How often should I visit my dentist?
Six monthly check ups are generally recommended. However if you have gum disease or have difficulty in maintaining good oral hygiene more frequent visits to the hygienist are recommended. If you have a low maintenance mouth and maintain good oral hygiene 12 monthly recalls are sufficient. Your regular dentist or hygienist who is familiar with you, can recommend an interval which best suits your needs.
Why should I visit a hygienist?
A hygienist is a dental professional who is highly trained to diagnose and treat gum problems from gingivitis (inflamed gums) to periodontal (gum) disease. She will examine your gums and recommend a treatment programme from scaling and polishing to deep cleaning under local anesthetic. She will also educate patients on a suitable home care regime and tailor her oral hygiene advice to suit each patient’s specific needs.
Her role is in enabling patients of all ages to maintain or re-establish good gum health which is the foundation to good dental health.
How often should I clean my teeth?
We would recommend brushing twice per day every day with fluoride toothpaste and cleaning between the teeth (flossing or interdental brushing) once per day.
Why choose a composite (tooth coloured) filling?
Composite is a compound made up of a resin base and filler particles which sticks or adheres to your tooth surface. Its big attraction is undoubtedly its appearance which can be difficult to distinguish from the actual tooth.
Composite would always be the material of choice for a filling on a front tooth and more and more so for the back teeth especially in areas of the mouth that can be seen when talking or smiling. There is also an argument for placing composites in that they may be less likely to cause cracks in teeth leading to broken teeth at a later stage.
It is ideally suited to the small to medium sized filling.
The material itself requires considerably more time and operator skill to place and where possible a rubber or dental dam should be used to keep the tooth free from saliva when the filling is being placed.
What is a root canal?
Root canal or endodontic treatment involves removing infected or damaged tissue from the central chamber or the root canal of a tooth. This tissue, called the pulp, contains nerves and blood vessels that help nourish the tooth. After the pulp is removed, the pulp chamber and root canals are cleaned, disinfected, filled and sealed. The benefit of endodontic treatment is that it saves teeth that would otherwise need to be extracted. Although the pulp is removed, the treated tooth remains viable, nourished by the surrounding tissues. There is no real substitute for your own tooth in terms of health and investment. Root canal treatment may require one or several visits and is always preformed under rubber or dental dam. With proper care and restoration, the tooth may last a lifetime.
What is a crown?
Each one of your teeth is made up of a crown and a root. The crown is the white portion you see in your mouth, the root is the portion hidden in your gum. If the natural crown of your tooth becomes badly damaged through for example tooth decay, whereby it is heavily filled, or through an accident it made need to be replaced with a laboratory made crown. The crown fits over the remaining portion of the natural crown of the tooth and the natural root is retained. It is made of metal, ceramic or a combination of both depending on the requirements for that tooth. Crowns can also be screwed into or cemented onto implants.
Root treated teeth are often crowned because these teeth have usually been extensively damaged by tooth decay and they are also more brittle than non-root treated teeth and so a crown may protect what remains of the tooth from breaking.
Teeth do not necessarily require root treatments prior to crowning.
Why do I have pain with my wisdom teeth?
The wisdom teeth or third molar teeth frequently cause pain because the gum around the tooth becomes irritated or infected. This tends to happen because there may not be enough space in your mouth and so these teeth cannot grow properly into your mouth. They then become stuck or impacted having cut partially through your gum. The area is often very difficult if not impossible to clean properly and so discomfort and infection can be the result.
Treatment may simply be a matter of learning how to keep the area clean to avoid problems or they may require extraction.
The lower wisdom teeth tend to be more problematic than the uppers and often require referral to a specialist oral surgeon to remove.
Are dental amalgams still used today?
Dental amalgam has been with us since 1835 and as a very robust, strong and hardwearing material, it has served dentistry well over the years. However, it is being used less and less today as it has largely been superceeded by better more aesthetic materials.
Is it necessary to have my old amalgams replaced?
No it is not necessary, however if you are concerned by your existing amalgams or simply do not like their appearance it is recommended to book a consultation to have your existing amalgams assessed and discuss the options that are right for you. Frequently amalgams can be replaced with newer composites though occasionally there are some risks. For example the tooth may be cracked under the amalgam and one may begin to experience pain symptoms following treatment. There may also be the risk that the tooth may break. In the case of teeth that are extensively restored with amalgam, it may be wiser to consider replacing the amalgam with a full coverage crown.
Can you tell me about bleaching?
Bleaching is a treatment which has become increasingly popular over recent years. It is a cosmetic treatment that will improve your smile without damaging your teeth! There are two methods of bleaching the teeth either “at home” or” in office. Both methods use the same basic ingredient, hydrogen peroxide up to a maximum concentration of 6% (or 16% carbamide peroxide equivalent).
The “in surgery” bleaching typically involved having a rubber dam placed on the teeth and a high strength bleach placed on the teeth. However since restrictions on the concentration of bleach used were introduced in 2012 and the tchair time taken to do this, the at home method has become the bleaching method of choice.
In the at home method you will have “trays” made up to fit your teeth. There are very close fitting plastic covers which you take home together with your bleaching gel. You place the gel into the trays and wear the trays for up to 90 minutes during the day or ideally overnight for several nights until you get the amount of whitening you require.
Either method will produce the same end result. The two main disadvantages of bleaching are that your teeth may become sensitive during bleaching, but this is transient, and bleach will not lighten existing fillings or crowns. It is, therefore, advisable to bleach before having work carried out on your teeth Rubber damor be prepared to consider replacing white fillings or crowns on your front teeth after bleaching.
A rubber dam is a sheet of latex rubber which is fitted around your tooth to enable some dental procedures. It acts as a safety net to trap water and debris from your tooth and will protect you from inadvertently inhaling or swallowing this debris or small instruments such as those used for root canal treatment.
It also works in the opposite direction keeping saliva off your tooth whilst you are having composite or white fillings bonded to your tooth. The use of rubberdam is currently considered manditory for all aerosol generating procedures (AGP’s) during this Covid 19 pandemic as it significantly reduces the risk of creating contaminated aerosols which keeps us all safer.
Why is smoking detrimental to our oral health?
There is a lot of evidence in relation to smoking, and the detrimental effects on both oral and general health. We are all aware of the effects it has on our overall health and well being. But are you familiar with the risks smoking has on your dental health?
Increases the risk of developing gum disease, a leading cause of tooth loss.
Delays the healing process following tooth extraction, periodontal treatment or oral surgery.
Increases the risk of developing a dry socket (inflammation of the bone) after an extraction.
Lowers the success rate of dental implant procedures.
Increases the risk of developing oral cancer.
Smoking also causes bad breath and tooth discolouration.
With this in mind smokers should visit the dentist regularly as with all patients who visit our surgery, you will be screened for early signs of oral cancer as part of your routine examination. Remember that early detection is the key to a good outcome
Options for replacing a missing tooth or teeth
The options to replace missing tooth or teeth can be divided into two broad categories, removable or fixed as follows:
Removable options are confined to dentures of which there are two basic types: Acrylic or chrome.
Made up quickly which is useful in an emergency situation
Easily adjusted and added to
Provide excellent aesthetics
Have metal attachments such as clasps to improve retention in the mouth
B) CHROME PARTIAL DENTURES
A chrome denture has a cast chrome cobalt metal framework onto which acrylic teeth are fitted. It can be used to replace one or several teeth. It does depend on well positioned sound natural teeth or implants for retention. It has many advantages over acrylic and some disadvantages as follows
Acrylic is a type of plastic which is used to make dentures to replace a single tooth, to a full mouth of teeth. Acrylic dentures can be:
Its disadvantage is that the fit in acrylic dentures tends not to be quite as accurate as other restorations and so may be more difficult to keep in place.
Fixed options can also be divided into two broad categories i.e. Tooth supported and implant supported
a) TOOTH SUPPORTED BRIDGES
Permanent tooth supported replacement teeth are called bridges. A bridge relies on a reasonably sound tooth on at least one side of the space, ideally both sides. Bridges perform best in shorter spaces where the opposite teeth don’t bite too heavy onto the bridge.
A bridge can also be built onto implants. Bridges can be divided into two broad categories:
The fit is more accurate and so better retained in the mouth
It covers less of the palate in the upper or tongue space on the lower making for greater patient comfort
It is strong and can be used to change a patients biting position which can allow for repair or adjustment of the natural teeth
It can be securely fastened onto implants or crowns to give a very secure fit
It is more expensive than acrylic
It takes more planning and takes longer to make than acrylic
Whilst it is light weight and rigid, if dropped on a hard surface it can bend and become distorted which can be next to impossible to repair.
Resin Bonded Bridges (RBB) or Adhesive
RESIN BONDED BRIDGES (RBB) OR ADHESIVE
These are false teeth that usually have some form of metal wing on either side of the false tooth which is bonded to the backs of the teeth either side of the space RBB depend on sound teeth with preferably no existing fillings or damage to the enamel of the tooth a favourable bite where the opposing teeth will not bite down on the metal wings or retainers. RBBs are suited to:
A conventional bridge is attached by way of full coverage retainers which involves reducing down the abutment teeth or the teeth to which the bridge is attached by 1.5 to 2 mm all around. The retainer portion of the bridge then resembles a crown or cover over all sides of the tooth. Conventional bridges are suited to a situation whereby the abutment tooth or teeth are heavily filled and perhaps needed a crown. Perfectly good abutment teeth tend to be used less and less today for bridges as we now have a very predictable alternative in implants
What is an implant?
An implant is a piece of titanium that is embedded or implanted into either the upper or lower jaw where the root of a tooth once was. It then enables the secure attachment of a tooth or teeth to the jaws. In its simplest form, a simple implant can be used to replace a single tooth where just one tooth has to be replaced. Where more than one tooth is to be replaced, one or more implants can be used onto which a bridge can be attached, in much the same way as a conventional tooth supported bridge that is if there is just one space.
Combinations of the two or hybrids can sometimes be made.
What are dental implants?
Dental implants are an excellent option to replace missing teeth. A dental implant is an artificial tooth root, made of titanium, which is placed into the bone of the mouth where the root of the natural tooth would normally be. This procedure is carried out under local anaesthetic (with sedation if the patient prefers) and we work closely with with implant surgeons for this surgical part of the procedure. The patient then returns to us for the restorative part of the procedure when the teeth are fitted.
If the patient is missing just one single tooth then an implant can be placed into the space and a single crown fitted to that implant. If several teeth are missing sometimes a bridge is the preferred option where several teeth are fixed to two or more implants.
Dentures can also be fixed in place with two or more implants giving a really secure and well fitting replacement for several teeth with a chewing capacity close to that of natural teeth.
Implants are very successful especially in a fit non-smoking patient. Implants can almost always be fitted in the front of the mouth though the position of sinuses and nerve structures in the back of the mouth may mean that fitting implants here may not be as predictable.
Why should I bring my children to the dentist?
Firstly it is important to establish good dental health practices from an early age. If your children are in the habit of making routine trips for check-ups then they will have little to fear. Your dentist can advise you with regard to diet for the prevention of tooth decay, oral hygiene instruction, check for tooth decay which if detected early can be easily treated and check for the normal development of the permanent teeth.
Your dentist can also advise you regarding preventive treatments such as fluoride treatments and fissure sealants.
How should I prepare my child for their first dental visit?
It is important that your child’s first dental visit is a positive experience and parents are encouraged to speak positively to their child about their forthcoming visit.
As children are at their best early in the day a morning appointment would be preferable. Then once you and your child arrive you are both welcomed into the surgery. The parent is encourage to observe as their child engages with the dentist whereby a “tell-show-do” technique is employed i.e. we will explain to your child in language that he or she understands e.g. “we are going to count your teeth” followed by showing your child how this will be done e.g. we will give your child a small dental examination mirror to check out following by actually carrying out the procedure i.e. examining your child’s teeth. This procedure will take more or less time, depending on your child. It is important not to rush your child so as to create a positive experience.
X rays (or” pictures” in your child’s language) may then be taken at this stage dependant on your child’s needs, their level of cooperation and of course in consultation with you the child’s parent, as up to 75% of tooth decay between the primary (baby) teeth can go undetected without x rays. We will usually then clean and polish (“tickle”) your child’s teeth which is generally very well received by your child and familiarises him with the concept of dentistry.
Lastly children are presented with a small reward for their good behaviour whilst you will have a full discussion of your child’s needs.
Why treat baby teeth, don’t they fall out anyhow?
It is quite correct that the baby or primary teeth fall out or exfoliate. However most parents would prefer not to have their child experience toothache and have to attend for emergency treatment. Secondly if the baby teeth are lost too soon it leads to space loss whereby teeth drift into the space caused by removing a tooth, a space which will be required by the replacement permanent teeth. This in turn leads to crowding in the permanent teeth. So the baby teeth in effect hold the spaces for the permanent teeth.
What is a fissure sealant?
This is a resin or “paint” which is applied to the fissures or grooves on the biting surfaces of the back teeth thereby sealing them and making these surfaces more resistant to tooth decay. The first permanent molar teeth erupt into the mouth at approximately age 6 and the second permanent molars erupt at approximately age 12. It is strongly advised that these teeth be sealed as soon as they erupt. It may also be advisable to seal some of the primary (baby) molars where the fissures or grooves are deep as these teeth may be at increased risk of tooth decay.