Complex Dentistry

Root canal treatment

Root canal is the commonly used term for the main canals within the dentine of a tooth. Inside each tooth is the pulp, a soft tissue that contains nerves, blood vessels and connective tissue, which provides nutrients and nerves to the tooth. When the pulp is diseased or injured, the pulp tissue dies. In these cases the only treatment that can save the tooth will be root canal treatment. This means removing the nerve from the root canal and filling the empty canal with a filling material that will prevent ingrowth of bacteria and reinfection.

What are the most common reasons for root canal treatment?

The most common causes of pulp death are caries (holes) and tooth fractures that allow bacteria enter the pulp, which can cause an infection inside the tooth. Left without treatment, an abscess will form and cause damage to the bone around the teeth. If this process is irreversible, an endodontic treatment is advised in most of the cases and your dentist should be seen for advice and treatment.

What will my dentist do?

With a special dental procedure called root canal therapy you may save that tooth. After the dentist removes the pulp, the root canal is cleaned and sealed off to protect it. Then your dentist refills or. Most of the time, a root canal is a relatively simple procedure with little or no discomfort.

Root canal treatment
Root canal treatment

 

What are the benefits?

You can save your tooth and your smile! Your restored tooth could last a lifetime, if you continue to care for your teeth and gums. Regular checkups are necessary.

Dental Implants

A dental implant is essentially a substitute for a natural tooth root, commonly screw or cylinder shaped. This ‘foundation’ forms the support for an oral prosthetic e.g. a dental crown. The implant is carefully placed into a socket drilled in the jaw bone at the exact location of the intended tooth replacement. The initial stability is further enhanced as the bone grows over time to fill the micro roughness on the implant surface. The result is a stable foundation for the placement of various oral prosthetics e.g. crowns, bridges or dentures.

Use of implants

Implants can be used to support single teeth or form a foundation for the support of dentures or bridge work. Large spaces left by two or three teeth may not require implants for each missing tooth but this will depend on the quality and depth of bone at each implant site. In the upper jaw where bone density is generally poorer than the lower, 6 or more implants may be needed to support a full arch of 10 or more replacement teeth. Conversely in the lower jaw, similar treatment might be achieved with 4 or 5 implants but each case will be judged by your dentist.

Dental Implants to replace single tooth
Dental Implants to replace multiple teeth
Dental Implants to replace a full arch of teeth
Dental Implants to stabilise dentures

 

Use of implants to support over dentures

If a patient is not ready for multiple implant replacements, conventional dentures can be significantly improved by the provision of two or more implants to act as ‘anchors’ for the denture – this is called an ‘over denture’. Implant supported dentures are still removed for daily cleaning but once back in the mouth the implants make them much more stable than conventional dentures.

Suitability for dental implants

If you are in good general health, implants will almost certainly work for you. However, heavy drinking and/or smoking can compromise the initial healing process following the placement of the implant and adversely affect the long-term health of the gum and bone around the implant. Consequently it is possible that your dentist may insist on ceasing or reducing smoking/drinking before treatment begins.

Length of treatment

Implant treatment time can vary considerably and is typically between 6 weeks and 6 months. This is often dependent on the availability of better bone structure which acts as the foundation for the implant – poorer bone structure can lead to longer treatment times.

How long will my implants last?

The average durability of implants is generally very good with more than 90% of them being functional after 10 years. There are many factors influencing the longevity of a dental implant but if they are well maintained, they will last for many years, sometimes a lifetime. However, you must be prepared to look after your implants and present for regular inspections at your dentist. As with conventional crowns, dentures and fillings, implants may require occasional maintenance or replacement of the supported crown during their lifetime.

Dental Fixed bridges

A fixed bridge is an appliance made of a metal alloy covered with porcelain. They can also be made out of high strength porcelain. They are used to replace missing teeth in the most natural way possible. This procedure usually takes a few appointments to complete and is very similar to having a crown placed on a tooth.

Sometimes called a fixed partial denture, a bridge replaces missing teeth with artificial teeth, looks great, and literally bridges the gap where one or more teeth may have been.

Unlike a removable bridge, which you can take out and clean, a fixed bridge is not usually removed.

Dental Crowns

Dental crowns

A crown is an artificial restoration that fits over the remaining part of a prepared tooth, making it strong and giving it the shape of a natural tooth.
Crowns can be made of a variety of different materials:

  • Porcelain bonded to precious metal (a precious metal base is made and then porcelain is applied in layers over it)
  • Porcelain crowns (these crowns are made entirely out of porcelain; they are not as strong as bonded crowns, but they can look very natural and are most often used for front teeth)
  • All- ceramic crowns (it offers a metal-free alternative, which can give the strength of a bonded crown and the appearance of a porcelain crown; suitable for use in all areas of the mouth)
  • Porcelain and composite (they can sometimes look the most natural; they are not as strong as bonded metal crowns)

What will my dentist do?

The tooth to be crowned is prepared by your dentist and records are given to a dental technician to fabricate the crown, which can then be inserted at another dental appointment. The shade of the neighbouring teeth will be recorded and the crown will be made to match your other teeth exactly.

What are the benefits?

Crowns are an ideal restoration for teeth that have been broken, or have been weakened by decay or a very large filling. A crown could be also used for discoloured fillings and you would like to improve the appearance of the tooth. Properly cared for crowns should last for many years. Your dentist will be able to tell you how long the crown may be expected to last.

Dental Inlays

Dental inlays are restorations that may reasonably be described as fillings created within the dental laboratory. They are typically made of ceramic, gold or porcelain with porcelain often the material of choice due to its strength and potential to match natural tooth colour.

Inlays and onlays are cemented into the tooth and form a very strong bond with the underlying natural tooth surface. They are used for repairing larger cavities or when the tooth structure is significantly broken down. Inlays lie between the cusps of the tooth and are slightly smaller restorations than onlays which tend to be used for substantial reconstructions.

Inlays and onlays will typically be applied during two visits to your dentist. During the first visit the tooth area will be prepared by removing any decay or old filling and an impression made for sending to the dental laboratory. The laboratory will construct the custom made restoration which will be fitted during your second visit to the dentist.

Removable Dentures

Denture

A denture is an appliance, which is worn to replace lost or missing natural teeth and provides support for cheeks and lips. A full denture is one that replaces all of the natural teeth in either the upper or lower jaws.

A partial denture fills in the spaces created by lost or missing teeth and is attached to your natural teeth with metal clasps or devices called precision attachments. Partial dentures not only improve the appearance but also prevent the remaining teeth from drifting out of line.

We will make sure that your dentures will:

  • Be of high quality
  • Restore the natural movements of the jaw and phonetics
  • Be compatible with sensitive tissues in the mouth · Be comfortable to wear, and be taken for granted during eating or speaking
  • And not at last, restore a smile to your face

It will take you several visits to us in order to be properly fitted with a denture. We will take several impressions of the gums, and send these to a dental lab, which uses these impressions to construct your dentures.

On the next appointments you and your dentist will check the dentures to ensure that your fit is correct and that the dentures meet your approval.

Tooth Abscess

Abscesses are well localized infections that originate from bacteria entrapped in the root canals. The infection usually spreads along the root canal until they reach the bone around the tip of the root. When the nerve in the root is dead and pus forms in the bony area around the tip of the root it is called an abscess. Abscesses may become enlarged and start draining. Sometimes they can spread widely and rarely, may become life-threatening. An infection that causes a wide-spread swelling of the face is called cellulitis (not the the kind of cellulitis gossip magazines talk about)

Abscesses may result from deep cavities or trauma to the tooth, such as when a tooth is broken or chipped. Openings in the tooth allow bacteria to penetrate and infect the pulp. Infection results in a collection of pus (dead tissue, live and dead bacteria, white blood cells) and swelling of the tissues within the tooth. Infection may spread out from the root of the tooth and to the bones supporting the tooth.

What are the symptoms?

  • The symptoms may vary from a dull discomfort to agonising pain so pain alone is not solely descriptive of an abscess but normally the following symptoms may be present
  • Pain when chewing
  • Toothache
  • Sensitivity of the teeth to hot or cold
  • Bitter taste in the mouth
  • General discomfort, uneasiness, or ill feeling · Swollen area of the upper or lower jaw

Possible Complications

  • Loss of the tooth
  • Spread of infection to soft tissue
  • Spread of infection to the jaw bone
  • Spread of infection to other areas of the body resulting in brain abscess, pneumonia, etc

Treatment

  • Over-the-counter pain killers may relieve the toothache and fever
  • Root canal therapy may be recommended in an attempt to preserve the tooth and a crown may be placed over the tooth
  • Surgical drainage of the abscess or extraction of the affected tooth may be necessary

Call us if the pain is or other symptoms of tooth abscess occurs.

Jaw Joint Problems

A surprisingly large number of people suffer from headaches, face pain and jaw clicking which is often related to problems with the jaw joint.
What problems can affect the jaw?

Various problems can cause jaw pain, clicking, spasm or stiffness. Older people may get pain as the jaw joint wears or with the onset of arthritis. Small bony growths can develop around the joint restricting its movement with the subsequent onset of pain. Jaw problems can also develop if the way your teeth come together or align changes for whatever reason e.g. a dislocation or multiple tooth removal. One of the most common problems affecting the jaw joint is called temporomandibular joint dysfunction (TMJD), where the jaw joint does not open or close correctly.

Temporomandibular Dysfunction (TMD):

The medical name for the jaw joints are the temporomandibular joints (TMJ) – you have two of these joints in front of your ears where your lower jaw bone meets the skull. These joints, working in conjunction with the muscles and ligaments around them, allow you to flex your jaw up and down and from side to side. Problems with the joints or the surrounding muscles can result in temporomandibular dysfunction (TMD) characterised by jaw pain, headaches, clicking and even jaw locking.

What causes TMD?

Some of the most common causes of TMD are:

  • Grinding or clenching the teeth (bruxism), especially at night
  • Biting your nails or holding objects between the teeth
  • Fatigue, stress or anxiety

Diagnosis and Treatment:

Your dentist will be able to diagnose your jaw problems by asking you about your symptoms and also by looking for wear and tear due to grinding. He or she will ask you to open and close your moth while feeling your jaw and muscles to check for tenderness. Thereafter, the appropriate treatment will be recommended depending on the type of jaw problem you have.

Treatment may range from changing your diet to reduce pain by eating softer foods, a series of physiotherapy activities to do at home or if stress is considered to be a root cause, counselling or therapy sessions. If your dentist considers that the jaw problem is resulting from tooth grinding or clenching, then you may be advised to wear a tooth splint or mouthguard at night. Very often, relatively simple treatments with relieve the symptoms of TMD but in some more complex and rare cases, surgery on the jaw joints may be required.

Gum disease

Gum disease is a disease caused by oral bacteria. It has different degrees of seriousness and if left untreated it may destroy the bone and the gums surrounding the teeth causing them to become loose and increasing the risk of losing them. It is important to visit your dentist regularly and to follow oral hygiene advice carefully since gum disease if often not noticed by the patients until it becomes painful at which stage it may be too late to treat it successfully.

It is also called periodontal disease. It ranges from gingivitis, to serious disease that results in damage to the bone. In gingivitis (simple gum inflammation), the gums become red and swollen. They can bleed easily.

What causes gum disease?

Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky plaque on teeth. Plaque that is not removed can harden and form tartar that brushing doesn't clean.

If the plaque and tartar are not removed the bacteria will cause inflammation of the gums that is called gingivitis.

In gingivitis, the gums become red, swollen and can bleed easily. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.
If you leave your gingivitis untreated it can lead to periodontitis. Now, the gums pull away from the teeth and form pockets that are infected. If you don’t treat them, the bones, gums and connective tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.

Healthy gums and teeth
Gingivitis
Periodontitis
Advanced Periodontitis

How do you know if you have periodontal disease?

Symptoms are often not visible until the disease is advanced. They can include: bad breath, red or swollen gums, tender or bleeding gums, painful chewing, loose teeth and sensitive teeth.

What is the way of helping to stop gum disease?

The number and types of treatment will vary, depending on the extent of the gum disease. Brushing and flossing help get rid of plaque. You can reverse this with daily brushing and flossing and seeing their dentist regularly. Eat a well balanced diet and don’t use tobacco products. Only a professional cleaning by a dentist or dental hygienist can remove tartar through a deep-cleaning method called scaling and root planing.