General Dentistry

General Dentistry Services

White Fillings

White fillings are also known as composite fillings. They are tooth coloured and are highly aesthetic in appearance. Hence, many people prefer them to amalgams.
These fillings can be used to restore badly stained teeth, to close up gaps between teeth and improve the shape and size of the tooth They can be used for small restorations in back teeth. However, they are not as suitable for large restorations, especially those subject to heavy biting forces. This is where cerec onlays and inlays are more preferable.

Crown & Bridges

CROWNS

The outside of the tooth is made of enamel, an extremely hard substance. However, through a fall, the tooth may chip or break. Tooth decay may weaken a tooth to the extent that it is highly compromised. A root treated tooth is also weakened . Teeth may also wear down over time.

In all these cases, a crown is often necessary to save the tooth and return it to normal functionality and aesthetics. A crown fits over the existing tooth.

BRIDGES 

Bridges replace one or more missing teeth. Should the tooth become too badly decayed to save or if the tooth was knocked out as in a fall or a fight, then a bridge may be the treatment of choice. With a bridge over a gap, the teeth on either side are crowned and a pontic or an artificial tooth takes the place of the missing tooth.

Crowns and bridges are made of porcelain and gold alloy. Porcelain is strong and can be made to match the colour of the teeth. It is resistant to staining and can be cleaned if it becomes stained.

Gold alloy is used for its strength, hardness and durability. It is used for molars which must withstand the grinding and crushing forces. Both the gold alloy and porcelain are well tolerated in the mouth.

The purpose of crowns and bridges is to replace the missing teeth. This in turn:

 improves chewing ability
improves appearance
prevents the teeth from either side from tilting into the gap and
maintains the natural bite
 prevents stresses to other remaining teeth
Please Note: Appointments are required for the preparation and the fitting of the C&B.

Dental Implants

Modern dentistry can replace missing teeth in much the same way as medicine replaces damaged body parts such as knee and hip joints. Dental implants are very popular these days. 
If there is only one missing tooth and the two adjacent teeth on either side are perfectly good, the best solution would be to have an implant to close up the gap. One requirement for an implant is that the remaining bone in the jaw must be of sufficient quality and thickness to take the implant.

As holes have to be drilled into the jaw bone to receive the cylinder shaped titanium implant, care is taken to avoid areas where major nerve and blood vessels are found. For this reason, in the lower jaw, implants are usually placed only in the front part, just behind the lower lip.

Once the titanium implant has been placed in the jaw bone, the overlying gum is sewn back over it and it is left embedded in the jawbone for 3 to 6 months. This gives the implant sufficient time to permanently attach itself to the jawbone. At the end of this period, the gum tissue is cut away and the implant re-exposed. A special post is then screwed into the implant and it then serves as a foundation for a crown or bridge to be attached.

Dental implants offer teeth that look, feel and function like natural teeth. Once the procedure is completed and if oral hygiene is maintained, the implant can last indefinitely. Success rates are over 97%.

Loose and uncomfortable dentures are now been replaced with implants as they feel more secure, thus causing a lot less embarrassment. 

Tooth Bonding

This is a procedure where the tooth coloured material is bonded or “stuck” onto the surface of the tooth. It is used to improve the appearance of chipped, stained and heavily filled front teeth. It is also used to close up small gaps between the front teeth and improve the appearance of slightly crooked ones.

The dentist cleans the tooth thoroughly, then conditions it by applying a mild acid etch. The acid opens up microscopic pores in the surface of the tooth and the tooth coloured resin flows into these. The tooth is then washed with water and dried and a thin, clear primer is painted on. Finally, the bond is painted on and the tooth coloured resin is placed and moulded to the correct contour and set hard with the white light. This process ensures that the resin is firmly bonded to the tooth.

How long this type of bonding lasts depends on the experience of the operator and the conditions in which it was carried out. It cannot have any contamination of any sorts or it will fail. On average, it has a life span of 5 years.

Even if it should fail, there are no serious complications. Being an “add-on” procedure, the original tooth has not been damaged and the procedure can be repeated.

Gum Infections

Inflammation and infection of the gums is also known as periodontal disease.

This is usually caused by a thick, sticky film of bacteria that builds up on the teeth.

Plaque hardens to become calculus which is commonly known as tartar. Plaque and calculus are caused by poor oral hygiene. This usually stems from teeth that are not cleaned thoroughly or often enough.

Bacteria in plaque and calculus can cause inflamed and angry looking gums, called gingivitis. In early stage of gum disease, gingivitis can be treated by removal of plaque and calculus, usually done by the dentist and maintained at home by the patient through thorough but gentle brushing and flossing several times a day.

In advanced stage of gum disease, there will be severe bone loss. Pockets form between gum and teeth and the gum may recede from the teeth, thus exposing more of the teeth structure. As a result, the teeth become loose and require extraction by the dentist.

Periodontitis can result in the loss of many teeth in some people. 

Treating periodontitis will result in healthier, cleaner looking teeth and gives a better chance of keeping your teeth for life.

Results of Treatment

Gum tenderness. 

Use a extra soft toothbrush or a mouth wash containing Chlorhexidine if brushing causes discomfort.

Tooth Sensitivity. 

Sensitivity to heat and cold which will lessen with time. Use Colgate Pro-Relief or similar special tooth paste

Gum Shrinkage.   

Gum will recede and expose more tooth structure, hence teeth appear longer.

Gum Diseases tend to recur, so home maintenance therapy and regular visits to the dentist is important.

Symptoms of periodontal disease
  • Red, swollen, tender painful and bleeding gums
  • Persistent bad breath
  • A bad taste in the mouth
  • Abscesses between teeth and gums
  • Loose teeth and gaps appearing between teeth
  • Increased risk of root decay as more root is exposed
What your dentist will do:
  • Check your gums for colour and texture. 
  • A periodontal probe is used to measure depth of pockets formed between teeth
  •  Check each tooth for mobility as gum disease can cause teeth to become loose
  • Take an X-ray to reveal depth of bone and confirm bone loss
  • If very severe gum disease, several visits of curettage will be needed
This involves deep scaling whereby each tooth surface is cleaned to remove all plaque and calculus from above and beneath the gum line.This procedure is usually done under local anesthesia. 

and smooth    

thus contributing to the gum disease.

treatment.

  • Root planning is carried out using instruments that leave the root surface clean
  • Give instructions on how to improve oral hygiene.
  • May advise replacement of fillings if they are rough and “ digging “ into gums 
  • May advise to quit smoking as smoking reduces the chances of successful
  • Give Antibiotics in severe cases of infection where gums are not healing well
  •  Do periodontal surgery in severe cases.

Cracked Tooth Syndrome

 As name implies, there is a crack in the tooth. To save the tooth, early diagnosis and treatment are important. 

Causes
The crack can involve any tooth but occurs usually in the molar or premolar where:
  • the tooth is heavily filled, thus weakening it and making it prone to fracture and the crack runs under a weakened cusp
  • the tooth has been subjected to abnormally heavy biting forces due to grinding and clenching, esp at night (Bruxism)
  • the tooth has suffered trauma such as a blow to the teeth chewing hard food or substances (ice, pencils)
  • The crack may start in the top of the tooth and run downwards. It may affect the pulp, nerve and root
Treatment For A Cracked Tooth
Early intervention and hence treatment will increase the chances of the tooth being saved. However, the treatment will depend on the location of the crack and its extent.

Simple Crack: 
  • This involves the removal of the weakened cusp and placing a filling or a crown on the tooth. When the crown is prepared for the tooth and a temporary crown is placed, the usually subsides
  • Sometimes, a steel band is placed over the tooth with a dressing to see if the pain will stop. If the pain ceases, then a filling or a crown will be placed. However, if the pain persists, the dentist will suggest the need for root canal therapy
  • The crown protects the tooth, preventing the crack from traveling further
Complex Crack
Sometimes, the crack has progressed to the pulp and caused inflammation in that area. The dentist would then suggest 2 alternatives: extraction or root canal therapy, followed by a crown in order to save the tooth.

Wisdom Teeth

Most of us have 4 wisdom teeth. They are the last teeth to come through (usually from the late teens to the twenties) and sometimes they remain buried in the gum without ever causing any problems.

Wisdom teeth are usually large and with so little space at the rear of the jaw, they are more trouble than their worth. Due to little room at the rear, they do not come through easily and may in fact remain wedged or become impacted. 

As it remains horizontally impacted, it can push on the tooth in front. This can cause an erosion cavity where the wisdom hits on the other tooth. This in turn can cause damage to both teeth resulting in removal, not of one but both of them.

Also, pressure from the wisdom tooth may cause pain in the adjacent tooth.

An upper wisdom tooth may push sideways out of the gum and rub against the inside of the cheek. This will cause an ulcer. Alternately, food becomes trapped between the wisdom and the molar and can cause decay in both teeth.

If the wisdom tooth is not removed, a cyst can form around the tooth and may displace it. This can destroy bone and damage other teeth.

As it tries to push its way through the gums, food may get trapped in the gum around the top of the tooth. This could set off inflammation and infection, thus causing swelling, pain and jaw stiffness. Swallowing may be painful. The infection can in turn cause bad breath.

Your dentist may thus suggest early removal of your wisdom teeth. It is best to have them out early as the tooth roots would not have formed completely and the bone surrounding the tooth is softer allowing easier removal with less risk of damage to bone or surrounding teeth.

If there are signs of decay on the wisdom, it should be removed sooner rather than later to avoid surgical intervention as a badly decayed tooth will fragment into pieces and make the extraction procedure difficult and uncomfortable. ( Remember, the tooth is far back and there is little room.)

Dental Extractions

In the past, extractions seem to be the treatment of choice for all problematic teeth.

These days, the longer we hold onto our own teeth, the better it is. This is not only for appearance but also for functionality as most of us do enjoy our food!

However, there are cases where extraction is the best option to take, eg in the case of wisdom teeth. Majority of us have 4 wisdom teeth. As there is little space at the rear of the jaw for these to come through, they can sometimes become wedged or impacted or through lack of proper brushing, can decay. Some impacted wisdom teeth remain buried and not ever present a problem. However, others can cause severe problems as they can contribute to overcrowding or can cause gum infection around the top of the tooth as it pushes its way through the gum. Infection and inflammation can cause pain, swelling and jaw stiffness. In such cases, the dentist will recommend removal.

Removal of a wisdom tooth is a common procedure. Orthodontists are always recommending extractions of the thirds or premolars in their treatment planning.

Should there be a decay already present in the wisdom tooth, extraction should not be delayed. The longer you wait, the worse the decay and instead of coming out in one piece, it could break into several pieces making the task very difficult for the dentist, let alone uncomfortable and painful for you.

Extraction of troublesome wisdom teeth should be done when you are still young. This is because the tooth roots have not completely formed and the bone holding the tooth is softer allowing easier removal and less risk of damage to nerves, bone and adjacent teeth.

Extractions of the upper wisdom teeth usually do not present a problem unless the root is into the sinus cavity.

Extractions of the lower wisdom can be more challenging. The patient is usually sent to have an I-cat scan done before the dentist will agree to do the extraction or send the patient to an oral facial maxillosurgeon.

Root Canal Treatment

This is also known as endodontic treatment. It is a way to save a tooth that is badly damaged due to decay, injury or disease and it has an abscess at the root tip. Short of an extraction of the badly decayed tooth, the alternative is to save it through RCT which then affords the owner better functionality than an artificial tooth.

Another reason to save the tooth is to prevent the teeth on either side of it from tilting into the space left by the missing tooth. This can make chewing and biting difficult.

In this practice, patients who take this option, are advised to follow up with crowning the tooth. If they choose not to have the crown, it is best they have the extraction as not following up the treatment with a crown could result in the tooth splitting and hence money spent would be wasted.

Root canal therapy is only done if the dentist feels it has a high success rate.

Procedure
An X ray is taken to show if there is an abscess at the tip of the root. If the latter is present, it is usually dark at the tip.

An injection is given to block the pain. A sheet of rubber latex called rubber dam is used to isolate the tooth and keep it clean and dry during treatment. It also helps in preventing any of the instruments from falling into the throat.

To reach the pulp, an opening is made in the tooth with the drill. Then using special instruments called files, the dentist removes the infected material and dead pulp.

Each canal is cleaned with bleach, EDTA and rinsed with saline. The canal is enlarged and shaped and antibacterial and anti-inflammatory medicines are added to the canal to help stop the infection and inflammation. If there is an abscess, oral antibiotics may be needed to further treat the infection.

2 to 3 visits are required for RCT depending on the number of canals. A temporary filling material will protect the inside of the tooth between visits. When the inside of the tooth is satisfactorily cleaned, the canals are filled and the pulp chamber sealed. To confirm a job well done, the dentist then takes an X Ray. This will show how well sealed the canals are. Then, a post may be inserted for strength and a general core build up prepared in anticipation for a crown. However, it is advisable to wait and watch for a few weeks before a crown is placed.

The crown protects and further strengthens the tooth, restores it to normal function and occlusion and restores an aesthetic appearance.

Pain or discomfort may cease immediately after treatment is started. However, sometimes, the pain lingers for a few more days. Patients are advised to take pain killers such as Ibuprofen or paracetamol.

When is it done?
It is done when there is infection or inflammation of the pulp. This could be due to:
  • breakdown of a filling or a crown.
  • A very deep cavity
  • Trauma
  • Gum disease
  • Crack or chip in the tooth
  •  Extreme wear or severe grinding
  • Extensive dental work to the tooth
Symptoms
  • pain, sensitivity to heat and cold
  • tooth discoloration
  • swelling and soreness at the root tip
  • throbbing sensation
  • tooth becomes loose to touch
  • pain on biting

Tooth Whitening

Tooth whitening is the use of bleaching agents, such as carbamide peroxide, hydrogen peroxide (Opalescence Go) to lighten the colour of the teeth. It is a cost effective and safe means of getting the teeth whiter.
Enamel stains, a generalized discoloured pattern in the teeth and trauma to baby teeth that have resulted in stained permanent teeth can all benefit from bleaching.

In this practice, we do not commence the treatment until the patient has had a checkup and clean and all cavities have been restored. This is to reduce the risk of sensitivity to hot and cold.

We take a mould of your teeth and make customized plastic trays. We then give you the trays ,the bleaching gel and instructions. You wear the gel filled trays at home once or twice daily, depending on how quickly you want the teeth whitened and how comfortable you feel. You could wear them from half an hour to 2 hours at a time each day.

The length of the treatment may vary between 1 and 6 weeks, with an average lasting between 7 and 14 days.

During the course of bleaching, the patient returns to the surgery every 2 weeks and have the shade monitored. This is usually done without referring to the shade the previous visit. Patient continues to use the gel until s/he is happy with the final lightened shade.

Internal Bleaching of a root-filled tooth
A root treated tooth usually darkens and if it happens to be a front tooth, your dentist may suggest internal bleaching of the tooth.

It involves drilling a small hole into the back of the tooth and removing some of the filling from the tooth’s root canal and inserting the bleaching product. The hole is temporarily filled and you will need to return in about a week to have the bleaching product and temporary filling removed. 

A fresh lot of bleaching agent is inserted again and the process is repeated over several weeks or months until the tooth lightens to the desirable shade.

Once treatment is completed, the bleaching agent is removed and the hole is permanently filled.
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