- Air Polishing
- Amalgam Fillings
- Braces
- Bridges
- Check Up
- Children’s Dentistry
- Composite Fillings
- Crowns
- Decay
- Dentures
- Fillings
- Fissure Sealants
- Flossing
- Gum Disease
- Implants
- Inlays
- Interdental Brushing
- Invisalign
- Local anaesthetic
- Nightguard
- Partial Dentures
- Prevention
- Oral Cancer
- Root Canal Treatment
- Scaling Teeth
- Toothbrush
- Tooth Whitening
- Veneers
- Wear
- Xrays
Air polishing
A method of cleaning staining and plaque off teeth. It uses a fine jet of air, water and fine particles to gently remove staining caused by tea, coffee, red wine etc resulting in an improved appearance of teeth. This is often done by hygienists in collaboration with other gum treatments to improve oral health and the appearance of teeth.
Amalgam Fillings
Dental amalgam is the traditional silver-grey coloured filling we are all familiar with. Although there is mercury in dental amalgam, once it is combined with the other materials in the amalgam filling it tends to remain stable.
Braces
There are generally two different types of braces – removable and fixed braces. Removable braces can be used to tilt teeth. Other removable braces (functional braces) make changes to the size, shape and relationship of your jaws. Fixed braces use brackets, bands and wires to straighten teeth.
Orthodontic treatment often takes many months to complete. It is important to clean your teeth thoroughly twice a day with a fluoride toothpaste and to avoid sugary and acidic foods and drinks as this can damage to teeth around and under the brace. A mouthwash that contains fluoride will also help to stop tooth decay.
If the orthodontic treatment is completed retainers will usually be made. Fixed retainers are cemented in place. Removable retainers are usually worn full time for a few months and then wear is reduced to night time only. Often retainers should be worn for as long as you want your teeth to remain straight.
Many children will have a brace and an increasing number of adults are improving their smile with braces.
Bridges
A dental bridge can be used to fill the gap between two adjacent teeth. A specially designed structure incorporating a hollow crown to support the missing tooth is prepared in the dental laboratory. Similarly, to crowns and implants, the replacement bridge “tooth” will be matched to the rest of your teeth to give as natural a result as possible.
Generally there are two different types of bridges: conventional and adhesive.
Conventional bridges usually involve drilling away significant amounts of tooth and filling material to create space for the bridge. This often gives a stronger result but at the expense of the supporting teeth with similar risks to crowns.
Adhesive bridges stick to the sides and backs of adjacent teeth. The advantage is that they usually require no or little tooth removal, but the disadvantages are that they are less strong and may debond.
Bridgework can be constructed from a variety of different materials depending upon the application – your cosmetic dentist will advise what is most appropriate.
Check up
We recommend these are done on a regular basis: somewhere between every 3 months to 2 years depending on your dental health for adults and between 3 months to 12 months for children. We check for signs of dental disease, oral cancer and its an opportunity for you to ask any questions you have about your mouth. Remember to book your next check-up before you leave the practice.
Children’s Dentistry
New parents often have questions regarding the care and management of their children’s teeth. When should you start brushing? What kind of toothpaste is best? When should you go to the dentist? Knowing the answers to these questions can help you to keep your kids’ teeth healthy and cavity-free.
We advice parents and guardians to bring their babies to the dentist in the first year. This allows those questions to be asked and allows babies and children to get used to the dental environment. Prevention is the cornerstone of dental care and it starts with young babies.
Composite Fillings
A natural looking alternative – the composite or tooth-coloured filling which can be provided on almost all teeth. Composite resin is a tooth-coloured plastic mixture. These filling materials are increasingly versatile and strong. They can usually be matched so that they that it is very difficult to tell the white filling from the tooth.
Crowns
A crown is a ‘cap’ that is placed over a tooth and held in place by dental adhesive or cement. Crowns can be made from a variety of materials. They can be made from plastic, ceramic or metal alloys. A combination of metal and ceramic is also possible to maximise strength and simulate the appearance of natural teeth. Crowns are often provided when it is difficult to get sufficient retention for a filling.
The placement of a crown (or bridge) is a significant procedure for a tooth and sometimes the nerve of the tooth can react by devitalising (the tooth dies) and the tooth becomes non-vital. The risk of a tooth becoming non-vital after a crown preparation is variable and may be as high as 20% depending on the clinical circumstances. In those situations, sometimes, root canal treatment may be necessary or the tooth has to be extracted.
Decay
Tooth decay (‘dental caries’), can occur when acid is produced from plaque which builds up on the surface of teeth. Acid is produced by the bacteria in plaque which convert refined sugar to acid. This acid eventually produces holes (‘cavities’) in enamel of teeth. These cavities then continue to progress through the dentine of the tooth to the pulp (nerve) in the middle.
As these cavities get deeper they get closer to the pulp which becomes swollen and irritated. This irritated pulp then starts to cause various feelings of discomfort.
The greater the frequency and volume of refined sugar eaten the greater the decay. So the amount of decay can be reduced by reducing the frequency and volume of refined sugar we eat.
Refined sugars are found in sweets, cakes, chocolate, a lot of processed foods, as well as most fizzy drinks.
See www.nhs.uk/conditions/tooth-decay/
Dentures
A denture is a removable prosthesis used to replace missing teeth. Commonly referred to as ‘false teeth’, a denture is usually made of acrylic or a combination of acrylic and metal. Sometimes flexible dentures can be made which feel softer. A partial denture is fitted to replace some missing teeth whilst a complete denture is indicated when all natural teeth are missing. A good set of dentures helps you to eat, speak, function, and often improves a person’s appearance.
A denture can often be made before a tooth is extracted to avoid having a gap, so called ‘immediate replacement dentures’. Sometimes they need to be adjusted or remade after several months when the socket has finished healing.
Extractions
This is the dental term for removal of a tooth. The procedure involves applying force to the tooth with a variety of different instruments to remove the root from the bone. Sometimes the tooth fractures during the procedure and the surrounding bone needs to be removed to help complete the extraction and stiches may need to be placed.
Complications may include prolonged bleeding, bruising, infection, retention of part of the root or displacement of the root into adjacent structures such as the sinus. Rarely damage to adjacent nerves can occur with resulting tingling or numbness of the face and lips.
In some cases we may refer you to a colleague to have an extraction.
Fillings
A filling is normally done to replace part of a tooth when it has broken or it is decayed. There are several different materials which can be used to try to repair the tooth and restore some function and appearance. Common filling materials include amalgam, composite and glass ionomer. A filling usually involves having some drilling done to remove decay, shape the tooth and create retention. Sometimes the nerve of the tooth can become inflammed or infected after a filling, resulting in the nerve dying and the tooth needing root canal treatment and a crown or extraction.
Fissure Sealants
Deep pits and grooves can be found on the chewing surfaces of the back teeth. Such pits and grooves are termed ‘fissures’ and are usually so narrow that toothbrush bristles and streams of water are not able to clean them effectively. Fissure sealants can be applied to the teeth. Fissure sealants are special materials used by dentists to seal off pits and fissures from the oral environment. Sealing the tooth surface protects fissures from bacteria and fermentable foods like sugar and starches to prevent decay from starting deep within the fissures.
Flossing
Brushing teeth properly and consistently helps to remove most dental plaque but brushing alone cannot remove plaque that is located in places that a toothbrush cannot reach – particularly between teeth. In addition to removing plaque with a toothbrush, flossing also helps to remove debris that adheres to teeth and gums in between teeth, polishes tooth surfaces and controls bad breath.
Flossing should take place at least once a day for two to three minutes each time to be most effective in the prevention of gum disease and tooth decay.The different types of dental floss include waxed and unwaxed, flavoured, unflavoured and wide and regular.
Dental tape looks similar to floss, but tape is slightly wider and can be more effective.
Alternatives to flossing and taping are Interdental brushes (‘tepes’) which can be very effective.
Fluoride
Fluoride is a naturally occurring mineral found in water in varying amounts depending on where you live. Fluoride is also found in almost all brands of toothpaste.
It can help prevent tooth decay (dental caries) and in some minor cases it can help to repair very small areas of damaged enamel.
We recommend brushing with a fluoride toothpaste twice a day for at least 2 minutes and don’t rinse the toothpaste off afterwards as it washes away the goodness: ‘spit don’t rinse’. Fluoride remains active on teeth for about 20mins.
We also may apply a high concentration toothpaste on children’s teeth when they come to the dentist. This further helps to reduce decay.
See www.nhs.uk/conditions/fluoride/
Gum disease
Gum disease is an infection of the gums. It is often painless and can progress at various speeds with spurts of activity and then it becomes less active. Bacteria in plaque that can be found in plaque and tartar (calculus) cause a semi-autoimmune response which then causes the inflammation and micro ulceration of the gums which eventually damages the bone.
Bone loss progresses with loss of the supporting bone around teeth and eventually those teeth may become loose.
The gum pockets around the teeth get bigger and different types of bacteria grow in those pockets to develop into ‘periodontal disease’.
Periodontal disease and poor oral hygiene is related to the health of the patient and it has been linked with many general ‘Inflammatory health conditions’ such as diabetes, heart disease, stroke, Alzheimer’s disease and several more general health problems.
Smoking makes gum disease a lot worse. Contact the NHS for various ways to support stopping smoking.
Good daily oral hygiene techniques to remove plaque such as twice daily toothbrushing with an ossillating electric toothbrush and using dental floss, tape or interdental brushes each day helps to reduce the risks of gum disease.
Scaling and the removal of tartar can also help to reduce the amounts of bacteria and make oral hygiene easier.
Also, if you are diabetic and your diabetes is poorly controlled you are more likely to suffer from gum disease. Speak to you GP or the practice nurse at your Doctor’s practice to keep you blood sugar at safe levels.
Dental hygienists spend most of their time trying to help you to prevent and manage gum disease.
Implants
Implants are one way of replacing missing teeth. Alternatives as dentures or bridges.
An implant post is planted in the jaw bone to support a replacement tooth. This acts like the root of a natural tooth by supporting the top of the tooth. Implants can also be used to support crowns, fixed bridges or dentures. Implant treatment normally has two stages. First, the implant is placed in the jaw. Then, when the jaw has fused onto the implant (osseointegration), the replacement teeth are attached to the implant. In some situations, it is possible for temporary teeth to be attached to an implant at the time of fitting but this reduces the success rate.
Implants an effective way of filling the gap of a missing tooth.
Implants can be prone to a type of gum disease of implants (‘peri-implantitis’) which results in loss of bone around implants making them loose. The aftercare of implants is very important and regular 6 monthly visits to the hygienist is normally advised to keep the gums and bone healthy.
Inlays
Porcelain (usually tooth coloured) inlays and onlays are restorations placed usually on the chewing surfaces of the back teeth. An inlay fits within the confines of the teeth. An onlay covers the entire chewing surface of the tooth. These can be made of either plastic resin or porcelain. Other alternative materials include gold. The procedure involves removing decayed tooth structure or old fillings, preparing the tooth cavity, taking an impression of the cavity to fabricate a custom-fit inlay or onlay. Two visits are usually required to complete the treatment.
Interdental Brushing
As a result of improved diet, oral hygiene and fluoride, more people are keeping their own teeth into old age, but in order to continue to maintain healthy teeth and gums, a regime of brushing twice a day should be combined with ‘interdental brushing’ (ie cleaning in between the teeth). This is made possible by the use of dental floss, interdental brushes, single-tufted tooth brushes, dental sticks, rubber tip stimulators and irrigation devices.
A commonly used type of interdental brush is a ‘tepe’. There are different types (and colours) of tepes for different shape and size spaces between teeth. It is important to use the correct size of tepe.
Invisalign
Invisalign treatment uses discreet, removable, near-invisible aligners to straighten your teeth. The aligners are made of a thermoplastic material. They’re entirely transparent and custom-made to gradually straighten your teeth without the need for any metal wires of brackets.
Local anaesthetic
This is usually given by an injection close to the tooth inside the mouth to anaesthetise (numb) the area and tooth (or several teeth).
Most local anaesthetics contain lignocaine and a very small amount of adrenaline. The local anaesthetic often numbs the gums, lips, cheeks and tongue near by which can often last for a few hours afterwards. So be careful not to bite those areas or burn them on hot drinks or foods. Its best not eat or have hot drinks until the numbness wears off.
Nightguard
A removable custom made appliance to reduce the wear and damage caused by teeth rubbing against other teeth in the opposite jaw.
These can be made of different materials from flexible materials to hard acrylic. They aim to reduce the effects of chlenching and grinding teeth and some guards can be worn day or night.
For those who grind a lot replacements are needed from time to time.
Best cleaned with cold water as hot water can distort them.
Partial Dentures
A denture is a removable prosthesis used to replace missing teeth. Commonly referred to as ‘false teeth’, a denture is usually made of acrylic or a combination of acrylic and metal or flexible materials. A partial denture is fitted to replace some missing teeth whilst a complete denture is indicated when all natural teeth are missing. A good set of dentures helps you to eat, speak, function, and often improves a person’s appearance.
The limitations to complete dentures are the amount and shape of the bone and gum that a denture sits on and any remaining teeth. This can mean that some dentures need a fixative to reduce movement and make them feel more comfortable.
Alteratives to dentures are implants and bridges.
Prevention
Central to maintaining a healthy teeth and mouth.
There are two common oral diseases: decay of teeth and gum disease.
The main messages are:
a. Reduce the frequency and amount of sugar in food and drink. Sugar causes teeth to decay. The more frequent the sugar attacks, the weaker the teeth become and decay starts. Sugar is present in many processed foods and drinks.
b. Brush twice a day with a fluoride toothpaste and don’t rinse it off afterwards. Adult toothpastes have more fluoride in them than children’s toothpaste. Pick a toothpaste appropriate to the age of your child, and remember toothpaste is good for teeth so ‘spit don’t rinse’.
c. Visit the dentist regularly (that’s usually at least once a year for adults and twice a year for children). Early diagnosis makes any treatment easier.
d. Don’t smoke. Smoking can cause oral cancer, as well as gum (periodontal) disease and many other health problems.
Oral cancer
Also known as mouth cancer, this is where a tumour develops in a part of the mouth. It may be on the surface of the tongue, the inside of the cheeks, the roof of the mouth (palate), the lips or gums.
Early diagnosis is important, so that a rapid referral can be made into hospital. Your dentist will examine your mouth for signs of oral cancer during a check up. The NHS has a useful website:
https://www.nhs.uk/conditions/mouth-cancer/
Root Canal Treatment
Root canal treatment involves the removal of the nerve and blood vessels (pulp) tissues from the tooth in the event that it gets infected or inflamed. Removal of the infected or inflamed pulp is the first step in saving the tooth. Debris within the canals is removed by filing and flushing it out. The canals are finally shaped, filled or sealed and the tooth restored to full shape and function by either a permanent filling or a crown.
Root canal treatment is not always successful and infection can remain. The process may be uncomfortable and post-op discomfort is common so normal analgesics are often needed. Success rates for root canal treatment varies from approximately 65% to 85%. Teeth undergoing root canal treatment can be prone to fracture and occasionally instruments can seperate within the canal. Sometimes extraction is needed.
Root canal treatment on molar teeth can be difficult especially if the canals inside the tooth are very narrow. A better success rate for root canal treatment can be achieved by seeing a dentist with extra skills in root canal treatment. They will often have methods to magnify the canals such as high magnification loops or a microscope to navigate the canals and have extra expertise. Usually root filled teeth are crowned to secure a good seal.
Scaling teeth
This is a method of removing plaque and tartar (calculus) from the surfaces of teeth and so help to reduce gum disease. This can be done by a dentist or a hygienist.
Scaling is usually done with scaler machine that sprays water and vibrates the plaque and tartar off the teeth which can sometimes make the teeth sensitive as the pores in teeth then become exposed. Various types of sensitive toothpastes can help.
Different types of scaling can be done from simple scalings to more advanced removal of plaque and tartar in the gums pockets around teeth. Scaling of teeth is part of periodontal treatment.
Scaling needs to be backed up with good daily oral hygiene techniques to be effective.
Toothbrush
A trusted friend. When used in collaboration with a fluoride toothpaste this is an effective combination to remove plaque and prevent tooth decay and gum disease. Often seperated into manual and electric toothbrushes. We usually recommend a medium or multitufted head to a toothbrush. Ossillating electric toothbrushes are very effective at removing plaque and are the least abrasive to teeth. Change all toothbrushes regularly when they start to splay.
Brushing twice a day for 2 minutes is a good idea and remember not to wash the toothpaste off afterwards as toothpaste is good for teeth: “spit don’t rinse”.
Tooth Whitening
Whitening is a process where the tooth discolouration is ‘whitened’ to a lighter shade. It removes the staining through chemical means and makes the teeth look lighter. It is a safe procedure when carried out under professional supervision and most patients see an improvement in the colour of their teeth, although there can be a wide variation in the success depending on the structure of the teeth.
Veneers
A process which usually involves the removal of a layer of enamel so that a thin porcelain facing (similar to a false finger nail) can be made in the laboratory. Sometimes there is no need to remove enamel. The veneer is then cemented on to the tooth. The whole process takes two visits and is often used to improve aesthetics.
Care is needed when biting hard with veneers as they can break easily.
Wear
Teeth can wear in different ways such as on the biting surfaces, sides or all over. Wear on the biting services is often caused by the grinding of teeth on other teeth in opposite jaws. The wear on the sides of teeth is often associated with scrubbing horizontally with manual toothbrushes (so best to brush in small circles or better still use an ossillating electric toothbrush). Wear all over the teeth can be caused by acid erosion from acidic fruits, stomach acid, but more commonly from fizzy drinks. Fizzy drinks are usually acidic as well as having lots of sugar in them: a rather toxic combination for teeth.
Xrays
Ionising radiation passes through a imaging plate and then is loaded onto a computer screen. Dense objects stop xrays and appear white on a screen. Less dense objects appear black, with various other different shades of grey. Xrays allows dentists to look inside and inbetween teeth as well as seeing the bone levels. Xrays are a useful aid to diagnosing dental disease.
Xrays do pose a risk of damage to the cells inside our bodies so we keep the doses of xrays as low as possible. Those risks are highest for pregnant women, so if you are pregnant or think you might be pregnant it’s best to tell us before the xray is taken. We can still take xrays on pregnant women if we need to, or on the other hand you might wish to defer them.