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Dental Examination

What is it?

A dental examination shows how healthy your mouth is. After the examination, you and your dentist can discuss the results and plan the best way to deal with any problems.

What will my dentist do?

As well as looking in your mouth, the dentist will ask you some questions.

These may include the following:

• Why you’ve come for an examination.

• Any problems you’ve noticed (such as pain or sensitivity). Your general health and any medicines you might be taking (because these can affect your dental care).

• Your diet (because sugary snacks and drinks can cause tooth decay, and because a balanced diet is important to your general health and resistance to disease).

• How you clean your teeth (because correct cleaning helps prevent tooth decay and gum disease).

• Tobacco and alcohol use (because both can harm your mouth as well as your general health).

Some of the questions will depend on what the dentist sees in your mouth.

You should expect your dentist to:

• look at your face and neck to see that they are healthy

• feel under your jaw

• look inside your mouth, at your tongue, your cheeks and lips, the roof of your mouth and the back of your throat (places where there might be a problem that you can’t see or feel) look at your teeth and gums to see whether they are healthy or whether there are signs of decay, damage or gum disease (for children, your dentist will also look at tooth and jaw development in case orthodontic treatment might be needed now or later)

• compare your mouth now with how it was when they last saw you

• decide whether they need more information from X-rays, or from plaster models showing how your teeth bite together

• tell you about any treatment you need, explaining the choices and whether there will be any cost.

The examination may take longer if you are seeing a new dentist for the first time.

What are the benefits?

• Regular examinations mean that your dentist can spot problems and correct them early before the treatment becomes complicated.

• A thorough examination helps you and your dentist look after your mouth and prevent future problems. The dentist will explain the options and then you can decide together what will be best for you.

Supportive periodontal care (scale and polish)

What is scaling?

Scaling is the removal of hard deposits from the surfaces of the teeth. Scaling is carried out by a dentist, dental therapist or hygienist.

Plaque is a soft, sticky substance that builds up on your teeth. It is mostly made up of bacteria.

The bacteria in plaque feed on sugar from food and drink, producing acids as a waste product. The acids attack the teeth by dissolving the minerals in the tooth surface. If this happens too often, tooth decay results.

And, if plaque is allowed to build up, the bacteria in it can cause gum disease, making your gums sore and infected.

Tartar (also known as ‘calculus’), formed by hardened plaque, helps plaque to gather and makes it harder to remove when you brush. You can’t remove tartar just by brushing your teeth, but a dentist, dental therapist or hygienist can remove it using special instruments – this is known as scaling.

What is polishing?

A dentist, dental therapist or hygienist can also polish your teeth. This removes stains from coffee, tea, cigarettes or red wine; and it makes it more difficult for plaque to stick to your teeth.

If you clean your teeth very thoroughly at home, your scale and polish treatment will take less time.

What happens?

Dentists, dental therapists and hygienists use two types of precision instrument for scaling:

• Hand precision instruments are made of metal and come in different sizes and shapes, to reach different parts of the teeth. This is why you will see the dentist, dental therapist or hygienist changing instruments quite often.

• Sonic/ultrasonic precision instruments use a tip that vibrates very fast in a stream of water. The water is removed from your mouth using a small suction device. A hand precision instrument is also used along with a sonic/ultrasonic instrument, to check whether the teeth are completely clean.

For polishing, your dentist, dental therapist or hygienist will use a rotating brush or rubber polisher with a special toothpaste.

If you have periodontal disease, it may be necessary to carry out deep scaling (periodontal treatment) to clean root surfaces below the level of the gum. You may need a local anaesthetic prior to periodontal treatment.

Your dentist, dental therapist or hygienist will also tell you about the best way to clean your teeth and gums thoroughly at home.

Etch-retained restorations

What are they?

Many of the newer dental materials are adhesive, which means that they stick or ‘bond’ to teeth. The surface of the tooth needs to be made slightly rough so that the repair (the ‘restoration’) can grip properly. This is called ‘etching’ and your dentist will use a harmless mild acid. ‘Etch-retained restorations’ are any repairs attached to the tooth in this way – either fillings, veneers, inlays or onlays.

What will my dentist do?

Your dentist will:

• sometimes numb the tooth, but this is not always needed

• dab the etching acid onto the tooth surface that needs to be roughened

• leave the acid on the tooth for a short time while you keep your mouth open

• wash the tooth very thoroughly with a jet of water, which is sucked out of your mouth through a tube held by the dental nurse

• dry the tooth and check the surface (it might need to be etched again, in the same way)

• paint the ‘bonding agent’ (a sort of glue) onto the roughened area, before filling the tooth or applying some other sort of restoration.

What are the benefits?

• The bond between the tooth and the restoration can be very strong so that the restoration stays in place for a long time. .Even if the bond breaks, it may be possible to re-glue the restoration in place.

• Because restorations are held in place by the bonding agent and not just by the shape of the tooth, less of the natural tooth is lost.

Veneers

What are they?

A veneer is a thin layer of tooth-coloured material that is put onto the front of the tooth to make it look better. This is done because the tooth might have been damaged by decay or an accident, or might be badly discoloured for some reason.

What will my dentist do?

Veneers are usually made out of porcelain by a dental technician. You will have to visit the dentist more than once for this type of veneer.

• Your dentist will check any fillings in the teeth first.

• A very small amount of natural tooth material needs to be removed – just enough to prevent the veneer making the tooth look or feel bulky. For this reason, it may not be necessary for the dentist to numb the tooth.

• Preparation time will depend on how damaged the tooth is and whether it needs to be built up with a filling first.

• The dentist will need to use a putty0like material to make a mould of your moth (called an ‘impression’), so the dental technician can tell the shape and size of veneer to make for you.

• Your dentist will glue the veneer made by the technician to the tooth when you next visit.

• Veneers sometimes come away from the tooth or break if the tooth is knocked or if you clench or grind your teeth. They can sometimes be glued back on, but will have to be replaced if they are damaged.

• Occasionally, sensitivity or death of the nerve can occur.

Some veneers are built up on the tooth directly using the same material that is used for white fillings. The surface of the tooth is roughened with a mild acid. Then white filling material is applied in layers until the teeth look right.

Your dentist may recommend trying internal bleaching of the tooth prior to veneer placement. Sometimes this can lighten the tooth sufficiently so that a veneer is not required, or if the tooth is very dark, it can lighten the shade making it easier for the veneer to mask the discolouration.

What are the benefits?

• Veneers can greatly improve your appearance. They hide imperfections, and you lose very little natural tooth material.

• Veneers also protect teeth from any more damage. Tooth surface can be dissolved away by acid in the mouth (usually from too frequent consumption of certain kinds of food and drink); this can make teeth very sensitive to hot and cold. In this situation, veneers can protect the teeth.

If the tooth is strong, a veneer is often a better option than a crown for improving a tooth’s appearance.

Extraction

What is it?

A tooth which is very decayed or damaged, or loose because of gum disease, may have to be extracted (taken out of your mouth).

Wisdom teeth sometimes have to be extracted if they have come through at an awkward angle and are causing problems (such as decay in adjacent teeth or, being difficult to clean, causing infections).

Teeth are sometimes taken out from children’s mouths to help other teeth which are crowded to grow straight, usually on the advice of an orthodontist.

What will my dentist do?

Some teeth are easier to take out than others. A local anaesthetic (an injection in your mouth) will be used to numb the tooth before it is extracted; this is the best treatment for most patients.

In some cases, for children or nervous patients, or where a tooth might prove difficult to remove, sedation (something to make you relaxed) with a local anaesthetic may be used. On rare occasions a general anaesthetic may be considered. If a general anaesthetic is needed, you will have to go to a hospital or a specialist treatment centre (you are likely to be able to go home the same day, but not all patients are able to do so).

After working out the best way to take the tooth out, your dentist will discuss with you:

• how to minimise what you feel while the extraction is happening

• whether you should bring someone with you if you are to have sedation or a general anaesthetic

• when it would be convenient for you to have the tooth removed

• you might also discuss other treatment you might need – for example, whether you may require a denture

While the tooth is being taken out…

You may hear some noise and feel some pressure as the tooth is being eased out – but you should not feel pain. Sometimes stitches are put into the gum to minimise any post extraction bleeding, to make the area more comfortable and help it heal quickly.

Afterwards…

You may need a day or so off work to recover, depending on how difficult the extraction was and whether sedation or a general anaesthetic was used. Most people experience very little post-operation discomfort. The dentist will ensure that bleeding has stopped before you leave the practice. You should not smoke or drink for at least 24 hours after an extraction.

The dentist will give you advice on:

• how to look after the space where the tooth was while it is healing

• which painkillers are suitable to use so you are not in any discomfort when the anaesthetic wears off

• how to contact the practice if there are any problems

Tooth coloured fillings

What are they?

A filling replaces part of a tooth that has been lost because of decay or through accidental damage.

You may hear the dentist talk about ‘composite’, ‘glass ionomer’ and ‘compomer’ – these are different types of tooth coloured filling material.

What will my dentist do?

Your dentist will:

• Usually numb the tooth and adjacent area with an injection – some small fillings may not need this.

• Remove any decay, together with any old filling material, and shape the cavity using a small, high-speed drill.

• Wash and dry the tooth by blowing water and then air onto it.

• Use one of a variety of means to isolate the tooth and keep it dry.

• Apply a special adhesive to the tooth, typically in two or three stages, and then place the filling, again in stages.

• Harden the filling material between stages of the filling procedure, by the use of a bright light shone inside the mouth – this is called ‘curing’.

• Trim the filling as necessary and then polish it, checking that you can bite together comfortably.

What are the benefits?

• A tooth needs less drilling for a tooth coloured filling than for a silver filling.

• Unlike silver fillings, tooth coloured filling materials, which come in different shades to match different coloured teeth, are glued into place, sealing the filling and helping to strengthen the remaining part of the tooth. Tooth coloured filling materials can be used in most situations, including the filling of back teeth and making front teeth look better.

• When used in back teeth, tooth coloured fillings look better than silver fillings, but take longer to place, partly because they are finished and polished in one visit. Tooth coloured fillings may not wear as well as silver fillings but they do have the advantage that they can be repaired, rather than replaced, as and when something goes wrong.

• The longevity of tooth coloured fillings is greatly extended by good oral hygiene.