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Endodontics (Root Canals)

The pulp or pulp chamber is the soft area within the centre of the tooth. The tooth’s nerve lies within root canals, which lie within the roots or “legs” of the tooth. The root canals travel from the tip of the tooth’s root into the pulp chamber, which also contains blood vessels and connective tissue that nourish the tooth.

A tooth’s nerve is not vitally important to a tooth’s health and function after the tooth has emerged through the gums. Its only function is sensory – to provide the sensation of hot or cold. The presence or absence of a nerve will not affect the day-to-day functioning of the tooth.

Why Does the Pulp Need to Be Removed?

When nerve tissue or pulp is damaged, it breaks down and bacteria begin to multiply within the pulp chamber. The bacteria and other decayed debris can cause an infection or abscessed tooth. An abscess is a pus-filled pocket that forms at the end of the roots of the tooth. An abscess occurs when the infection spreads all the way past the ends of the roots of the tooth. In addition to an abscess, an infection in the root canal of a tooth can cause:

Swelling that may spread to other areas of the face, neck, or head
Bone loss around the tip of the root
Drainage problems extending outward from the root. A hole can occur through the side of the tooth with drainage into the gums or through the cheek with drainage into the skin.

What Damages a Tooth’s Nerve and Pulp in the First Place?

Nerve and pulp can become irritated, inflamed and infected due to deep decay, repeated dental procedures on a tooth and/or large fillings, a crack or chip in the tooth, or trauma to the face.

What Are the Signs that a Root Canal Is Needed?

Sometimes no symptoms are present; however, signs to look for include:

Severe toothache pain upon chewing or application of pressure
Prolonged sensitivity/pain to heat or cold temperatures (after the hot or cold has been removed)
Discoloration (a darkening) of the tooth
Swelling and tenderness in the nearby gums
A persistent or recurring pimple on the gums

What Happens During the Procedure?

A root canal requires one or more office visits and can be performed by a dentist or endodontist. An endodontist is a dentist who specializes in the causes, diagnosis, prevention and treatment of diseases and injuries of the human dental pulp or the nerve of the tooth. The choice of which type of dentist to use depends to some degree on the difficulty of the root canal procedure needed in your particular tooth and the general dentist’s comfort level in working on your tooth. Your dentist will discuss who might be best suited to perform the work in your particular case.

The first step in the procedure is to take an X-ray to see the shape of the root canals and determine if there are any signs of infection in a surrounding bone. Your dentist will then use local anesthesia to numb the area near the tooth. Anesthesia may not be necessary, since the nerve is dead, but most dentists still anesthetize the area to make the patient more relaxed and at ease.

Next, to keep the area dry and free of saliva during treatment, your dentist will place a rubber dam (a sheet of rubber) around the tooth.

An access hole will then be drilled into the tooth. The pulp along with bacteria, the decayed nerve tissue and related debris is removed from the tooth. The cleaning out process is accomplished using root canal files. A series of these files of increasing diameter are each subsequently placed into the access hole and worked down the full length of the tooth to scrape and scrub the sides of the root canals. Water or sodium hypochlorite is used periodically to flush away the debris.

Once the tooth is thoroughly cleaned, it is sealed. Some dentists like to wait a week before sealing the tooth. For instance, if there is an infection, your dentist may put a medication inside the tooth to clear it up. Others may choose to seal the tooth the same day it is cleaned out. If the root canal is not completed on the same day, a temporary filling is placed in the exterior hole in the tooth to keep contaminants out between appointments.

At the next appointment, to fill the interior of the tooth, a sealer paste and a rubber compound called gutta percha is placed into the tooth’s root canal. To fill the exterior access hole created at the beginning of treatment, a filling is placed.

The final step may involve further restoration of the tooth. Because a tooth that needs a root canal often is one that has a large filling or extensive decay or other weakness, a Crown or an Onlay or a large white filling often needs to be placed on the tooth to protect it, prevent it from breaking and restore it to full function. Your dentist will discuss the need for any additional dental work with you. Images below – optional extra treatment:

How Painful Is the Procedure?

Root canal procedures have the reputation of being painful. Actually, most people report that the procedure itself is no more painful than having a filling placed. The reputation for pain is based around old technology and techniques, the most common response is what, is that all, are you finished? that was easy!

What Should One Expect After the Root Canal?

For the first few days following the completion of treatment, the tooth may feel sensitive due to natural tissue inflammation, especially if there was pain or infection before the procedure. This sensitivity or discomfort usually can be controlled with over-the-counter pain medications such as Ibuprofen (Nurofen) or Panadeine. Most patients can return to their normal activities the next day.

Until your root canal procedure is completely finished – that is to say, the permanent filling is in place and/or the crown, it’s wise to minimize chewing on the tooth under repair. This step will help avoid recontamination of the interior of the tooth and also may prevent a fragile tooth from breaking before the tooth can be fully restored.

As far as oral health care is concerned, brush and floss as you regularly would and see your dentist at normally scheduled intervals.

How Successful Are Root Canals?

Root canal treatment is highly successful; the procedure has more than a 95% success rate. Many teeth fixed with a root canal can last a lifetime. Also, because the final step of the root canal procedure is application of a restoration such as a crown or a filling, it will not be obvious to onlookers that a root canal was performed.

Complications of a Root Canal

Despite your dentist’s best efforts to clean and seal a tooth, new infections might emerge. Among the likely reasons for this include:

More than the normally anticipated number of root canals in a tooth (leaving one of them un cleaned)
An undetected crack in the root of a tooth
A defective or inadequate dental restoration that has allowed bacteria to get past the restoration into the inner aspects of the tooth and re contaminate the area
A breakdown of the inner sealing material over time, allowing bacteria to re contaminate the inner aspects of the tooth

During treatment very delicate instruments are used to clean and shape the tooth. Very occasionally these instruments can separate (break) in the canals. This does not necessarily mean the entire treatment is a failure. Most often the fractured piece can be removed or by-passed, and a normal root filling placed. Sometimes the treatment is completed leaving the piece of instrument in the root. Most often this is not a problem. If the treatment does fail one can consider an alternate surgical solution: either extracting the tooth or doing an apicoectomy (cutting off the tip of the problem root and sealing it from the outside).

Alternatives to a Root Canal

Saving your natural teeth is the very best option, if possible. Your natural teeth allow you to eat a wide variety of foods necessary to maintain proper nutrition. The root canal procedure is the treatment of choice. The only alternative to a root canal procedure is having the tooth extracted and replaced with Dental implant(s) or Bridge or Partial Denture to restore chewing function and prevent adjacent teeth from shifting. These alternatives not only are more expensive than a root canal procedure but require more treatment time and additional procedures to adjacent teeth and supporting tissues.

What happens if I dont have root canal treatment?

If a tooth has an abscess it can firstly cause severe pain, but not always. Some abscesses can be surprisingly painless. Nevertheless, the infection at the root tips can spread into the surrounding bone and soft tissues and cause more serious infections there that could cause swelling and pain. Bacteria also enter the blood stream and can infect other parts of the body. Prosthetic hip and knee joints and heart valves are particularly prone to infection. Patients with other health problems could also be at higher risk.

Root Canal Prevention

Since some of the reasons why the nerve of a tooth and its pulp become inflamed and infected are due to deep decay, repeated dental procedures on a tooth and/or large fillings, following good oral hygiene practices (brushing twice a day, flossing at least once a day, and scheduling regular dental visits) may reduce the need for a root canal procedure. Trauma resulting from a sports-related injury can be reduced by wearing a mouth guard.

Dental Implants

Standard Dental Implants

What are Standard Dental Implants?

A dental implant is really a very simple metal screw which is designed to thread into the bone of the jaw and to allow for the attachment of a (prosthetic) tooth at the top. Implants are made of Medical grade Titanium or Titanium Alloy. Your dentist will purchase the implants in sterile packaging and place them in a small hole in the bone which he or she has prepared as part of the implant placement procedure. The bone will fuse to the implant over a short period of time in a process referred to as ‘osseointegration’ and once this process is successfully completed (3 to 6 months) the implant is permanently in place.

Types of Implant

Single tooth replacement

Multiple tooth replacement
Denture Stabilization

Single Tooth Replacement

A single Implant is used to replace a single tooth, can be used both in the front of the mouth and the back of the mouth

Central Incisor :

Multiple Teeth Replacement

Can be used to replace teeth in the form of a Bridge ( teeth joined together ) or with multiple individual teeth

Denture Stabilization:

Denture Clicks in and out using precision attachments on at least two implants

Strong, durable, and natural in appearance, implants are among the most successful dental procedures performed. Although you have a number of restorative options for the treatment of missing teeth, none has proven to be as functionally effective and esthetically natural as implants. In many cases, dental implants may be the only logical choice for the restoration of all necessary functionality of the teeth and supporting structures.

Advantages of Implant Dentistry

Dental implants are stronger, more durable, and more natural than their restorative counterparts (bridges and dentures). Implants offer a permanent solution to tooth loss.

More attractive appearance.

Great comfort.
Don’t need to drill into the teeth on either side.
Helps prevent bone loss due to tooth removal.
Greater ability to chew food.
No rubbing, clacking, or pain.

No cream or adhesives.
Not having to take out at night.

The Dental Implant Procedure

1. Initial Consultation

The Implant process needs three people; The Surgeon to place the Implant, the Dental technician to make the tooth and the Dentist to connect the tooth to the Implant and oversee the process. The first step is an examination and consultation. This usually involves x-rays and may include taking impressions for models of your teeth. If you have already lost a significant amount of bone, additional x-rays taken at another facility that specializes in this type of x-ray may also be recommended. During the examination, we will be evaluating the area(s) of your mouth where teeth are missing, including the amount of bone available to support the placement of implants. we will also be evaluating the type of replacement teeth that will best meet your needs. A review of your health history will indicate whether there are any medical conditions that could prevent you from being a candidate for implant treatment.

2. Dental Implant Placement Procedure

The dental implants are placed in the bone using a gentle surgical technique. The Surgeon places a small-diameter hole (pilot hole) at edentulous (where there is no tooth) jaw sites in order to guide the titanium screw that holds a dental implant in place. To avoid damaging vital jaw and face structures like the inferior alveolar nerve and the mandible (lower jaw), a Surgeon must use great skill and expertise. After the initial pilot hole has been drilled into the appropriate jaw site, it is slowly widened to allow for placement of the implant screw. Following this placement, a protective cover screw is placed on top to allow the implant site to heal and the dental implant to anchor (osseointegration).

3. Abutment Attachment Procedure

Following the appropriate bone remodeling period, a small connector post called an abutment is attached to each dental implant. The permanent replacement teeth will eventually be attached to the abutments.

4. Fabrication of Replacement Teeth

A series of appointments will be needed to take impressions of your teeth and the implant abutments; place temporary replacement teeth; select the appropriate shade for your replacement teeth and try them for proper fit. In between these appointments, the laboratory technician will fabricate your replacement teeth and the underlying structures that will be attached to the dental implants.

5. Completion of Dental Implants

Once the above phases are complete, then your new dental implants will be fixed to the abutment and you’ll have a beautiful new set of teeth that look, feel and function just like the real thing.

6. Ongoing After Care

Regular examinations will be necessary to monitor and maintain you Implants to ensure that any problems are caught early, this will help ensure the best chance for longevity

Today’s dental implants are virtually indistinguishable from other teeth. This appearance is aided in part by the structural and functional connection between the dental implant and the living bone. Implants are typically placed in a single sitting but require a period of osseointegration.

Osseointegration is the process by which direct anchorage of a dental implant root and the bone of the jaw occurs. Osseointegrated implants are the most commonly used and successful type of dental implant. An osseointegrated implant takes anywhere from three to six months to anchor and heal, at which point your dentist can complete the implant procedure. Once the implant has anchored with the jawbone, an artificial prosthesis (tooth) may be attached and the process is done. If osseointegration does not occur, the implant will fail. Detailed procedural steps are as follows:

What are the Risks?

In rare circumstances Implants have been known to fail and they will have to be removed through a subsequent procedure. ( usually just unwinding them by hand )
It is possible that implant superstructure may fracture during the implant’s life cycle, and in the event a fracture were to occur, the fractured implant may be removed or left in the jaw if its causing no problem, determined by professional judgment.
If the patient keep good oral hygiene and does not return for return for appropriate post-operative care including plaque removal, Implants can fail.

The use of tobacco, including cigarette smoking as well as excessive alcohol consumption can cause failure of the dental implants.
Swelling, infection, bleeding and/or pain may be associated with any surgical procedure, including Implants and the said conditions may occur during the life of the implants.
Temporary or permanent numbness may occur in my tongue, lip(s), chin, or jaws as a result of this procedure as well as the possibility of sinus involvement in my upper jaw. Although cases occurring with Mini Implants are extremely rare

Does the Procedure Hurt?

It is often done under local anesthesia and patients generally experience some discomfort after the procedure although this is usually controlled by paracetamol. It is similar to having a simple tooth extraction.

Success Rates of Dental Implants

Studies have shown a five-year success rate of 95% for lower jaw implants and 90% for upper jaw implants. Many other studies have shown 5 year success rates in the high nineties.

Failure of a dental implant is often related to failure to osseointegrate correctly. A dental implant is considered to be a failure if it is lost, mobile or shows peri-implant (around the implant) bone loss of greater than 1.0 mm in the first year and greater than 0.2mm a year after.

Dental implants are not susceptible to dental caries but they can develop a condition called peri-implantitis. This is an inflammatory condition of the mucosa and/or bone around the implant which may result in bone loss and eventual loss of the implant. The condition is usually, but not always, associated with a chronic infection. Peri-implantitis is more likely to occur in heavy smokers, patients with diabetes, patients with poor oral hygiene and cases where the mucosa around the implant is thin.

Currently there is no universal agreement on the best treatment for peri-implantitis. The condition and its causes is still poorly understood.

Risk of failure is increased in smokers. For this reason implants are frequently placed only after a patient has stopped smoking as the treatment is very expensive. More rarely, an implant may fail because of poor positioning at the time of surgery, or may be overloaded initially causing failure to integrate. If smoking and positioning problems exist prior to implant surgery, clinicians often advise patients that a bridge or partial denture rather than an implant may be a better solution.

Failure may also occur independently of the causes outlined above. Implants like any other object suffers from wear and tear. If the implants in question are replacing commonly used teeth, then these may suffer from wear and tear and after years may crack and break up. This is a very rare occurrence, however possible. The only way to minimize the risk of this happening is to visit your dentist for regular reviews.

In the majority of cases where an implant fails to integrate with the bone and is rejected by the body the cause is unknown. This may occur in around 5% of cases. To this day we still do not know why bone will integrate with titanium dental implants and why it does not reject the material as a ‘foreign body’. Many theories have been postulated over the last five decades. A recent theory argues that rather than being an active biological tissue response, the integration of bone with an implant is the lack of a negative tissue response. In other word for unknown reasons the usual response of the body to reject foreign objects implanted into it does not function correctly with titanium implants. It has further been postulated that an implant rejection occurs in patients whose bone tissues actually react as they naturally should with the ‘foreign body’ and reject the implant in the same manner that would occur with most other implanted materials.

Implant Dentistry: New Procedural Strategies

Experienced implantologists have begun to use a new strategy for the replacement of missing teeth. Dental implants are placed into locations where teeth have recently been extracted. When successful, this new strategy can shed months off of the treatment time associated with dental implants because osseointegration is sped up. Candidacy for this type of early intervention is dependant upon anatomical factors of the extracted tooth site. For example, in many cases the extracted tooth site is wider than the implant, making it impossible to place the implant into the site immediately after extraction. Dental work would have to be performed first in order to create a perfect fit for the implant.

Analyse your Smile

If you’re not completely happy with your smile, perhaps it’s time to get a new one! The following self-analysis will help you make that determination.

Are your two upper front teeth too long or too wide?
Do you have a space between your front teeth?
Are the surfaces of your teeth rough and worn?
Are the edges of your teeth worn flat, or giving you an ‘older smile’?
If your front teeth contain tooth-colored fillings do they match the shade of your teeth?
In a full smile, the back teeth normally show. Are your back teeth free of stains and discolorations from unsightly restorations?
Do your front teeth protrude, stick out or overlap?
When you smile broadly, are your teeth all one colour and are they white enough?
Are your lower six front teeth straight and even in appearance?
When you smile broadly, does your top lip rise above the necks of your teeth so that your gums show?
Are your lower six front teeth straight and even in appearance?
When you smile broadly, does your top lip rise above the necks of your teeth so that your gums show?
Do your restorations—fillings, laminates and crowns—look natural?
Are your gums pink and ‘knife-edged,” or are they red and swollen?
After many months of neglect a good scale and polish brought back natural good looks and health. An appointment with our hygienist can help to give back confidence and beauty.

…and one more

If you could alter your smile, what would you most like to change? See photos of completed cases in treatment options gallery under makeovers.

Come in and have a talk with us about your smile.

Emergency Services

We can help with:

• Toothache & Wisdom Teeth Pain

• Broken teeth

• ACC Accidents

• Broken fillings or bonding

• Chipped teeth

• Teeth knocked out

• Emergency extraction

• Fractured veneers and crowns

• Abscesses

• Broken bridges

• Fractured implants

We can source help quickly with:

• Broken dentures

• Missing denture teeth

Crowns and Bridges

Crowns are placed to improve the appearance of your teeth if they are damaged, discoloured or slightly crooked. A crown will protect heavily filled teeth and may be the only possible long term solution.

What are Crowns Made of?

There are several different materials from which crowns can be made- Gold, porcelain with a metal base, all porcelain and composite. The different types of crowns are suitable for different situations in the mouth.

What is involved in Crown preparation?

The tooth is assessed and any existing decay and gum problems are treated. Once the tooth and supporting tissues are healthy there are normally two appointments required.

At the first appointment the tooth and existing filling are reduced in size before recording an impression. In order to take an accurate impression of the margins of the crown we must pack a cord round the gum line of the tooth.

A temporary crown is made and cemented on the tooth. If the crown is to be made from porcelain then a shade needs to be taken. We will either record a shade for you or request that the technician choose the shade depending on where the crown is and the quality of light.

The impression is then sent to the laboratory where the ceramist/technician makes the crown. After this appointment your gum will often feel tender round the tooth for a few days and the tooth may initially be a little temperature or pressure sensitive. If the bite is not right, or problems persist after 2-3 days please let us know.

At the second appointment 10-14 days later the finished crown is tested in the mouth for proper fit, shape and colour.

The bite is adjusted on both the crown and occasionally on adjacent or opposing teeth to get the best possible chewing platform. Once everything has been checked the crown is cemented.

Complications?

The length of time that a crown will last depends on a wide variety of factors including the way in which your teeth meet, how heavily you chew, whether you grind your teeth and your own maintenance of your oral hygiene. Usually you can expect a lifetime of 10 – 15 years for a crown in a well maintained mouth. Most crowns will however last for considerably longer.

The most common complication after the placement of a crown is the loss of vitality of the tooth. This is most commonly due to a pre-existing deep filling. We make every effort prior to crowning a tooth to ensure its vitality. However, should a tooth become non-vital and require root canal treatment this can be done through the existing crown in the vast majority of cases. If a root canal is required the cost will be additional.

Recurrent decay around a crown or advancing periodontal disease around a crown are both preventable with a good home care regime and regular check ups with both the dentist and the hygienist.

Less common problems such as the fracture of a crown or chipping of the porcelain can be assessed on an individual basis- all work is covered under a warrenty of a year, which is normally sufficient time for problems with the manufacture of the crown to arise.

Fissure Sealants

What are Fissure Sealants?

These are resin coatings placed on teeth to protect them from decay.

Why use sealants?

Tooth surfaces are not smooth. In particular, the biting surface (occlusal), and those surfaces adjacent to the cheek (buccal) and tongue (lingual) exhibit developmental pits and fissures. These can be difficult to keep clean and retained plaque can lead to decay which will require removal and filling.

This decay accounts for more than 50% of the decay treated by dentists. The use of sealants has been shown to significantly reduce the prevalence of this decay. An unsealed tooth is three times more likely to develop pit and

When should teeth be sealed?

Ideally, deep pits and fissures should be sealed soon after the teeth have erupted in the mouth. This is when they are most susceptible to decay. Practically, the need for sealants is made on an individual basis, depending on the depth of the pits and fissures, their cleansability, and the patient’s decay susceptibility.

Which Teeth?

Although all molars and premolars develop pits and fissures, the molars are particularly susceptible to decay and sealants are more commonly recommended for them only.

How are they placed?

The teeth are cleaned with Calcium Carbonate (Prophyflex-Kavo), then Ozone is applied (Healazone-Kavo) conditioned and dried. A special low-viscosity resin is flowed in the susceptible pits and fissures and cured with a bright light. No local anaesthetic is necessary and no cavity preparation is required in most cases. In some cases Air Abrasion ( Rondoflex – Kavo ) can also be used to clean the teeth.

Fissure sealants should last at least three years. They should be checked at yearly recall visits and may be repaired or extended in a manner similar to their initial placement.

KaVo HealOzone – for gentle caries treatment

• No pain

• No drilling

• No side effects or ensuing disorders

HealOzone, the new approach to caries treatment, offers you all this and more. It is very easy to use and is scientifically proven. Caries bacteria are surrounded with ozone without manual contact and are killed in a matter of seconds – without an injection, without drilling, without pain and without side effects.

HealOzone Procedure

The procedure is very simple: after cleaning and drying the tooth surface, the dentist measures the caries damage by a laser technique. If a certain value is exceeded, the new pain – free treatment is used: your dentist places a small cap on the area affected by caries. The inflowing ozone cures the caries – and is sucked away again.

Thanks to a final mineral treatment and a remineralisation set for use at home, your tooth will be intact and resistant, up to the follow – up examination. Kavo HealOzone – you will never need to worry about going to the dentist again.

How to Maintain Healthy Teeth

Decrease the frequency of snacks.
Decrease sources of sugars by reducing intake of dried fruits, muesli bars, ribena, milo, biscuits, fruit juices, energy drinks flavoured milk and sweets.
Drink water rather than sugary fruit juices
Dilute fruit juices and follow them with a glass of water.
Always follow snacks with a glass of water
Cheese is helpful after snacks or a meal increases the pH (alkaline levels) and reduces the acid levels.
Use a fluoride toothpaste
If you have undergone dental treatment or surgery, consider using a fluoride mouth rinse or APF gel.
See the oral hygienist regularly – at least every 6 months – to assess gum tissue, reduce plaque build-up and scale away tartar which is so often the cause of gum disease.
See your dentist regularly.

Orthodontics (Braces and Straightening Teeth)

Orthodontics is a specialist area of dentistry concerned with improving the appearance, function, and stability of the teeth and jaws by straightening the teeth and correcting the bite.

The aim of Orthodontics is to produce a healthy, functional bite, creating greater resistance to disease and improving personal appearance. This contributes to mental and physical well-being.

The benefits of undergoing a course of treatment are as follows:

improvement in facial aesthetics
improvements in the function of the dentition
prevention of trauma to prominent teeth and treatment of impacted teeth
improved resistance to dental disease

Orthodontics is the straightening of teeth using appliances like braces or retainers, which apply pressure to the teeth. Since people are generally very conscious of what their smile looks like, orthodontists play a critical role in boosting their patient’s self-esteem.

Orthodontics plays an important role in oral health, appearance, and overall self-confidence. Misaligned teeth can cause bite problems that hinder eating. In addition, crooked or overcrowded teeth are harder to brush and floss. These problems can lead to severe tooth decay and a host of other problems.

Braces

Braces are used to align teeth and give you a healthier and more attractive smile. Braces are most often made of metal and wire although many patients opt for cosmetically appealing options like clear, tooth-colored or gold braces. Some braces can actually be hidden behind the teeth. Another option is Invisalign, which consists of removable sets of clear aligners. In most cases, patients wear braces for 20-24 months.

Benefits

The benefits of wearing braces include a perfectly straight smile and teeth that are easier to clean and floss. If your teeth are crooked and you tend to grind your teeth at night, and you’re grinding down and you’re putting pressure on the crooked teeth, that will affect your TMJ joint and become a lot more tense, and the muscle will start to ache. If you get braces your teeth can be perfectly straight and you can correct your bite. Your bite will be in perfect alignment and this will possibly eliminate any future jaw problems that you might have.

Invisalign Braces

Your Invisalign treatment consists of a series of nearly invisible, removable aligners that you change every two weeks for the next set of aligners. Each aligner is individually manufactured for your teeth, and your teeth only. As you replace each aligner, your teeth will move – little by little, week by week – until they have straightened to the final position prescribed by your dental practitioner. .. more details on Invisalign

Traditional Braces

Traditional metal braces are the most common type of braces and are more comfortable today than ever before. Made of high-grade stainless steel, metal braces straighten your teeth using metal brackets and archwires.

With metal braces, you have the option of adding coloured elastics (rubber bands) for a more unique and colourful smile.

Ceramic braces are made of clear materials and are therefore less visible on your teeth than metal braces. For this reason, ceramic braces are used mainly on older teenagers and adult patients who have cosmetic concerns. While they are visually less prominent, they do require more attention to oral hygiene as ceramic braces are larger and more brittle than their metal counterparts. For these reasons, ceramic braces tend to be used more on upper front teeth than on lower teeth.

Partial Dentures

A missing tooth or missing teeth can be replaced by a removable partial denture. There are two types- depending on their framework. The plastic partial denture and the metal partial denture.

Plastic Partial Denture

A plastic partial denture consists of false teeth, normally plastic, which are attached to a plastic plate. In most instances these plates are held in place by clasps which go around remaining teeth. Sometimes when the plate is temporary and replaces only one tooth (as in a temporary plate during implant treatment) the plate can be held in by utilising natural undercuts round the teeth.

Advantages

Relatively inexpensive.
Can be a good short term replacement for a lost tooth.
Easy to repair or make additions to.
Gum coloured plastic can be used to fill out an area where there has been gum shrinkage.
Can be made from biocompatible materials such as dental “D”.

Disadvantages

Removable.
Bulky.
Can cause damage to remaining teeth and gums.

What is involved?

Impressions are made of the upper and lower teeth, and then the bite, shape and shade of the missing teeth are recorded. They are then sent to the dental technician who makes the denture.

Depending on the type of partial denture the turnaround can be as little as a day – or as much as a week. Once the partial denture is back we fit it into the mouth and make any adjustments required. Occasionally sore areas or ulcers can arise under a partial plate. Should this occur please contact us so that further adjustments can be made.

Metal partial denture

A metal partial denture can be made to fit more accurately than a plastic one. The false teeth and pink plastic representing the gum is attached to a thin strong metal frame normally made from a chrome cobalt alloy. The framework can also be made of titanium or be gold plated.

Advantages

Better fit and longer life span than a plastic partial denture.

Again, gum coloured plastic can be used to fill out areas where there has been gum shrinkage.
False tooth can easily be repaired.

Disadvantages

Removable.
Some bulk in mouth.
More costly than a plastic partial denture.
Less chance of damage to teeth and gums than a plastic partial- but still carries a risk of increasing the deterioration of remaining teeth if a patient does not practice good oral hygiene.
Not easy to make additions to though often still possible.

What is involved?

As the life span of the metal partial denture is dependent on the life span of the teeth on which the claps will rest, we ensure that there is no decay or gum disease before we start. Ideally teeth which are heavily filled should be crowned, and restorations which are as permanent as possible- such as Gold or Porcelain restorations, placed.

Some minor tooth adjustments are normally required to optimize clasping the teeth. Impressions are then recorded. Once the metal framework has been made we try this in to check the fit. Then the plastic teeth are added to the metal framework set in wax. We check the teeth for colour, shape and check that the bite is correct. The plate is then sent back to the lab and is processed. The completed denture is fitted into the mouth and any adjustments required are made. As with the plastic partial, sore areas or ulcers can occasionally arise. Should this occur please contact us so that further adjustments can be made.

Types of restoration which is suitable for a tooth depends on a variety of factors – not all filling types suit all situations. We are happy to discuss the different options available for your mouth.

Which Filling?

Gold
Porcelain Inlay
Composite
Glass Ionomer
Amalgam
Sensitivity
Gold Inlay/Overlay (Filling/Restoration)

Gold is very durable as well as inert in the mouth. When restorations run very deeply under the gum line, or very little tooth tissue remains, Gold can still be the material of choice.

Porcelain Inlay/Overlay (Filling/Restoration)

Similar to Gold, but is white & durable, but there is a small risk these may fracture.

Composite

Composite is a resin material filled with silica particles and other fillers to increase its toughness and provide colour. Composites may be placed directly into the cavity by the dentist or made by a technician in the laboratory from an impression taken by the dentist.

Composite placed directly in the mouth enables us to provide an aesthetic, quick restoration for cavities within enamel. As composite does not wear well it is most suitable for anterior teeth and small fillings in back teeth which will not be under too much pressure in the bite.

Glass lonomer

Glass lonomer is a mixture of polyacrylic acid and silica. It is the only material we have available which will actually bond to tooth tissue and has a special benefit of very slowly leaching fluoride into the tooth to prevent decay around the filling. It is quite a soft material which means that it is suitable only for children, the elderly, and cavities on the facing surfaces of teeth. It is also commonly used in adults as a temporary filling material.

Amalgam

The main constituents of amalgam are silver, tin, copper and mercury. The mercury is added to ‘wet’ the particles of silver and tin so that they will mix together.

Amalgam is reasonably resilient in the mouth and lasts quite well. The main disadvantages with amalgam are:

The poor aesthetics
The mercury content- 50 % by weight

Amalgam fillings expand and contract quite differently to your tooth and can thus act as a wedge within the tooth leading to weakened tooth structure and eventually fracture.

The use of amalgam is slowly declining as other materials are developed for use in the mouth which are superior; tooth coloured, and do not contain mercury. However there are still some instances, where due to lack of enamel and financial considerations, it is the only material which will serve in the medium term.

Sensitivity after placement of a restoration

It is not unusual to have some initial sensitivity after a filling is placed. Often the gum around the tooth can be a little tender- in particular when decay has gone between the teeth- necessitating the use of bands or strips. It is not uncommon for a tooth to be sensitive to cold immediately after the placement of a large or deep restoration, Provided the pain is of short duration and gradually lessens over the next few weeks the tooth should eventually settle.

It can also be difficult to establish the correct bite when teeth are numb and when the muscles round your jaw are tired, making it difficult to close in the correct position. Teeth which are high in your bite, will become tender to bite on and may also become temperature sensitive. It is important to come back for an adjustment should your bite feel incorrect.

Occasionally after the placement of a restoration a tooth can become non-vital and require root canal treatment. Each time we replace a filling there is trauma to the pulp (nerve, blood supply). This trauma is caused by a combination of the drilling itself, toxins released by the bacteria that cause decay and the reaction of the pulp to the filling materials themselves. Other factors such as tooth grinding and fracture lines within teeth also affect the health of the pulp.

The accumulation of this trauma over time can result in a ‘stressed pulp’, that is a state of chronic near-death.

As a result, a tooth which was seemingly fine prior to dental treatment may require root canal treatment afterwards because the pulp of that tooth, having already been compromised, is unable to withstand any further stress.

Teeth that are, or are becoming non-vital generally become sensitive to hot and cold, as well as being tender to bite on. Pain will often arise spontaneously and last for a long period of time, perhaps even be constant and will often be throbbing in nature. Should this occur please contact us immediately.

Periodontal Health (Gum Disease)

There are two main types of gum disease- gingivitis and periodontitis. Gingivitis is very common and may affect up to 70%-80% of the population. Periodontitis affects around 25-35% of adults over age of 30 years. Both these infections can be treated and controlled, but the earlier they are diagnosed and managed, generally the better the prognosis for your teeth

Periodontal disease is typically painless and often the signs are subtle. Some of the symptoms may include:

gums that bleed easily with brushing or flossing
red, swollen or tender gums
pus between gums and teeth
Gum recession and gums that pull away from the teeth
persistent bad breath
loose or separating teeth
Gaps of spaces between teeth getting worse
Tooth sensitivity
a change in the way your teeth fit together when you bite

Normal healthy gums

Healthy gums and bone anchor teeth firmly in place.

Periodontitis

Unremoved plaque hardens into calculus (tartar), As plaque and calculus continue

to build up, the gums begin to recede( pull away) from the teeth, and pockets form

between the teeth and gums.

Advanced Periodontitis

The gums recede further, destroying more bone and the periodontal ligament. Even healthy teeth may become loose and need to be extracted

An increasing amount of research also suggests that there is evidence linking chronic periodontal disease to conditions such as coronary heart disease, diabetes and respiratory disease. Moreover, current research suggests that if you have periodontal disease during pregnancy you may be significantly more likely to have a baby born prematurely or with a low birth weight. Keeping your gums healthy will ensure a better chance of good general health.

A patient with generalised gingivitis. Note the red, swollen, inflammed gum tissues around the teeth. These gums bleed easily on brushing.

The main cause of periodontal disease is bacterial plaque. Oral bacteria form a sticky, colourless film on your teeth. These bacteria release various toxic by-products which irritate your gum tissues. While plaque bacteria are the main cause of periodontal disease there are other factors, such as those outlined below, that can also affect the health of your gums.

The use of tobacco is linked with many serious illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. Smoking also increases the risk of periodontal disease and recent research has shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease. Smoking also reduces the ability of your gums to heal properly following treatment, which may mean a less successful treatment outcome. Patients who smoke are also more prone to developing post operative infections following treatment. For these reasons all patients are encouraged to quit smoking as part of their periodontal therapy.

Recent studies suggest that approximately 30% of the population may be genetically more susceptible to developing gum disease. Thus, some individuals are more prone to periodontal disease. Often the susceptibility to periodontal infection can be traced thru families. Patients with a susceptibility to periodontal disease may require more intensive maintenance and more frequent recall for ongoing hygiene treatment.

At certain times such as puberty, menopause, menstruation and pregnancy your gum tissues may be more susceptible to irritation and infection. During these particular times your body experiences specific hormonal changes which can affect your gum tissues. Your gums may become more sensitive and at times react strongly to the hormonal fluctuations. Recent research also suggests that pregnant women with chronic gum disease are up to seven times more likely to deliver pre-term, low-birth-weight babies.

Certain drugs, such as antidepressants, oral contraceptives and some heart medicines, can have an effect on your oral health. You should always inform your dental professional of the medications you are taking so that these can be taken into consideration.

Diabetes is one of the main risk factors in periodontal disease. Diabetics are generally more prone to developing infections, including periodontal disease. Periodontal disease is often more severe in diabetics and can be more difficult to treat, depending you the level of diabetic control.

Chronic stress can have a negative effect of you body’s immune system. This may in turn make you more susceptible to periodontal disease as it can make it more difficult for the body to fight off infection.

A diet low in important vitamins and nutrients can compromise the body’s immune system and make it harder for the body to fight infection and interfere with proper healing. One of the more common conditions is iron deficiency. Deficiencies such as this can worsen the condition of your gums.

Tooth grinding typically occurs at night while you are asleep and is also know as bruxism. Your jaw joint may click on opening or may be painful at times. If you wake up with frequent headaches and show wear on your teeth, you may be grinding your teeth. Tooth grinding may worsen your gum health if you have pre-existing periodontal disease.

Certain diseases may worsen your gum disease by interfering with the way your body’s defenses deal with infection. Some examples include uncontrolled diabetes, radiation therapy, chemotherapy, corticosteroid use.

Am I at risk of gum disease?

Find a periodontist for evaluation and treatment

Treatment options for periodontal diseases

Helpful Links

Learn more about how gum disease can affect your general health

http://www.perio.org/consumer/mbc.top2.htm

American Academy of Peridontology

http://www.perio.org/consumer/gum-disease.htm

Preventative Dentistry Using Lasers

Highly sensitive

The patented laser fluorescence method of KaVo DIAGNOdent works on the basis of the differing fluorescence between healthy dental substance and diseased dental substance. KaVo DIAGNOdent detects even the smallest lesions; using a number scale and an audible alert – it’s reliable and doesn’t expose you to radiation. And there’s no probing, no scraping and no damage to healthy dental substance.

Clinical View (a) of hidden caries. Histological View (b) of hidden caries. The histological section indicates the presence of dentine caries despite the occlusal surface enamel appearing intact to the eye.

Fissures usually cannot be probed with conventional instruments

The KaVo DIAGNOdent laser penetrates almost 2mm into the fissures and reliably detects pathological changes.

KaVo DIAGNOdent Characteristics

The best thing for you: – a thorough yet gentle treatment that is non-invasive and preserves teeth.

• Unerring early caries detection

• Modern exploration without scratching or damaging the healthy tooth structure

• Pain-free

• Minimally invasive treatment

• Long-term satisfaction with your own teeth

Sensitive Teeth

What Causes Sensitive Teeth?

Cavities and fractured teeth can cause sensitive teeth, as well as worn tooth enamel, cracked or exposed teeth.

A layer of enamel, a very strong substance, protects the crowns of your teeth. A layer called cementum protects the tooth root under the gums. Beneath the enamel and the cementum is dentin, a part of the tooth that is less dense.

The dentin contains microscopic dentinal tubules (small hollow channels) which go down into the tooth’s nerve centre, the pulp. If the enamel and cementum is worn away, the dentin loses its protective covering, and the tubules allow heat and cold or acidic and sticky foods to reach the nerves in the tooth. This causes sensitivity and pain. This however, does not cause permanent damage to the pulp. Damage can be minimised with proper oral hygiene.

Proper oral hygiene is the key to preventing gums from receding and causing tooth sensitivity. If you brush your teeth incorrectly or over-brush, gum problems can result.

Sensitivity after placement of a restoration

The accumulation of this trauma over time can result in a ‘stressed pulp’, that is a state of chronic near-death. As a result, a tooth which was seemingly fine prior to dental treatment may require root canal treatment afterwards because the pulp of that tooth, having already been compromised, is unable to withstand any further stress.

Tooth Discolouration

There are several reasons why teeth become discoloured, and these are generally characterized as; extrinsic, intrinsic, and age-related discolouration.

.Extrinsic discoloration occurs on the outer tooth surface, when the enamel is stained by coffee, smoking, cola, red wine, dark coloured foods and drinks.
Intrinsic discoloration occurs if the dentin layer of the tooth becomes darker and more yellowish- brown, or gray.

This can be caused by the following:

.excessive fluoride exposure when a child
.tetracycline exposure during your mother’s second half of pregnancy while carrying you.
.tetracycline use before the age of eight.
trauma to tooth/teeth when you were young.

Age-related discoloration is usually due to both extrinsic and intrinsic features. Dentin usually darkens with time because it becomes thicker, and the tooth enamel stains with time and also becomes thinner with wear. This thinning allows the dentin discolouration to show through the enamel.

Some children are also born with a rare tooth problem called “dentinogenesis imperfecta,” which causes a gray, purple or amber discoloration of the teeth.

Symptoms:

Symptoms can range from white spot and lines on the enamel to yellowing or browning of the enamel. With thinner enamel, dentin discolouration most likely will be visible.

Diagnosis:

Tooth discolouration can be diagnosed simply by viewing the teeth.

Expected Duration:

Extrinsic discolouration may be removed by a professional teeth cleaning, however some stains are more permanent. Teeth whitening, bonding, porcelain veneers, and/or crowns can correct this discolouration.

Prevention:

Proper oral hygiene will help you to prevent extrinsic staining in most cases. Also, avoiding coffee, cigarettes, cigars, and other staining foods and beverages will help to prevent extrinsic staining. You should also visit your dentist and/or dental hygienist for regular professional teeth cleanings.

Intrinsic staining can be more difficult to prevent, and is dependent upon the health of your teeth. Try to prevent damage to the dentinal layer and pulp, by visiting your dentist for regular checkups and have routine dental procedures performed if necessary. Try to avoid fluoride overexposure.

Treatment:

Extrinsic staining can usually be treated by proper oral hygiene at least twice daily and after every meal. Other procedures to treat tooth staining involve: teeth whitening; bleaching of non-vital (teeth with pulpal injury) combined with a root canal; bonding; porcelain veneers; and crowns.

Calling the Dentist:

As tooth discolouration is a cosmetic problem, call your dentist if you are not pleased with the brightness of your teeth. Alterations in your child’s tooth colour must be viewed by your dentist or child’s dentist to determine the cause.

Prognosis:

Extrinsic staining can be treated with the prognosis being good; while intrinsic staining is more difficult to treat.

Why use a Dental Hygienist?

Dental hygienists are specially trained members of the dental team who work together with the dentist to provide complete dental care.

Periodontal (gum) disease is the main cause of tooth loss in adults, with 80% of adults having some form of periodontal problem. It is often painless and most adults are unaware that they have a problem.

Dental hygienists are trained to treat and prevent periodontal (gum) disease, by evaluating and assessing your periodontal tissues, scaling and polishing of teeth and giving home care instructions based on individual needs.

How do I know if I have Gum Disease?

Do your gums ever bleed when you brush your teeth or when you eat hard food?
Have you noticed any spaces developing between your teeth?
Do you have discoloured or dirty teeth?
Do your gums ever feel swollen or tender?

Are your gums red and puffy?
Have you noticed that your gums are receding (pulling back from your teeth) or your teeth appear longer than before?
Do you have persistent bad breath?
Have you noticed pus between your teeth and gums?
Have you noticed any change in the way your teeth fit together when you bite?
Are your teeth loose?
Do you ever develop sores in your mouth?
Do you have a bad taste in your mouth?

If you have answered yes to any of the questions then you may have gum disease.

What our Hygiene Department Provides

Detailed diagnostic assessment for periodontal disease, including evaluation of pocketing, bleeding and bone loss.
Computerized tracking charts showing the progression of the disease.
Treatment procedures including scaling, root planning,
Decay risk assessment program
Preventative maintenance for Adults and children
Dietary guidance
Tooth Whitening
Mouth guards
Oral health education
Stain removal
General cleaning
Cosmetic cleaning


Denture Stabilisation with 2 x Implants		Denture Stabilisation with 2 x Abutments

Denbture Stabilisation with 2 x Locators		Denture Stabilisation with 2 x Implants


Denture Stabilisation with Dental Implants x 2		Denture Completed

Denture Stabilisation with 2 x Implants		Denture Locators


Single Implant – Radiograph (X-Ray) – Before		Single Implant – Radiograph (X-Ray) – After


Dental Implants x 6 – Before		PIB (Prosthetic Implant Bridge ) and Crowns – After


Dental Implants x 6 & Crowns – After		Dental Implants x 6 & Crowns – After


Replacing Amalgam with Porcelain – Before		Replacing Amalgam with Porcelain – After


Clinical view if hidden caries	Histological View

Fissues probed		Kavo Diagnodent Laser