Treatments

A dental examination is a direct inspection of the teeth and the soft tissues of the mouth, assisted by special tests such as X-rays and other diagnostics.

It is followed by a diagnosis of any dental disease, a presentation of your treatment options, then planning, treatment, follow-up and maintenance.

Examination is free if you are covered by PRSI.

A scale and polish removes the plaque (a soft, sticky film full of bacteria) and tartar (calculus) that build up on the teeth over time. It leaves the surfaces of your teeth clean and smooth, so bacteria are less likely to stick to them and your teeth are easier to keep clean at home.

Teeth are continually bathed in saliva, which contains calcium and other substances that help strengthen and protect them. This is a good thing, but it also means teeth tend to collect calcium deposits. This chalky substance builds up over time, like limescale in a pipe or kettle. It is usually tooth-coloured and easily mistaken for part of the tooth, but it can also vary from brown to black.

If plaque or calculus is allowed to build up, it creates the right conditions for bacteria to thrive next to the gums.

Treatment of gum disease is based mainly on a thorough deep cleaning of the affected teeth, both above and below the gum line. This usually means treating the mouth one section at a time, numbing the teeth to be cleaned with local anaesthetic first.

Advanced gum disease is a chronic condition that needs ongoing monitoring and treatment as necessary. Prevention, through good home care and regular professional monitoring, gives the best results.

About gum disease:

• Gum disease, also known as periodontal disease, is a chronic bacterial infection that affects the gums and the bone supporting the teeth.
• It is a serious infection that can lead to tooth loss if left untreated.
• Gum disease can affect one tooth or, more commonly, many teeth. It begins when the bacteria in plaque cause the gums to become inflamed.
• While the main cause of gum disease is bacterial plaque, other factors can also affect the health of your gums. Recent studies indicate that tobacco use is one of the most significant risk factors in the development and progression of gum disease.
• Other risk factors include stress, poor nutrition, clenching or grinding your teeth, diabetes, certain medications, pregnancy and genetics.
• In the earliest form of gum disease, known as gingivitis, the gums redden, swell and bleed easily, but with little or no discomfort. This stage is often caused by inadequate oral hygiene, and it is reversible with professional treatment and good oral care at home.
• Untreated gum disease can advance to periodontitis. At this stage, plaque and tartar spread and grow below the gum line. As this develops, deep pockets form and more gum tissue and bone are destroyed.

A filling is a restorative material used to restore the function and integrity of missing tooth structure. The loss of tooth structure that calls for a filling usually results from decay or external trauma.

The most commonly used filling materials are composite (tooth-coloured) and metal (amalgam). Each has advantages and disadvantages, and there are also other, less commonly used materials.

A root canal is the space within the root and top of the tooth that contains nerve tissue. Root canal treatment is a dental procedure in which the nerve is removed from the tooth, and the root canal is then disinfected and filled.

The procedure is relatively routine and successful. It is carried out for a variety of reasons, such as infection, trauma and occasionally as part of a restorative procedure. Afterwards, the tooth will need further treatment, such as a filling or crown, to restore its structure.

Dental crowns, also known as ‘caps’, preserve the function of damaged teeth. A crown may be used to protect a cracked tooth, restore a tooth with excessive decay, or replace an existing crown. It encases the tooth in a custom-designed material.

There is usually a variety of more conservative ways to restore a tooth. Ideally, these should be explored and discussed before choosing a crown.

A bridge (also known as a fixed partial denture) replaces a missing tooth or teeth. Artificial teeth are made in a laboratory to fit the gap and match the neighbouring teeth, and are permanently attached to the teeth or implants on either side of the gap.

There are different types of bridge, depending on how they are made and how they anchor to the neighbouring teeth. They include porcelain fused to metal, porcelain only and metal only. Bridges are normally made in a dental laboratory by a technician, working to instructions from the dentist.

Preparing for a bridge involves some reduction of the teeth on either side of the gap. How much depends on the type of bridge, the cosmetic needs of each situation, and the way the teeth meet the teeth of the opposite jaw. Depending on the circumstances, old fillings in these teeth may need to be replaced, and occasionally a tooth may need to have its nerve removed.

If you have a bridge, take good care of it: the teeth supporting it can still develop problems such as tooth decay and gum disease.

A dental implant is an artificial tooth root, placed in the bone, that supports a restoration resembling a tooth or group of teeth, such as a crown, bridge or denture.

Placing the implant is a minor oral surgical procedure, and is typically painless. From placing the implant to fitting the final restoration can take 8 – 16 weeks.

Dentures replace missing teeth and are supported by the surrounding soft and hard tissues of the mouth. Conventional dentures are removable.

There are many different denture designs. Some rely on clasping onto teeth, or on attachment to dental implants, to stay in place.

Teeth whitening is a common procedure in general dentistry. Teeth can become stained and discoloured by bacterial pigments, food and drink, tobacco, and the changes that happen in tooth enamel over time. Whitening can reverse these effects and brighten teeth beyond their original natural colour.

Whitening will not change the colour of fillings, crowns, veneers or any other artificial material used to restore teeth. It can fade over time; if you have ‘at home’ whitening trays, you can top up by repeating the whitening for a short time. Tooth whitening does not damage normal teeth.

A veneer is a thin layer of restorative material placed over the surface of a tooth, to improve its appearance, to protect a damaged surface, or both.

Veneers are made from one of two main materials: dental porcelain or composite resin. A composite veneer may be built up directly in the mouth, or made by a dental technician. Porcelain veneers are made in a dental laboratory. They are the most commonly used veneers, and give better, more predictable and longer-lasting results.

Teeth are extracted for a wide variety of reasons. A typical extraction involves numbing the relevant part of the mouth with local anaesthetic, then gently removing the tooth using the most suitable instruments and methods.

Occasionally an extraction is more complicated and needs more time and work. If the problem is particularly difficult, or the patient is apprehensive, sedation (‘twilight sleep’) can be offered. It leaves the patient considerably relaxed and sleepy, usually with very little or no recollection of the procedure.

Reasons for extracting teeth include:

• Severe tooth decay or infection. Despite a worldwide fall in tooth decay, it is still the most common reason for extraction, accounting for up to two thirds of extractions.
• Severe gum disease, which may affect the supporting tissues and bone of the teeth.
• Preparation for orthodontic treatment (braces).
• Extra teeth that are blocking other teeth from coming in.
• Fractured teeth.
• Not enough space for wisdom teeth (impacted third molars). Although many dentists remove impacted third molars that cause no symptoms, American and British health authorities have recommended against doing this routinely, unless there is evidence of disease in the impacted tooth or the area around it.
• Teeth in a fracture line in the jaw.
• Radiation treatment to the head and neck, which may require extraction of teeth in the field of radiation.

Third molars, commonly called wisdom teeth, usually appear between the ages of 17 and 25. Most adults have four wisdom teeth, but it is possible to have more or fewer. Humans are gradually losing their wisdom teeth, and some people never develop them.

If there is not enough room for a wisdom tooth, it may become impacted, or ‘stuck’. This can lead to problems such as infection or damage to the tooth in front, and impacted wisdom teeth may also play a role in orthodontic problems. They are often extracted when these problems occur.

Traditionally, many were done in hospital under general anaesthetic, but in experienced hands they can be performed safely in a general dental clinic under IV sedation. Extracting wisdom teeth is not without risk, and needs a careful assessment beforehand, including X-rays, which we discuss with you.