Q. WHY AREN'T AMALGAM FILLINGS PLACED?
A. Amalgam is a very forgiving and generally long lasting material as a dental filling. It is a tin, silver and mercury preparation that is mixed together and very easily pressed into the cavity, and the corrosion products create a seal against bacteria entering the tooth. It expands and contracts with temperature changes, very differently to the supporting tooth structure, which can create stress fractures inside and on the outside of the tooth. Sometimes the cracks fatigue and a piece of tooth breaks off that previously supported the filling. If the crack is above the gum line, dentists term this a favourable fracture, meaning it can be restored. If the crack has reached the nerve of the tooth, bacteria can invade this area which must be kept sterile, and the tooth will die. To keep the tooth is an expensive and time consuming process, with root canal treatment (and crown work required for the back teeth). Usually amalgam will last for around 8 to 12 years and is particularly good for the very back teeth, and for mouths that have a high decay experience.
In 2017, we tend to remove amalgams and bond porcelain inlays and onlays into the damaged tooth. We tend to be conservative, and monitor amalgams for distortion, wear and defects, until there appears to be a problem. We shape and clean up the cavity, and leave as much tooth as possible. Generally the amalgam has caused discolouration into the tooth around the filling, after some years. An imprint of the cavity is sent to the technician, and porcelain is computer designed and milled. It is then custom glazed and matched exactly to the surrounding tooth by a master ceramist. We then bond this into the cavity. Porcelain inlays and onlays are extremely durable, biocompatible, incredibly strong and undetectable > everything that dentists could wish for for restorations of damaged teeth.
Q.MY CHILD'S TEETH ARE COMING THROUGH CROOKED?
A. Adult teeth can often come through in a crooked arrangement. Sometimes they even out and other times they don't. Around the age of 7 and 8 years, the bite is termed as being at an 'ugly duckling' stage, and sometimes with growth in the width of the jaw, the crowding is corrected. For severe bite discrepancies, an orthodontic referral might be necessary around the age of 8, prior to the pubertal growth spurt. In general, orthodontic referrals are arranged around the age of 11 or 12 years. It can be helpful for your child to have a rapport with the orthodontist, as they may be seeing your child for some time to correct the bite.
It is best to seek preventive dental care for your child every 6 months for monitoring of growth, health and dental hygiene habits.
Q. WHAT IS INVOLVED IN TOOTH WHITENING?
A. Tooth whitening is the chemical removal of organic stains from on and just below the tooth's surface.
Tooth lightening is achieved by placing a special gel in contact with the tooth enamel. The gel normally contains either hydrogen peroxide or carbamide peroxide and works by penetrating the tooth enamel and oxidising the organic stains within, releasing oxygen as a by- product.
It has been proven to be a safe and predictable procedure, provided it is performed under the supervision of a dental professional.
We are able to offer our patients two types of tooth whitening; home whitening, and in- office whitening- using the computer activated Zoom teeth whitening system.
Home whitening works by taking mouldings of the teeth and constucting custom- fitted trays to hold the whitening gel. It is important that the trays fit your teeth exactly, to ensure thet no gel comes into contact with the gums as it can cause irritation.
The trays are worn for half an hour for consecutive days (normally 1-2 weeks) or until the desired result is achieved.
Home whitening normally involves three appointments- the first to take the mouldings, the second to fit the custom trays once they have been made and the third appointment is a follow- up to check how the process is going and ensure there are no problems.
In office whitening with Zoom whitespeed is a way to achieve immediate whitening results in a two- hour appointment.
The whitening process is sped up via the use of a blue LED lamp, which has been designed to activate the special Zoom whitening gel. New gel is applied every 15 minutes, for a total of 3 or 4 whitening cycles . This usually produces significant results.
While the procedure is being performed, we have a selection of DVDs for patients to watch, or some people even choose to have a nap!
Before and after photos are taken before any whitening is done, in order to record progress and results.
Q. WHAT DO I DO IF I HAVE SEVERE PAIN ON A WEEKEND OR OVER A RECOGNISED HOLIDAY, AND CAN NOT LOCATE A DENTIST QUICKLY?
A. In the very short term, sometimes antibiotics prescribed by a doctor may help to settle the pain. Normally pain that is severe is due to a dental abscess. The swelling or pain will return at some point, until the offending tooth is dealt with, where it is normally either root treated, or removed. So the short answer is to go to your doctor if a dentist is unavailable, and see your dentist ASAP. Maybe toothache drops from the chemist could help until you get there. Over the counter anti-inflammatories, like Nurofen, sometimes settle the pain. However, consultation is required with the pharmacist to ensure that it will not adversely react with current medications and known ailments or medications. It is very unhealthy to allow a tooth to fester and some people do end up with facial swelling and with other medical complications as a result. There are incidences of people ending up in the intensive care ward, with dental infections, so it is important to see your dentist asap.
Q. WHAT ARE WISDOM TEETH?
A. Wisdom teeth are the last teeth to develop, at the very back of our mouths, and usually come through between the ages of 17 and 23. The modern mouth is usually not large enough for the wisdom teeth to come through properly. When this happens the teeth are known as 'being impacted' which means that they are trapped by a tooth or bone from assuming a normal position in the mouth. A special x-ray known as an OPG (orthopantogram) takes an image of the jaws, all of the teeth, and shows exactly where the wisdom teeth are and what angle they are positioned in.
Q. HOW OFTEN SHOULD I HAVE DENTAL CHECKS?
A. Most people see the dentist each six months. Those with an exceptional set of teeth, who have never had a filling, or evidence of gum issues, are sometimes seen yearly, and sometimes patients with a higher decay rate or gum problems are seen more regularly.
Regular preventive care allows the teeth to be examined closely to capture early changes before they worsen and cause problems that can be costly and inconvenient to sort out. Preventive bitewing x-rays find decay well before it can be seen by looking in the mouth and allow a direct view of the bone support around the roots of the teeth. Even calcified plaque under the gums can be seen on these x-rays, which are taken every two years and captured in the computer with sophisticated technology.
Seeing the dental hygienist regularly allows the stains and calcified bacteria to be lifted off the teeth, and for the gum and bone health to be carefully checked. Modifications to home care can make all the difference in maintaining a healthy smile for years to come.
Calculus trapped under the gum can leave to loss of the bone that holds the teeth. Sometimes there is so much bone damage that the tooth becomes mobile, and is lost. Once the calculus hardens like cement, it cannot be removed with a toothbrush anymore. It has to be professionally cleaned. That way the gums sit against clean teeth again.
This diagram shows hardened plaque under the gums, which is a bit like barnacles under the water line on a boat. It is more porous than the tooth, so more bacteria sticks to it. If it is left under the gums, it can allow the bacteria to burrow down the roots of the teeth, and in 23% of the population, the jaw bone is eaten away from around the roots, and in advanced cases, the teeth become wobbly and painful ( see periodontal disease). Regular dental hygiene care, by way of scaling and cleaning, allows the gum to stay healthy, along with careful monitoring of home care and checking by the dentist.
Q. I DON'T THINK I NEED TO GO TO THE DENTIST BECAUSE I DON'T HAVE ANY PAIN?
A. Just like your car requires maintenance, your teeth also require maintenance and preventive care. Furthermore, your mouth is part of a biological system, and teeth can sustain forces of biting that can measure over 90kg. Your dentist can see cavities in the mouth and on preventive x-rays before they become so advanced that you end up in pain, and that can require expensive treatments in order to try to save them. Oral cancer screens are also undertaken by the dentist. Most dental disease is preventable.
Bone disease of the jaws is not normally painful until it has reached an advanced stage and it affects 23% of the adult population. There is a large amount of scientific research that may indicate links of this type of bone disease, known as periodontal disease, to other systemic diseases, such as hardening of the heart arteries, stroke and Alzheimer's. The bacteria found in diseases in the mouth are said, by scientific researchers, to be able to impact on the blood supply and affect other body systems.
The bacteria that are found in a healthy mouth are vastly different to those that breed in an unhealthy mouth. There are 615 different types of bacteria that can live in the mouth.
Consider this picture: the mouth is a humid and wet environment, with 6 billion bacteria, where foods are introduced which are laden with sugars and carbohydrates, the perfect substrate for bacteria, and which can cause the teeth to soften and decay. Coffee and green tea can cause brown staining of teeth. Wine, sport drinks and soft drinks are acidic and can cause softening of the tooth enamel. Plaque that is left undisturbed in the mouth calcifies around and under the gums to form calculus, a bit like barnacles on the bottom of a boat, and if not regularly professionally scaled away, are associated with gum disease. For some people the bacteria that are trapped deep under the gum leads to bone disease. A healthy body definitely starts with a healthy mouth.