Dental Treatments

X-rays show any decay, any possible infections in the roots or bone loss around the tooth. They can help us to see between your teeth or under the edge of your fillings.

In children, X-rays can be used to show where the second teeth are and when they will come through, how the jaw is growing too.

The dentist, as well trained members of the dentist’s staff can take x-rays.

• With modern techniques and equipment, risks received from the amount of radiation received are extremely small
• However, we will only take x-rays if they are needed; after that, x-rays are usually recommended every 6 to 24 months depending on the person, their history of decay, age and the condition of their mouth
• We may still ask you whether you are pregnant or whether you might be, and whether you would rather not have an x-ray

When the x-ray is taken:

• You will need to keep very still for a few seconds to give a clear picture
• We usually compare a new x-ray with one taken some time ago
• According to the law we will keep old x-rays in your file for at least two years from the date of your last course of treatment

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

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.

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. .

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.

A veneer is a thin layer of restorative material placed over a tooth surface, either to improve the aesthetics of a tooth or to protect a damaged tooth surface. The most popular types of veneers are porcelain, which offer a stronger and more durable alternative to composite veneers. They are made by a dental technician and fitted by your dentist. Composite veneers are a quick non invasive alternative to porcelain veneers. Composite veneers are ideal for small changes in the appearance of the teeth.

When should I opt for treatment with dental veneers?

You should opt for dental veneers if your teeth are stained, damaged by decay or an accident, or if you have got gaps between your teeth.

What will you do?

Most veneer procedures require two appointments to complete, the first of which is dedicated to preparing and taking an impression of the teeth. After the tooth or teeth are prepared, an impression is taken, which, along with accompanying photos and models, is sent to the dental technician. The dental lab fabricates porcelain shells, which fit onto your teeth. These are called veneers. During your second appointment, the dentist will cement your veneers onto your teeth. Each veneer will be assessed for aesthetic before final cementation. If required, fine adjustments will be made prior to or immediately after final cementation.

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.

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.

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.

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 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.

A dental examination is the process where your dentist will examine your teeth and gums to check how healthy they are and also assess if there are any problem areas within your mouth. If any problems are identified, your dentist will advise the most suitable course of treatment available to you.

What does the examination process involve?

During the dental examination your dentist will:

• Check your jaw and face to see that all appear healthy
• Look at other places in and around the mouth i.e. no just the teeth and gums to ensure that they are in a healthy condition. He will typically check the back of your throat, roof of the mouth and your tongue
• Check your teeth and gums for signs of decay, disease, wear, damage and correct alignment.
• Compare the condition of your teeth and gums to the last visit by examining patient notes and possibly x-rays. This is to assess if any additional treatment is necessary and to check progress of any treatment programme you may be undergoing.

The importance of regular dental examinations:

It is important to undergo regular dental examinations, typically every 6 months to ensure that your teeth, gums and mouth remain healthy. If any problem is identified it can be addressed quickly before it becomes more complex and requiring prolonged treatment.

When decay has dissolved the tooth substance, i.e. enamel and dentine, the softened structure may break and create a hole. The dentist needs to fill this hole produced by the decay and thus a filling is placed.

There are two types of filling, 'silver' fillings and 'white' fillings. In our time fillings are not only functional, but can be natural looking as well. Many people don’t want silver fillings that show when they laugh or smile because they are more conscious about the way they look.

Temporary filling

Patients often attend the dentist at short notice or without appointments. If a patient has lost a filling or in pain, a temporary filling material allows the dentist to rapidly place a restoration, which will protect the tooth from hot drinks, cold air and bacterial invasion.

It is usually best to change fillings only when your dentist decides that an old filling needs replacing. You can ask to have it replaced in a tooth-coloured material.

An extraction is the removal of a tooth from the mouth. Extractions are performed for a very damaged tooth, or loose because of severe gum diseases, which may affect the supporting tissues and bone structures of teeth.

Extractions of problematic wisdom teeth are routinely performed. Also, some permanent teeth are extracted in order to make space for orthodontic treatment.

Types of extractions

Simple extractions are performed on teeth that are visible in the mouth, usually under local anaesthetic.

Surgical extractions involve the removal of teeth that cannot be easily accessed, either because they have broken under the gum line line or because they have not erupted fully.

Your dentist

• We will make sure you are properly numb during the procedure!
• Infection does occur on rare occasions. The dentist may opt to prescribe antibiotics pre- operatively and/or post-operatively if he determines you are at risk
• You will receive advice on how to look after the space where the tooth was while it is healing
• You will receive advice on how to use painkillers so you are not in any discomfort when the anaesthetic wears off

Adults can have up to 32 teeth. The wisdom teeth are the large molars at the end of each line of teeth (there is one wisdom tooth at the end of each row, 4 in total).

Wisdom teeth are the last permanent teeth to develop. They appear in the mouth between the ages of 18-24 years and may develop in the jaw but never erupt or appear in the mouth. Sometimes they appear many years later.

If part of the wisdom tooth has appeared through the gum and part of it is still covered, the gum may become sore and swollen. Food particles and bacteria can collect under the gum edge, and it will be difficult to clean the area effectively. This is only a temporary problem that can be dealt with by using mouthwashes and special cleaning methods and possibly antibiotics. If the problem keeps coming back, it may be better to have the tooth removed.

Common symptoms associated with impacted wisdom teeth are:

• Vague ill-defined pain ·
• Pain and swelling overlying the wisdom tooth, sometimes associated with a bad taste or an unpleasant taste in the mouth or purulent discharge
• Earache
• Limited mouth opening

If the pain does not go away or if you find it difficult to open your mouth, you should come and see a dentist. The dentist will usually take x-rays to see the position of the root, and to assess whether there is room for the tooth to come through into a useful position.

Everything depends on the position and the shape of the roots. Your dentist will tell you how easy or difficult each tooth will be to remove after looking at the x-rays. Upper wisdom teeth are often easier to remove than lower ones, which are more likely to be impacted. Your dentist will say whether the tooth should be taken out at the dental practice, or whether you should be referred to an oral surgeon at a hospital.

Reasons for wisdom teeth to be removed:

• Constant pain
• Abscess
• Associated cysts
• Tooth decay
• Tumours

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.

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.

Fissure sealants are white plastic coatings that are painted onto the biting surface of the back teeth. They help to stop the chewing surface from getting decayed.

Sugar from food and drink collects in the fissure or groove on the biting surface of the back teeth. These sugary deposits promote tooth decay and are difficult to remove by regular brushing because the toothbrush bristle is too wide to reach the base of the fissure. The fissure sealant resists the decay by providing a protective coating for the surface of the tooth.

Before the sealant is applied, the tooth will be cleaned and dried in readiness. Following application, the sealant is hardened by the application of a special light for approximately 30 seconds. The process is painless and correctly applied sealants can last for 2 – 5 years.

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.