Tooth decay is a common problem, and most people have a 95% chance of suffering with some form of it. As soon as it occurs, it is important to remove the decay, clean and repair the tooth. Missing or lost teeth should also be replaced to ensure you have the highest possible oral health.
Direct Composite Restorations (bonding/white fillings)
Composite fillings are tooth-coloured (compared to the silver amalgam ones) and are usually made from a resin that is mixed with powdered glass quartz, silica or other forms of ceramic.
They are aesthetically better that amalgam fillings and have been developed extensively in recent years so that they can be made to mimic the natural tooth layers very closely.
Composite fillings are bonded chemically to the tooth structure and so can be used to strengthen and protect teeth with thin and fragile cusps.
Although very much improved over recent years, the wear resistance of composite is lower than some other materials. This may mean that laboratory produced restorations (such as ceramic crowns and inlays) may be more hard wearing for restoring whole or large parts of front and back teeth, especially in high load bearing areas.
Inlays & onlays
An inlay is a small setting within the biting surface of the tooth. An onlay is a facing which restores & replaces the whole biting surface of the tooth.
Inlays & onlays can be made of either porcelain or gold.
Porcelain offers the advantage that it can be perfectly shade matched to the remaining tooth and also that it can be chemically bonded to the tooth, making it very strong. Gold offers the advantage that it can be made very thin and still keep its strength, and so can be useful in back teeth where there is very little space to restore the tooth.
Onlays can offer the advantage that they require less tooth removal than traditional tooth preparation for crowns, so preserving as much natural tooth surface as possible.
A crown, sometimes called a ‘cap’, is a way to cover chipped, broken or weakened teeth, strengthening your teeth and restoring your smile. A crown could also be used to protect the space left from a root filling or to help hold a denture or bridge in place.
Usually your tooth will need to be shaped, under local anaesthetic, and an impression taken by your dentist, which is then sent to the laboratory in order for your crown to be custom-made out of porcelain or porcelain bonded to gold.
Sometimes, especially with root fillings, it is necessary to set a post before fitting the crown. This supports the crown and adds stability and strength. Posts are custom made or pre-made from metal or ceramic materials and are cemented directly into the root canal, ready for the crown to be fitted over the top. In certain circumstances it is necessary to custom-made a post, which is easily done by a dental technician.
There have been a great number of advances in the ceramic materials used to provide onlays, crowns and veneers over the last decade. This means that beautiful restorations can now be produced which are imperceptible to natural teeth, even by dentists!
A bridge is used to fill the space left by a missing tooth, giving you back a full smile. They are only possible if your surrounding teeth are healthy and strong, as it is these which are used to support the bridge. They are usually made from a porcelain and precious metal blend, although non-precious metals are also sometimes used.
Highly Aesthetic, all porcelain bridges may also be suitable in some cases.
It is important to replace missing teeth not only to improve the appearance of your smile, but also to prevent weakening of the teeth either side, decay and gum disease caused by trapped food particles or alterations to your bite.
Your dentist will help you to choose the best method to replace any missing teeth you may have.
Root canal treatment
This treatment is sometimes necessary if the nerve in the tooth is dead or dying or if the prognosis for the health of the nerve is bad long term. The process involves cleaning the internal parts of the tooth and remving as much bacteria and diseased tissue as possible. This in the majority of cases will allow the tooth to be kept and maintained in the mouth. In many cases it is desirable to place a crown or an onlay soon after the root canal treatment has been completed.
A root canal treatment is performed under a local anaesthetic and should feel much like having a regular filling done, although it may take a little longer.
A dental implant is the closest we can come to giving you back a natural tooth.
A dental implant is used to secure one or more false teeth, or dentures, into place. It consists of a titanium rod, set into the jawbone, which the false teeth are then fixed to. The combination of rod and false teeth are collectively known as 'implants'. This is a well-established method, with 95% lasting many years, providing they are cared for correctly.
Setting an implant requires a small operation, using local anaesthetic or even sedation if you are a nervous patient. Occasionally a generally anaesthetic may be required for complex cases. After the operation you will feel some discomfort for about a week, as with any healing process.
Cleaning & Prevention
The best way to reduce decay and gum disease, and to maintain the health or your mouth, is to attend regular dental appointments. This is called preventive dentistry, and ensures we can catch any potential problems before they develop and so the amount of treatment required is reduced. This means you can avoid having so many extractions and fillings, and are more likely to keep your own teeth for life.
Your dentist and hygienist will work together to create a recommended course of treatment, or maintenance plan, to keep your teeth in the best condition possible. Your dentist will assess your mouth and discuss any necessary treatment with you, to try to prevent any reoccurring problems. Any fillings you have will also be checked, making sure they are in good repair.
Your hygienist will perform a thorough scale and polish, and will teach you how to properly clean your teeth of bacterial plaque. Plaque is an invisible layer of bacteria, which when mixed with sugar turns into acid. This can then cause tooth decay, or infect the gums if it is not removed regularly. Your hygienist will also discuss dietary and lifestyle habits that might affect your teeth, and advise you on which oral care products are best suited to you.
Gum disease is caused by a build up of plaque, and can be avoided if you brush and floss your teeth twice a day. There are various symptoms of gum disease, including swelling, redness, soreness and bleeding during brushing, but there are only two main forms of it: gingivitis and periodontal disease.
Gingivitis is an inflammation of the gums, causing the symptoms described above. If you have gingivitis for a long time, it can turn into periodontal disease, which affects the tissues supporting the teeth. Over time this can lead to the deterioration of the bone that teeth are anchored to in the jaw, eventually causing teeth to become loose or even fall out completely. Periodontal disease causes more tooth loss than tooth decay, and so you should ensure you maintain your daily routine of brushing and flossing to prevent the build up of plaque.
The jaw joints, jaw muscles and teeth must all function in harmony to prevent problems occurring in some part of the system.
It is possible that a lack of harmony in the way that the teeth bite together can lead to a number of symptoms ranging from fractured and sensitive teeth to headaches and jaw joint pain.
Occlusal disease, as this may be termed, can lead to more problems even than tooth decay or gum disease although it is more difficult to diagnose and less well understood.