Frequently Asked Questions
Crowns
A crown is an artificial restoration that fits over the remaining part of a prepared tooth, making it strong and giving it the shape of a natural tooth. A crown is sometimes referred to as a 'cap'.
Crowns are an ideal restoration for teeth that have been broken or have been weakened by decay or a very large filling. A crown could be used for many other reasons, Such as:
- You may have large discoloured fillings and would like to improve the appearance of the tooth.
- You may have had a root filling on a back tooth which will need a crown to protect it.
Crowns can be made of a variety of different materials and new materials are continually being introduced. Some of the popular materials are listed below:
- Porcelain bonded to precious metal: A precious metal thimble is made and then porcelain is applied in layers over it. The colour of the porcelain is matched to that of the adjacent teeth.
- All-Ceramic Crowns: They are made entirely out of reinforced porcelain and look very natural as they are translucent.
- Gold alloy Crowns: These are usually used to crown back teeth as they are very hard wearing and very biocompatible. Also gold is strong in thin sections and so more of the natural tooth can be preserved.
Your dentist will prepare the tooth to the ideal shape for accommodating the crown. This will involve removing some of the outer surface of the tooth being crowned. Once the tooth is shaped, your dentist will take an impression (mould) Of your teeth and one of the opposite arch. This information ,along with the correct tooth shade, is transferred to the Dental Laboratory who will then construct the Crown.
A pre- fabricated temporary crown is cemented over the prepared tooth while you wait for the custom Crown to arrive.
When the dentist is happy with the fit and appearance of the new crown it will be fixed into place with a special adhesive dental cement.
You will need at least two visits: the first for the preparation, shade taking and fitting the temporary crown ; and the second to fit the definitive crown. There will usually be about 1 to 2 weeks in between appointments.
No. A Local anaesthetic is used and the preparation should feel no different from a filling.
How long your crown lasts depends on how well you look after it. The crown itself cannot decay, but decay can start where the crown edge joins the tooth. Therefore, it is important to keep this area clean and to have you dental check ups regularly.
Peridontal Disease
Gum disease describes swelling or inflammation of the tissues supporting the teeth. There are two main types of gum disease, namely gingivitis and periodontal disease (periodontitis).
Gingivitis means inflammation of the gums. This is when the gums very red and swollen and tend to bleed on brushing.
Prolonged gingivitis can turn into Chronic Periodontal disease. As the condition progresses the support structure of the teeth is undermined and the teeth eventually become mobile and are lost.
Uncontrolled collection of plaque, a white bacterial deposit which forms naturally on the teeth everyday, is the main causative factor in gingivitis. If this is allowed to progress unchecked, then periodontal disease can follow, with damage to the attachment apparatus of your teeth. The conversion from gingivitis to chronic periodontitis is usually slow and painless, which is why patients, often, don't realise that they have a gum problem until the latter stages when the teeth start to exhibit mobility. By this time the damage to the support structure is extensive and treatment very difficult. This is why it is important to have regular check ups so that the condition can be detected and treated at an early stage. This has a much better prognosis.
Poor brushing results allows the formation of mature plaque which then calcifies to form a hard deposit called calculus. Calculus has a rough surface and once formed, it attracts more plaque and the cycle progresses. Calculus, being hard, can only be effectively removed by your dentist/hygienist with special dental instruments. This is why it is important to have your teeth scaled (process by which calculus is removed), regularly.
Smoking can also exacerbate gum disease. Smoking creates an environment in the mouth whereby the host's natural resistance to infection is suppressed and the natural bacteria in plaque can create more damage. Blood flow to the gums (vascularity) in smokers is often reduced, which means that resistance to infection is reduced. This is why in smokers the gums may not bleed, even though the patient has periodontal disease.
In most cases the condition progresses slowly and eventually as a result of the extensive damage to the support structure, the teeth become mobile and are lost. The condition progresses at a different rates around the various teeth which is why all the teeth may not be similarly affected at any one given time. Even around a particular tooth, the condition may progress at a different rate around its different roots. The condition can sometimes spread rapidly in certain individuals.
Bleeding of the gums on brushing is usually an indication of gum inflammation. There may be associated bad breath and bad taste in the mouth. Some patients may experience small areas of acute inflammation around the gums (periodontal abscesses).
The first thing to do is to visit your dentist for a thorough check up of your teeth and gums. The dentist will then carry out a periodontal analysis. X- rays may also be needed to determine bone levels present around the teeth. Based upon this information, appropriate treatment can be provided.
Your dentist will give your teeth a thorough clean. You will also be shown how to clean your teeth effectively. This may take a number of sessions. In some cases, additional, localised application of antibiotics may be required to treat the gums. The state of your periodontal condition will be recorded and monitored.
On stabilisation of the periodontal disease, it is very important to have regular maintenance of your gum health. If oral hygiene levels drop then the condition can start up once again and all the hard work of getting the condition under control would be undermined. Regular check ups at the dentist are extremely important for the well being of your teeth.
Root Canal Treatment
Root Canal treatment (endodontics) is needed when the pulp (blood/nerve supply) of a tooth is infected through decay or injury.
When the pulp becomes contaminated with bacteria then the infection spreads through the root canal system of the tooth and is usually associated with considerable pain. This may eventually lead to a dental abscess. Root canal treatment helps to get rid of this infection and prevents any recurrence of the infection.
No. A local anaesthetic is used and it should feel no different to having an ordinary filling.
The aim of the treatment is to remove all infection from the root canal. The root canal is cleaned and shaped so that it can be filled with an inert material to prevent re-contamination. Most courses of treatment will involve two or more visits. Root canal treatment is a skilled and time consuming procedure and in order to be successful it needs to be highly accurate. We carry out this procedure using rubber dam isolation ( a rubber sheet placed around the tooth to maintain an aseptic environment) and the dentist uses special magnifying lenses with enhanced illumination to enable him to see clearly the fine and narrow root canals. This helps us to carry out this procedure to a high degree of accuracy and helps us to achieve high levels of success. At the first appointment, the infected pulp is removed. The root canal is then cleaned and shaped ready for the filling. A temporary filling is placed in the tooth along with an antiseptic dressing to allow the tooth to decontaminate thoroughly. At the next visit the tooth is checked and if the infection has cleared, the root canals are filled with an inert material called Gutta percha (rubber like material). Small X rays are taken to check the accuracy of the root filling.
In comparison with routine fillings, yes, a root filling is more expensive. This is because it is a time consuming process, if it is carried out to a high standard.
The alternative is to have the tooth taken out. Once the pulp is infected it cannot heal and it is not recommended to leave an infected tooth in the mouth.
Yes. However, for a back tooth it is usually better to provide extra support for the root treated tooth in the form of a crown. A front tooth, providing it is not too badly broken down, can generally be filled with a conventional white filling.
Implants
A dental implant is a small screw shaped attachment made form titanium. It is inserted into the bone in the jaw and takes the place of a missing tooth root. Once osseo-integration (process whereby which bone joins the implant) has taken place, a replacement tooth can be attached to the top of the implant. This new prosthetic tooth can look, feel and perform like a natural tooth. It is also possible to support a denture or a bridge using multiple implants.
- Implant supported prosthetic teeth are more comfortable than conventional dentures because they are firmly held in position and do not move or slip. This provides more self-confidence.
- Dental Implants are a good alternative to conventional fixed bridgework as they eliminate the need to grind down natural teeth.
- Dental implants help to preserve bone. When natural teeth are removed the supporting alveolar bone shrinks. However by placing implants soon after the extraction the supporting bone is maintained.
Initial assessment and planning- At the initial consultation, after discussing the possible alternatives, the dental surgeon will assess the feasibility of providing implant treatment. Appropriate X-Rays would need to be taken and study models prepared. A written treatment plan along with an estimate of the cost would be provided.
Implant placement- A minor surgical procedure is performed under sterile conditions in the dental surgery under local anaesthetic and if required, this can be supplemented with conscious sedation. If the surgical stage reveals inadequate bone for implant placement then the procedure may be have to be abandoned or bone regeneration options pursued.
Integration period- Although some implants can be loaded quickly, it is generally thought to be a good idea to allow a period of 3-4 months before loading the implant. This allows the implant enough time to osseo-integrate successfully. A temporary adhesive bridge or a removable denture can be provided in the interim, to satisfy aesthetic need.
Restorative phase- Once integrated, the implants usually need to be uncovered and can then be linked to using an abutment and a crown. Impressions are taken of the implants and using this information the dental technician constructs the prosthetic crown. All ceramic crowns can be constructed to give that ultimate natural look.
Maintenance- Following completion of implant treatment it is important for the patient to practice a good level of oral hygiene and to attend check up appointments regularly.
Yes, once completed patients should be able to eat a normal healthy diet.
Usually from start to finish it takes 4-6 months. In some cases they can be provided in a shorter period.
Once treatment is successfully completed, a routine of careful dental hygiene and regular check ups should ensure that the implants last for many years. Smoking is detrimental to the well being of implants and patients are encouraged to give this up.
There is no upper age limit for patients to undergo implant treatment, provided they enjoy reasonable good health.
Patients are often surprised at how little discomfort they experience during and after implant procedures.
