Treatments

Composite Fillings

Composite resins, or tooth-coloured fillings, provide good durability and resistance to fracture in small- to mid-size fillings that need to withstand moderate pressure from the constant stress of chewing. They can be used on either front or back teeth. They are a good choice for people who prefer that their fillings look more natural.

It generally takes longer to place a composite filling than it does for a metal filling. That’s because composite fillings require the tooth be kept clean and dry while the cavity is being filled.

Porcelain Fillings (Porcelain Inlays)

Porcelain fillings are similar to gold. They look like actual teeth and can help you maintain a natural appearance. They are a form of indirect filling, usually require more than one visit to the dentist. Porcelain fillings need to be made by a highly skilled dental technician. This means that once the dentist removes the decay from your tooth, he takes a dental impression, this is then sent to the dental technician who can then make a porcelain inlay to fit into the cavity.

Whilst you are waiting for the technician to make your new porcelain filling you will be fitted with a temporary filling material.

The manufacturing process takes around 1 to 2 weeks and once the porcelain inlay is fitted it should last for many years.

Gum Disease

Gum disease is an infection of the tissues surrounding the teeth. Infection leads to a red, swollen and tender area. This area often bleeds when the teeth are brushed or the tender area is touched. This is particularly important as bleeding gums have been linked with a number of health risks including heart disease and diabetes.

How does gum disease occur?

  • Gum disease occurs when large amounts of bacteria stick together to form a sticky substance called dental plaque.
  • This plaque lives where the gum and the teeth meet and causes extreme irritation leading to a red, swollen and tender area.
  • As the area becomes more swollen the gums separate from the teeth leading to the development of a pocket where more dental plaque lives and eventually damages the gum and kills the bone around the tooth.

How common is gum disease?

Gum disease is the most common infectious disease affecting more than 80% of people worldwide.

How do I know if I have gum disease?

There are a number of signs and symptoms that may indicate you may have gum disease including:

  • Dark red or swollen gums
  • Tender or bleeding gums
  • Pain when you bite on food
  • Gums that look like they are low down on the teeth
  • Sensitive or loose teeth
  • Smelly breath

What should I do if I think I might have gum disease?

The best way to know if you have gum disease is to have a check up with your dentist to find out the state of your gums, and oral health in general. If it is discovered that you do have gum disease, treatment can be started immediately which will have positive effects on both your oral and general health.

Periodontal Treatment

Periodontal health should be achieved in the least invasive and most cost-effective manner. There are two types of advanced periodontal treatments:

  • Non-Surgical Treatment: root surface debridement: A careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins), followed by adjunctive therapy such as local delivery antimicrobials and host modulation, as needed on a case-by-case basis. Most periodontists would agree that after scaling and root planning, many patients do not require any further active treatment, including surgical therapy. However, the majority of patients will require ongoing maintenance therapy to sustain optimum health. Non-surgical therapy does have its limitations, however, and when it does not achieve periodontal health, surgery may be indicated to restore periodontal anatomy damaged by periodontal diseases and to facilitate oral hygiene practices.
  • Periodontal Surgery: Periodontal surgery is necessary when your periodontist determines that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment. Following are the four types of surgical treatments most commonly prescribed:
    • Pocket Reduction Procedures: Reduced pockets and a combination of daily oral hygiene and professional maintenance care increase your chances of keeping your natural teeth.
    • Regenerative Procedures: These procedures can reverse some of the damage by regenerating lost bone and tissue.
    • Crown Lengthening: These procedures are available to lay the groundwork for restorative and cosmetic dentistry and/or to improve the aesthetics of your gum line
    • Soft Tissue Grafts: can be used to cover roots or develop gum tissue where absent due to excessive gingival recession. This can be done for one tooth or several teeth to even your gum line and reduce sensitivity.

Endodontic treatment can often be performed in one or two visits and involves the following steps:

  • Step 1

The endodontist examines and x-rays the tooth, then administers local anaesthetic. After the tooth is numb, the endodontist places a small protective sheet called a “dental dam” over the area to isolate the tooth and keep it clean and free of saliva during the procedure.

  • Step 2

The endodontist makes an opening in the crown of the tooth. Very small instruments are used to clean the pulp from the pulp chamber and root canals and to shape the space for filling

  • Step 3

After the space is cleaned and shaped, the endodontist fills the root canals with a biocompatible material, usually a rubber-like material called gutta-percha. The gutta-percha is placed with an adhesive cement to ensure complete sealing of the root canals. In most cases, a temporary filling is placed to close the opening. The temporary filling will be removed by your dentist before the tooth is restored.

  • Step 4

After the final visit with your endodontist, you must return to your dentist to have a crown or other restoration placed on the tooth to protect and restore it to full function.

If the tooth lacks sufficient structure to hold the restoration in place, your dentist or endodontist may place a post inside the tooth. Ask your dentist or endodontist for more details about the specific restoration planned for your tooth.

Why would I need endodontic surgery?

  • Surgery can help save your tooth in a variety of situations.
  • Surgery may be used in diagnosis. If you have persistent symptoms but no problems appear on your x-ray, your tooth may have a tiny fracture or canal that could not be detected during nonsurgical treatment. In such a case, surgery allows your endodontist to examine the entire root of your tooth, find the problem, and provide treatment.
  • Sometimes calcium deposits make a canal too narrow for the instruments used in nonsurgical root canal treatment to reach the end of the root. If your tooth has this “calcification,” your endodontist may perform endodontic surgery to clean and seal the remainder of the canal.
  • Usually, a tooth that has undergone a root canal can last the rest of your life and never need further endodontic treatment. However, in a few cases, a tooth may not heal or become infected. A tooth may become painful or diseased months or even years after successful treatment. If this is true for you, surgery may help save your tooth.
  • Surgery may also be performed to treat damaged root surfaces or surrounding bone.

Although there are many surgical procedures that can be performed to save a tooth, the most common is called apicectomy or root-end resection. When inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure, your endodontist may have to perform an apicectomy.


What is an apicectomy?

In this procedure, the endodontist opens the gum tissue near the tooth to see the underlying bone and to remove any inflamed or infected tissue. The very end of the root is also removed.

A small filling may be placed in the root to seal the end of the root canal, and a few stitches or sutures are placed in the gingiva to help the tissue heal properly.

Over a period of months, the bone heals around the end of the root.

Are there other types of endodontic surgery?

Other surgeries endodontists might perform include dividing a tooth in half, repairing an injured root, or even removing one or more roots. Your endodontist will be happy to discuss the specific type of surgery your tooth requires.

In certain cases, a procedure called intentional replantation may be performed. In this procedure, a tooth is extracted, treated with an endodontic procedure while it is out of the mouth, and then replaced in its socket.
These procedures are designed to help you save your tooth.

Will the procedure hurt?

Local anaesthetics make the procedure comfortable. Of course, you may feel some discomfort or experience slight swelling while the incision heals. This is normal for any surgical procedure.
Your endodontist will recommend appropriate pain medication to alleviate your discomfort. Your endodontist will give you specific postoperative instructions to follow. If you have questions after your procedure, or if you have pain that does not respond to medication, call your endodontist.

Can I drive myself home?

Often you can, but you should ask your endodontist before your appointment so that you can make transportation arrangements if necessary.

When can I return to my normal activities?

Most patients return to work or other routine activities the next day. Your endodontist will be happy to discuss your expected recovery time with you.

How do I know the surgery will be successful?

Your dentist or endodontist is suggesting endodontic surgery because he or she believes it is the best option for saving your own natural tooth. Of course, there are no guarantees with any surgical procedure. Your endodontist will discuss your chances for success so that you can make an informed decision.

What are the alternatives to endodontic surgery?

Often, the only alternative to surgery is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge, or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these alternatives require surgery or dental procedures on adjacent healthy teeth, endodontic surgery is usually the most biologic and cost-effective option for maintaining your oral health.
No matter how effective modern artificial tooth replacements are—and they can be very effective—nothing is as good as a natural tooth. You’ve already made an investment in saving your tooth. The pay-off for choosing endodontic surgery could be a healthy, functioning natural tooth for the rest of your life.

Prosthodontics is the term dental professionals use to explain how they replace missing or damaged teeth. The aim is to bring back your natural smile and prevent future oral health issues.

Why prosthodontic procedures are important

Filling in empty spaces in the mouth helps to keep teeth in the right place

Replacing teeth helps to maintain good oral care habits, which can help prevent oral disease and plaque build-up

Missing teeth can affect your health, looks and how you feel about yourself

Prosthodontic treatment options

There are a few different treatment options your dental professional may suggest. These include bridges, crowns, dentures and implants.

Crowns

A crown is a tooth-shaped cap that is placed over a tooth. It is used to strengthen and protect your tooth structure. Crowns are either made of precious metal which may be veneered or of a hard, white substance (ceramics) to help them look natural.

A crown is ideal for people with broken teeth or cavities.

The crown is cemented into place over the damaged tooth.

Bridges

A dental bridge covers or “bridges” the gap between missing teeth. After you lose a tooth, your dentist may suggest that you get a bridge. A bridge can keep your other teeth from moving out

of place.

Once a bridge is placed, it works just like your natural teeth.

A bridge is used when one or more teeth are missing. The bridge is fitted perfectly and cemented to your teeth.

Dentures

Dentures are removable false teeth made of acrylic (plastic), nylon or metal. They fit snugly over the gums to replace missing teeth and eliminate potential problems caused by gaps.

Gaps left by missing teeth can cause problems with eating and speech, and teeth either side of the gap may grow into the space at an angle. Sometimes, all the teeth need to be removed and replaced.

You may therefore need either:

  • complete dentures (a full set) – which replace all your upper or lower teeth, or
  • partial dentures – which replace just one tooth or a few missing teeth

Dentures can help to prevent problems with eating and speech and, if you need complete dentures, they can also improve the appearance of your smile and give you confidence.

Looking after your dentures

Dentures may feel a bit strange to begin with, but you’ll soon get used to wearing them.

At first, you may need to wear your dentures all the time, including while sleeping. Your dentist or clinical dental technician will advise you on whether you should remove your dentures before you go to sleep.

It isn’t always necessary to remove your dentures at night, but doing so can allow your gums to rest as you sleep. If you remove your dentures, they should be kept moist – for example, in water or a polythene bag with some dampened cotton wool in it, or in a suitable overnight denture-cleaning solution. This will stop the denture material from drying out and changing shape.

Dental hygiene

Keeping your mouth clean is just as important when you wear dentures. You should brush your remaining teeth, gums and tongue every morning and evening with fluoride toothpaste to prevent tooth decay, gum disease and other dental problems.

Dental implants can be used to replace a single tooth, several teeth, or all the teeth. The aim of teeth replacement is to restore function as well as aesthetics.

When it comes to tooth replacement, generally, there are three options: (1) removable dental appliance (full denture or partial denture), (2) fixed dental bridge (cemented), and (3) dental implant. Deciding on which option to choose depends on many factors. Specifically, for dental implants, these factors include:

  • location of missing tooth or teeth,
  • quantity and quality of the jawbone where the dental implant is to be placed,
  • health of the patient,
  • cost,
  • patient preference.

The dentist examines the area to be considered for the dental implant and makes a clinical assessment of whether the patient is a good candidate for a dental implant.

There are great advantages to choosing a dental implant for tooth replacement over the other options. Dental implants are conservative in that missing teeth can be replaced without affecting or altering the adjacent teeth. Furthermore, because dental implants integrate into the bone structure, they are very stable and can have the look and feel of one’s own teeth

Intravenous (IV) sedation is when a sedative is injected directly into a vein. If you are nervous about having dental treatment or you are having a procedure which may cause discomfort, intravenous (IV) sedation is an effective and safe treatment.

While under IV sedation, you will feel deeply relaxed but you will still be able to understand and respond to requests from the dentist. You will be unaware of the operation and this form of treatment is ideal for patients who wish to avoid the noise and vibration of the drill.

IV sedation is extremely safe when it is supervised by a specially trained dentist.

IV sedation has four main effects:

  • It will reduce your anxiety and make you feel relaxed.
  • It will make you feel sleepy.
  • It will make you unaware of the procedure.
  • It will result in partial – or total loss of memory of the procedure.

A Dental Hygienist plays an important part in dental health care and is mainly concerned with preventive dental health and treating gum disease – showing you correct homecare and helping to keep your teeth and gums healthy. Regular professional cleaning combined with looking after your teeth and gums well at home will help keep your mouth healthy.

Our Hygienists work closely with our dentists and they:

  • Provide clinical and educational care to help you achieve and maintain good oral hygiene 
  • Focus on preventing gum disease by scaling and polishing teeth 
  • Develop home care plans with patients to maintain their oral health 
  • Clean teeth efficiently (a far more complex and skilled procedure than most people realise!)
  • Identify those areas where patients have difficulty in removing plaque and work with them to modify their toothbrushing technique to ensure effective cleaning
  • Apply topical fluorides and fissure sealants to reduce tooth decay 
  • Give specific preventative advice including: nutritional guidance, smoking cessation

Airflow – Teeth Stain Removal

Airflow polishing is the ideal way to remove the stains and discolouration caused by smoking or by drinking red wine, tea and coffee while thoroughly removing dental plaque.

The innovative Airflow polishing technique uses a mix of water, compressed air and fine powder particles. This method is far superior to traditional cleaning methods that use scraping tools, rubber cups and polishing discs and which can be uncomfortable.

The Benefits of Airflow Stain Removal

More effective cleaning

A powerful yet controlled jet of water, air and fine powder not only polishes all the surfaces of a tooth, removing plaque, discolouration and soft deposits, but also reaches deep into periodontal pockets up to a depth of 5 mm. It is far more efficient than traditional scrape and polish treatment at removing the damaging biofilm colonized by bacteria causing periodontitis and peri-implantitis.

Improved patient comfort

Anyone who has ever cringed as a scraping tool digs into their gums or a polishing disc presses onto tooth enamel will welcome air polishing for its painless, fast and non-invasive method of cleaning. Even deep pockets and interproximal areas are easily reached without uncomfortable and potentially damaging probing by curettes and scrapers, pressure, heat or vibration. The non-toxic powder used in air polishing is also more pleasant and less gritty than the heavy paste used in traditional polishing.

Reduces teeth sensitivity

Airflow polishing is ideal for those who suffer from sensitive teeth. This is not only due to the lack of direct contact and the absence of heat and vibration, but because the tiny micro particles of powder can actually fill any exposed dentine tubules and reduce dental sensitivity. Airflow polishing can also encourage the re-mineralization of damaged teeth.

Faster cleaning

Studies have shown that air polishing is over three times faster at removing stains and plaque than traditional methods. Teeth are cleaned in a much less abrasive manner than scraping and polishing which also causes less damage to the teeth. Any small areas of decay are gently blasted away without the need to drill into the healthy structure of the tooth.

Ideal for use before orthodontic treatment

Airflow polishing is an ideal way of cleaning before procedures that require bonding and the use of sealants as it removes nearly 100 percent of bacteria and endotoxins. Not only that, but traditional polishing pastes contain glycerin that can interfere with bonding procedures.

Tooth whitening can be a very effective way of lightening the natural colour of your teeth without removing any of the tooth surface. It cannot make a complete colour change, but it may lighten the existing shade.

There are a number of reasons why you might get your teeth whitened. Everyone is different; and just as our hair and skin colour vary, so do our teeth. Very few people have brilliant-white teeth, and our teeth can also become more discoloured as we get older.

Your teeth can also be stained on the surface by food and drinks such as tea, coffee, red wine and blackcurrant. Smoking can also stain teeth.

‘Calculus’ or tartar can also affect the colour of your teeth. Some people may have staining under the surface, which can be caused by certain antibiotics or by tiny cracks in the teeth which take up stains.

Professional bleaching is the most usual method of tooth whitening. Your dentist will be able to tell you if you are suitable for the treatment, and will supervise it if you are. First the dentist will put a rubber shield or a gel on your gums to protect them. They will then apply the whitening product to your teeth, using a specially made tray which fits into your mouth like a mouthguard.

The ‘active ingredient’ in the product is usually hydrogen peroxide or carbamide peroxide. As the active ingredient is broken down, oxygen gets into the enamel on the teeth and the tooth colour is made lighter.

The total treatment can usually be done within three to four weeks. First, you will need two or three visits to the dentist. The dentist will need to make a mouthguard and will take impressions for this at the first appointment. Once the dentist has started the treatment, you will need to continue the treatment at home.

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5 August 2015

www.gatewaydental.co.uk

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