General Dentistry

Root Canal Treatment

The procedure involves removing inflamed or damaged tissue from inside a tooth and cleaning, filling and sealing the remaining space. The pulp, or soft inner tissue of your tooth, is normally surrounded and protected by a layer of dentin.  Above the gumline, the dentin is protected by a layer of enamel; below the gumline, the dentin is covered by cementum.  When a deep cavity, decay or crack destroys these protective layers, the pulp is exposed to the bacteria in your mouth.  This can result in inflammation, infection and, eventually, necrosis (pulp death).  A severe blow to the tooth can also damage the pulp.  Irritants may then escape from the end of the root and cause a diseased area (apical lesion) in the bone.

Root canal treatment removes the damaged pulp and irritants.  This allows the bone surrounding the root end to repair and heal. Steps of the operation is depicted below, click on each image for better viewing.

Fillings

If a single spot on one of your teeth is not cleaned daily, the remaining bacteria will transform themselves into a sticky film substance called plaque. The plaque will produce acids which eat away at the enamel of the tooth and will eventually cause cavities.  When the cavity gets through the enamel, into the underlying tooth structure (the dentin), repair or restoration is necessary. If there is sufficient tooth structure remaining after removal of all the caries, a filling is placed. There are three types of fillings commonly used:

Amalgam fillings

Amalgam (silver) fillings have been used for decades and they remain one of the most commonly used filling materials. They are often referred to as metal fillings. Amalgam is a mixture of silver and other metals, such as copper, tin and zinc, grounded into powdered form. The silver powder is mixed with mercury and placed into the cavity preparation where it is shaped before hardening. In recent years, the safety of amalgam fillings has come under scrutiny because of the mercury it contains. The absorption of elemental mercury is known to be a contributing factor to several diseases, including Alzheimer's, multiple sclerosis, dementia and arthritis. However, recent studies have proved amalgam fillings to be perfectly safe.

Gold fillings

Gold fillings are widely viewed of restorations. From a bio-mechanical perspective, they are the ideal material as they will not tarnish or corrode and they wear at the same rate as tooth enamel. The placement of a gold filling requires two separate appointments with your dentist. At the first visit, the cavity is removed and the tooth is prepared. An impression is taken of the tooth preparation and a temporary restoration is placed. A custom made filling is made from the impression. At the second visit the temporary restoration is removed and the gold filling is placed.

Composite fillings

Composite fillings are the newest type of filling in common usage. They are commonly known as white fillings. They are a porcelain/plastic hybrid that is bonded directly to the cavity preparation.  Composite fillings were created as an alternative to traditional metal dental fillings. They are coloured to look like natural teeth and are more aesthetically pleasing than amalgam or gold fillings. They are also strong, durable, and make for a very natural looking smile. Your dentist will give you a local anaesthetic to numb the area before preparing an access to the decayed area of the tooth and removing the decayed portions. Traditional drills, micro air abrasion or even with a dental laser can be used to accomplish this. A special dental material is then used to open up the pores of your tooth's dentin and roughens up the surface of the exposed enamel. This creates a stronger bond between the tooth and the filling. The bond resin is applied to stick the composite to your tooth. This material is made of the same dental resin as the composite however it is much more fluid. With a composite filling, your dentist will be able to preserve more of the natural tooth as the composite resin can be bonded to the tooth in thin layers and slowly built up to form a complete filling. A bright dental light will harden each layer before the next is applied.

Crown & Bridges

As we get older, many of us discover that our teeth that are no longer as structurally sound as they were in our youth. Your regular dentist will usually be able to recognise problem areas which may lead to tooth damage and a need for dental crowns.

Grinding your teeth, an improper bite, age, fillings and tooth decay are all contributing factors in the erosion, cracking or breakage of your teeth. If the entire surface of the tooth is damaged, but the root system has remained intact, your dentist will usually suggest that a dental crown be put in place.

Dental crowns are also capable of replacing missing teeth entirely. The dental crown is secured to the teeth on either side using a bridge section which connects the two dental crowns. Alternatively, single tooth dental implants can be placed. This eliminates the need for supporting the dental crowns so no bridge is required.

A dental bridge is a false tooth which is fused between two porcelain crowns in order to replace a missing tooth. Each bridge is custom made to fill in the space. If spaces are left unfilled the surrounding teeth are liable to drift out of position. Furthermore, spaces from missing teeth can cause your other teeth and your gums to become far more susceptible to tooth decay and gum disease. If you have missing teeth and have good oral hygiene practices, you should discuss this procedure with our dentist.

There are three types of dental bridges:

Traditional Fixed Bridge

The false tooth is attached by the bridge to the two other teeth around the space - bridging them together. Unlike partial dentures, fixed bridges are set in place permanently and cannot be removed. This procedure is used to replace one or more missing teeth.

Resin Bonded Bridge

The resin bonded is normally used for your front teeth and requires less amount of preparation on the surrounding teeth. The false tooth is fused to metal bands that are bonded to the abutment teeth with a resin which is hidden from view. This type of bridge is less expensive than the others but the abutment teeth must be healthy.

Cantilever Bridge

If the gap is situated in the front of your mouth then a Cantilever bridge will be used. It will also be used when your teeth can only offer support on one side of the open space. The procedure involves anchoring the false tooth to one side over one or more natural and adjacent teeth.

Dentures

Dentures are removable replacements for missing teeth. They are made out of an acrylic resin and normally porcelain or metal will be added for additional structural support. If your dentures are well looked after, you will have a very natural looking smile. Your dentures will also help strengthen muscles controlling your expressions and you will be free of any speech problems which were caused by missing teeth.

The procedure differs depending on the type of dentures you are having fitted. This is a simplified breakdown of the procedure for the placement of complete dentures:

• A "wax bite" impression is created to help your dentist can find the exact measurements of your mouth.
• You will try-on the dentures and the colour, shape, and fit will be adjusted until a perfect match is found.
• Your dentures are fabricated and then placed in your mouth.
• Your dentist will instruct you on taking care of your dentures.

More often than not, some teeth will have to be extracted. In some cases surgery is required to improve the bony ridges that stabilize your dentures.

Types of Dentures

Complete Dentures: replace all of your teeth
Immediate Dentures: are placed all at once
Over Dentures: similar to Complete Dentures but not all teeth are extracted and they use one or more natural teeth for their support.
Partial Dentures: Partial dentures are placed to fill the gaps in your

Emergency Dentistry

Extraction

We believe that every tooth is precious and one of the main goals of modern dentistry will always be the prevention of tooth loss. All possible measures should be taken to preserve and maintain your teeth because the loss of a single tooth can have a major impact upon your dental health and appearance. However, it is still sometimes necessary to remove a tooth. Some of the reasons for doing so can be seen below:

• Severe Decay
• Advanced periodontal disease
• Infection or abscess
• Mal-positioned teeth
• Fractured teeth or roots
• Impacted teeth

Extracting teeth is made less difficult when the general principles of oral surgery are understood and practiced. If your dentist has recommended that a tooth be extracted, the following information will help you get through the first few days after your extraction. Should anything occur that seems out of the normal, do not hesitate to call your dentist.

Pain management must be addressed. Various pain management techniques must be used including:

• Medical management (pre-surgical and post-surgical medications), regional nerve blocks, and local nerve blocks.
• The top (coronal) 1/3 of the alveolar bone surrounding the tooth has 2/3rds of the holding power.
• Periodontal fibres are not designed to withstand slow, continuous torque.
• Multi-rooted teeth are transformed into single-rooted teeth.
• Gingival preservation is paramount.
• Complete extraction of root confirmed by radiograph.
• Closure of alveolus to maintain blood clot.

The techniques of extraction include surgical and non-surgical procedures. Following a close study of your radiographs your dentist will be in a position to advise you on which is the best procedure for you.

Veneers

Veneers are an important tool for the cosmetic dentist. A dentist may use one veneer to restore a single tooth that may have been fractured or discolored, or multiple teeth to create a "Hollywood" type of makeover. Many people have small teeth resulting in spaces that may not be easily closed by orthodontics. Some people have worn away the edges of their teeth resulting in a prematurely aged appearance, while others may have malpositioned teeth that appear crooked. Multiple veneers can close these spaces, lengthen teeth that have been shortened by wear, fill the black triangles between teeth caused by gum recession, provide a uniform colour, shape, and symmetry, and make the teeth appear straight. Dentists also recommend using thin porcelain veneers to strengthen worn teeth. It is also applied to yellow teeth that won't whiten. Thin veneers is an effective option for ageing patients with worn dentition. In many cases, minimal to no tooth preparation is needed when using porcelain veneers.