There are a multitude of ways to repair teeth and your dentist will discuss the best option for you, taking into account your needs, your desired outcome and your budget.
Teeth need repair from time to time for many reasons including:
• They are painful
• They break or are about to break
• They suffer tooth decay
• Their appearance is less than desirable and other treatment options such as whitening or orthodontics cannot be applied
Fillings are suitable for tooth breaks, areas of decay, or where a tooth requires only a small improvement in its appearance (such as a small stain). There are three types of fillings:
• Composite resin – by far the most commonly used filling material today, composite resin is tooth-coloured and can be matched to the surrounding colour of your tooth to give it a natural appearance.
• Glass ionomer cement – also tooth-coloured and useful in children’s teeth, in cavities on the sides of teeth and for temporary fillings. GICs, as they are referred to by dentists, are not as strong as composite resins but can provide a lot of protection to a tooth by releasing fluoride into them.
• Amalgam – older patients may recall the days when silver amalgam fillings were the gold standard. While obsolete and rarely used, amalgams can be useful for larger cavities in back teeth in certain patients. At Banyo Dental, where possible we will obtain your verbal consent PRIOR to placing such a filling.
Inlays, Onlays and Overlays
Inlays, onlays and overlays can be useful for back teeth in the following situations:
• Teeth with large existing fillings that are broken, decayed or unsightly
• Teeth that are broken down severely but have sufficient tooth structure not to require a full crown
• Teeth that have had root canal therapy
• Teeth that are cracked, or showing signs of cracking
Unlike fillings, these are done in a 2-stage process as follows:
• Visit one – the tooth is prepared, an impression is taken and sent to an external laboratory and you are given a temporary filling
• Visit two – (usually a fortnight later, though can be earlier by negotiation) the inlay, onlay or overlay is fitted to your tooth.
Patients can choose between metal (usually a gold alloy) and ceramic (tooth-coloured), with metal being preferred in areas of high tension and ceramic being preferred where appearance is of utmost importance.
Veneers can be useful for front teeth where an improvement in appearance is sought and/or there have been some minor cracks and chipping. These are ceramic and usually only as thick as a fingernail. Because of the effect it can have on a patient’s appearance, a lot of work goes into veneers and you will require the following:
· Initial impressions to have stone casts made
· A diagnostic mock-up on the stone casts to ensure you will be happy with the final result
· A preparation appointment where your tooth will be shaved back ever so slightly with impressions taken. (Please note temporary veneers may not be possible due to the thinness of the preparation).
· A cementation appointment where the veneers are tried on and fixed on with adhesive.
Veneers are best used for patients who have reasonably healthy front teeth with plenty of enamel (the white part of your tooth). Patients with severely worn front teeth and/or grind their teeth may be better off considering crowns.
A crown is like a thimble that fits around your tooth to restore it to its former glory. They are very useful for:
· Heavily worn, broken down or stained teeth for which the other options detailed above are not suitable for
· Broken down teeth in patients who grind or clench their teeth heavily either at night or during the day
· Teeth that have had root canal therapy, especially back teeth which can be at high risk of breaking afterwards.
Placement of a crown involves the following:
· Sometimes, pre-impressions are required to assist with planning your treatment and the procedure afterwards
· A preparation visit, where the tooth is shaved back into a mini tooth, an impression taken and sent to a laboratory and a temporary crown made for your tooth
· A cementation visit, where the crown is tried on and fitted to your tooth.
Crowns can provide a very long-lasting result for your tooth and negate the need for constantly having to repair breakages over time. They can be tooth-coloured ceramic (useful where appearance is important), or metal (usually a gold alloy, very good for back teeth where a lot of force is applied).
Root canal therapy
Teeth consist of a few layers. The white material on the outside that we see is enamel. Then beneath the enamel sits a large amount of yellow-brown-red dentine which makes up the bulk of your tooth. And inside this is a little area called the pulp which consists of blood vessels and nerves. These nourish the tooth and also convey sensations from the tooth to your nervous system, including pain and sensitivity.
Breakages to the enamel and dentine are usually remedied one or more of what you have read above but when the pulp is broken into, either by decay, crack or accident, a root canal therapy is required.
Root canal therapy simply involves the removal of all tissues, living or dead, from the pulp and canal spaces using instruments and disinfectants followed by the filling up of this space with a rubber material called gutta-percha. It is done under an isolation material called a rubber dam, which is intended to prevent your canal spaces from being reinfected from the millions of bacteria that occupy your mouth as well as protecting you from swallowing or inhaling any instruments or disinfectant.
Many patients are fearful that root canal therapy can be painful. This is often because root canal therapies are provided immediately following a toothache. However, most of the time these are painless – indeed we’ve had patients go to sleep during their root canal appointments! Where patients are feeling pain during the procedure, measures can be taken to alleviate this, including placing local anaesthetic into the canal. This, however, is very rare.
The treatment will often require more than one visit and can sometimes be quite complicated, requiring several visits depending on the complexity. Some cases, especially for molar teeth, may be referred to a specialist.
X-rays also need to be taken BEFORE, DURING and sometimes AFTER the procedure to assess the level of treatment complexity, check the effectiveness of the treatment and ensure it is done to the best standard possible.
Root canal therapies can sometimes be done on an elective basis especially in cases where a post placement into your tooth is necessary to place a filling or crown.
After a root canal on a premolar or molar tooth, it is imperative that you have a crown, overlay or full-coverage filling placed on the tooth to prevent it from breaking and/or becoming re-infected. For front teeth, the decision or place a crown or a filling depends on how broken down and/or stained the tooth is.