dentistry

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.

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.

Fissure sealants

What are fissure sealants?

Fissures are grooves usually found in the chewing surface of back teeth. They are difficult to keep clean so there is more risk of decay. Fissures can be sealed with tough plastic to protect them.

The plastic is runny at first but sets hard, like paint Sealants may be see-through or tooth-coloured. They are normally only used for children and only on permanent teeth, not on milk teeth.

Your dentist will discuss whether your child needs sealants. If they do, you will also have to agree which teeth need to be sealed. The need for sealants will depend on:

• the shape of each tooth;

• how much a child’s teeth have already decayed;

• how much decay a brother or sister has had (because there can be family patterns in tooth decay); and

• a child’s general health (because general health problems can make it especially important to avoid dental problems).

What will my dentist do?

The dentist will:

• clean the tooth thoroughly with a rotating brush or rubber polisher

• dry the tooth and keep it dry by putting cotton wool round it and using suction

• dab a mild acid on the tooth and leave it for a short time to make the tooth surface rough (this will not hurt at all)

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

• change the cotton wool rolls around the tooth to keep it dry

• paint the plastic onto the fissures

• harden the plastic by pointing a bright light at it (you will see the dentist and dental nurse protecting their eyes)

• check that the tooth is comfortable to bite on

• trim the sealant

What are the benefits?

• Fissures sealants protect teeth from decay.

• They can last for years. Or, if they fall out or wear out, they can usually be replaced if there is no decay underneath.