Treatments

Examination and Treatment Planning

The dental examination is the cornerstone of any dental treatment planning and will be undertaken after a detailed medical and social history has been taken and before any scheduled treatment is carried out. It is carried out in four stages:

1. Soft tissue examination of the tissues in the mouth.
2. Periodontal examination of the gums.
3. Hard tissue examination of the teeth.
4. Extra-oral examination of the face, head and neck.

Findings are recorded and discussed with the patient together with any appropriate treatment options. A treatment plan is drawn up and the costs discussed; this is put in writing.

At the examination, x-rays may be taken to assist with treatment planning.

Crowns

A crown is a dental restoration which completely caps or encircles every surface of the tooth. Crowns are often needed when a heavily-filled tooth breaks or the aesthetics of a discoloured tooth need to be improved.

Crowns can be made of many materials (porcelain, porcelain bonded to metal, metal and composite resins). They are indirect dental restorations made on models in a laboratory, constructed from impressions the dentist has taken in the patient’s mouth after preparing the tooth. They are held in place by dental cement.

The Practice also offers private crowns which are more tailored to the variations of the patient’s teeth. Whilst the fit is no better, the technicians can match the aesthetics of the crown in a more detailed way by spending more time fabricating the crown.

Scaling

Mouth saliva contains millions of bacteria which, over a period of time, adhere to the tooth surface, forming plaque. Calcium within the saliva is then deposited on these bacteria to form scale. This hard deposit, once formed, cannot be removed by regular brushing.

It is important that scale is removed as it is full of bacterial toxins which cause inflammation of the gums. If left in place, scale will cause the gums to recede from the teeth, leading to eventual tooth loss.

At each examination appointment, a score is recorded which allows the Dentist to assess the severity of any gum disease and make a decision as to whether a visit to the Dental Hygienist is required.

Hygienist appointments can be booked privately; they are only available under the NHS if, following the gum assessment, the progression of the gum disease falls into a more severe category (NHS hygiene appointments are not routinely given to all patients).

Your teeth will be scaled by either your Dentist or a Dental Hygienist. They will use hand scalers and/or an ultrasonic scaler to remove the scale build-up.

Dentures

A denture, also known as false teeth, is a prosthesis made to replace missing teeth. It can be worn in the upper or lower jaw or both and may replace some teeth (a partial denture) or all the teeth (full denture). They are supported on the soft and hard tissues in the mouth.

Partial dentures

This type of denture replaces some of the teeth; they are generally made of acrylic resin on models, constructed from impressions taken of the patient’s mouth. If the patient has an unstable dentition (where more tooth loss is likely), the denture will be made entirely of acrylic because it can easily be altered if further tooth loss occurs. This type of denture has the advantage of being easy to alter but sometimes its retention in the mouth can be compromised because it relies on suction alone to hold it in.

Some patients have lost teeth through trauma or dental infection but have a stable dentition (where there is no current dental disease). In these cases, an acrylic denture is often made, supported on a metal framework which clips to the teeth. This style of denture is considerably firmer than an all-acrylic denture and is retained using suction and positive clasp pressure. It is always a firmer fit, and because it has a metal framework, it is thinner and stronger than an all-acrylic denture. It is technically demanding to construct and very difficult to alter should any further tooth loss occur. It is therefore only made for patients who have a healthy disease-free mouth.

Full dentures

These replace all the teeth and are now quite rare; they are made of acrylic resin and rely on suction to retain them. Your Dentist will discuss the appearance carefully with you because there is generally a compromise to be made between the prominence of the teeth and how well they will function.

If your denture requires a repair, in most cases this is free of charge under the NHS.

Fillings

Amalgam Fillings

Fillings are used to repair cavities in teeth caused by decay or fracture. Under the NHS, most fillings placed in posterior teeth (molars and premolars) will use dental amalgam. Dental amalgam is a silver-coloured mixture of metals including mercury, silver, tin and copper. Those materials mixed together from a very hard, durable alloy, ideal for the restoration of posterior teeth. Concerns are frequently expressed about the possible toxicity of dental amalgam. However, this material has been used for approximately 150 years and to date, there is no evidence of any systemic toxicity resulting from its use. Amalgam is considered to be safe and the ideal filling material for restoring the biting surfaces of the posterior teeth which are subjected to the greatest chewing forces.

Composite filling

These are white adhesive fillings and are made of acrylic resin. They are placed and set once the tooth cavity has been repaired and then set and trimmed to shape.

Composite fillings are generally used to repair broken or decayed anterior teeth. Once the cavity has been prepared, so that it is a fillable shape and decay-free, the tooth is dried, and etching gel is used to prepare the tooth surface so that the filling will bond to the tooth. The tooth is washed, and primer and bond are applied before the liquid filling material is introduced to restore the tooth. The material is cured by bright light; large fillings are built up in layers to guarantee a thorough cure. Once finished, the set filling is trimmed to shape. Composite fillings are a plastic material and can break if too large.

Cast Inlays

An inlay is an indirect restoration consisting of a solid structure (precious metal, porcelain cured composite resin) which is made in a laboratory on models constructed from impressions taken in the mouth after the tooth has been prepared by your Dentist. Once made, they are held in place by dental cement. They are generally stronger than fillings placed in a soft state in the teeth which then set.

An onlay is very similar to an inlay but is generally a larger filling, replacing at least one cusp; the biting surface generally covers more of the tooth to protect it from the pressure of chewing.

Inlays and onlays are not frequently used restorations as modern filling materials placed in a soft state have become much stronger. They are used when patients with a heavy bite continually break standard fillings.

Bridges

A bridge is a fixed dental restoration (used to replace a missing tooth (or several teeth) by joining an artificial tooth (pontic) to an adjacent tooth (abutment).

Permanent bridges are indirect restorations made by technicians on models made from impressions taken by your Dentist after the abutment tooth/teeth have been prepared. Bridges can be made of porcelain, porcelain bonded to metal or gold-coloured metal depending on their type and position. Typically, a bridge is made by initially reducing the teeth on either side of a gap. Then, in the laboratory, crowns or inlays are constructed on these teeth and an artificial tooth is fused in the middle to permanently join the two abutment teeth. It is important that the ratio of missing teeth to abutment teeth does not exceed 1:1.

Bridges are complicated restorations and make cleaning of teeth more difficult; the more teeth the bridge involves, the more difficult the cleaning becomes. They are only used when the patient’s oral hygiene is excellent because the risk of decay is high.

Bridges are not available under the NHS. Whilst the fit of a private bridge is no better, the technicians can spend more time fabricating the appearance to more closely match the aesthetics of the patient’s teeth.

Extractions

This procedure involves the removal of teeth from the mouth; it is done for two main reasons:

1. To remove a painful diseased tooth.
2. To make space to allow teeth to erupt in the correct position or to create space so that crowded teeth can be straightened.

Before this procedure is undertaken, local anaesthetic is applied to deaden the area around the tooth and an x-ray will be taken, if one is not available, to view the root shape and structure of the tooth. The tooth is then removed using instruments called elevators to prise away the bone around the tooth. The tooth is then lifted out of the socket using dental forceps.

Once the tooth has been removed, pads are applied over the socket to staunch any bleeding. Once it is observed that a clot has formed, the patient is discharged with a set of post-operative instructions so that they know how to look after the socket.

Fissure Sealants

This is a preventative procedure where a plastic resin is placed on the chewing surface of molar teeth in patients who are susceptible to dental decay. It helps to prevent dental decay.

Firstly, the tooth is cleaned and dried and then etching gel is used to provide a key to attach the resin to.

The tooth is then washed and dried before resin is flowed over its surface and set, creating a smooth surface to the tooth. This process fills up the pits and fissures on the tooth where bacteria collect, making the tooth less susceptible to decay.

The procedure is carried out for patients who have experienced decay in their primary teeth.

Fluoride Application

Fluoride applied to teeth helps to prevent decay.

Fluoride varnish is a temporarily adhesive form of fluoride applied to the tooth surface by a Dentist, Dental Hygienist or other health care professional. Fluoride varnish is not permanent but is designed to adhere to the tooth surface and keep fluoride in contact with the tooth for several hours. Fluoride varnish may be applied to the enamel, dentine or cementum of the tooth and can be used to help prevent decay, remineralise the tooth surface and treat dentine sensitivity.

We routinely apply fluoride varnish to all children’s teeth between the ages of 4 and 18 years at dental inspections. We also encourage patients to use fluoride toothpaste in the morning and evening and not to rinse out. Additionally, if patients are susceptible to decay, they will receive dietary advice and may be prescribed a higher fluoride toothpaste which will protect their teeth more thoroughly.

Root Canal Treatment

In the centre of each tooth there is a dental pulp, a collection of blood vessels and nerves. These blood vessels and nerves extend down the roots of the teeth in the root canals.

The pulp in your tooth can become infected by:

1. Dental decay.
2. Injury or trauma - such as a blow or fracture.
3. Cracked teeth.
4. Placement of deep restorations.

If the pulp becomes infected this can spread down the root canals of the teeth and eventually spread into the surrounding tissues. The aim of root canal treatment is to remove the damaged/infected tissue from the pulp and root canals. Root canal treatment is usually performed under local anaesthesia. In some cases where the tooth has died, this may not be necessary. After anaesthesia, the Dentist may place a rubber dam over the tooth to isolate it from the rest of the mouth. The pulp chamber will then be accessed through the occlusal surface of the tooth. The root canals once located, are measured. The Dentist will then use a series of small files to clean, shape and enlarge the root canals, facilitating the placement of an insert rubber-like filling material.

If the treatment is carried out over a number of visits, a small pledget (a small cotton wool ball) of bactericidal medication may be placed in the pulp chamber, secured by a temporary filling. Once completed, the root is then sealed, and a conventional filling placed. Root filled teeth are more likely to break than healthy unrestored teeth, so your Dentist may suggest placing a crown to help prevent this occurrence.

A root filling can sometimes be a complex procedure. If your Dentist can foresee problems with carrying out this treatment, they may suggest a referral to a specialist.

Veneers

If your teeth are stained, chipped, or not aligned on top of each other, veneers are a good treatment option to consider because they look like natural teeth and don't require a major procedure.

A veneer is a very thin, tooth-coloured piece of porcelain (like a false finger nail) that is bonded on top of your own tooth. Based on your needs, we can adjust the shape of your veneers to make your teeth look longer and/or closer together. You can have just one veneer or a whole set, known as a smile makeover.

For a single stained tooth, we can also match the precise shade of porcelain to give it a lighter appearance and fit in with the surrounding teeth. Veneers can also be used to close small gaps, when braces are not suitable. If one tooth is slightly out of position, a veneer can sometimes be fitted to bring it into line with the others.