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Need to know what your Dental Insurance Plan covers?


Am I covered?

This is one of the most common questions that our patients ask us, whether it is in response to a recommended treatment plan or just a general inquiry.

It is an important question because it is obviously one of the greatest factors that a patient takes into account when considering dental treatment. And although, treatment may be necessary for your dental health, no one wants any surprises when it comes to finances.

 


“It is becoming increasingly difficult for dental practices to gather information from your insurer on your behalf.”


 

Even if you already have an employee booklet that was given to you by your employer, it can sometimes be difficult to interpret or may not explain all the limitations your plan may apply to your covered benefits. Under Ontario’s Privacy Act, it is becoming increasingly difficult for dental practices to gather information from your insurer on your behalf. Oftentimes, they want the subscriber of the plan (the employee) to be present in the office to grant permission and that is not always practical.

When a patients needs to be seen by a dentist for an unexpected emergency or last minute appointment, they do not always have the luxury preparing for their visit. If we have to initiate immediate treatment in order to save the tooth, waiting for approval of a cost estimate is also always a choice. An inquiry to the insurer over the telephone about treatment eligibility can be further complicated if they do not wish to disclose the information about the plan’s benefits without the policy holder’s written permission (regardless of the emergency circumstances) or they want to review the treatment case and dental images first.

This is just one of the many scenarios that take place when dealing with dental insurance. It can be an exercise in frustration especially when you are faced with having to make an immediate or timely decision about your dental health needs. When treatment cannot be delayed and is a same-day necessity, the uncertainty of insurance coverage can trigger an additional worry for patients.

 

Dental Speak

Understanding your dental policy and the terminology used can be confusing. If you ever want to call your insurer to get a general breakdown of your policy there are a number of important terms and questions you may want to know and understand before making an inquiry:

 

Basic Services – Most insurance companies classify routine maintenance and restorative treatment under basic services. These include, but may not be limited to, exams, cleanings, fluoride, x-rays, sealants, fillings and extractions. Your plan will likely limit the frequency under which they will pay for such procedures and you should be aware of these date/frequency limitations.

When making an inquiry to your insurer, you would ask: “What procedures are considered Basic under my policy?  How often can will these Basic services be performed?”

 

Major Services –  Most insurance companies classify Major as those services that go beyond the scope of routine procedures because they involve more complex or extensive treatment in order to restore or repair a condition where breakdown, loss or damaged has occurred.

When making an inquiry to your insurer, you would ask: “Am I covered for major services? What are those major treatments and the associated limitations that I should be aware of?”

 

Fee Guide (aka. Fee Schedule) – is an annual suggested fee structure that is put together by a provincial or state dental association and serve as a guide when dentists are billing patients. Most insurance companies will base their fees according to this annual fee schedule. In order to make a dental plan more affordable for an employer to offer to employees, they may choose a plan that pays at a previous year’s suggested fees. For example, if you have an appointment in 2017 and your dentist bills you at 2017 prices, but you plan pays out at 2015 prices, you will pay the difference in fees between these two dates. From year to year, some dental fees increase, some decrease, while others may remain the same price. Dentists are not required to follow any fee guide, but most do. If the dentist practices a specialty such as oral surgery or endodontics you should inquire about their fees.

When making an inquiry to your insurer, you would ask: “What fee guide does my plan follow?”  “Does it cover both General and Specialist practitioners?”

 

Deductible – Similar to a car deductible, it is the annual dollar amount you must pay before your insurance policy takes effect. It usually is an annual deductible and is applied to your first visit of the year. You may have a deductible for each member on your policy or just one for the whole family.

Case Scenario 1: If your first visit of the year is a covered expense under the terms of your policy and you are charged $100.00 for the treatment, under a policy family deductible of $25 your insurer will pay $75.00 ($100 minus the $25 deductible). Subsequent dental treatment for your family members within the year will not be subjected to this deductible as it has already been applied.

Case Scenario 2: If your first visit of the year is a covered expense under the terms of your policy and you are charged $75.00 for the treatment, under a policy family deductible of $100 your insurer will pay not pay anything as the $100 deductible has not been met yet. In fact, there is $25 still outstanding and will be applied to the next visit in that particular year. Subsequent dental treatment for your family members within the year will not be subjected to this remaining deductible as only $75.00 has been applied.

Sometimes, the deductible is only applied to certain treatment procedures such as major services. Understand that any premium or co-payments usually do not count towards this deductible.

When making an inquiry to your insurer, you would ask: “Does my policy have a deductible and is it single or family? How much is the deductible? Is it applied  to all covered procedures or only certain treatment?”

 

Annual Maximum – Most dental plans have a certain dollar amount that they will pay towards your dental treatment per year. It involves a specific benefit period (January to December for example) and once this maximum dollar is reached then you are responsible for paying any remaining costs. It is important to understand that, if at the end of this benefit period, you still have a portion of this dollar amount still available and do not use it, it is usually lost and does not carry over into the next benefit period. Annual maximums vary depending on the policy and they are another way that employers and insurers limit their costs. There may be a different dollar amount applied to basic treatment as opposed to major services. It may also be applied to each individual under the policy or be a dollar amount for the entire family.

Case Scenario 1: If you have an individual annual maximum of $1000 and you have seven cavities totaling $700 and have not used any other monies from your plan during that specific benefit period, then you still have $300 remaining.

Other consideration that can affect this dollar amount of deductible, co-payments and type of dental services – basic or major.

Case Scenario 2: If you have an individual annual maximum of $1000 and you have seven cavities totaling $700 and have not used any other monies from your plan during that specific benefit period, but your plan only pays 80% for this type of basic treatment and has a $25 deductible, then they will pay $535 toward the dental cost leaving you with $465 remaining.

Unfortunately, the annual maximums that many insurance companies offer do not match the realty of today’s dental healthcare costs.

When making an inquiry to your insurer, you would ask: “Does my policy have an annual maximum? Is it a single or family maximum? What period does it cover? How is it applied – basic, major towards any treatment? What happens to remaining dollars at the end of the benefit period? Does my policy have a lifetime maximum? How can I best keep track of this annual maximum?

*TIPSometimes, a patient needs a lot of dental treatment during their benefit period. They may choose to have only the treatment that is covered by their annual maximum, and then delay the remaining treatment until their benefit period renews. Sometimes, it may be a viable option for you, while other times, delaying dental treatment can lead to higher costs in terms of fees, pain, complications and disease progression. Always consult your dentist if you are considering delaying recommended treatment. Oral health can be unpredictable, especially if you do not visit your dentist on a regular basis.

 

Co-Payments (aka. co-insurance) – is the percentage of the procedure bill that your insurance does not pay. It is your portion of the dental cost. If your dental office bills your insurance directly, then you will pay this fee after each dental visit. If you pay your dentist first and are reimbursed by your insurer then they will pay the covered costs minus this co-payment.  Co-payment are usually expressed as percentages.

Case Scenario: your dental policy may cover basic procedures at 80% and major services at 50%. You will be responsible for paying the remaining 20% or 50% respectively. For basic treatment, your insurer will pay $60 of a $75.00 dental bill.  If you were charged $500 for a major service your insurer will pay $250.00. Other factors will also be accounted for such as annual maximums and deductibles etc…

Again, it is a way for employers or insurance companies to limit their costs of offering dental coverage. Not everyone is fortunate enough to have a dental policy that covers 100% of all treatment. Like a deductible, a co-payment represents your portion of your dental expenses. Some patients ask their dentists to waive or write-off their co-payments, but each dentist in Ontario has a legal and ethical obligation via-a-vis the insurance company to collect all co-payments from a patient.

When making an inquiry to your insurer, you would ask: “What co-payments am I responsible under this policy? Are there different co-payments for different types of procedures?”

 

Coverage period – This term basically means the period of time for which you or a member of your dental plan is covered for insured benefits. It can be used to describe a benefit year or the period of time that your policy is in effect. Some plans kick in only after a specified “waiting period”, so it is essential that you call your insurer to ensure that you are eligible to use the plan before you make a dental appointment. Additionally, you may only be covered for basic services for a period of time before any major coverage applies.

When making an inquiry to your insurer, you would ask: “When is the exact date that I can begin using this plan?” “Up to what age are my dependents covered and what conditions apply?” “What happens if I am laid-off or go on leave from my job?” “Is there a wait period for any procedures such as major treatment? “Is there anything else that can affect my eligibility under this plan.”

 

Single/Family – Single refers to the individual policy holder/employee and Family includes their spouse and at least one child. Single coverage usually costs less in premiums than a family plan. Clarify with your insurer who is covered under your plan and ensure that their personal information (spelling of name, date of birth etc…) is correct. If you are living in a co-habitation arrangement with a common-law spouse or separate with your spouse, ensure that you understand how it can affect their eligibility under the plan. Lastly, you may want to know if your yearly deductible applies to the family as a whole or each individual member of the plan.

When making an inquiry to your insurer, you would ask: “Does my policy cover my family?” “Do we have one maximum dollar amount for the whole family or do we have individual annual maximums?” “Is my plan’s annual deductible single or family?”

 

Frequencies – Your insurer often limits the number of times that they will pay for a particular dental procedure. The time lapse between two identical procedures and the limitation your insurer will place on having the same procedure performed again can be very problematic for patients if they are not aware of these plan limits. For example, you may be covered to have a check-up examination every 6 months. There are other plan frequencies applied to different treatment such as crown replacement (ie. every 5 years), orthodontics (ie. once in a lifetime), fillings (ie. once every 3 year for same tooth, same surfaces) or new patient exam (i.e. once every 36 months).

When making an inquiry to your insurer, it becomes a little trickier when asking about frequencies. If you think that a tooth has had dental tx performed on it in the past, your dental provider can make this inquiry to your insurer on your behalf.

 

Examinations – There are different types of exams that a dental provider may perform. The exam that is arranged for you depends on the situation and the amount of time involved for the dental provider.

Complete Exam (Procedure code 01101 baby teeth, 01102 mixed baby and adult teeth, 01103 adult teeth) – Exams that warrant a complete verbal, visual and radiographic (x-ray) evaluation of a new patient or of an existing patient that requires a more comprehensive assessment of their oral health status. It generally centers around in-depth information gathering to the extent that allows the dental team to acquaint themselves with a patient’s past medical/dental history, chart pre-existing dental work, diagnose current conditions and develop a plan for future care. Most insurers pay for this every 2-3 years.
Recall/Check-up (Procedure code 01102) – A regular, periodic maintenance examination of a pre-existing patient to ensure no dental problems/issues have arisen since your last check-up exam. It usually coincides with  a regularly scheduled cleaning. Every 6-12 months
Emergency Exam (Procedure code 01105)- An exam that is required in an unexpected, urgent situation such a fractured tooth, extreme pain or swelling of an area of the mouth. Insurers may limit how many of these exams can be done outside of your regular check-up exam.
Specific Exam (Procedure code 01104)- An examination that is required apart from your regular check-up exam for the assessment/diagnosing of a specific area or tooth of concern and is not urgent in nature. Again, your insurer usually place limitations on the frequency of this type of exam.

When making an inquiry to your insurer, you would ask: “How often can I have a check-up exam?” “What are my plan’s frequencies concerning emergency and specific exams” “How often can I have a complete new patient exam?”

 

Specialist – If you have been referred to a Specialist, typically their fees are higher than the suggested provincial fee guide for General dentists. Additionally, you will usually pay up front for your treatment at a Specialist office and be reimbursed by your dental insurer according to the terms of your policy. Although your insurer may not cover all of the fees, it may at least defray some of the cost. Ensure that you know the payment policy of the Specialist you will be seeing and how you are to submit a claim for treatment to your insurer.

When making an inquiry to your insurer, you would ask: “Does my policy covers Specialist fees and at what percentage and up to what maximum dollar amount?”  

 

Composite on molars – This is term that is used to describe a white filling on a molar. Some plans will only pay for an amalgam fillings on back teeth where aesthetics are less of a concern since most people cannot see your back teeth. Many dental offices no longer provide amalgam material as a choice for fillings when a tooth is decays or fractures. There is a cost difference – with the composite white filling being slightly higher in price – so insurers will scale their payment of white fillings to the amalgam price.

When making an inquiry to your insurer, you would ask: “Does my plan cover composite on molars?”

 

Dual Coverage – This is when a patient has dental coverage through 2 separate dental plans – usually their own plan and then an additional plan through another employer, school, spouse or partner. Other dependents and children oftentimes have coverage through both parents. When there is eligible coverage under 2 dental plans one becomes the Primary plan that pays first and the other plan is the Secondary policy that pays all or some of the cost that the Primary does not. When submitting your claim to your Secondary insurer, you will need to enclose proof of Primary insurance payment before they will cover the remaining cost. You may not “double dip” meaning – both insurers require that you fully disclose the presence of dual coverage as you cannot claim your dental fees in such a manner that results in both the Primary and Secondary insurers reimbursing you or the dentist for more than 100% of the claim. Having 2 plans to help defray the cost of dental treatment helps to lower your out-of-pocket expenses, not profit from it. When your Primary claim is submitted, it will include details that will indicate to your Primary insurer that you have Secondary coverage and vice versa. If, for whatever reason, you no longer have the benefit of a Primary plan, you may need to provide proof to the Secondary insurer before they step up to their new position as Primary Benefit provider.

When making an inquiry to your Secondary insurer, you would ask:  “What kind of proof do you require to pay a Secondary claim?” There are two types of Statements of proof that are available – both referred to as EOB: Explanation of Benefits. One is the statement that the Primary carrier sends along with the dental cheque (it may be in postal, email or online form) while another form of proof that is sometimes accepted is the insurer’s response to the electronic submission that your dental office sends over a specific carrier network online and has the phrase EOB on the response.

 

Secondary payments – The is the benefit/money that is paid by a Secondary insurer as in the case of dual coverage or a Health Spending Account. See above. They are not the initial insurer that pays for a dental claim.

 

Health Spending AccountA Health Spending Account is a type of benefit that provides payment for healthcare-related expenses that are over and above any insurance benefits that an employee may have. Typically, a patient would pay the dentist bill first then provide receipt of payment to their HSA for reimbursement.

When making an inquiry : You would make any inquires about a HSA to your employer or  Human Resources department.

 

Orthodontic coverage – This refers to any type of treatment involving re-positioning of teeth like dental braces. It is typically categorized under major treatment and often has it’s own lifetime maximum and co-payment limitations. Generally, your orthodontic provider will submit a treatment plan to your insurer for consideration before any benefits will begin to be paid out and usually these costs are paid out over the course of  the treatment.

When making an inquiry to your insurer, you would ask: “Does my policy include orthodontic coverage?” “What is the maximum dollar mount I can claim under orthodontics and is it a lifetime maximum?” “Is there an age restriction?” “Does treatment have to be provided by an orthodontist?”

 

Assignment of benefits – As a courtesy to patients, some dental offices will submit and bill your insurance company directly then wait for payment of the covered portion of treatment. Dentists are not required to do this. The full cost of the procedure is ultimately your responsibility. Understand, that many offices may not offer assignment of benefits for a number of reasons. It is getting increasingly difficult to do business with or make inquires on behalf of patients to insurance companies who implement very strict information policies based on their interpretation of Ontario’s Privacy Act. Lastly, dentists treat you based on your needs – not your dental plan. A dentist is still obligated to recommend treatment based on sound, evidence-based diagnosis even when your benefits do not completely match your health needs. Providing dental care while being a third party and fee collector to an agreement between a you and your insurer is a relationship that many healthcare providers do not wish to engage in.

When making an inquiry to your insurer, you would ask: “Will you make payment directly to my dental provider?” “Do you accept electronic claim submissions?”  Your dental office will then have additional information about this electronic claim process.

 

Estimates – A written treatment plan (and images/x-rays, if requested) that is submitted to your insurer to determine whether any or all of the dental procedures in the treatment plan will be covered by your plan. Most insurers no longer provide verbal authorization over the telephone and recommend that you send them an estimate for any treatment over $300-$500. In this way, you will know in advance what your plan will cover and what your out-of-pocket expenses will be. It is important to remember that a pretreatment estimate does not guarantee payment from your insurer. Your insurer will calculate benefits according to your current eligibility, any deductibles that may be applied and how much is remaining of your yearly allowed maximum.

When making an inquiry to your insurer, you would ask: “Can you tell me over the phone if I will be covered for “such and such” treatment.  If not, approximately, how long will the estimate process take?” When making an inquiry to your dentist, you would ask: “Will you submit an estimate to my insurer for the proposed dental treatment and await their reply before we proceed?” Will it be safe to postpone advised treatment until my insurer replies?”

 

Age Limitations – This is another restriction in coverage and applies to limiting or denying benefits based on age. An example is fluoride or orthodontic braces that may be limited to children under a certain age or the termination of coverage once a dependent reaches adulthood. Many plans allow dependents to still remain eligible for benefits as long as they are still in school full time and can provide proof of this. Ensure that you provide your insurer with any pertinent information they require for your post secondary school aged child to remain eligible.

When making an inquiry to your insurer, you would ask: “What are the age restrictions that limit the eligibility of any members on this plan? What information do you require in order for my post secondary children to remain eligible?”

*TIP – Know the date when your child will no longer be covered under your policy due to any age/school restriction and ensure that they receive a comprehensive dental examination and complete any recommended/outstanding treatment before this date. Waiting until last minute will put unnecessary time constraints on both you, your dependent and your dentist.

 

EOB – A statement issued by your insurer showing what the dentist billed for each procedure and how much the insurer paid. Oftentimes, the statement will contain additional information with respect to why a particular procedure was not covered, the remaining balance of your yearly allowable maximum and perhaps some information pertaining to frequencies.

When making an inquiry to your insurer, you would ask: “How will I receive an accounting of what my dentist billed and what you, the insurer pays – Email? Online? Mail?

 

Other Consideration….

Alternative  Provision: When it comes to dental treatment, your dentist will usually make recommendations based on your individual circumstances. You may be fortunate enough to have several different options available to you. When it comes to options, however, each option generally comes with their own set of advantages/disadvantages in terms of cost, material, long-term prognosis (outcome), stability, patient comfort and compliance, success, limitations, etc.  When it comes to your insurer providing payment for any particular treatment, you are limited to the terms of your policy.

Alternative  Provision 1: Your insurer may agree to pay for your treatment, but only if your choose a less costly option or another treatment option of their choosing. The least expensive alternative is not always the best treatment option for you. For example: Your dentist may suggest a crown for a tooth that has been heavily restored and your insurer may only pay for the tooth to be repaired using pins and filling material. What happens when that tooth breaks sooner than later because the filling did not provide the necessary coverage/support/strength? What happens if the break extends down into the root and the tooth has to be removed?

Alternative Provision 2: Your insurer may agree to pay for your treatment, but will only pay out at the price of a less costly option or another treatment option. For example: Your dentist may suggest an implant in the area of a missing tooth. Your plan may provide benefits for a less expensive option, but agrees to pay for your implant, but only up to the price they would have paid for the less costly option.

It’s great to have dental coverage until you find out that your plan does not cover your individual needs – needs that become more complicated with due to age, neglect accidents, disease or wear. Remember, your dentist treats you not your dental plan.

 

Pre-existing Conditions – There may be a clause in your policy that restricts benefits if your particular condition already existed before you had your current dental plan. One such common condition is the “Missing Tooth.”  If your dentist recommends that that you replace a missing tooth/teeth with a bridge, implant or denture, but this tooth was removed before you were insured under your dental plan, your insurer may not pay any money towards restoring your condition back to ideal dental function. Likewise, for treatment of gum disease if they can prove that the condition of your gums and supporting structures of the periodontium were already compromised before your plan came into effect.

 

Whew!

This is a lot of information to take in.

In dentistry, we work with many, many different types of dental plans – all with various limitations and rules. Although a dental office may become familiar with a certain number of dental plans in their particular area or community, it is not practical to expect dental staff to be fully knowledgeable of all the individual plans available.

Your dental coverage is usually part of an overall benefits package offered by your employer and is designed to help employees offset their healthcare expenses. It is generally not based on your dental care needs – needs that are necessary to keep your smile happy and healthy!

 

Help Us to Help You!

Prevention is the number #1 way to keep dental costs down!

Prevent dental disease by practicing good oral hygiene and nutrition.

– Brush and floss daily
– Limit sugary drinks and snacks
– Don’t smoke or use tobacco/marijuana products
– See your dentist at least once a year for a thorough examination and cleaning.
– Except for water, space your food intake to 4-5 hours apart to allow saliva to repair damage from acid attacks. – – If you must snack, choose raw, crunch vegetable or fruit.

Prevent  insurance complications for your dental office by informing them of any policy or personal life changes that could alter your coverage such as: changes to employment status changes (as in the case of a temporary layoff), a child in post secondary school or a change in marital status.

Prevent small issues from becoming bigger problems by maintaining regular recare visits and attending to dental issues when they are small and under control. This will go a long way in reducing the likelihood of unexpected emergencies and their associated costs in terms of pain, dental fees and future restorative care.

Prevent dental cost surprises by understanding the ins and outs of your dental plan including what’s covered, limitations and what you are expected to pay before having treatment done.

Prevent future worries by taking the time now to consider future dental costs when planning for your overall healthcare needs in retirement.

Prevent disappointment by taking the time now to discuss treatment options and expectations with your dentist. This includes asking about any risks, future maintenance, long-term prognoses, as well as the consequences of delaying or opting out of treatment.

Prevent any miscommunications by practicing good dialogue techniques with your provider, including the insurance company. Practice active listening, repeat back what you understand and ask for clarification when necessary, be open about your concerns including financial considerations, voice any objections immediately, know what your portion of the bill will be etc…

 

Understanding dental insurance is crucial to making smart decisions about your dental plan’s features. Now that you have a solid grounding in the basics of dental insurance, you’ll be better prepared to understsnd you own plan’s features and help you and your family get the dental care you need!

Who’s taking care of Your Smile?

 

 

 

Yours in Better Dental Health,
The Your Smile Dental Care team
(905) 576-4537
(416) 783-3533
www.yoursmiledentalcare.com

 


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Healthy Summer Teeth

Summer is officially here!

 

We’re looking forward to all that Summertime has to offer after one of the wettest Springs on record!

We know that rain is necessary for healthy flowers and crops, we just hope that it limits itself to overnight and the periodic shower during the hot, midday sun.

Speaking of respite from the sun, a cold, refreshing treat goes a long way to help beating the Summer’s heat.

Without raining on your summer fun, we want to remind everyone that it is very important to limit the amount of snacking in between meals to reduce the number of acid attacks that occur in your mouth during the day. Sometimes, in the hot weather, this can be a tall order to fill when you are looking for ways to cool down and stay hydrated.

If sunshine is your 2nd favourite accessory next to Your Smile,  keep in mind the idea of “Smart Snacking” so you can still beat the heat and keep your teeth safe.

 

Here are some tips to protect Your Smile this summer: 

1. Water – Water is still nature’s healthiest choice to help you stay hydrated. Zero calories and zero sugar!

2. Sweetened Beverages – If you are looking for some tasty excitement in your water there are recipes that you can find online made with xylitol as a sweetener. The great thing about using xylitol is that is helps prevent tooth decay by reducing the growth of bacteria in our mouths and blocks acids that can erode our enamel. It occurs naturally in many fruits and vegetables and once extracted to be used as a sweetener it looks and tastes like table sugar but contains 40% less calories. You can purchase xylitol in most grocery and health food stores, just be sure to read the ingredients to ensure that it does not contain other “sugars.” You may also want to try “infused water” that can be low in sugar is you choose the right fruits, vegetable and herbs. There are lots of recipes online for infused water.

3. Cheese – Eating a cube of cheese before eating will coat your teeth with a special protein called casein for added protection.

4. Low Sugar Fruits – There are fruits/vegetables that are lower in sugar than others like cucumbers, raspberries, guava, cranberries, apricots, rhubarb, and kiwi. Presentation can make all the difference when offering them as a summer treat, so consider arranging them into kabobs, using cookie-cutter shapes or serving them in a melon or fancy glassware to make them more appetizing. Watermelon contains natural-occurring sugars, but because of their high water content it dilutes the affects of these sugars while increasing saliva flow.

5. Smoothies – Blending low sugar fruits/vegetables then freezing them into delicious and healthy smoothies, chilled beverages or frozen popsicle treats is a healthy snack alternative for all ages.

6. Yogurts – can be chilled/frozen or made into delicious parfaits that you can top with other fruits and granolas. You can also coat fruits in yogurts then freeze.

7. Sugarless gum – Chewing gum that contains xylitol promotes saliva flow and reduces bacteria buildup. Saliva goes a long way in neutralizing our mouths and healing the damage of acid attacks that occurs when we eat sugars and starches – even naturally occurring ones.

8. Oral care – Summer can be a busy time with more recreation, vacations and relaxation. Sometimes we become so busy and away from our home that brushing and flossing becomes an afterthought. Remember to bring your toothbrush kit with you when you travel and rinse with water after eating if you can’t get to your toothbrush right away!

9. Junk – Ice creams, popsicles, slushies, soda pops – they all sound like refreshing and tasty hot weather treats, but they can wreak havoc on your oral health. Here are a list of the worst foods for your teeth:

– hard candies
– chewy candies
chewing on ice cubes
– dried fruit
sports drinks
– energy drinks
– soda pop
sipping coffee/tea that with sugar added all day long
– gum with sugar
– highly acidic foods like lemons, pickles and
– chips and crackers

10. Habits – Sometimes, it’s just a matter of habits – some good, others bad. Summertime, and in particular, vacation time, can often turn into a free for all. You can still appreciate all that this fun season has to offer without compromising Your Smile. Oral health isn’t the only thing that will thank you for your wise summer choices. There is an overall health benefit from choosing a healthy lifestyle, so that when you do want to “indulge” a little, you can do so guilt-free.

 

 

 

Have a Great Summer,
The Your Smile Dental Care team
(905) 576-4537
(416) 783-3533
www.yoursmiledentalcare.com

 

 

 


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Your Stinky Floss: The Debate Continues

Even though it was last year that the Associated Press report suggested that flossing was overrated and unnecessary, we are still being asked by patients whether flossing is necessary or not. The simplest answer seems to be answering their question with another question: “What do you suggest for cleaning plaque and food from in between teeth and under the gums?”

 

Although there are other effective interdental aids for cleaning in between teeth, flossing is the only device that can actually get into the tight area between teeth – assuming there is not already a space or gap.

 

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People will have to excuse their dental care providers for getting a little defensive when the health benefits of flossing is called into question. At Your Smile Dental Care, we’ve seen the value that flossing brings to our patients’ oral care over the past 30 years and we will continue to dig in our heels on the subject.

 

We only need to use our common sense about flossing. If you have something in a body part that is causing a foul odour and inflammation that can lead to loss of surrounding tissue, infection and loss of said body part, would you not want to get it cleaned out?

 

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Practicing the best oral care you can with the tools available is important when it comes to your overall health. The link between gum disease and a number of other serious health conditions such as heart disease, diabetes, respiratory infections, and immune system disorders has been well established.

 

Most of us are already making changing in our lifestyles so that we can live healthier and longer. A daily 2 minute routine seems like one of the easier changes we could be making. The bottom line is this: There is research and studies that both sides of this argument can cite to continue their claims. No doubt, the debate will go on and on while the plaque and tartar build up and up!

 

Note to the Associated Press: For all those people that are able to remove meat and popcorn caught between their teeth using their floss – Is that evidence enough? How about how stinky our floss is after use – Is that evidence enough?

 

Yours in Better Dental Health,
The Your Smile Dental Care  Team
(905) 576-4537
(416) 783-3533
www.yoursmiledentalcare.com


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The Sudden Appearance of Cavities

The Tooth Sleuth…

 

20170123_122329Why does tooth decay suddenly begin in patients who have had no history of multiple cavities?

This is actually a common question that is not generally an age-specific misfortune as much as it tends to be a lifestyle occurrence. It is understandable why someone becomes frustrated and very concerned about the sudden appearance of tooth decay when they have had great teeth their whole lives with little or no decay.

Cavities can occur at any age and without warning. Some factors we can control, while others are a more complicated set of circumstances. The sudden appearance of cavities depends on someone’s individual situation, so it often becomes a fact-finding mission for both the dentist and the patient.

 

You may not think of dentists as detectives, but it is one of the many roles we assume as healthcare practitioners

 

Narrowing down the cause can be tricky, but here are a few of the most common culprits:

 

Cavities under fillings – Like anything that is man-made and designed to replace something that is natural, there are limitations. Fillings can wear down, chip or lose their marginal seal with the tooth allowing bacterial acids to seep in and cause cavities under fillings. Maintaining regular dental check-ups allow us to monitor the integrity and health of teeth and their existing restorations.

Orthodontic treatment – Wearing braces, especially the new Invisalign type of braces, give food and plaque more places to hide making it more difficult to see and remove them. Your food choices and attention to the detail when tooth brushing becomes very important to reduce your likelihood for tooth decay. Your orthodontist will warn you of the higher susceptibility for cavities when wearing braces and make recommendation that should be followed diligently.

Dietary change – A sudden change in what and how often you eat and drink can have a huge impact on the health of your teeth, Ideally, you should allow 4-5 hours in between food intake so that your saliva can repair (remineralize) the damage from the acid attacks that occur during meals. If you have acquired a new habit such as frequent snacking, sipping coffee all day, chewing sugar gums/candies, drinking more pop/juices/alcohol, or using throat lozenges you may be putting your teeth at risk for more tooth decay.

Nutritional Deficiencies – The quantity and quality of our saliva is impacted greatly by nutrition. The immunoglobulin, proteins and minerals in saliva help to protect and repair our teeth, so any deficiencies in our food intake or health can and will affect the efficiency of saliva.

Dry Mouth – Saliva plays an important reparative, cleansing, buffering and digestive role in our mouth. A disruption in the quantity and quality of saliva  can put you at risk for more cavities. Illness, medications, medical treatments such as chemotherapy and radiation, stress, weather, alcohol-based mouth rinses, and even the addition of exercise can affect the character of your saliva and it’s ability to do it’s job efficiently. Never ignore dry mouth. Read all about dry mouth here.

Medication – Did you know that there are hundreds of medications that can affect the quality and quantity of your saliva and impact the health of your teeth? Even over-the-counter products such as anti acids, antihistamines, and cough syrups can be harmful to your teeth with prolonged use. Check with your pharmacist about your medications to help narrow down the ones that can cause dry mouth. Perhaps, they can then suggest an alternative and check with your physician about a change in prescription.

Vomiting – When stomach acids make frequent contact with your teeth it can lead to the eroding away of the enamel eventually resulting in a mouth full of cavities. Frequent acid refluxing, prolonged illnesses and eating disorders that use the elimination of meals just eaten, are serious matters that cause nutritional deficiencies and cause an increase in cavities.

Teeth Whitening – We believe that the frequent use of teeth whitening products can eventually cause the wearing away of protective enamel. Moderation is key here and your dentist will advise you as to what is considered a safe, but effective whitening regime for your specific-to-you situation.

Oral Hygiene – Have you changed your oral care routine? Changing toothbrushes, eliminating fluoride, slacking off with brushing and flossing, brushing too hard or excessively and even choosing a natural oral care product can all lead to more cavities. We had one patient who switched to an electric toothbrush but did not know that they were missing the entire gum line area resulting in cavities all along this area. And, as popular as some homemade and natural remedies are, care must be taken to choose a product that is both effective and gentle on teeth and gums.

Fluoride Intake – Fluoride is actually an element that is found in rocks, soil, fresh water and ocean water. Over 70 years ago, it was discovered that populations living and ingesting naturally occurring fluoride had significantly better teeth – in both health and appearance – than those who did not. Many municipalities decided to add 1 part/million fluoride to community drinking water. Today, we still see the evidence of better oral health in fluoridated areas.

Relocation – Sometimes, just moving from one geographical location to another can lead to significant lifestyle changes in terms of habits and access to health and healthy choices. Students who move away from home may find it difficult to maintain healthy habits and make wise nutritional choices. People who move to an underdeveloped area may struggle accessing good nutrition and healthcare. Even a lack of fluoridated water has been shown to impact oral health.

Receding Gums – When your gums recede, the soft root of the tooth is exposed, making it more susceptible to decay and the scrubbing action of your toothbrush. The tissue covering the root is half the hardness of protective enamel. Root exposure and the eventual cavities and abrasion crevices cavities is a common dental problem, especially in older persons and those who use a hard toothbrush or brush to harshly and in in those.

Medical treatments – As unavoidable as they are, some medical treatments affect your oral health and result in unexpected tooth decay. Medical treatments can cause altered taste, saliva changes, mouth irritations, damaged tissues, sensitivity, vomiting, difficulty eating and swallowing, delayed dental treatment, and can disrupt home oral hygiene. All can play a role in an increased likelihood of cavities. At Your Smile Dental Care, we suggest a pre-treatment examination to record baseline charting, identify and treat dental problems and provide oral hygiene education before your medical treatment begins.

Sharing Salvia – Dental disease is an infectious disease. You can be contaminated with the saliva from another person through kissing, sharing a toothbrush or eating utensil. Is cross-contamination capable of actually causing tooth decay ? Saliva is laced with germs and some people have more of the tooth damaging bacteria than others. It is thought that mother’s can pass on bacteria to their children and, in turn, increase the likelihood of decay in the child when they share spoons, so it stands to reason that this is not the only situation where one’s mouth germs can directly affect the quantity and types of germs in another’s mouth. Sometimes, sharing is not caring!

Work Routine – Even something as seemingly insignificant as a change in your work time hours, such as switching from days to nightshift, can affect the way you prioritize and approach your oral care and eating habits. Exhaustion, insomnia, stress, a hurried life can all impact your usual routine and put you at risk for additional tooth decay. Scour the internet to find some great practical tips on how to manage work shifts better.

Don’t make cavities part of your future…

These are all examples of some of the changes that can occur in your life that you may want to consider and review if you notice that you are suddenly being diagnosed with more cavities, more often than usual. A solid review of your nutritional, dental and medical history may reveal something that could account for the high incident of tooth decay. Hopefully, by process of elimination, you and your dentist will be able to narrow in on one or a few of your risk factors and implement some changes in your life now so that tooth decay will not become a recurrent problem.

 

 

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Yours In Better Dental Health,
The Your Smile Dental Care Team
(905) 576-4537
(416) 783-3533
www.yoursmiledentalcare.com

 

 

 

 

 

 

 

 

 


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Alzheimer’s Drug in Dentistry

Alzheimer’s Drug may be sinking it’s teeth into dental care!

 

Needless to say, tooth aches have plagued humans for years, but a recent discovery may soon sink it’s teeth into this age old problem.

 

Scientists have been looking for ways to repair rotten teeth for years. Now it seems that a team of researchers at Kings College in London may have found a way to regenerate tooth dentin using a drug that is usually used to treat people with Alzheimer’s.

 

wearing-timeThe outer layer of the tooth, called enamel, is the hardest substance in the human body. It is very densely calcified and contains no stem cells. Currently, the only way to repair enamel is to hope that a person’s mineral-rich saliva can reverse the very early stages of enamel demineralization cause by bacterial acids.

 

There is always a daily battle during and after meals between the mouth bacteria and our mineral-rich saliva. Simply put, the bacteria metabolize the sugars we eat and create a erosive acid that can dissolve and break open enamel rods allowing minerals to leech out. Our saliva plays a reparative role by then depositing minerals into this surface damage to try to harden the weakened area of the tooth. This repair process takes upwards of 4-5 hours in between meals which is why frequent eating/snacking interferes with our saliva’s reparative ability. Unfortunately, when the amount of demineralization far outweighs the restorative work of saliva and the damage is deep enough, repair is irreversible and the tooth must be cleaned out and filled with a dental material.

 

the-toothHowever, researchers at Kings College were concerning themselves with very large areas of decay – cavities that ate through the enamel and into the next tissue called dentin. Dentin is roughly 50% less harder (calcified) than enamel, but unlike enamel, it  is capable of some regeneration to protect the pulp. Just like bone, dentin is able to acquire more calcified tissue in the event of repair. We call this secondary or reparative dentin and the stem cells needed to produce extra dentin comes from the pulp. That repair is limited, however.

 

Until now….

 

Dentistry already has dental products that attempt to soothe and protect the more vulnerable pulpal tissue from deep tooth decay, but it can only do so much,  especially if the decay is very close or has reached into the pulp. What these scientists have done essentially is found a more natural way for dentin to repair itself. Using a biodegradable collagen sponge soaked with the Alzheimer’s drug called “tideglusib”, they placed it on the dentin where the decay had reached the pulp.

 

Essentially, Tideglusib switches off an enzyme called GSK-3, which is known to prevent dentin formation from continuing.  The testing was done using mice, but the results were very promising. Not only did their body defence systems begins growing natural dentinal tissue, but testing showed the damaged tissue replaced itself in as little as six weeks – much more quickly that the body’s current natural ability. And, unlike the dental materials currently used in dentistry that remain after placement, the sponge eventually dissolves over time after the new dentin replaces it.

 

A Great Step Forward

Image B shows exposed dentin. When drilling continues the pulpal tissue is eventually reached as in Image C. CREDIT: KING’S COLLEGE

This discovery is exciting because, not only do we, as dentists, try to repair decayed teeth, we try to stop it in it’s tracks before it reaches the pulpal tissue. Once the pulp chamber is exposed to the oral environment, we use dental materials designed to cap the exposure and encourage the growth of dentinal stem cells to preserve the health of the pulp, but it’s success rate is not what we’d like it to be.

Many factors play into the repair process and if the body does not cooperate and form a sufficient layer of dentin to seal the pulp, then the vitality of the pulpal tissue will become compromised and eventually begin to rot. Once this happens root canal treatment is necessary to save the tooth from extraction. In addition, tideglusid is not a new pharmaceutical. It has undergone testing and is already being used as a drug for patients with Alzheimer’s.

 

“In addition, using a drug that has already been tested in clinical trials for Alzheimer’s disease provides a real opportunity to get this dental treatment quickly into clinics.”

Professor Paul Sharpe, lead author of the study
Dental Institute of King’s College,  London  UK

 

At Your Smile Dental, we know that, “Not all that glitters is Gold”, but with more than 30 years of dental experience, we also know that many of the technologies we use today in dentistry were the impossible dreams of yesterday. The dentin is a very important protective layer between the enamel and the vital centre of the tooth. Once decay gets into this layer, it can advance quickly. Finding a way to regenerate this tissue faster, before it poses a threat to the nerve, will be a great step forward in the treatment of dental disease.

 

It may not be the end of fillings since enamel cannot grow back, but we’re happy to stick around a little longer to help you with all of your dental care needs!

 

Your Smile - Copy

 

The Your Smile Dental Care Team
(9050 576-4537
(416) 783-3533
www.yoursmiledentalcare.com

 


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Signs of a Healthy Mouth

Do you know the difference between a healthy and unhealthy mouth?

Our patients at Your Smile Dental Care look to us to keep them up to date on all the advances in modern dentistry and to educate them on how to get their mouths and teeth as healthy as possible. Today, people know that they CAN keep their teeth for a lifetime and want to be aware of the first signs of trouble.

 

Gums

20-10-2014 1-32-21 PMHealthy gums are pale pink and firm. They are not white, red and puffy nor do they bleed when you brush or floss. Healthy gums also are not tender or sore and do not have pus filled pimples on them which may be signs of infection. One way we help patients gain a new perspective on the idea of bleeding gums, is to ask them if they would be concerned if they had persistent bleeding elsewhere on their body? Chances are they would answer yes and bring it to the attention of their physician immediately for a diagnosis and treatment.

There is also a triangular portion of gum tissue that should extend between adjacent teeth that ends in a point and has a free space (depth) of about 2-3 mm where your floss would slide for cleaning. As the gums recede due to unhealthy conditions, this triangular shape becomes more blunt and the space becomes deep, forming a pocket into which more bacteria, plaque and tartar can accumulate. Your dentist or hygienist monitors the health of your gum and will routinely measure the depth of these pockets.


Teeth

04-04-2016 3-08-02 PMObviously, healthy teeth should be cavity free, but when your dentist or hygienist checks your teeth, they are looking for many others signs of health also. They examine for any erosion, staining, chips or cracks, disease, failing dental work, looseness, missing teeth, crookedness, sensitivity, etc.

If teeth have had repair work done on them in the past such as fillings, crowns, or root canal treatments, they are checked to ensure that these restorations are holding up under the wear and tear that the chemical and mechanical forces of the mouth and jaws can place on them. Intact restorations have a good fit/seal against the tooth to prevent bacteria from getting in underneath and causing tooth decay. We look for signs of leakage, cracks, chips, movement and tooth decay.

Healthy teeth also do not appear longer as you age. When gums recede due to disease, the crown portion of the teeth will begin to look longer.

Case Scenerio

A patient comes into the dental office because their cap has fallen off of one of their teeth. The dentist notices immediately that not only has the cap come off the tooth, but the crown of the tooth has broken off at the gumline and is still inside the cap. Upon closer examination, they can see and feel with their instruments that both the part of the tooth that is in the cap and the portion that is still in the jawbone have rotted  from tooth decay. Bacteria has gotten in underneath the cap and diseased the hard tooth structure to the point that it crumbled enough for the tooth to break in half. It had been almost 7 years since their last exam. Maintaining regular dental checkups would have allowed the dental staff to monitor the marginal integrity of the cap and periodic x-rays would have detected signs of tooth decay when the cavity was small enough to be repaired.

 

Fresh Breath

Hidden Smile - CopyA healthy mouth does not have persistent or significant bad breath (halitosis). Early morning breath can have an odour after a long night of  bacterial action and growth when there is very little saliva production.

Most often, bad breath is caused by an accumulation of bacteria and their odours and sulphur smelling gases. It is also one of the first signs of gingivitis that can lead to gum disease, worsening mouth odour, the loss of teeth and other complications for the body. Smoking, dieting, dehydration, illnesses, diseases, unclean denture and appliances, tonsil stones, nutritional deficiencies and foods all can cause bad breath.

Wonder if you have bad breath? If you can’t already taste or smell it yourself then you can smell your floss after use or scrape some plaque off your teeth or tongue to smell. Alternatively, you can ask someone to smell your breath and give an honest answer. Most importantly, do not ignore bad breath or just try to mask it with gums, mints or mouthwash. Your physician or dentist can usually help you get to the underlying cause when good oral hygiene does not solve the problem.


Pink, Clean Tongue

You may not realize this, but we also examine your tongue for signs of health. A healthy tongue is pink and covered with tiny nodules we call papillae that help you perceive taste. The overall surface should be flat, smooth and clean looking. The surface papillae can and do harbour bacteria that, if left to accumulate, can grow to unhealthy levels. Keep your tongue clean with a tongue scraper as part of your regular oral hygiene.
Tongue Scraper

A discoloured or painful tongue can be an indicator of trauma, smoking or canker sores, but can also be signs of more serious conditions including a nutritional deficiency, auto immune disease, allergic reaction, Kawasaki syndrome, anemia, diabetes or even cancer. White coatings, lines, or patchy areas should not go ignored.

There is a condition known as “geographic tongue” whereby the top surface of the tongue presents with a map-like pattern of reddish spots that sometimes have a white border on them. It is usually a benign and harmless condition that requires no treatment except topical medications if it becomes sore or uncomfortable.

Medications and menopause can also cause the tongue to become painful or even drier than normal. Always consult your physician if you notice something unusual about your tongue, especially any lumps or sores that do not go away.

 

Proper Bite

25-04-2016 11-19-29 AMIdeally, in a healthy mouth, your upper and lower teeth fit together in an even manner so that the forces of chewing are equally distributed and shared amongst all teeth throughout the jaw.

Teeth rely on one another for support and uneven bites, open spaces or teeth that are crooked, crowded, displaced or missing can hinder the performance, appearance and health of the teeth and can impact breathing, speaking, digestion and oral hygiene. Misaligned and crowded teeth can make teeth more difficult to clean and keep healthy and can cause jaw problems leading to clenching, grinding, head/neck/ear/sinus aches and TMJ disorder.

Pain Free

A healthy mouth is not painful, dry nor sensitive. Yes, we may temporarily cause it trauma through injury or hot foods or have the periodic canker sore show up, but overall, a healthy mouth is pain free. There are products and treatments to help with minor sensitivities and the source of dry mouth situations can be investigated. However, you should be aware and not ignore any changes, pain or afflictions in the mouth and it’s tissues that can be a sign of breakdown or disease. The rule of thumb is to have anything that lasts more than 7-10 days examined.

Lastly

Just because you may brush and floss everyday, does not mean that your mouth is healthy. The phrase, “Your mouth is the window to your overall health” is a reminder that caring for your oral health is an investment in your overall health.

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Yours in Better Dental Health,
The Your Smile Dental Care team
(905) 576-4537
(416) 783-3533
http://www.yoursmiledentalcare.com/


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If I have a cavity why can’t I feel it?

The Battleground

3-14-2016 5-27-20 PMThere is always a battle going on in your mouth! There is bacteria present in your mouth that produce an acid that can attack your tooth and dissolve (demineralize) it away. Fortunately, we also have saliva that is capable of repairing (remineralizing) the early stages of this acid attack on the tooth. This process is natural and a hole begins to form in the tooth only if  demineralization action  far outweighs remineralization.

Once a hole in the tooth become irreversible, there are different stages to the cavity process. As a disease, it is progressive like any other disease of the body. The enamel portion of a tooth has no feeling which is why you are usually not able to feel it. The longer you wait to have a tooth with a cavity repaired, the  larger it will grow until it finally progresses into that portion of your tooth that is more sensitive to the presence of this decay. This is when you may begin to feel some of the discomfort associated with deeper cavities.

3-14-2016 6-05-10 PMIf left untreated, it will eventually reach what people commonly refer to as the “nerve” of the tooth. If a decay is allowed to reach this portion of the tooth, then it can no longer be cleaned out and replaced with dental filling material. At this stage, repair will also involve treatment to the nerve (pulpal) center of the tooth.

What Cavity?

When you attend your dental office for a check-up exam and are told you have some cavities that need to be repaired, it is understandable why you would ask the question, “If I have a cavity, why doesn’t it hurt?”  Some people even decide to put off having the tooth repaired because it isn’t really bothering them now. If your tooth is showing very early sign of decay which is still at a stage where steps can be taken to prevent it from getting bigger, then your dentist will probably give you some oral hygiene and diet instructions and monitor the situation.

We call these areas Incipient Decay (“watches”), and it is important that you return for your regular check-up visits so that the dentist can re-check the decayed area to ensure that there has been no further damage.

Understanding that dental decay (cavities) is a disease process and that is involves the rotting away (decaying) of body tissue will help you appreciate why we take the matter so seriously. If your family doctor told you that you had another part of your body that is rotting away, you would not likely delay treatment until it hurts. No one wants to have a condition in their body that can eventually become an infection. Infections can become so severe that it can lead to the loss of a body part. Untreated tooth decay can eventually lead to the loss of a tooth.

Still, we understand that if you are not experiencing any discomfort and can’t see any damage, then it can be hard to justify immediate treatment.

It’s like…

18-01-2016 3-00-40 PM…going to your physician for your annual examinations hoping for the reassurance that everything is fine with your body and that, overall, you are healthy. Sometimes, however, your doctor may detect an issue of concern and order further tests. Sometimes, these tests  reveal  an underlying condition even though you are feeling quite well and are experiencing no signs or symptoms – ones that you can detect that is!

Clinically (with our eyes), we only see about a third of a person’s dental health which is why, in the absence of pain or signs and symptoms, a picture is truly worth a thousand words. X-rays provide valuable information of that portion of the tooth that is below the gum line as well as the bone that supports it. We also have intra-oral cameras that can zoom into an hard to see area of the mouth and show up on our computer monitor for better patient viewing.

Blind Trust

06-05-2014 9-56-15 AMGone are the days of blind trust when people rarely questioned the recommendation of a health care practitioner. Nowadays, information abounds and patients are “informed consumers.” They also know that communication is key to understanding their state of health and any treatment options offered. No matter the level of trust a person may or may not have, healthcare providers sometimes have to convince patients of the need for treatment. When there is no pain or symptoms, patients can be especially distrustful and may even question the provider’s competence or integrity.

Dentistry is no exception, but we are an evidence-based industry which is why our diagnostic tools are so essential during examination. Being able to show a patient an infection, a broken tooth or a cavity where no symptoms exist helps a patient to see what we see and to understand why intervention is necessary.

One of the cornerstones of our practice at Your Smile Dental Care is trust, but trust is often built up over time as the patient/doctor relationship grows. Some of our most skeptical and suspicious patients have become our most trusting and loyal patients.

So don’t put of tomorrow what you can fix today!

Yours in Better Dental Health,
The Your Smile Dental Care team
(905) 576-4537
(416) 783-3533
www.yoursmiledentalcare.com