What Are Indirect Fillings? Indirect fillings are similar to composite or tooth-colored fillings except they are made in a dental laboratory and require two visits before being placed. Indirect fillings are considered when not enough tooth structure remains to support a filling but the tooth is not so severely damaged that it needs a crown.
During the first visit, decay or an old filling is removed. An impression is taken to record the shape of the tooth being repaired and the teeth around it. The impression is sent to a dental lab that will make the indirect filling. A temporary filling (described below) is placed to protect the tooth while the restoration is being made. During the second visit, the temporary filling is removed, and the dentist will check the fit of the indirect restoration. Provided the fit is acceptable, it will be permanently cemented into place.
There are two types of indirect fillings -- inlays and onlays.
Another type of inlay and onlay -- direct inlays and onlays -- follow similar processes and procedures as the indirect, but the difference is that direct inlays and onlays are made in the dental office and can be placed in one visit. The type of inlay or onlay used depends on how much sound tooth structure remains and consideration of any cosmetic concerns.
Root canal treatment
Teeth have pulps(nerves). Nerves can get infected at the centre of a tooth (the root canal system).The infection is caused by bacteria that live in the mouth and invade the tooth. This can happen after:Tooth structure
A tooth is made up of two parts. The crown is the top part of the tooth that's visible in the mouth. The root extends into the bone of the jaw, anchoring the tooth in position.
Teeth also consist of:
When root canal treatment is neededRoot canal treatment is only required when dental X-rays show that the pulp has been damaged by a bacterial infection. The pulp will begin to die if it's infected by bacteria, allowing the bacteria to then multiply and spread.
The symptoms of a pulp infection include:
Further symptoms eventually occur, such as:
Leaving the infected tooth in your mouth may make it worse. There may also be less chance of the root canal treatment working if the infection within your tooth becomes established.
Antibiotics – medication to treat bacterial infections – aren't effective in treating root canal infections.
How root canal treatment is performedTo treat the infection in the root canal, the bacteria need to be removed. This can be done by either:
After the bacteria have been removed, the root canal will be filled and the tooth sealed with a filling or crown. In most cases the inflamed tissue near the tooth will heal naturally.
Before having root canal treatment, you'll usually be given a local anaesthetic. This means the procedure shouldn't be painful and should be no more unpleasant than having a filling.
Root canal treatment is usually successful. In about 9 out of 10 cases a tooth can survive for up to 10 years after root canal treatment.
Read about how root canal treatment is performed.
Recovering from root canal treatmentIt's important to look after your teeth when recovering from root canal treatment. You should avoid biting on hard foods until all of your treatment is complete.
After your final treatment, your restored tooth shouldn't be painful, although it may feel sensitive for a few days.
Over-the-counter painkillers, such as paracetamol or ibuprofen, can be used to relieve any discomfort. Return to your dentist if you continue to experience pain or swelling after using painkillers.
In most cases it's possible to prevent the need for further root canal treatment by:
What is teeth whitening?
Teeth whitening involves bleaching your teeth to make them lighter. Teeth whitening can't make your teeth brilliant white, but it can lighten the existing colour by several shades.
Who can perform teeth whitening?Teeth whitening is a form of dentistry and should only be performed by a dentist or another regulated dental professional, such as a dental hygienist or dental therapist, on the prescription of a dentist.
Some beauty salons offer teeth whitening, but this is illegal if there's no dental professional present, and it may put your oral health at risk.
You can also buy DIY home teeth whitening kits but these may also carry risks.
What happens during teeth whitening at the dentist?If you have teeth whitening you will need to make several visits to the dental surgery over a couple of months.
The dentist will take an impression of your teeth to make a mouthguard and will instruct you how to use it with a bleaching gel. Then, using your mouthguard at home, you regularly apply the gel for a specified period of time over two to four weeks. Some whitening gels can be left on for up to eight hours at a time, which shortens the treatment period to one week.
Another type of teeth whitening system that a dentist can provide is called laser whitening, which is also known as power whitening. This is where a bleaching product is painted onto your teeth and then a light or laser is shone on them to activate the whitening. Laser whitening takes about an hour.
Can any dentist whiten teeth?
Yes, provided they are registered with the Bulgarian Dental Association. Registered dental therapists and dental hygienists can also carry out teeth whitening on the prescription of a dentist.
What about home kits and beauty salons for teeth whitening?Only go to a registered dental professional for teeth whitening because whitening by people who aren't qualified, for example in beauty salons, is illegal. Home kits also carry risks.
What are the risks of home kits and salon teeth whitening?Some home kits don't contain enough of the whitening product to be effective. More generally, if a dental professional is not doing the whitening, the mouthguard provided may not fit properly so some of the bleaching gel may leak out onto your gums and into your mouth, causing blistering and sensitivity.
Where teeth whitening is carried out in beauty salons by staff without any training or dental qualifications it not only carries a risk to your oral health, but is also illegal.
Teeth whitening by a dentist or other dental professional can only be done privately because it's considered to be a cosmetic treatment. Costs vary and, as a general rule, laser whitening is more expensive than professional bleaching.
How do you go about getting teeth whitening?Your dentist will advise you whether whitening is right for you. It may be that teeth whitening isn't suitable, for example if you have gum disease or crowns.
What questions should I ask the dentist before going ahead?Don't be afraid to ask simple questions about the types of whitening treatment available, what results you can expect and whether the work is guaranteed for a certain amount of time. Also, ask them what they consider to be the risks in your particular case, for example increasing sensitivity of the teeth.
Try to talk to other people who have had the same treatment or visit another dentist for a second opinion until you feel confident. Always ask for a written treatment plan and price estimate before going ahead.
Is teeth whitening permanent?No, teeth whitening isn't permanent. It can last from a few months to up to three years, but this varies from person to person. Generally, the whitening effect won't last as long if you smoke or drink red wine, tea or coffee, which can all stain your teeth.
Will teeth whitening work on false teeth?No. Teeth whitening won't work on dentures, crowns, fillings or veneers.
What are the risks of teeth whitening?No matter what treatment you use, there is a chance your gums can be sensitive to the chemicals used in teeth whitening, especially if you already have sensitive teeth. There's also a chance of burns to gums and some of the whitening kits used at home can harm tooth enamel.
How to keep your teeth clean. Plaque is a film of bacteria that coats your teeth if you don't brush them properly. It contributes to gum disease and tooth decay. Tooth brushing stops plaque building up. Try to make sure you brush every surface of all your teeth.
Your dentist or hygienist may give you more advice based on your own dental health and needs.
Should I use an electric or manual toothbrush?It doesn't matter whether you use an electric or manual toothbrush. They're both equally as good, as long as you brush all the surfaces of all your teeth and you use fluoride toothpaste. However, some people find it easier to clean their teeth thoroughly with an electric toothbrush.
What should I look for in a toothbrush?For most adults, a toothbrush with a small head and a compact, angled arrangement of long and short round-end bristles is fine. Medium or soft bristles are best for most people.
If you're using an electric brush, one with an oscillating or rotating head may work better than a manual toothbrush.
However, making sure you thoroughly clean your teeth at least twice a day is more important than the type of brush you use. If in doubt, ask your dentist.
What type of toothpaste should I use?It's important to use a toothpaste with the right concentration of fluoride. Check the packaging to find out how much fluoride each brand contains.
How to brush your teethMake sure you brush all the surfaces of all your teeth, which should take about two minutes. Remember to brush the inside surfaces, outside surfaces and the chewing surfaces of your teeth.
How to help children brush their teethChildren need to be helped or supervised brushing their teeth until they're at least seven years old.
Don't rinse with water straight after toothbrushingAfter brushing, spit out any excess toothpaste. Don't rinse your mouth immediately after brushing, as it will wash away the concentrated fluoride in the remaining toothpaste, thus diluting it and reducing its preventative effects.
Should I use mouthwash?Using a mouthwash that contains fluoride can help to prevent tooth decay, but don't use mouthwash – even a fluoride one – straight after brushing your teeth or it will wash away the concentrated fluoride in the toothpaste left on your teeth. Choose a different time to use mouthwash, such as after lunch. Don't eat or drink for 30 minutes after using a fluoride mouthwash.
How to use dental flossFlossing isn't just for dislodging food wedged between your teeth. Regular flossing may also reduce gum disease and bad breath by removing plaque that forms along the gum line. It's best to floss before brushing your teeth.
How to use interdental brushesYou can use interdental brushes or single-tufted brushes instead of flossing, especially if there are gaps between your teeth. The brush should fit snugly between the teeth.
Never use toothpicks to remove trapped food from between your teeth, as you may damage your gums, which could lead to an infection.
Your dentist or hygienist can advise you on the best way to use interdental cleaning for your teeth.
A Dental Implant is a titanium cylinder that is placed gently into bone to replace a root of a tooth. The Implant itself is a single unit of a 3 unit system which holds a crown.The 3 parts to a Complete Dental Implant
A smaller number of Dental Implants can be used to permanently fix a Dental Bridge Prosthesis
Dental Implants can be also be used to securely support loose dentures. The Denture is removable.
Treatment Stages. Tooth Implant treatment can be considered to involve a minimum of 4 stages.
What are Dental Crowns and Tooth Bridges?
Both crowns and most bridges are fixed prosthetic devices. Unlike removable devices such as dentures, which you can take out and clean daily, crowns and bridges are cemented onto existing teeth or implants, and can only be removed by a dentist.
How do Crowns Work?
A crown is used to entirely cover or "cap" a damaged tooth. Besides strengthening a damaged tooth, a crown can be used to improve its appearance, shape or alignment. A crown can also be placed on top of an implant to provide a tooth-like shape and structure for function. Porcelain or ceramic crowns can be matched to the color of your natural teeth. Other materials include gold and metal alloys, acrylic and ceramic. These alloys are generally stronger than porcelain and may be recommended for back teeth. Porcelain bonded to a metal shell is often used because it is both strong and attractive.
Your dentist may recommend a crown to:
A bridge may be recommended if you're missing one or more teeth. Gaps left by missing teeth eventually cause the remaining teeth to rotate or shift into the empty spaces, resulting in a bad bite. The imbalance caused by missing teeth can also lead to gum disease and temporomandibular joint (TMJ) disorders.
Bridges are commonly used to replace one or more missing teeth. They span the space where the teeth are missing. Bridges are cemented to the natural teeth or implants surrounding the empty space. These teeth, called abutments, serve as anchors for the bridge. A replacement tooth, called a pontic, is attached to the crowns that cover the abutments. As with crowns, you have a choice of materials for bridges. Your dentist can help you decide which to use, based on the location of the missing tooth (or teeth), its function, aesthetic considerations and cost. Porcelain or ceramic bridges can be matched to the color of your natural teeth.
How are Crowns and Bridges Made?
Before either a crown or a bridge can be made, the tooth (or teeth) must be reduced in size so that the crown or bridge will fit over it properly. After reducing the tooth/teeth, your dentist will take an impression to provide an exact mold for the crown or bridge. If porcelain is to be used, your dentist will determine the correct shade for the crown or bridge to match the color of your existing teeth.
Using this impression, a dental lab then makes your crown or bridge, in the material your dentist specifies. A temporary crown or bridge will be put in place to cover the prepared tooth while the permanent crown or bridge is being made. When the permanent crown or bridge is ready, the temporary crown or bridge is removed, and the new crown or bridge is cemented over your prepared tooth or teeth.
How Long do Crowns and Bridges Last?
While crowns and bridges can last a lifetime, they do sometimes come loose or fall out. The most important step you can take to ensure the longevity of your crown or bridge is to practice good oral hygiene. A bridge can lose its support if the teeth or bone holding it in place are damaged by dental disease. Keep your gums and teeth healthy by Brushing with fluoride toothpaste twice a day and flossing daily. Also see your dentist and hygienist regularly for checkups and professional cleanings.
To prevent damage to your new crown or bridge, avoid chewing hard foods, ice or other hard objects.
Acrylic temporary crowns.
Full porcelain fused to metal.
Full cast gold crown.
All ceramic crowns.
Same type of materials as crowns.
Teeth around the space are prepared.
The bridge is mounted and adjusted for fit and comfort.
The bridge is cemented into position.
What are dental cleanings (scale and polish) and why have them?Dental cleanings involve removing plaque (soft, sticky, bacteria infested film) and tartar (calculus) deposits that have built up on the teeth over time. Your teeth are continually bathed in saliva which contains calcium and other substances which help strengthen and protect the teeth. While this is a good thing, it also means that we tend to get a build-up of calcium deposits on the teeth. This chalky substance will eventually build up over time, like limescale in a pipe or kettle. Usually it is tooth coloured and can easily be mistaken as part of the teeth, but it also can vary from brown to black in colour.
If the scale, or calculus (tartar, as dentists like to call it) is allowed to accumulate on the teeth it will unfortunately provide the right conditions for bacteria to thrive next to the gums. The purpose of the cleaning and polishing is basically to leave the surfaces of the teeth clean and smooth so that bacteria are unable to stick to them and you have a better chance of keeping the teeth clean during your regular home care.
Also it leaves your teeth feeling lovely and smooth and clean, which is nice when you run your tongue around them. Actually, come to think of it, there’s nothing worse than someone you fancy running their tongue around your teeth and finding a piece of spinach or something! Still, if they’re hungry…
The professional cleaning of teeth is sometimes referred to as prophylaxis (or prophy for short). It’s a Greek word which means “to prevent beforehand” – in this case, it helps prevent gum disease.
How are dental cleanings done?The dental hygienist or dentist uses specialized instruments to gently remove these deposits without harming the teeth. The instruments which may be used during your cleaning, and what they feel like, are described below.
Commonly used first is an ultrasonic instrument which uses tickling vibrations to knock larger pieces of tartar loose. It also sprays a cooling mist of water while it works to wash away debris and keep the area at a proper temperature. The device typically emits a humming or high pitched whistling sound. This may seem louder than it actually is because the sound may get amplified inside your head, just like when you put an electric toothbrush into your mouth.
The ultrasonic instrument tips are curved and rounded and are always kept in motion around the teeth. They are by no means sharp since their purpose is to knock tartar loose and not to cut into the teeth. It is best to inform the operator if the sensations are too strong or ticklish so that they can adjust the setting appropriately on the device or modify the pressure applied.
With larger deposits that have hardened on, it can take some time to remove these, just like trying to remove baked-on grime on a stove that has been left over a long time. So your cleaning may take longer than future cleanings. Imagine not cleaning a house for six months versus cleaning it every week. The six-month job is going to take longer than doing smaller weekly jobs.
Fine hand tools.
Once the larger pieces of tartar are gone, the dental worker will switch to finer hand tools (called scalers and curettes in dental-speak) to remove smaller deposits and smoothen the tooth surfaces. These tools are curved and shaped to match the curves of the teeth. They allow smaller tartar deposits to be removed by carefully scraping them off with a gentle to moderate amount of pressure. Just like taking a scrubbing brush to a soiled pot, the dental worker has to get the areas clean and smooth.
Once all the surfaces are smooth, the dental worker may polish your teeth. Polishing is done using a slow speed handpiece with a soft rubber cup that spins on the end. Prophylaxis (short for prophy) paste – a special gritty toothpaste-like material – is scooped up like ice cream into the cup and spun around on the teeth to make them shiny smooth.
Your dentist may also apply fluoride. This is the final, and my favorite part of the dental cleaning! Fluoride comes in many different flavours such as chocolate, mint, strawberry, cherry, watermelon, pina colada and can be mixed and matched just like ice cream at a parlour for a great taste sensation! Make no mistake though, this in-office fluoride treatment is meant for topical use only on the surfaces of the teeth and swallowing excessive amounts can give a person a tummy ache as it is not meant to be ingested.
Fluoride foam or gel is then placed into small, flexible foam trays and placed over the teeth for 30 seconds. Afterwards the patient is directed to spit as much out as possible into a saliva ejector. The fluoride helps to strengthen the teeth since the acids from bacteria in dental tartar and plaque will have weakened the surfaces. It is best not to eat, drink or rinse for 30 minutes after the fluoride has been applied.
Is it going to be painful?
Most people find that cleanings are painless, and find the sensations described above – tickling vibrations, the cooling mist of water, and the feeling of pressure during “scraping” – do not cause discomfort. A lot of people even report that they enjoy cleanings and the lovely smooth feel of their teeth afterwards! There may be odd zingy sensations, but many people don’t mind as they only last a nanosecond.
Be sure to let your dentist/hygienist know if you find things are getting too uncomfortable for your liking. They can recommend various options to make the cleaning more enjoyable.
Painful cleaning experiences can be caused by a number of things: a rough dentist or hygienist, exposed dentine (not dangerous, but can make cleanings unpleasant), or sore gum tissues.
In case you may have had painful cleaning experiences in the past, switching to a gentle hygienist/dentist and perhaps a spot of nitrous oxide can often make all the difference. You could also choose to be numbed. If you find the scaling a bit uncomfortable because the gum tissues (rather than the teeth themselves) are sensitive, topical numbing gels can be used.
What is Deep Cleaning?
Deep Scaling and Root Planing.
If plaque and tartar is left on the teeth, as we mentioned before, it provides the right conditions for bacteria to thrive. The bacteria irritate the gums, which means that they bleed more easily. You may notice this if you are brushing your teeth, or eating, and sometimes your gums may bleed a bit. This is the early stage of gum disease called gingivitis. If you have gingivitis, your dentist or hygienist will clean your teeth by scaling and polishing them. They may also recommend an antiseptic mouthwash containing chlorhexidine (e. g. Corsodyl in the UK, Eludril or Parodontax in EU) ), and show you how to brush and floss your teeth effectively. Most adults have some degree of gum disease.
If gingivitis not treated and nothing is done about it, the inflammation will work its way down towards the foundations of the tooth causing a “periodontal pocket”. Again, within the confines of the pocket, the conditions are such that the bacteria can have a right old party, and cause more damage.
Gum disease can break down the support (bone) structures of the teeth, so that eventually, they will become loose. The problem is that until it gets quite severe, the person often has no symptoms. Sadly, the damage to the support structures of the teeth is irreversible. The good news is that if gum disease is caught in time, its progression can be halted and improved upon, and that is the key.
To stop gum disease from progressing, your dentist may advise periodontal therapy, or deep cleaning. This gets rid of the bacteria in the pocket and provides the necessary conditions for healing to occur.
What is the difference between an ordinary cleaning and deep cleaning? There is some confusion about the difference between scaling and root planing. Scaling is basically the process of removing dental tartar from the surfaces of the teeth . Root planing is the process of smoothening the root surfaces and removing any infected tooth structure. If you have gum disease or gum pocketing, the gum pockets around the teeth will have deepened, thereby allowing tartar deposits to form under the gumline.
The two processes tend to blur together since during the cleaning process, the dental worker scales away tartar and performs any necessary root planing at the same time. Any roughness can be planed away to result in a silky smooth surface.
Does it hurt?
Depending on the depth of the pocket and severity of the root surface irregularity, the dentist may wish to make the area numb so that the process is comfortable for you. Don’t hesitate to discuss with your dentist or hygienist how to best manage any discomfort.
As an alternative to injectable anaesthetics, Oraqix might be an option to try with deeper pocket cleaning. It is a special non-injection device that delivers topical anaesthetic gel gently into the gum pockets thereby avoiding numbing of the lips and or tongue as can occur with injected local anesthetics. Oraqix mostly numbs the gum pocket itself so it may not be effective in eliminating sensations in the teeth themselves. Some offices may not have this device so it’s best to check with your dental office.
Sometimes if the pockets are not too deep, there may be little or no discomfort during the procedure – even without numbing. The only sensation may be the physical scraping feeling along the teeth as the area is cleaned and smoothened. A root planed root surface free of tartar has a better chance of allowing the gum tissues to heal and reattach to it. As a result, some deep gum pockets can be reduced after a deep cleaning.
How long does it take?
Typically with deeper pockets and extensive rough root surfaces, the deep scaling and root planing procedure might be broken down into quadrants of work per appointment. For example, the upper right side of the mouth might be worked on one day, and the three other parts worked on at separate appointments. Or alternatively, one half of the mouth (right or left, upper or lower) might be cleaned per appointment. This also allows for only a part of the mouth being frozen at a time and makes for more manageable, shorter appointments.
The dentist may use antibiotic gels within the periodontal pocket, again to remove any nasty bugs, or may rinse out the pocket with various medications such as chlorhexidine.
What can I expect afterwards?
Gum disease is a very common condition where the gums become swollen, sore or infected.
Most adults in have gum disease to some degree and most people experience it at least once. It's much less common in children.
If you have gum disease, your gums may bleed when you brush your teeth and you may have bad breath. This early stage of gum disease is known as gingivitis.
If gingivitis isn't treated, a condition called periodontitis can develop. This affects more tissues that support teeth and hold them in place.
If periodontitis isn't treated, the bone in your jaw may be damaged and small spaces can open up between the gum and teeth. Your teeth can become loose and may eventually fall out.
What causes gum disease?
Gum disease is caused by a build-up of plaque on the teeth. Plaque is a sticky substance that contains bacteria.
Some bacteria in plaque are harmless, but some are harmful for the health of your gums. If you don't remove plaque from your teeth by brushing them, it builds up and irritates your gums. This can lead to redness with bleeding, swelling and soreness.
Seeing your dentist.
You should make an appointment to see your dentist if your gums are painful, swollen or if they bleed when you brush your teeth.
Your dentist can carry out a thorough dental examination to check the health of your gums, which may involve inserting a thin metal stick with a bend in one end (periodontal probe) beside your teeth.
In some cases, a number of X-rays may be needed to check the condition of your teeth and jaw bone.
Preventing and treating gum disease.
Mild cases of gum disease can usually be treated by maintaining a good level of oral hygiene. This includes brushing your teeth at least twice a day and flossing regularly. You should also make sure you attend regular dental check-ups.
In most cases, your dentist or dental hygienist will be able to give your teeth a thorough clean and remove any hardened plaque (tartar). They'll also be able to show you how to clean your teeth effectively to help prevent plaque building up in the future.
If you have severe gum disease, you'll usually need to have further medical and dental treatment and, in some cases, surgery may need to be carried out. This will usually be performed by a specialist in gum problems (periodontics).
It's important to have regular dental check-ups so any problems with your teeth and gums can be detected and treated early.
If you've never had gum disease and have good oral health, you may only need to visit your dentist every one to two years for a check-up.
You may need to visit your dentist more frequently if you've had problems with gum disease in the past. At each appointment your dentist will advise when you need your next appointment.
If you have an increased risk of developing gum problems – for example, if you smoke or have diabetes – you may be advised to visit your dentist more often so your teeth and gums can be closely monitored.
Complications of gum disease.
If you have untreated gum disease that develops into periodontitis, it can lead to further complications, such as:
Recovering from wisdom tooth removal.
It can take up to two weeks to fully recover after having your wisdom teeth removed.
During this time, you may experience:
To reduce pain and aid your recovery, it can be helpful to:
It's usually recommended that you take a day or two off work after having a wisdom tooth removed.
You can drive immediately after the procedure if local anaesthetic was used, but you should avoid driving for at least 24 hours if a sedative was used, or 48 hours if the procedure was carried out under general anaesthetic.
Returning to normal.
After your wisdom teeth have been removed and any swelling and bruising has disappeared, your mouth and face should return to normal.
You'll usually be able to brush your teeth normally after a few days. Make sure you finish any course of antibiotics you've been given.
A check-up appointment may be arranged for about a week or so after the procedure. At this point, any remaining stitches may be removed.