dentist jobs

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.

Fixed bridges

What are they?

A bridge fixes a replacement tooth (or teeth) to one or more remaining natural teeth or implants. Some bridges have crowns at each end. Others are fixed to the surface of the teeth next to the gap. Sometimes a bridge is only fixed to the tooth on one side of the gap.

Bridges are made of metal and porcelain or sometimes just porcelain.

What will my dentist do?

There are several stages in making a bridge:

• The dentist uses a soft, mouldable material to take impressions of your mouth. A dental technician makes exact plaster models of your uppper and lower teeth and gums, which show how your teeth bite together.

• The teeth that will support the bridge are prepared to take the fixings and to make sure that the bridge is not too bulky.

• Another impression is taken of the teeth and any gaps, and the dental technician uses this to make the bridge. A plastic temporary bridge or temporary crown may be fitted in the meantime.

• At your final visit, the dentist will check that the bridge fits, make any minor adjustments and then fix it permanently in place. Your dentist or hygienist will show you the best way of keeping your new bridge clean.

What are the benefits?

• A bridge lets you almost forget that you have missing teeth.

• It can improve the way you look, bite, chew and speak.

• The teeth can be matched to the colour of your own teeth.

• A bridge can last many years if you keep it and the adjacent soft tissue clean and if there is no accidental damage.

• Natural teeth are protected from wear and tear, and from moving or tilting out of line, which could cause your teeth to bite together incorrectly.

Other options…

It may be possible to restore small spaces with one or more dental implants. This has the advantage that adjacent teeth do not need to be cut, but the disadvantage that a surgical procedure is required, and treatment time may be extended. Implants are not widely available within the NHS, apart from in certain situations.

Another option for a small space could be a ‘minimum preparation bridge’, where the false tooth is held in place with a wing that is bonded onto adjacent teeth. This involves less destruction of tooth tissue but can require repair or replacement.

Longer, or multiple, spaces may be restored with acrylic or metal partial dentures. These are removable and so are easier to keep clean; it’s also easier to clean the adjacent natural teeth. However, some patients find dentures difficult to tolerate.

Tooth whitening

What is it?

Like hair and skin, teeth vary in colour. Some are yellower or darker than others, even when they are quite healthy. teeth tend to get darker as people get older.

Teeth sometimes become darker if their roots have been damaged or diseased and the ‘nerve’ has died.

Tooth colour can be very effectively lightened with Hydrogen Peroxide (bleach), used on either the outside or the inside of the tooth.

Tooth bleaching is safe as long as the bleach does not touch your gums and burn them. Dentists use a special jelly bleach.

Tooth whitening should only be carried out by a trained dental professional.

What will my dentist do?

Where the ‘nerve’ of a tooth has ‘died’ (through damage or disease) and the tooth’s root has been filled, bleach is put inside the tooth, under a removable try or temporary dressing. This can take from a few days to a week.

There are two ways of bleaching the outside of teeth. One takes place at home and the other in a dentist’s surgery.

Home bleaching works like this:

  • The dentist will give you weak bleach jelly to use at home in a tray which fits closely round your teeth. The tray makes sure that the jelly does not burn your gums. You will need to put the tray in your mouth overnight (for a few hours) on several occasions, as instructed by your dentist (probably over a period of weeks)
  • The dentist will need to use a putty-like material to make moulds of your mouth (called ‘impressions’), so a dental technician can make the tray to fit. At your next appointment, your dentist will check that the tray fits and show how you put the bleach in the tray at home.

Bleaching in the surgery looks like this:

  • Your dentist (or dental care professional) will use a stronger bleach jelly than is used for home bleaching. Dentists use this method to bleach all the teeth at the same time in either your upper or lower jaw. The strong bleach will touch the teeth for less time than with home bleaching
  • The dentist should protect your gums. They will paint the bleach onto the teeth and either shine a special light at them or just leave the bleach on the teeth for some time
  • The bleach is then washed off with water.

For both techniques, your dentist will make a note of your tooth colour using model teeth in different shades before they treat you. Look at the colour match yourself before the treatment, so you can compare it with the colour after bleaching. Occasionally bleaching can cause your teeth to become more sensitive to hot, cold and sweet things. Should this occur, stop bleaching for a night or two if you are using the nightguard bleach, and use desensitising toothpaste. If the problems persists, see your dentist.

Over-bleaching can also lead to sensitivity or less of vitality (where the tooth dies) which is why it is essential for the procedure to be carried out by a trained dental professional.

What are the benefits?

Bleaching improves the appearance of your teeth without removing any of the natural tooth surface. Bleaching is a better option than a crown or veneer if you want to lighten the colour of healthy teeth, as the placing of crowns and veneers involves changing the shape of the tooth.

Speak to your local Clear Dental Practice to learn more about tooth whitening.

Periodontal (gum) diseases

What are they?

The simplest form of gum disease, gingivitis, is often a reaction to a build up of plaque on the junction of the gum and the teeth. Plaque is a soft, sticky film of bacteria, which grow on the warm, moist surface of the mouth. Plaque builds up in difficult to clean areas, especially below the contact areas between teeth. It is important to clean these areas daily with interdental brushes or dental floss.

The earliest sign of disease is bleeding of the gums. They may also look red or swollen. Gingivitis can often be cured simply with good mouth hygiene- brushing twice a day, together with interdental cleaning, as advised by a dental healthcare professional, and the use of clinically proven mouthwash. If your gums become infected or sore and you notice an unpleasant metallic taste, this is acute gingivitis and you should seek urgent treatment.

As gum disease progresses the tissues holding teeth in place start to break down and pockets (gaps) develop between gum and teeth. This allows even more plaque to gather. This stage is called chronic periodontitis. It is usually painless and can become quite severe if not treated resulting in teeth becoming loose, appearing to move position or eventually to fall out.

Symptoms to watch out for are:

  • bleeding gums
  • gums that have come away from teeth
  • pus between the teeth and gums
  • persistent bad breath or a bad taste
  • Permanent teeth that are loose or are changing position

Scaling and polishing by a dentist or hygienist can remove tartar and stains. This will help you to remove the plaque efficiently.

In more severe cases of gum disease, deep cleaning below the gumline by a dentist or hygienist may be neccesary. Occasionally surgery is required in which the gum is reshaped under local anaesthetic tro allow affected areas to be treated or cleaned.

If gum disease has progressed too far, the tooth or teeth involved may have to be removed.

Who gets gum disease?

Gum disease can start when you are a child, but chronic periodontitis is normally only a problem in adults.

Some people are more likely to have periodontal disease than others:

  • smoking makes gum disease considerably worse. Quitting smoking is important for your general and mouth health
  • diabetes and some other diseases reduce people’s resistance to gum disease. People who have these conditions need to be especially careful about their mouth hygiene
  • certain drugs and medicines can affect your gums: ask your dentist about these
  • crooked teeth are more difficult to keep clean, so the gums supporting such teeth might be more prone to gum disease
  • existing gum disease can be worsened by hormonal changes, due to pregnancy or oral contraceptives (‘the pill’). Here again, good hygiene is important
  • eating a healthy diet with plenty of fruit and vegetables helps resist gum disease
  • untreated gum disease can adversely affect your general health and wellbeing

Speak to your local Clear Dental Practice to learn more.