Dental Treatments

The only way to ascertain what is happening inside and underneath teeth is through the use of x-rays. Radiographs taken inside the mouth are of minimal dose and pose virtually no danger. To further reduce the risk, the practice has invested in the very latest digital x-ray system, which reduces the already small radiation dose by a further 80%. This means that for the same dose of one traditional dental film, five digital x-rays can be taken.

The purpose of the treatment is to remove the bacteria from inside the tooth and to disinfect the root canals. This is achieved by making a small hole through the tooth into the pulp chamber, locating and measuring the root canals, then cleaning and widening them using fine instruments called files. Once clean, the canals are filled to seal them from re-infection. In most cases an abscess will start to heal at this point.

This can vary according to the complexity of the root canals, or if re-treatment is being carried out. Initial consultations are usually made for half an hour. A follow-up appointment of between one to two hours may be required. On some occasions it may be possible to complete treatment in one extended appointment.

NO. Local anaesthesia is used throughout the procedure. With modern anaesthetic solutions, every possible step is taken to ensure that you are comfortable while the work is carried out. Following treatment there is the possibility of discomfort from the area. This is usually minor, and does not last long.

Root canal treatment does enjoy a high level of success. However, it should be remembered that it is impossible to guarantee the success of any medical procedure.
Even with the very best treatment, equipment and magnification, healing may not occur due to circumstances beyond the control of the clinician. Should this occur further steps might need to be taken to eradicate the infection.

Your own particular requirements can and will be discussed before treatment is undertaken. If you are considerably anxious, oral or intravenous sedation can be arranged.

Deep inside every tooth is a pulp chamber and root canals that contain living tissue called the pulp. The pulp is often mistakenly referred to as the 'nerve', but in fact it contains a fine network of tissue fibres, nerves, and blood vessels. If a large cavity in a tooth reaches the pulp chamber, or if a tooth breaks, bacteria can reach the pulp. These bacteria damage the pulp and eventually destroy it. The root canals become infected and inevitably an abscess forms beneath the root of the tooth, in the jawbone.

If your jaw is in the wrong position the muscles that move your jaw will have to work a lot harder and can get tired and go into spasm. The main symptoms are chronic headaches or migraine, especially first thing in the morning, pain behind your eyes, sinus and pain in your neck and shoulders. Sometimes even back muscles are involved.

• Are you aware of clenching or grinding your teeth?
• Do you wake up in the morning with an awareness about your teeth or jaw as if you had been clenching or had been grinding them in your sleep?
• Do you have chronic headaches, or chronic head, neck and shoulder pain?
• Do you have recurring pain or discomfort on the side of your face around your ears or jaw joints?
• Have you ever had clicking or popping in your jaw joints or difficulty in moving your jaw?
• Have you lost some teeth at the back of your mouth? This may lead to your bite being unbalanced.

The symptoms are sometimes collectively referred to as the T.M.J. Syndrome.

A large number of cases involving headaches, muscle spasms and pain in the jaw are a dental problem. If your teeth don't close together properly, are heavily worn, crowns are constantly breaking, or if you have ringing in your ears and difficulty in opening or closing your mouth, you may well be suffering from TMJ problems.

The medical and dental profession are becoming increasingly aware of the intricate relationship between proper bite and the muscles and nerves of the jaw joint. A very delicate balance must occur in the chewing system for total harmony, comfort and stability.

For a long time, medicine and dentistry have overlooked the Temporomandibular Joint as a potential source of problems for patients with facial pain and headaches. With today's new technology and increased understanding dentists with special advanced training in TMJ disorders can treat a large majority of these patients. Relief can be obtained immediately via a wide range of dental treatments by addressing the cause of the imbalance.

We will assess your problem by taking a full medical history. We will examine your bite, find the first contact when your teeth come together and look for evidence of grinding or clenching. A set of models will be taken to be analysed on an articulator to mimic the function of the TMJ.

If the pain is acute a Jig will be fitted to the front teeth that will separate the way you bite on the back teeth. Once relief is obtained, a plastic appliance will be fitted very accurately so that when you bite on it, all your teeth meet at the same time in a position where your muscles are relaxed. If the problem is more complicated, we will advise on a treatment plan to correct the problem.

Smoking is a major cause of mouth and throat cancer and gum and bone disorders in the mouth. The team at Dunedin Clinic recognise that quitting smoking is a difficult challenge for most people and have established a quit smoking program to support and encourage their patients to quit, and reduce their risk of mouth cancer. Please ask a member of staff who will be more than willing to discuss the alternative solutions for quitting smoking. Limiting the amount of alcohol you drink will also reduce the risk of mouth cancer.

Cancer can occur in any part of the mouth, on the tongue, lips and in the throat. Sadly, mouth cancer has a very high mortality rate. This is due to late detection. The positive news is that a ‘precancer’ will sometimes form a long time before cancer develops, and if detected early, it can be treated rapidly with an excellent chance of prevention or cure. Some of the early symptoms of mouth cancer include:

• An ulcer or a sore throat that has persisted longer than three weeks.
• A white or red patch on the soft tissue, gums, tongue or lining in the mouth.
• A chronic sore throat or hoarse voice that persists for longer than six weeks.
• Difficulty in swallowing or a constant feeling that something is caught in the throat.
• A neck swelling that persists longer than three weeks.
• Numbness of the tongue or other area of the mouth.

This is by no means an exhaustive list, but a list of some of the more common symptoms.

At a routine dental check-up, the dentist is forming a diagnosis of your health in relation to the head and neck (extra-oral), all the areas inside your mouth (intra-oral), your lymph nodes, soft tissues, Temporomandibular joint, facial and chewing muscles and any exposed skin or soft tissue abnormalities. This is all in addition to checking the condition of your gums, the health of your tooth structure, looking for decay and worn or leaking restorations.

The dentist not only needs to check the health of your head and neck and inside of your mouth but is also assessing your overall health. This includes your past and current medical history, any allergies or chronic medical conditions and any medication you might be taking. Letting the dentist know what medication you are on is important as some medications have an effect on the treatment that the dentist prescribes. For example, some medications cause your glands to produce less saliva causing ‘dry-mouth’. This can increase the risk of decay, as the plaque is more likely to dry on the teeth rather than be washed away by saliva. The dentist and hygienist can advise ways to reduce such risks and a full medical history can help them to assist you.

Discussing your past and present medical history will also allow the dentist to recognise when the need exists to work in consultation with other health care professionals such as your G.P. or specialist. Any information is treated as strictly confidential by all members of the team.

This will depend on when you last had dental radiographs taken and the dentist’s assessment of your mouth and teeth. The introduction of digital radiographs and photographs not only reduce the patient exposure to radiation that traditional dental film requires, but also enables us to enlarge and view images on an LCD screen, increasing diagnostic capabilities, not to mention the speed at which these images can be transferred to dental and medical colleagues anywhere in the world via e-mail. Intra-oral cameras work in much the same way, transmitting an image directly to the computer, which allows us to show patients any areas of concern in their mouth. The approach to dentistry today is a conservative one and saving teeth is of primary concern.

Nowadays fillings are not only functional, but can be natural looking as well. The material for white fillings can vary, and are mainly made of glass particles, porcelain and a synthetic resin and a setting ingredient.

An inlay is made outside the mouth by the laboratory and serves to fill a large hole in the tooth. The material used can be tooth-coloured porcelain or gold.
An impression of the tooth is taken once the decay and damaged tooth has been cleared. This records the shape of the tooth being repaired and the teeth around it. A temporary inlay will be placed to protect the tooth while the laboratory makes the inlay. On the next visit the inlay will be bonded to the tooth and slight adjustments will be made to the bite if necessary.
An onlay is positioned on the tooth and builds up its shape. The process of making an onlay is the same as the inlay.

Inlays and onlays are strong and last longer than fillings. They are most suitable for large restorations on the back teeth.

A bridge is made by constructing crowns on the teeth on either side of the space, and joining these two crowns together by placing a false tooth in the space. The procedure is the same as the crown procedure. The end result is very aesthetic and functional.

The placement of missing teeth depends on the location of the gaps and the condition of the remaining teeth. There are a few options to replace missing teeth. A bridge is usually used where fewer teeth need replacing. An implant can be placed into the gap of the missing tooth or a partial denture.

The tooth will be prepared to the ideal shape of the crown. This will involve removing most of the outer surface of the tooth leaving a core. The thickness of the crown will be the same as the amount of tooth that has been removed.

Once the tooth is shaped an impression of the prepared tooth will be taken and one of the opposite jaw and another to mark the way you bite. All the impressions will be sent to the technician to reproduce a crown that fits the tooth. A visit to the laboratory will be needed to match the colour of the crown to the existing teeth. The prepared tooth will have a temporary crown fitted until the new crown is ready.
The treatment takes two visits to the surgery.

The life of a crown depends on how much pressure is applied on the bite and how well it is looked after. The crown cannot decay, but decay can start where the edge of crown joins the tooth. It is very important to keep the gums and crown clean. Eight to ten years would be an average life expectancy for a crown.

Bridges are used to bridge between two teeth that have a gap left by a missing tooth.

Crowns are made of a variety of materials including porcelain and gold. Different materials are used for different areas of the mouth.

Veneers are often used to close small gaps, when orthodontics is not suitable. If one tooth is slightly out of position, a veneer can be fitted to bring it into line with the rest of the teeth.
Veneers can protect teeth from further damage caused by acid in foods and drinks or from acids in the stomach that cause the teeth to wear away. The teeth become thin and weak and can be protected by veneers.
Precious metal crowns- Gold and palladium crowns are very strong and hardwearing and are usually used at the back of the mouth. They are not visible and most suitable for people who grind and clench their teeth.

Crowns are an ideal restoration for teeth, which have been broken, or have been weakened by decay or by placing a very large filling. Root treated teeth may require a crown to protect the remaining tooth.

Appearance and better function of the mouth. The gap left by a missing tooth can mean greater strain is put on the teeth on each side. The bite can be affected because the teeth on each side of the missing tooth can lean into the gap and alter the way the upper and lower teeth meet. Food can get into the gap and decay and gum disease may develop.

Some of the outer enamel surface of the tooth will be removed, to ensure that the veneer can be bonded to the tooth . The amount of enamel to be removed is minimal and will be the thickness of the veneers to be fitted.

The tooth is prepared in two stages. The first stage will involve removing a small amount of enamel and taking an impression of the tooth. The impression is sent to the laboratory where they will reproduce a veneer to fit the tooth. We will place a temporary veneer on the tooth to protect it against sensitivity. A visit to the laboratory may be necessary to make sure that the colour matches with adjoining teeth and a natural look is achieved. The second stage will involve placing the veneers on the required teeth with a bonding material.

Veneers can last for some years but they can chip or break, just as your own teeth can. People who grind their teeth or clench put more stress on the teeth and the veneers and the life span will be shorter.

Veneers can improve the colours, shape and position of teeth, and protect teeth from further damage caused by acid in foods and drinks or from acids in the stomach. Without the protection of a veneer the teeth can become thin and weak.

Some minor adjustments might be needed to make sure that your bite is correct.

A veneer is a thin layer of porcelain made to fit over the front surface of a tooth, very much like a false fingernail fits over a nail. Sometimes a natural colour composite material is used instead of porcelain.

A precise shape and shade of porcelain can be chosen to lighten the upper front teeth or to reshape them. It can make a chipped tooth look intact again - the porcelain covers the whole of the front of the tooth replacing the broken part.

Nobel Biocare, who produce the Brånemark implants we use have experience from over 40 years of replacing missing teeth with dental implants. Dental bridges supported by implants have been shown to last over 15 years in 90 of cases. We have every indication that they will last for much longer. Most patients can expect them to last a lifetime. The first patient received his dental implants more than 40 years ago and they are still functioning today.

Implants are not new to the dental field. Prof. Brånemark started his research in the early '50s and has revolutionized implants as we know them today. Prof. Brånemark placed his first osseointegrated implant in a patient in 1965, after many years of preclinical studies.

Treatment time will vary depending on your particular situation. Nowadays it is often possible to get well-functioning and aesthetic looking teeth within a few days. In some cases it may be necessary to wait longer before finishing the restoration in order to obtain an optimal result.

The fee for tooth replacement with dental implants will depend on several factors, including the number of teeth being replaced and the number of implants required to support your replacement teeth. It is important for you to know that you do not necessarily need an implant for each missing root. Some additional procedures may be required prior to the placement of your dental implants to ensure the long-term health of your dental implants. To obtain a specific fee estimate, it is necessary to have a doctor examine your mouth. After a diagnostic examination, your dentist will recommend the treatment that is best for you and what your investment would be for the procedure.

The benefits of implant treatment include appearance, the enhanced ability to chew and enjoy your food, and often protection of your remaining teeth and jawbone. Dental implants offer many benefits never before available for the treatment of missing teeth. In short, dental implants will look, feel and function like your real teeth.

Yes! Maintaining care of the implants will help to assure the long-term success of your treatment. You will be responsible for daily plaque removal, which can be accomplished through brushing and flossing around your restoration. Your dentist or hygienist will show you how to properly care for your implants. You should visit your dentist at least once a year for maintenance appointments.

Most patients report that there is very little discomfort and that they were much more comfortable following the procedure than they anticipated. Implants are placed in a very gentle fashion and care is taken to avoid damage to the various tissues involved. Anesthesia is used to eliminate any discomfort during the procedure. Your dentist may recommend that you speak with another patient who has already had tooth replacement therapy to assess their personal experience

Bone may be successfully grown in the sinus space above your upper back teeth allowing implants to be placed. Bone from other areas of the mouth or body is placed into these empty areas and over a period of time this is replaced by new bone thus providing a bed into which implants can be fixed.

If the amount of bone is adequate, some surgeons prefer to place the implants at the same time as the grafting procedure. Whatever type of bone is added to it must be left to mature before implants are placed or brought into function. If the implants are placed as a secondary procedure (depending on the amount of bone being grown and the nature of the graft material used), they can be inserted after four to nine months, although occasionally it may be necessary to wait longer.

As with other bone grafting procedures the implants are left to become firmly attached to bone. Commonly a slight extended healing period is chosen with an average of six to nine months before a denture or crown and bridgework is fitted. However, all bone grafting is unique to each individual and this information is for guidance only.

Despite the thoroughness of the planning, extra procedures are sometimes required during treatment to produce the best result. It is important that in this event you accept that appropriate alternative treatment performed at the time of treatment although it may be different to that already planned.

During treatment fees may vary due to: Alternative procedures required due to changes in the treatment plan, new treatments becoming available in the course of your treatment, or treatment extending over a longer period of time than anticipated.

A dental implant is a small man-made titanium screw that serves as the replacement for the root portion of a missing natural tooth. The implant is placed in the bone of the upper or lower jaw and allowed to bond with the bone and serve as an anchor for the replacement tooth. Dental implants can be used to replace a single lost tooth or many missing teeth. Implant-supported replacement teeth look, feel and function like natural teeth. Dental implants are a proven restorative option with a long clinical history. Dental implants preserve the integrity of the facial structure and reduce the inconvenience associated with tooth loss.

Anyone who is missing one or more of their teeth due to injury, disease or decay may be a candidate for dental implants. If one, a few or all teeth are missing, dental implants in conjunction with a crown or bridge can replace those teeth. Occasionally, older patients express concern that their age may prevent them from enjoying the benefits that dental implants offer. However, health is more of a determining factor than age. If you're healthy enough to have a tooth extracted, you're probably healthy enough to receive dental implants. Your dentist will determine if you are a candidate for dental implants after a careful evaluation of your dental and medical health history. At this time all your questions can be answered.

This depends on your situation. Most patients can leave the office wearing some type of temporary prosthesis.

The length of time that your teeth will stay white will depend on your lifestyle. Tea, coffee, red wine and smoking do stain teeth, however by maintaining regular hygiene appointments and practicing good hygiene maintenance at home, your teeth can stay white for up to two years.

The ultimate goal of whitening is to achieve your optimum level of natural whiteness. The results will vary according to the shade of your natural teeth and what restorations you have in your mouth. The special whitening gel, which is applied to your teeth during the procedure, is designed to whiten natural tooth structure. Veneers, crowns and bridges will not change colour although some stains may be removed with whitening. The dentist will discuss this with you at your consultation.

Although the ideal time to have orthodontics is whilst the patient is still growing, age need not be a barrier. Adults who missed the opportunity to have orthodontic treatment during childhood, or who have more recently developed problems, are now able to benefit from the improvements in technique and aesthetic materials, making orthodontic care acceptable whatever the age.

Orthodontics is a specialised area of dentistry that diagnoses and treats irregularities of the teeth and jaws. Treatment is conducted over a period of time using appliances attached to the teeth, guiding them into new positions with gentle pressure.

It is estimated that that a high percentage of people suffer from chronic bad breath. It is an embarrassing problem that can affect your job prospects and personal relationships.

Gum disease can start when you are a child. Chronic periodontitis is normally only a problem for adults. You might be worried about bad breath or your teeth looking longer as the gum covers less of them. Please choose from the questions below for more information on this condition:

Periodontal, or gum disease, affects the gums and bone supporting your teeth. It is caused by sticky plaque and hard deposits of tartar. It happens when teeth and gums are not kept clean enough. Without regular cleaning the gums will come away from the tooth creating pockets around the teeth where food and plaque can collect. Pockets are difficult to keep clean and gum disease will get worse if treatment is not carried out. The condition may progress to the next stage of the disease which involves loosing the bone that supports the teeth and the teeth may become loose until they eventually have to be taken out. Severe gum disease can be an inherited factor or an indicator of problems with general health. Scientists have discovered that periodontal disease is linked to coronary heart disease and stroke, especially for people who smoke or have high blood pressure.

While bad breath originates in the mouth 80% of the time, at other times it is a symptom of underlying disease that needs the earliest possible treatment. Persistent bad breath is usually caused by the smelly gases of the bacteria that coat your teeth and gums. Smoking, garlic and onions can add to the problems. Certain illnesses such as diabetes, liver or kidney problems, nasal or stomach conditions and "dry mouth" (xerostomia) that affects the flow of saliva can be the cause of bad breath. Dental problems account for the majority of breath disorders. These can range from broken, leaking fillings or obvious infections to impacted teeth and calculus build up that can harbour odour-causing bacteria. Bits of food that get caught between the teeth and on the tongue will rot and cause an unpleasant smell.

Once we have determined the degree and cause of the breath problem, the treatment can take many forms. If medical problems are found to be the underlying cause of bad breath, proper referral will be made. Recommendation will be made by your dentist to correct and treat any dental disease that is directly related to the breath problem or gum disease.

The dentist will monitor and chart the condition of your gums before and after root planing and scaling. They will instruct in the best way to brush your teeth and gums and will advise on best devices and products to use as an effective home care program to destruct the volatile sulfur gases.

Some people are more likely to have periodontal disease than others:

• Crooked teeth are more difficult to keep clean so you might have gum disease in just one part of your mouth.
• People have different bacteria in their mouths. This may explain why gum disease can get worse very quickly for some people but not for others.
• Smoking and drinking a lot of alcohol can make gum disease worse. Both are also linked with mouth cancer.
• Drugs and medicines can affect your gums so your dentist will ask you about your general health.
• Diabetes and some other diseases can reduce how resistant gums and bones are to damage.
• Hormonal changes can also affect gum health. It could make a difference if you are pregnant or using an oral contraceptive.

However healthy and strong your teeth are, they need to be supported by healthy gums and bone. Periodontal disease can lead to you losing teeth and all the difficulties that this can cause for eating and speaking. Scientists are now discovering that periodontal disease is linked to coronary heart disease and stroke, especially for people who are already at risk in other ways (through poor diet, smoking or high blood pressure).

Oral sedation is a medication that will take effect 20 minutes after being administered. You become relaxed and unaware of any treatment, but you are still able to co-operate with the dentist. The effect of the sedation takes a few hours to wear off and you must have a companion to take you home.

For some people, their fear of dentistry is so great that it prevents them from attending the dentist for regular maintenance such as 6 monthly exams and hygiene visits. They will attend only when in pain, which in turn will reinforce their fear. We are sympathetic to these feelings and can offer ways to overcome the fears with different techniques. Relaxation is a way in which we can teach our brain to be in control of the body not vice versa. When we are faced with something we are afraid of, our bodies produce substances that raise our anxiety. Learning relaxation controls our bodies.

Sedation can be administered orally or intravenously.