatment available. For this reason, we use digital x-rays in our office. Digital x-rays provide improved and clearer images, and expose patients to less radiation than traditional x-rays. The prescribed x-rays taken at your appointments help the dentist identify and diagnose dental issues such as decay in its early stages. Early detection prevents larger, potentially painful problems from occurring in the future.
Our Panoramic x-are taken extra-orally and the entire head and neck view allows us to examine all of your teeth as a unit, as well as your jaw, TMJ joints, and part of your sinuses. This is very important when considering wisdom teeth removal, jaw or facial injuries, TMJ disorders, and potential pathology.
Sedation during dental treatment
The principal benefit of sedation during dental treatment is to make your dental experience a comfortable one. This can be achieved in the following ways:
- The reduction or elimination of anxiety associated with your dental procedure
- The management of barriers or difficulties associated with dental treatment (eg, severe gag reflex)
- Decreased perception of both the dental treatment (eg, sights, sounds, smells) and the treatment time (ie, will seem significantly shorter)
Nitrous Oxide Sedation
"Laughing gas" is a form of conscious sedation inhaled through a mask. Patients are fully concious and usually nitrous oxide is used to help patients relax during a dental procedure. Patients usually feel that time passes by more quickly and a heaviness or tingling in their limbs which is all part of the calming process. Following a procedure with nitrous oxide; the patient does not need any assistance. They are able to carry on with the remainder of the day’s activities immediately . It should also be clarified that while Nitrous Oxide Sedation reduces apprehension, it does not provide any local anaesthesia. In other words, patients who use this form of concious sedation also need to be frozen.
A state of relaxation and comfort in which you will be sedated (sleepy) and may in fact fall asleep but you will still be responsive to physical stimulation during the dental procedure. Patients typically have no memory of the procedure afterwards with this type of sedation.
During a state of general anesthesia, you will be completely asleep (ie, unconscious) during the dental procedure and will not be responsive to physical stimulation. With this modality, you will not have any memory of the procedure.
We are fortunate to be associated with Dr. Stephen Ing, a certified dental anaesthetist; who administers and safely monitors more profound sedation anesthesia for our patients so that they can have thier procedures completed by our dentists.
The following are points to keep in mind when considering the use of sedation/anesthesia for your dental treatment:
- You will likely be drowsy for the remainder of the day, similar to how you would feel after taking a medication with sedative side effects (eg, Tylenol 3 or Percocet)
- You will not be able to drive a car, operate machinery, or go to work or school for at least 24 hours following the procedure, or longer if drowsiness or dizziness persists
- You must have an escort to take you home and you must be in the care of a responsible adult once you get home for the remainder of the day
- You cannot have anything to eat or drink for a minimum of 8 hours prior to the procedure
- There is an unlikely potential for serious harm, including respiratory and cardiac arrest. However, the chances of this would be significantly lower than being involved in a catastrophic event such as a fatal car accident.
Stephen Ing, BSc, DDS, MSc (Anesthesia)
Dr. Stephen Ing graduated with his Doctor of Dental Surgery degree and postgraduate diploma in Dental Anesthesia, both from the Faculty of Dentistry at the University of Toronto. The postgraduate program in Dental Anesthesia at the University of Toronto is unique in that it is the only one of its kind in Canada that provides focused training in sedation and general anesthesia for dental treatment. In fact, Dr. Ing is one of only a small group of dentists in Canada who have received training in both dentistry and anaesthesiology. He is a Diplomate of the American Dental Board of Anesthesiology and is also registered with the Royal College of Dental Surgeons as a certified specialist in Dental Anesthesia. As well, Dr. Ing currently lectures on the techniques and principles of sedation in dental practice.
Dr. Ing’s ultimate goal is to ensure your dental treatment is carried out in a comfortable, stress-free, and safe manner. If you are one of the many patients who experience pain or anxiety during dental procedures, the use of sedation may be the solution. It is Dr. Ing’s belief that positive dental experiences will lead to better oral health and ultimately contribute to overall well-being.
In House Custom Shading and Staining
Our lab technician can customize porcelain shading and staining directly in our office under optimal lighting conditions. This is a service we provide that tremendously improves satisfaction and happiness from the patients perspective as well as a greater sense of confidence and self-esteem from the completed work.
For all of our porcelain work in the anterior of the mouth we are very fortunate to work with Innovative Dental Laboratory, located in Toronto.
When trying to add lifelike qualities to cosmetic dentistry, there are many factors to take into consideration besides the type of material used. Natural teeth have many nuances like incisal translucency, colour differences between the gingival third and remainder of the tooth, and natural hairline crack lines. This becomes especially important when trying to match porcelain to an adjacent natural tooth.
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of the Year
Congratuations to Dr. Rory Hunter who was awarded Markham's Dentist of the Year for 2014.
Dr. Hunter also received this award in 2012 and 2013.