Treatments

This is one of the more interesting sides of modern dentistry because we can now create a brighter smile without doing invasive procedures like crowns or veneers. Your teeth function in a fairly difficult environment: severe temperature changes, bacterial attack from the plaque and lots of strongly discolouring food substances which can leave their marks after many years of service. These yellowing food stains are called chromagens and if you drink tea, coffee, red wine and especially smoke, there are ample opportunities for these chomagens to be absorbed by the enamel. These stains can now be removed by using oxidising gels like carbamide peroxide. This penetrates the enamel and oxidises the stains.

We use the home bleaching technique which works with a mild carbamide peroxide gel in a custom made night guard. Think of what rugby player use to protect their teeth but then in a wafer thin variety. The fit is important as it needs to keep the gel on the tooth surface. A poorly fitting night guard will not only be uncomfortable to sleep with, it will also increase the sensitivity of the teeth during the procedure. Some sensitivity can be expected as a side effect during the whitening process but most patients work their way around that by alternating upper and lower jaw every couple of days. The use of Sensodyne Rapid Relief toothpaste is also recommended during the whitening procedure. The advantage of night time bleaching is the fact that saliva flows are reduced and the gel does not get diluted as quickly as during day time bleaching.

Please note that the carbamide peroxide will influence natural tooth material only so it will not have any effect on crowns, bridges or fillings. They will stay the same colour and as a result may become more noticeable if they are close to the front of your mouth. If whitening is desirable despite that, these restoration could of course be remade in a lighter shade after the whitening has been done to a satisfactory level. It does in that case make the procedure a little more involved but, dependent on the number of restorations, cetrainly not impossible.

Advantages of implants

When a tooth is lost because it was impossible to restore either due to trauma, gum disease or tooth decay, an implant can be the most elegant way to fill the gap. The advantage of an implant is that none of the neighbouring teeth need to be touched which for a bridge would be the case. The drawback is that the cost is higher compared to the bridge. The third way to fill a gap is with a denture but this is not comparable to a bridge or implant from the point of comfort.

Procedure
We work closely together with a local implantologist who takes care of the surgical phase of the implant process. Below is a short graphic animation of the process:

Normally you are ready for the implant insertion approximately 10 weeks after the extraction in order to let the socket heal adequately. The implant then needs to fuse to the jaw bone (osseointegration) which takes another 10 weeks. If the tooth in question is cosmetically visible you may opt to get through this period with the help of a small temporary denture. The immediate insertion of an implant after an extraction without the healing phases is almost always contra-indicated as it increases the failure rate. The after effects of the surgical insertion of the implant normally consists of no more than a few days of mild discomfort after which you will be unaware of the process of the osseointegration. Once the healing has been completed, we will take an impression of the implant and have the crown or bridge made onto it. The crown or bridge may be cemented or screwed into the implant with the latter being preferential but not always possible.

On the left photograph below you can see the implant after the healing has taken place and is ready for the core build-up and the crown. The healing cap which has been in place during the last 10 weeks since the implant was inserted has been removed, showing healthy gum around the implant. On the right the crown is in place and the gap is filled beautifully.

Cost
The cost of the surgical phase of the implant is approximately £1300 but this figure may vary upwards if CT scans and/or bone augmentation are needed and may be lower if multiple implants are inserted at the same time. The cost of building the crown/bridge once the implant is in place is £1250 (per crown or bridge unit).

Aftercare
Implants are very reliable replacements for missing teeth but they will need to be looked after in a similar way as you would look after a natural tooth. Thorough but gentle brushing with a soft toothbrush and daily flossing and/or interdental brushing will make sure the surrounding gum and bone will stay healthy. Failing to take proper care can result in the bony support of the implant deteriorating as a result of the toxins of the dental plaque (bacteria). This process is very similar to what gum disease can do to a natural tooth.

When one or more teeth are missing, they can be restored by placing crowns on the teeth next to the gap onto which an extra false tooth is fixed. This is called a bridge and can be made out of normally three or more units. A bridge is cemented in place and cannot be removed by the patient and should be looked after as well as your own natural teeth as underneath your bridge you will still have the roots that keep it secure.

In order to make a bridge, we therefore need other teeth around the site of the missing tooth/teeth to be in reasonable condition. Heavily filled adjacent teeth are not a problem but if the neighbouring teeth are mobile because of gum disease then a bridge may not be the best solution. Alternatives to a bridge are dentures (which are removable by the patient) or implants (titanium screws into the jaw bone). We will examine you first and advise you on the best possible solution.

Crowns are also known as 'caps' and are normally only made when teeth are so heavily damaged that filling is no longer a reliable prospect.

In order to restore normal function and/or aesthetics the teeth will be prepared, removing all old filling material and making sure that there is no underlying tooth decay. A badly broken tooth with a root filling may need a carbon fibre post fitted into the root canal to give better support to the crown. The tooth is then built up with a composite filling material providing us with an incredibly strong basis onto which we can safely make the crown.

We will then take an impression of your teeth so that the technician in the laboratory can make the crown. As it normally takes the laboratory two weeks to get the finished crown back to us, we make temporary crowns to protect the teeth for that period. It is advisable not to eat hard or sticky food during the fortnight you have temporary crowns as they are slightly fragile and are cemented on with a relatively soft cement. This enables us to remove the temporary crowns easily when the real crowns are ready. Also be careful during those two weeks with foods that contain strong stains or pigments like curry as they with stain the temporary crown.

For your front teeth, where the appearance is of the highest priority, we now recommend all porcelain crowns, like Cercon (Zirconia) crowns which have superior aesthetics and excellent strength.

Fillings are used to repair minimal tooth fractures, tooth decay, or otherwise damaged surfaces of the teeth. In many cases, individuals with enamel loss resulting in tooth sensitivity will notice a significant improvement or complete elimination of sensitivity once the appropriate dental filling material is placed. In some cases, depending on the extent of tooth decay or damage, the affected tooth may require additional or alternative procedures like root fillings or crowns.

The aim of the procedure is to firstly make sure that the cavity is clean, meaning there is no tooth decay left behind. This is the drilling stage and we will have to give the cavity the correct shape so that it can be filled. This shape is dependant on the material used. We do not use amalgam as technological advances in composite have improved these materials so much in recent years, we see no need to use amalgam anymore.

Teeth are held in the jaw by their roots, which have nerves inside of them. When tooth decay or an injury damages the tooth, it can cause the nerve to die. This will eventually result in the formation of an abscess at the tip of the root, deep inside your jaw. Root fillings involve removing damaged or dead nerves and after careful cleaning the root canals are filled. This allows us to reconstruct the tooth that is left. The success rate of root fillings is around the 85% mark as long as no root treatment has been done before. The success rate of a re-root filling (an attempt has been made before but it has not been successful) is much lower at around 50%.

If an abscess is diagnosed a course of antibiotics will only suppress the infection but it will never solve the problem as the source of the infection (the dead nerve) is not removed. A successful root treatment or an extraction will achieve this. You can give yourself the best possible chance of avoiding an abscess by having tooth decay treated at the earliest possible stage. The deeper the decay, the more chance you will have of the nerve dying off. It comes as a surprise to many patients that many root treatments can actually be done without making it numb as the nerve has died. We will however usually give you a local anaesthetic as you will be more comfortable that way. The images below show the sequence of a root filling needing to be done as a result of tooth decay:

The basis for a healthy mouth is healthy gums. The absence of gum disease and tooth decay will help you maintain your teeth for life. There is no need to start having teeth extracted as you grow older, as long as you look after your teeth and gums well. This starts with good home-care on a daily basis so that the dental plaque (the bacteria) are removed every day and therefore gum disease and tooth decay do not get a chance to develop. We will teach you how to achieve this with the use of manual or electric brushing, and the essential use of either dental floss or inter-dental brushes. Both tooth decay and gum disease are preventable diseases but without proper care and guidance teeth can still be lost.

Gum disease does not progress at an even pace. There will be periods when the disease will progress extremely rapidly and then slow down again. These period of rapid deterioration may coincide when you are feeling low or run down. The bad news is that the bone attachment that is lost during the active phases is virtually impossible to regain. The good news is that we can control the advance of the gum disease as long as you remove the plaque completely every day.

Because gum disease is on the whole a pain free disease, is can gradually creep up on you without you realising. It is most important to realise that just brushing your teeth, even if you do it really well, will leave the plaque behind in between the teeth, under the contact points. It is vital that once a day those areas are cleaned with dental floss or inter dental brushes. We will teach you how to use these and in the case of the inter dental brushes we will assess which size is the optimal size for your teeth.

Treatment becomes more difficult as the gum disease progresses but it can be very successfully treated in the earlier stages. Early detection is very important! One particularly important aspect of gum disease is the impact smoking has on it. The loss of bone, the attachment of the teeth, is lost much faster than in an equivalent non-smokers mouth. Definitely non something you would want to do!

There are other factors that influence periodontal disease like diabetes, medications, stress, excessive biting forces and a poor diet. On the issue of pregnancy it is good to know that with proper care, there is no need for a deterioration of your teeth and gums during a pregnancy. The gum are more likely to bleed though, caused by hormonal changes in you body. With meticulous oral hygiene and some straight forward dietary advice you will come through your pregnancy without any problems.

Snoring is an issue that should not be taken lightly. Apart from the fact that a good night sleep is essential to functioning well during day-time, it is the third biggest cause of marriage breakdown after infidelity and financial problems. So, what actually happens when you snore?

The noise of snoring is caused by the vibration of the soft tissues in the upper airway. During sleep the muscles of the upper airway relax, resulting in the formation of bottlenecks or even complete obstruction of the airways. The body reacts by increasing the velocity of the air which in turn causes vibration of the soft tissues which generates the noise of snoring. Research has shown that approximately 40% of the adult population snore. As a person gets older the chances of snoring increases. (i.e. in men aged 60 this increases to 60%.) The chances of snoring are also increased if a person is overweight or drinks alcohol.

Obstructive Sleep Apnoea
This is a medical condition. People suffering from it are heard to gasp for breath while they are asleep. Additional symptoms are daytime drowsiness or the feeling of not having a full nights sleep. Where Sleep Apnoea is suspected an anti-snoring device may still be prescribed but it is essential that you consult your medical practitioner and if he confirms that Sleep Apnoea is suspected, that you are referred to the sleep clinic of a hospital for further investigation. Not everyone who snores suffers from Sleep Apnoea – but nearly everyone who suffers from Sleep Apnoea will snore.

What help is available?
In the surgery we can make you an oral appliance which is worn at night to prevent snoring. This consists of two thin plastic formings which fit over the upper and lower teeth. They are joined together by two connectors that gently hold the lower jaw in a forward position.

You need to have most of your own teeth; if you have full dentures we will not be able to help you with this method as the appliance has to be inserted over you natural dentition. Further, there are some people who cannot manage to get used to the more forward position of the lower jaw. The system we use has the ability to alter the amount of forward displacement to suit you.

Unfortunately it is not possible to guarantee that the appliance will work on everyone. Statistics demonstrate that in 62% of people that snore it will totally eliminate the noise of snoring. In the remaining cases the noise of snoring may be reduced or it will not work at all. The appliance does require regular maintenance but the intervals between maintenance periods are difficult to predict because they depend on the individuals case. If you grind your teeth at night the life of your appliance will be reduced.

Examination : £35
Scale & Polish : £35

At Dental Care Centre, we understand that the treatment we need can be costly and can come at a time that is not convenient, so we have teamed up with Tabeo.

Tabeo provides payment solutions for dental patients as well as patients of many other healthcare providers in the UK.

With Tabeo, you can spread your payments interest-free, making the treatment more affordable so you can choose the best treatment option that is right for you.

Explore Interest Free Dental Finance