Dental implants

What are they?

Implants are one way of replacing missing teeth.

Unlike other forms of replacement teeth, dental implants are small metal (mostly titanium) devices not unlike a screw fitting which are inserted into the jaw during surgery. Teeth, in the form of a crown or bridge are often then attached to the implant, or the implant can be used to support dentures.

What are the benefits?

Some people have real difficulties with removable dentures. Implants can overcome these difficulties, in particular for eating and speaking properly and they may improve appearance. If a denture is necessary, implants can greatly improve stability. People will not be able to see that your teeth are supported by implants. Implants can be used in place of bridges, for example when adjacent teeth are intact or may not be strong enough to support a bridge.

Are implants for me?

Your dentist should discuss with you whether implants would be right for you, and explain any associated risks.

Patients need to have healthy gums, and enough jawbone to take the implant that supports the replacement teeth although techniques are available to add (graft) additional bone if needed. Patients must also be prepared to maintain very good oral hygiene and visit the dentist regularly. Implants, like teeth, may be lost if mouth hygiene is poor.

Implant patients need to be in good general health. Some chronic diseases, such as diabetes, osteoporosis, or chronic sinus problems, could interfere with healing and make implants more likely to fail.

Make sure that you tell your dentist about any medicines that you take regularly, and about your smoking habits. Smoking may well shorten the life of your implant.

Implants involve treatment over a period of several months. Since they are a complicated form of treatment, implants can be expensive.

What will my dentist do?

Your dentist should tell you about the stages of treatment, who would be carrying out each stage and the timetable for completing treatment. You might be referred to a specialist.

This is what will happen:

  • Bone is exposed in the jaw where the tooth is missing. Then a hole is drilled and the implant is inserted into the bone. This is usually done under a local anaesthetic, but sometimes sedation or a general anaesthetic is necessary. The gum is then stitched over the implant and it’s left to heal for several weeks. This allows bone to grow around the implant and to make it secure.
  • A second procedure is then planned, in which replacement teeth are mounted into the implant. This requires a small cut in the gum above the implant. Once the soft tissues have healed, the replacement teeth may be fixed permanently or attached in a way that lets you remove them for cleaning. The replacement teeth may be single or in a group, and possibly as a ‘bridge’, attached to neighbouring natural teeth.
  • There may be circumstances in which an implant can be placed during the same visit when the tooth is removed.
  • More and more implants are being ‘loaded’ after placement rather than covered by the gum to heal. Please discuss this with your dentist.
  • Maintaining good oral hygiene is important to prevent dental decay and gum disease, which may affect crowned teeth.

Speak to your local Clear Dental Practice to learn more.

Removable dentures

What are they?

A removable denture replaces missing teeth. ‘partial’ dentures replace a few missing teeth, or ‘full’ or ‘complete’ dentures are needed if all the natural teeth are missing.

Complete dentures are made of acrylic (plastic). Partial dentures can also be made wholly of acrylic. Alternatively, they may consist of acrylic teeth on a light metal alloy base: this type of partial denture is more secure, stronger and less bulky, but also more expensive.

What will my dentist do?

  • The dentist uses a putty-like material to make moulds of your mouth – called ‘impressions’. A dental technician uses them to make models for the denture to be built on. Second impressions may be taken to provide a more accurate fit.
  • The technician makes wax blocks which fit the models. The dentist puts these in your mouth to record the position of your jaws in relation to each other. The dentist then trims and seals the wax blocks to show the technician how your teeth should bite together, and the shape to make the denture.
  • A trial denture is made and put in your mouth. The dentist will ask you how it fits, feels and looks before making any final changes.
  • The trial denture then goes back to the technician who permanently fixes the teeth. The next visit consists of placing the finished denture in your mouth, adjusting the final fit and providing instructions on how to look after your dentures.
  • The denture is then ready to sue. The dentist will want to see you again fairly soon to see how you are getting on with the denture. If there are problems, they can make small adjustments.
  • It is usual (unless you are exempt from charges) that the dentist will expect payment for the denture before placing in your mouth

What are the benefits?

  • If you have lost some teeth, dentures can improve the way you look, bite, chew and speak.
  • They are custom-made to match your mouth and can be made to look as natural as possible.
  • The teeth that are left are protected from wear and tear. Without dentures, the natural teeth may more or tilt, stopping your teeth biting together properly.
  • Dentures can be fitted immediately after front teeth have been taken out so that nobody will know you have a tooth out. These are called ‘immediate’ dentures. Immediate dentures will gradually lose their fit over six to 12 months and the dentist will need to see you during this time. Further visits will involve possible relining of the denture to improve the fit. After six to 12 months, the healing process will have settled down and the new denture will be made. Both relining and new dentures may lead to extra costs.

Dentures will never feel like your own teeth, and it can take time to get used to them. If you haven’t had a denture before, the dentist will want to explain the difficulties of wearing dentures, as well as the benefits and how you should look after your new dentures and the teeth you have left. Good oral hygiene is important to maintain the teeth supporting your dentures.

Speak to your local Clear Dental Practice to learn more.

Root planning / curettage

What is gum disease?

Gum disease is a complex condition affecting the gums and bone supporting your teeth. Several factors contribute to it, including family history, smoking and chronic diseases such as diabetes.

It begins with plaque, a soft, sticky substance, that builds up on your teeth. Plaque is mostly made up of bacteria, which feed on sugar from food and drink. Tartar, formed by hardened plaque, helps plaque to gather and makes it harder to remove.

If plaque is allowed to build up, the bacteria in it can make your gums sore and infected; they will look red and puffy and hey will probably bleed when you brush your teeth.

The gum will then start to become detached from the tooth, forming ‘pockets’ in which plaque can gather – and bone supporting the tooth will slowly be lost. Because this process is usually painless, it can become very bad without you noticing.

If left unchecked, gum disease will lead to the loss of teeth.

What is root planing / curettage?

Root planing is a way of helping to halt gum disease. It involves ‘deep’ scaling, to clean parts of teeth below the gumline, which cannot be reached with a toothbrush. Root planing cleans out the pockets, and removes plaque and tartar from the tooth roots.

What does the dentist or dental hygienist do?

Dentist and hygienist use two types of instrument for root planing:

  • Hand scalers come in different sizes and shapes to reach different parts of the teeth. This is why you will see the dentist or hygienist changing instruments quite often.
  • Electric scalers 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 scaler is also used along with an electric scaler, to check whether the roots are completely clean.

After a tooth has been root planed, the pocket should shrink, making the gum sit closer to the tooth. You then need to be especially careful about cleaning the teeth above the gumline. Root planing will probably need to be repeated regularly.

Root planing usually takes longer than a normal scale and polish, and is often done under a local anaesthetic. Your mouth might be treated in sections, at more than one visit.

Points to remember:

  • Root planing can help stop gum disease becoming worse and prevent tooth loss
  • Like scaling and polishing, root planing helps you to keep your teeth and gums clean at home.
  • To reduce the risk of your gum disease progressing, do not smoke, and eat a healthy, balanced diet.
  • Dentists and dental hygienists cannot keep your moth healthy by themselves. Your own cleaning is the key.

Speak to your local Clear Dental Practice to learn more.

Keeping a denture or bridge clean

Why is cleaning important?

Just like natural teeth, dentures and bridges collect bits of food, plaque (a sticky deposit, mostly made up of bacteria) and tartar (hardened plaque). By keeping them clean, you can stop decay in any remaining natural teeth and help prevent gum disease (which can lead to tooth-loss). It’s also good for your comfort and appearance to clean dentures, as dirty dentures can make your mouth swollen and sore.

Cleaning a denture is quite easy because, of course, you can take it out of your mouth. Cleaning all round and underneath a fixed bridge is harder. Your dentist or hygienist will show you how to do it.

How do I look after a denture?

  • Clean the denture over a basin of water so that it doesn’t break if you drop it.
  • Brush the denture inside and out every day. Use a soft-to-medium brush so that you do not scratch the denture. Use your normal toothpaste, or soap and water. Then rinse the denture.
  • Ask your dentist about denture-soaking solutions. Soaking a denture will not clean it. You also need to brush it. Rinse the denture before you put it back in your mouth.
  • Ideally, denture should be left out of the mouth for at least four to six hours, preferably eight hours, in every 24. However, if you find this impractical or embarrassing, you should still make sure you clean your dentures by brushing with toothbrush and toothpaste.
  • Keep a denture dry or in a denture-soaking solution when you are not wearing it. These solutions are mild disinfectants available at all chemists’ shops.

How do I clean a bridge?

  • How you clean will depend on where the bridge is in the mouth and its design. As well as normal brushing with a fluoride toothpaste and flossing at each end of the bridge, you need to keep the bridge clean underneath.

You might use:

  • Floss with a threader or a special floss with a stiff end which you can poke underneath the bridge and pull through
  • ‘Bottle brushes’ (your dentist will tell you what size and shape to buy) or
  • Water jets – sending a stream of water under the bridge

What are the benefits?

  • By keeping a denture or bridge clean, you help keep your gums and teeth healthy and avoid bad breath.
  • People who wear dentures sometimes get an infection called oral thrush. Thrush is more likely if you wear the denture all the time.

Good denture hygiene is important for preventing oral thrush.

Speak to your local Clear Dental Practice to learn more.

Tooth erosion

What is it?

Acids in the mouth can dissolve away tooth surfaces. Given the chance, teeth with repair themselves, using minerals from saliva. But if acid is in the mouth too often, teeth cannot repair themselves and the hard tooth surface (the enamel) becomes thinner – this is called ‘erosion’.

The teeth can then become extra sensitive to hot and cold food and drink. Eroded teeth can also be likely to suffer decay. The appearance of eroded teeth can also change: they can become discoloured (translucent or yellowish), and their shape can be altered.

The main cause of erosion is too frequent consumption of certain kinds of food and drink. All fizzy drinks (including ‘diet’ brands and fizzy mineral water), all ‘sports’ drinks, all squashes and all fruit juices are acidic to varying degrees. Pickles and citrus fruits are examples of acidic types of food.

Some medicines are acidic and, therefore, erosive.

And people with some illnesses (such as eating disorders) may suffer from erosion because of frequent vomiting, as stomach acids also erode teeth. For this reason, dentists may ask about eating disorders if they see teeth are very badly eroded.

How do I prevent erosion?

Don’t have acidic and/or drink too often during the day. Try to have them only at meal-times and drink acidic drinks quickly – don’t sip them. And don’t swash them around your mouth.

Between meals you should only have ‘safe’ drinks, which are not sugary or acidic. Milk and water are ‘safe’ drinks. So are tea and coffee if you do not add sugar to them (you can use non-sugar sweeteners).

You should try and avoid snacking between meals. If you do snack, only have ‘safe’ snacks, which are not sugary or acidic.  Fruits, vegetables and products such as sandwiches, toast, crumpets and pitta bread are all ‘safe’ snacks. You should try and avoid snacking between meals. Some fruits, especially citrus fruits, are acidic and are known to cause erosion if they are consumed in large quantities. This is not normally a problem for most people; however, you could discuss with your dentist or hygienist the safest way to enjoy these fruits.

Because acids temporarily soften the tooth surface, don’t brush your teeth immediately after eating or drinking something acidic. This will allow time for your salvia to neutralise the acid.

How can my dentist help?

Your dentist can identify erosion, pinpoint the causes and advise how to avoid further damage.

Speak to your local Clear Dental Practice to learn more.

Silver fillings

What are they?

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

Silver fillings are made of dental amalgam – a mixture of mercury with other metals, including silver, tin and copper. Amalgam is soft at first, but quickly becomes hard once placed in the tooth. Dentists use amalgam because it is tough and safe. However, there are alternatives to amalgam such as white fillings.

What will my dentist do?

Your dentist will:

  • usually numb the tooth and surrounding area with an injection – some small fillings may not need an anaesthetic.
  • Remove any decay, together with any old filling material, using a small, high-speed drill.
  • Remove any weak part of the tooth that might break later.
  • Shape the cavity, so that the tooth will hold the filling in place.
  • Possibly cut a cement lining in the bottom of the cavity before inserting the filling.
  • Pack soft amalgam tightly into the cavity – you might hear a squeaking noise as it goes in. The dentist might put a thin metal band around the tooth prior to packing the amalgam to help control the shape of the filling.
  • Carve the filling to fit the tooth.
  • Ask you to close your teeth together gently, to check that the filling is the right height and is comfortable.
  • Make any necessary small adjustments to the filling at the next visit.

What are the benefits?

  • A filling rebuilds the tooth so you can chew.
  • If decay is left unchecked, it can spread deep into the tooth, causing pain and infection. This could mean the tooth has to be root filled or even taken out.
  • A filling can prevent further toothache or discomfort.
  • Silver fillings are very strong and perform well in back teeth, where there is heavy wear from chewing. They do, however, have the cosmetic drawback of not being tooth coloured. Tooth coloured filling materials, which look better, require less drilling and can be repaired, are also available, but take longer to place and may wear less than silver fillings. Silver fillings are best used when existing silver fillings need to be replaced and in situations where the use of a tooth coloured filling material is difficult.

Speak to your local Clear Dental Practice to learn more.