Common Dental Topics

This information aims to give you some basic dental knowledge, so you can be informed when you speak to your dentist and devise a plan to keep your mouth healthy.

The information here is for educational purposes only, and should not be used for self-diagnosis or as a substitute for a professional dental exam (no matter how much you hate going to the dentist!).

Bridges Crowns Dentures Extractions/Oral Surgery Implants

Options for replacing a missing tooth Periodontal Disease Porcelain Veneers Root Canal Whitening

Bridges

What they are: A bridge consists of a replacement tooth or teeth attached to crowns on each side. The bridge is cemented to the teeth adjacent to the space, effectively replacing the missing tooth and preventing any shifting. Bridges can be made from the same materials as crowns - full porcelain, porcelain fused-to-metal, and all metal.

Why you'd need them: If tooth loss occurs, the dentist may recommend a bridge be placed. Your teeth support and rely on each other. If one or more teeth are missing, the others can shift, drift or tilt out of position making them more susceptible to decay and gum disease because they are more difficult to clean. All this shifting and drifting will also lead to changes in the bite, putting stress on your jaw, muscles and teeth. Ultimately, your ability to chew comfortably and your appearance may be affected.

About the procedure: You'll need at least two appointments to have a bridge placed. At your first visit, the dentist prepares the teeth next to the missing tooth for crowns, takes an impression of the prepared teeth, and places a temporary bridge. At your second visit, the dentist will fit and adjust the bridge and then cement it in place.

Post-operative Information

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Crowns

What they are: Crowns strengthen and protect the structure of a damaged tooth and can improve the appearance of your teeth. Crowns can be made from different materials, including full porcelain, porcelain fused-to-metal, or all-metal crown. You and the dentist will decide which type is appropriate, depending upon the strength requirements and aesthetic concerns of the tooth involved.

You may need one if you have

• A previously filled tooth where there is now more filling than tooth. The existing tooth structure becomes weakened and can no longer support the filling.
• Extensive damage by decay.
• Discolourations and compromised aesthetics.
• Fractures
• Root canal - After root canal, teeth tend to become brittle and are more apt to fracture, so they may need to be protected by a crown.
• Bridges - When missing teeth are replaced with a bridge, the adjacent teeth require crowns in order to support the replacement teeth.
  About the procedure: Fitting a crown requires at least two appointments. At your first visit, the tooth is prepared for the crown, an impression or mould is made of the tooth, and a temporary crown is placed over the prepared tooth. At your second visit, the temporary crown is removed and the final crown is fitted, adjusted and cemented into place.

Post-operative Care Information

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Dentures

Dentures are prosthetics made to replace missing teeth. Even though denture-wearers no longer have their natural teeth, they still need regular dental care to maintain their health, comfort and appearance.

Immediate Dentures - so you don't have to go around with no teeth
Immediate dentures help eliminate the need for you to go around without any teeth while your dentures are being made.

Suppose you need dentures, and you have 8 remaining upper teeth. These teeth are damaged and decayed, so they can't be used to support a new prosthesis.

If you were to have a traditional denture made, you'd need to have all these teeth extracted first. Then your bones and gums would have to heal before your dentures could be made. That means you'd have no teeth while your mouth healed, which can take several weeks, or longer.

With Immediate Dentures, we take an impression while the damaged teeth are still present and make your dentures. That way, we can have your denture ready the same day we extract your teeth, so you won't have to walk around without teeth!

About Immediate Dentures

• Because we can't try your denture before we extract your teeth, there may be some aesthetic compromises with immediate dentures-these should be minor, and shouldn't present a significant problem.
• Immediate dentures are placed immediately after the extraction of your remaining teeth. This may seem odd, but placing the dentures immediately helps minimise swelling from the extraction. If the denture isn't placed immediately, swelling in your mouth might mean your new dentures won't fit until the swelling subsides-leaving you without teeth for some time.
• You must wear your new immediate denture without removing it for three days following the surgery. This helps control swelling.
• Once your mouth has fully healed from the extraction (about 3 months), we will either reline your Immediate Dentures, or make an entirely new set of dentures to correct any aesthetic or phonetic issues with the immediate dentures. If you have new dentures made, you can keep the immediate denture as a spare.
  

Denture Relines
Denture relines are placed in your old or new dentures to improve retention (keep your dentures in place) and/or help condition your gum tissue by absorbing some of the pressure of chewing.

Types of Denture Relines

1. Hard permanent relines can either be done at the office with an office-cured plastic or prepared and sent to the dental laboratory where it is processed in a laboratory cured plastic. Laboratory relines tends to last longer due to the special processing. Unfortunately, your denture will need to be at the laboratory for a few days. The Appointment Coordinator will assist you in organising the laboratory process to minimise inconvenience to you.
2. Soft relines can be done at the office or in the laboratory. Soft relines made in the lab are more permanent, and can last up to one year. Office processed soft liners are more fragile, and will need to be removed and replaced more often.

Post-operative Care Information

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Extractions / Oral Surgery

What it is: The removal of a tooth

Why you'd need it: One of the main goals of modern dentistry is to prevent tooth loss. However, it is still sometimes necessary to remove a tooth. Here are some of the reasons a tooth may need to be extracted:

• Severe decay
• Advanced periodontal disease
• Infection or abscess
• Orthodontic correction
• Malpositioned teeth
• Fractured teeth or roots
• Impacted wisdom teeth

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Implants

For people who have lost teeth, implants provide artificial teeth that look more natural and feel more secure. Implants can be used to replace a single missing tooth or support a bridge, full dentures or partial dentures.
A titanium screw is implanted into the jawbone and a porcelain crown (cap) is attached to this.

FREQUENTLY ASKED QUESTIONS

What are dental implants?
Dental implants are screws made of medically-pure Titanium. The screws are placed in the jawbone where teeth are missing. The implanted screws may need to rest for 3-6 months to become cemented to the jawbone, this is known as osseointegration. After the appropriate healing time, the top of the implanted screw is uncovered, and a fabricated tooth is attached using either a cementing agent or a tiny screw.

How long have implants been used in dentistry?
Dental implants have been available for more than 50 years. The osseointegrated implants in use today were developed from research performed on bone healing in the early 1960s by Professor Per-Ingvar Brånemark, a Swedish Orthopaedic Surgeon.

Is there a difference between the different implant manufacturers?
Federal Departments governing manufacture and use of health related products regulate all implants in use throughout the world. Originally, the only system available was the Nobelpharma® Brånemark implant, now known as the Nobel Biocare®. Today, there are numerous implant companies to choose from, and all of must meet very stringent requirements. Your dental team will help choose the system that is best for you.

What are implants made of?
Implants are made of commercially and medically pure Titanium: the same metal that has been successfully used in hip implants for many years. Titanium is not known to cause any type of rejection phenomenon and is therefore classified as inert.

How complicated is the surgery?
This depends on your individual general, bone and oral health. The procedure can involve only one, two or three surgical phases. The two-stage surgery is most common. The first stage involves the placement of the implants into the jawbone. This is usually done with local anaesthesia. It is complicated only in the sense that the surgery requires great precision. Every attempt is made to ensure success. The room is set up like an operating room-the equipment thoroughly sterilised and the most modern techniques used. Stage two involves the uncovering of the implants after they have integrated (fused to the bone). This can be accomplished with minor gum surgery or with a dental laser, and is a relatively minor procedure. In both instances, minimal post-operative discomfort is noticed. You will be given the appropriated antibiotics and analgesics as a precaution. Very important post-operative instructions will be given to you at the time of surgery. If you follow the guidelines, everything should proceed without complications.

Can implants be rejected?
Implants are made of an inert metal, which is not known to cause any rejection phenomenon. Implant failure can occur from post-operative infections, poor systemic health and mechanical load. Implants have an 85 to 95 percent success rate depending upon factors that are evaluated before any implants are placed.

If I lose several teeth, do they each have to be replaced with a separate implant?
No. Although implants simulate the roots of teeth, one implant can be used to replace one or more teeth. This depends on your functional requirements for the teeth. At your consultation the dentist will discuss the various treatment alternatives and the type and number of implants needed.

What about infection and complications?
During the surgery every attempt is made to maintain a totally sterile field to minimise any potential for post-operative infection. The dentist will prescribe the appropriate antibiotics as a precautionary measure. Once the implant therapy has been completed with your fixed restoration, it is imperative for you to maintain meticulous oral hygiene. Success very often depends on your cooperation and homecare efforts.

What types of restorations can be placed on implants?
This depends upon your treatment objectives and can vary from simple removable dentures, using the implants for retention, to totally fixed (non-removable) implant supported porcelain-fused-to-metal crowns and bridges. Implant bridges can be either removable or fixed depending upon the number of implants. We can replace single or multiple missing teeth to return the mouth to a healthy and aesthetically pleasing state.

Will I be able to chew and function normally?
Yes. The dentist will construct the restoration to give you the best function possible. Implants are very rigid, unlike natural teeth that move slightly as we chew. This difference may or may not be noticed and will depend upon the type of restoration you and your dentist have chosen.

How long is the entire implant process?
Integration of dental implants takes approximately 3-4 months in the lower jaw and a minimum of 6 months in the upper. Once the dentist confirms full integration in the bone, the restorative phase can be initiated. This may take from several visits up to several months to complete depending upon the complexity. If your oral conditions support a single-stage implant procedure the entire process may only take 1-6 months.

What is the cost?
The cost of implant dentistry is based upon a combination of the surgical phase and the restorative phase. Your total treatment fee will depend upon the number of implants and the complexity of your final restoration.

Extra information:
http://www1.nobelbiocare.com/en/implants-and-abutments/home/
www.nzdental.co.nz/mdi/index.asp

Post operative Care Information

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Options for replacing a missing tooth

Plastic Partial Denture
Fits on the gum and usually has wire clasps to hold it in place. It is taken out of the mouth to clean.

Valplast Partial Denture
Thin slightly flexible poly acrylic material. Removable from the mouth.

Metal Precision Partial Denture
Fits tightly in the mouth as it is attached to the existing teeth with metal claps and rests. It is also taken out of the mouth to clean.

Bridge - Bonded Composite
A composite tooth is bonded directly to the tooth on one side, or the teeth on
both sides of the gap.

Bridge - Porcelain Fused to Metal
The teeth on either side of the gap are "capped" and are used to support the replacement tooth. The bridge is made in a laboratory using porcelain over a cast metal framework.

Implant
A titanium screw is implanted into the jawbone and a porcelain crown (cap) is attached to this.

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Periodontal Disease

Periodontal Disease is the major cause of tooth loss in adults. Early periodontal disease is painless and shows few symptoms, so clients are often unaware that there is a problem. That's why regular dental visits are essential for the early diagnosis and treatment of gum disease.

Gingivitis
Gingivitis is a form of periodontal disease, which occurs when inflammation and infection destroy the tissues that support the teeth, including the gingiva (gums), the periodontal ligaments, and the tooth sockets (alveolar bone).

Gingivitis is caused by the long-term effects of plaque deposits. Plaque is a sticky material, consisting of bacteria, mucous, and food debris, that develops on the exposed portions of the teeth. It is a major cause of tooth decay. Unremoved plaque mineralises into a hard deposit called tartar that becomes trapped at the base of the tooth. Plaque and tartar are irritants that stimulate inflammation in the gums. Bacteria, and the toxins they produce cause the gums to become infected, swollen and tender.

Injury or trauma to the gums from any cause, including overly vigorous brushing or flossing of the teeth, can also cause gingivitis. The risks for developing gingivitis include uncontrolled diabetes, pregnancy (because of hormonal changes that increase the sensitivity of the gingiva), general illness, and poor dental hygiene.
Misaligned teeth, rough edges of fillings, and ill-fitting or unclean mouth appliances (such as orthodontic appliances, dentures, bridges, and crowns) can irritate the gums and increase the risk of gingivitis.

Medications for the heart, epilepsy and birth control, and ingestion of heavy metals such as lead and bismuth are also associated with gingivitis.

Many people experience gingivitis to a varying degree. It usually develops during puberty or early adulthood due to hormonal changes and may persist or recur frequently, depending on the health of your teeth and gums.

Periodontitis
Periodontitis occurs when inflammation or infection of the gums (gingivitis) is untreated or treatment is delayed. Infection and inflammation spread from the gums (gingiva) to the ligaments and bone that support the teeth. Loss of support causes the teeth to become loose and eventually fall out. Periodontitis is the primary cause of tooth loss in adults. This disorder is uncommon in childhood but increases during adolescence.

Plaque and tartar accumulate at the base of the teeth. Inflammation causes a pocket to develop between the gums and the teeth, allowing it to fill with plaque and tartar. Soft tissue swelling traps the plaque in the pocket. Continued inflammation eventually causes destruction of the tissues and bone surrounding the tooth. Because plaque contains bacteria, infection is likely and a gum abscess may also develop, which increases the potential for bone destruction.

Pamphlet: Effective Flossing and Brushing

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Porcelain Veneers

About Porcelain Veneers: Porcelain laminate veneers are probably the most aesthetic means of creating a more pleasing and beautiful smile. They require a minimal amount of tooth reduction (approximately 0.5 mm) making them a more conservative restoration than a crown.

Porcelain veneers allow us to alter tooth position, shape, size and colour. They are not the only alternative for aesthetic abnormalities but are truly a remarkable restoration when they are the treatment of choice.

• Since they require approximately 0.5mm of tooth reduction, porcelain veneers are NOT considered a reversible form of treatment.
• Occasionally the preparation of a Porcelain Laminate Veneer does not necessitate the use of a local anaesthetic. However, for those clients that are particularly sensitive or anxious, a local anaesthetic is advisable.
• The laboratory time required for the fabrication of a Porcelain Laminate Veneer is approximately two weeks. Due to the minimal amount of tooth reduction, it is usually not necessary to fabricate any type of temporary restoration. Should a temporary be needed, they can, in most circumstances, be made at the time of treatment.
• Between your preparation visit and the insertion visit, you can expect some sensitivity to hot and cold. This is normal and is due to the removal of a small portion of the enamel covering of the tooth. This sensitivity should disappear after the placement of your Porcelain Laminate Veneer.
• At your second visit your laminate can be inserted with or without local anaesthetic. The laminates are placed with a light sensitive resin which is hardened using a white light.

Extra information:
http://www.yourdentistryguide.com/cosmetic

Post-operative Care Information

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Root Canal

What Is It and Why Do I Need It?
The dentist may suggest Root Canal Therapy (otherwise known as Endodontics) for a badly-infected tooth or a tooth with significant decay. Years ago, teeth like this were doomed to be extracted, but today, they can often be salvaged with Root Canal Therapy.

Some indications root canal treatment may be needed:

• Spontaneous pain or throbbing while biting.
• Sensitivity to hot and cold foods.
• Severe decay or an injury that creates an abscess (infection) in the bone.

About the procedure:
Root canal involves the removal of the infected or irritated nerve tissue that lies within the root of the tooth. It is this infected pulp tissue that causes an eventual abscess.

• The first step is to obtain access to the nerve by establishing a small access opening in the top of the tooth. It will be done under a local anaesthetic.
• The length of the root canals is determined and the infected pulp is removed.
• The canal where the nerve is located will be reshaped and prepared to accept a special root canal filling material.
• Root canal filling will likely not be done until your second visit. The number of visits necessary to complete your root canal will depend upon several factors including the number of nerves in the tooth, the infected state of the nerve and the complexity of the procedure.
• The final step is the sealing of the root canal with a sterile, plastic material called gutta percha. This helps prevent future infection.

The tooth may then possibly need a post and core and a crown in order to re-establish normal form and function.

If treated early, root canal therapy need not be uncomfortable. With the use of local anaesthetics, the entire procedure can be totally painless

A common misconception about Root Canal is that by removing the nerve, the tooth becomes dead. This is not true. The tooth is very much alive and functioning because it receives a source of blood and nerve supply from the surrounding tissues that hold it in place in your jaw bone. The tooth will have no sense of feeling hot or cold but will be responsive to biting pressures. With the proper restoration the tooth should last as long as your other teeth and can even be used as an anchor tooth for a partial denture or cemented bridge. The success rates for root canal therapy are reported to be as high as 95%.

Sometimes when there has been long standing infection or abscess, there may be some soreness associated with the first or second root canal visit. If this happens you will be given specific instructions to minimise the discomfort. When an infection is present, it may be necessary to take an antibiotic. If pain should be present, analgesics may need to be prescribed. In either case, be sure to call the dental office if either of these problems should arise.

Post and Core: What are they and why do I need one?

• A post is a metallic structure that is placed within the body of the root of a tooth that has a completed root canal therapy.
• It can only be placed in a tooth that has had endodontic therapy (root canal) since the nerve is no longer present. Root canal therapy prevents further infection and discomfort. During root canal therapy, the space previously occupied by the nerve is filled with sterile plastic material call gutta-percha.
• In fabricating your post, we remove some of this plastic material, making sure we leave the last two to three millimetres to seal the end of the root. This prepared space is necessary in order to anchor the post within the root of the tooth.
• There are different types of posts. The type that is chosen for you will depend on a number of factors. The post can either be prefabricated or it can be cast at the dental laboratory. In either case, the result of anchorage for a crown is the same.
• The part of the post that shows is called the core. It is upon this core that we can anchor a cap or crown. The post is cemented permanently into your tooth usually separate from the crown. The crown (or cap) is then ready to be placed.
• Although posts are usually recommended when there is minimal support for a crown, they are not always necessary. The use of a post will be determined on an individual basis based upon support and structural requirements.

Post operative Care Information

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Whitening

What it is: Treatment to make teeth whiter by bleaching them

Why you'd want it: How we look and how we perceive ourselves has much to do with our self-esteem. If the colour of your teeth makes you embarrassed to smile, it might be time to have your teeth whitened.

Not everyone is a candidate for bleaching. Teeth discoloured by ageing have the best results. If you have tooth-coloured resin or composite fillings in your front teeth, they will not change colour from bleaching and will be very obvious after the procedure. If you would like to have your teeth whitened, ask your dentist about it at your next check-up visit. If you are not a good candidate, he or she can suggest alternatives such as bonding or porcelain veneers.

Causes of discolouration: As one ages, teeth may darken from coffee, tea, smoking, berries and other substances that get into micro-cracks in the enamel, causing discolouration. Some people have gray or brown bands on their teeth caused by an early childhood fever or tetracycline medication taken when the tooth enamel was forming. In some parts of the country where fluoride is found in naturally high concentrations in the drinking water, individuals develop teeth with bright white patches or dark brown blotches (mottled enamel or fluorosis).

Treatment Options: There are various options for whitening your teeth. Bleaching can be an in-office procedure (chair-side). It may involve several appointments of 30-60 minutes each where the bleaching agent is applied to your teeth and activated with a special light.

There is also an at-home procedure where you wear a custom-made mouthguard filled with a bleaching gel for between two hours a day and overnight, for approximately two weeks. Some toothpastes have added whitening agents and can be used as an adjunct to the other two procedures.

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