GOT A TOOTH PROBLEM?
In this section you should find everything you need to know about teeth: restoration, preservation, repair, and replacement of lost or missing teeth as well as treatment for common problems.
We want to make sure your teeth look good, feel good, and last the rest of your life-here's how we can do it for you.
Root Canal Therapy
The word bruxism is used to describe what happens when you clench or grind your teeth together-usually when you’re asleep, but you can also do it while awake. Another dental term that means the same thing is ‘parafunction’. Parafunction is loosely defined as doing things with your teeth other than eating, talking, or smiling.There is no widely-accepted reason to explain why you might do this, but recent research suggests a link with disturbances in patterns of sleep, and may be related to the causes of sleep apnoea. In some people, parafunction is a habit, like using worry-beads or chewing pens and pencils or biting nails.
Others do it when they’re awake but are completely unaware that they do. A partner might tell you they can hear you grinding your teeth while you sleep; someone might notice a repetitive movement of your jaw as you grind while awake. Dentists can tell if you have this habit when we see excessive wear, chipping and fracturing of your teeth.
In the past, dentists believed you could ‘cure’ bruxism by adjustments to patient’s bite. Other groups of dentists supported the idea that complex dental interventions to completely ‘reconstruct’ a whole mouth would prevent problems. While this might be a good idea for some people with extensive wear, it doesn’t stop people bruxing. The truth is still unclear about exactly what might work to prevent us from doing this. What is true is that trying to stop the habit when you’re awake and attempting to protect your teeth when you sleep does work to prevent damage.
It’s important to know if you brux or not: apart from excessive wear, fillings can fracture, as so can your teeth. You can chip porcelain crowns and veneers, and you can develop acute pain as a result of clenching too much. That’s why, during your initial assessment and examination, we’ll look for signs that you might be ‘parafunction’ with your teeth.
CAD stands for ‘computer-aided-design’ and CAM stands for computer-aided-manufacture’. There are some things humans do really well, and other things machines do so much better. Computers make dental ceramic restorations quicker, with more accuracy and precision than is possible using old-fashioned methods. Dental technicians can also use Cad-Cam to make their lives easier. It’s now possible to manufacture all-porcelain bridges using Cad-Cam. A range of other procedures that either took longer or were difficult or impossible to complete by hand can also now be undertaken using computers and dental milling instruments.
For more information, see CEREC®.
A Crown is a specialised filling that covers a tooth. Called ‘caps’ in the USA, crowns have been used for more than a hundred years to restore teeth. Today there are more than 20 different types of crowns dentists can use. Gold was a common material used in crown manufacture and it’s still used today, where it is usually covered by a layer of porcelain. Most crowns can be made from high-strength dental ceramics, so they look and feel just like your own tooth.
You will need a crown if you have a root canal therapy, or your own tooth has fractured, or if you have a really big cavity.
CEREC® is the acronym for one Cad-Cam dental system sold by Sirona Dental Systems. The letters represent Chairside Economical Restoration in aEsthetic Ceramic.
Cerec restorations are made using a ‘millable’ dental porcelain to manufacture crowns, onlays and veneers in a single appointment. Here’s how:
Old fillings and decay are removed; your tooth is gently shaped and smoothed
An image of the tooth is captured by a specialised camera
Your new filling is designed with the aid of a ‘library’ of images and designs available within the Cerec software
The Cerec computer sends instructions to a milling unit which manufactures the finished restoration. This only takes the machine about 10 minutes.
The polished ceramic is bonded to your tooth, making it strong and comfortable once more.
But what's in it for you?
Here’s a comparison of old and new:
|Smooth and prepare tooth||Same|
|Impressions of both jaws and tooth with rubbery stuff||Get a video image of your tooth|
|Wait while the dentist makes you a temporary plastic crown||Read a newspaper, have a snooze, go for a walk for 10-15 minutes|
|Impression sent to a dental technician||Design and mill the crown|
|Wait 1-2 weeks||Bond the crown, dental treatment complete|
|Second appointment, second injection, cement the crown|
|Two appointments with impressions and temporary crowns||Summary: Single appointment, no yucky dental impressions|
Cracked Tooth Syndrome is a collection of symptoms caused by a fracture in a tooth. 99.999% of the time, the culprit is an existing filling, although if you brux you can crack your own unfilled tooth. The most common filling material in fractured teeth is silver alloy or amalgam. An ‘amalgam’ is a mixture of mercury and a silver/tin alloy (with other trace metals). Although these alloys were improved in the 1970s, silver used in earlier decades was susceptible to a number of problems that only show up after years in use. One of these is a fracture pattern that starts internally and can take months to progress to a broken tooth.
As the fracture progresses microscopically, you might experience sensitivity to cold, particularly with cold drinks, or cold air in winter. With further development, your tooth might become sensitive when you eat, typically when you try to chew something tough (meat, nuts, hard candy, ice). Cracked tooth syndrome is a very distinctive pain on chewing: it can be exquistely painful—but the pain has an extremely short duration, and doesn’t last.
It can be very difficult to diagnose exactly which of your teeth tooth are fractured. Occasionally there can be multiple teeth that have the same problem, and it’s very common to have more than one fracture in a single tooth. Some fractures are ‘favourable’—and others can cause you to lose your tooth.
Treatment varies from onlays to crowns and root canal therapy, depending on where the crack ends.
Enameloplasty is a method of making tiny changes to your teeth by altering your tooth enamel. Tooth enamel is ‘insensitive’, so these changes don’t hurt and don’t take long.
Most of the time the changes make your teeth look better—like eliminating points, irregularities or smoothing small fractures on front teeth. Enameloplasty can also relieve the discomfort of rough teeth and can be used to effect minor alterations in occlusion.
Endodontics is the art and science of treating teeth that have infected or damaged pulps. The pulp is a collection of soft tissues deep within your tooth; this tissue was originally responsible for forming your tooth. If bacteria infect the soft tissue, or it becomes exposed because of trauma, rather than have the tooth removed, endodontics (‘treatment inside the tooth’) is used to disinfect a tooth and allow you to keep it healthy. This treatment is also known as root canal therapy.
Extractions are the last thing we normally provide for our patients. But sometimes it’s the best treatment. Crowded teeth, wisdom teeth and extra teeth need to be removed. Trauma, or extensive decay can mean an extraction is the ideal treatment. Occasionally a tooth with severe periodontal disease cannot be kept or helped with periodontal therapy and requires extraction. If you need to have a tooth removed, I’ll provide instructions and help to plan for before and after. As for all prescribed treatment offered by me as a registered experienced health practitioner registrant, all patients are free at all times to seek a second opinion from another practitioner. Often on examination and after discussion, I will make clear to you that you may seek or should seek a second opinion for any and all treatment. For some people, specialist referral to an oral/maxillofacial surgeon is a desirable choice. If you would like to download a copy of our instructions for surgical procedures including extractions, please click here.
Fissure seals and Preventive Resin Restoration (‘PRR’) therapy are used when fissures in back teeth develop so they trap plaque and bacteria, causing decay and cavities. These cavities are so small, we need to use extremely small diamond-coated instruments to remove a thin layer of enamel to ensure all decay is exposed and removed. Once we are sure the surface of the tooth is healthy, tooth-coloured resin is securely bonded to repair the defect. These restorations can be expected to last many years, and are a wonderful way to protect the grooves in back teeth from biscuits, sticky foods and attack from sugary drinks.
These images show an upper molar before preparation, with the cavity prepared, and with the bonded resin restoration in place.