Tooth Problem? How to avoid dental problems

April 21, 2014

Ok, so I brush twice a day, floss at night, eat well – there is no pain so why should I go to a dentist?

A common misunderstanding about going to the dentist is that we can cure dental disease.   This is only partially true. The reality is that everything wears out, be it your new car, house, computer, fillings or teeth! I have many patients with healthy teeth well into their 80s and some in their 90s, and many people disappointed with their failing teeth and unhappy with the results of years of dentistry under the age of 50. So how can we help you to become one of our long term satisfied patients enjoying the benefits of a healthy mouth for decades?

Dentistry fails—preventistry works!

I had a small filling done on a bottom tooth 30 years ago. It was replaced with a larger but stronger gold filling 8 years later. The tooth cracked around this strong filling on my 40th birthday and I needed a crown. About 5% of teeth that are crowned need a root canal treatment in 5 years. Root canal teeth are weak and it may split and need eventual removal! Sound Familiar?

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So I may eventually lose one tooth but all my other teeth are in excellent shape. Why?

Prevention! Avoid the filling in the first place, or get it done as small as possible. Here’s my guide to healthy happy smiles for life!

Start Early –   Bring children every 6 months to build up their confidence, and get good advice on hygiene and diet. Start from pregnancy and you will avoid the fear cycle and make dental visits fun for your child.

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Seal Fissures– any grooves in your teeth attract bacteria and plaque films that can’t be brushed off. The most at risk are the biting surfaces of the adult 6yr old and 12yr old molars. Simple sealants that release protective minerals and stop bacteria starting decay on these areas are easily placed. Children who have been regularly from the age of 2 find this procedure fun and non-invasive, meaning they trust their dentist for life rather than developing fears.

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I still get my teeth sealed with plastic more durable adult sealants if necessary but some of mine were last sealed nearly 20 years ago!

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Treat Decay Early– If you need a filling, get it done ASAP. Why wait until there is little tooth left or you have a toothache and need a root canal – it just increases the risk!  The teeth below looked fine until you see what was lurking beneath.

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Maintain your engine– regular checks at the dentist also involves regular professional cleans. Over time the build-up on your teeth can result in gum disease. Your teeth become loose and the jawbone is damaged irreversibly. To prevent gum disease requires maintenance. Despite good home care and dental hygiene I still get moderate levels of calculus build-up after 6 months.

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The important thing is that there is no damage to the gums because I haven’t missed a 6 month exam and clean in my life. Having a father and brother as dentists helped me understand the value of preventive care over a lifetime. See below the results of gum disease when you leave it too long.

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Not having a regular clean is like driving a Ferrari around Fraser Island for years without a service and wondering what happened when it stops working!

Protect weak teeth – Old metal fillings creep over the years like lead being hit with a hammer. Eventually, this puts strains on your teeth and they can fracture and split. If you wait too long this split may be catastrophic.   Even replacing metal fillings with white plastic fillings may not be strong enough to resist fracture forces.  This is why dentists recommend a crown, and exactly what happened to me on my 40th birthday. (You can see my gold crown in the photo at the top of this post)  Not what a dentist expects when they look after their teeth—but nothing lasts forever and my filled tooth had been weakened. You can see how teeth can split in the following pictures.

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Below is a cracked tooth protected with a porcelain crown / cap

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Wear a mouthguard – I just put this one in as a no brainer—no mouthgaurd / no play!

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Replace missing teeth –   It may   not   seem important at the time but when you lose a tooth your other teeth have to work harder, and are more likely to break or wear out. This leads to an ever worsening cycle of destruction.   Also your jawbone becomes smaller and   weaker and your remaining teeth move into poor positions.

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Many people in later years find their mouth has become a complex and expensive concern to them. Intervention when they were younger would have made all the difference. People with full d entures have continuing jawbone loss because of the lack of bone stimulation dentures provide. As they lose more bone the dentures fit worse and worse in later years leading to great discomfort and lack of chewing power. The jaws also fail to support the face anymore. Many older people that have had dentures for decades complain that their   new dentures are worse than the original ones. We regularly see denture wearers wanting to   have implants to fix and recreate what they have lost.

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Trust your dentist– We are here to help you enjoy your teeth for life. If you have questions, we pride ourselves on taking the time to help you understand your options. We love to talk, educate, and have happy patients!  Does your dentist stand by their work.  Do they help you understand your particular risks.

Find a dentist that wants to be there helping you for life, not someone that is just cheaper, a health fund preferred provider, and that may not be around in 5, 10, 20 years to stand by their commitment to your health.

Oh, and smile!

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Composite Bonding Rehabilitation

October 30, 2011

This lady had worn and chipped her upper teeth on the inside until they were so thin they were about to break. The yellow tooth on the right second from the middle is an old crown which the patient couldn’t afford to redo so we had to match it in colour and shape. Crowns are hard and durable but bonding often means less tooth needs to be removed and they are cheaper. Because all of this patients teeth had worn we were needed to build them all up (or at least 10 of them) – compare $250-$300 per tooth for bonding vs. $1500 per tooth for crowns. They may not last as long or be quite as perfect in appearance but they can be a great low cost option without losing teeth and getting dentures. It was done in one day and crowns would take weeks or even months.  I would be happy to get 5 years up to 10 years for this kind of procedure.  Despite the cost, in the long term I would still prefer porcelain crowns.


Work in progress

July 10, 2010

I’ve shown this young guy before.  We are just picking away at it a bit at a time.  The most rewarding thing is this patient has listened to everything about home care and prevention and is looking after things beautifully. See how the gums are pink and healthy and the remaining decay is so clearly visible.  Without good home care, nothing will last.

This was the first day we met.

The front 2 right teeth we managed to avoid exposing the nerve in the centre of the tooth despite severe decay.  They have temporary fillings to keep things stable until we sort out the remaining teeth.  The 2 teeth further back have permanent composite resin restorations placed.

This was today before we started to tackle the upper eye tooth and tooth behind.  So far this has been four visits at about $300 a trip.  We are just going at a rate our patient can afford.  I’ll keep future updates as I get time.

Here is the latest.


More fillings

April 5, 2010

Just a patient I saw this week.  The second back tooth was chipped and needs more extensive repair.  We placed an interim repair in the chipped area.  The back tooth was decayed around the existing metal filling. The most important thing is to take the time to get a smooth, well sealed, and anatomic shape to the filling so it doesn’t catch food or leak and increase the risk of further decay or damage.  I am loving the challenge of creating beautiful work that stands the test of time.


Basic Resin Filling

March 10, 2010

Just a quick post to show people the general principle of a filling.  Bacteria enter a small entry point but may eat away a significant amount of tooth on the inside.  Your toothbrushing keeps the surface of the tooth looking and feeling solid.  This is a case I did today which is a comparatively small cavity.  See how much tooth can be damaged by a small hole causing no pain or symptoms whatsoever.  That is why we say to have 6 month checks and cleans at the dentist.  This tooth actually has two fillings.  Which of the two do you think will be better for the tooth?

Note the discolouration

Soft dark decay seen after removing surface enamel

 

All softened damaged tissue removed. Residual stain stable.

 

Protective liner placed

Final Restoration

As always, remember dental decay is a progressive disease.  Early damage is reversible, moderate needs a filling, severe needs a crown with or without root canal treatment, and extensive decay means an extraction.  Prevention and early detection rules!


Simplicity

February 1, 2010

This case came in today.  The front tooth has had a filling more many years and the metallic filling on the left had leaked and caused cracking of the tooth.

 

 

 

 

 

 

 

We replaced both fillings with tooth coloured composite resin in a single appointment.  The metal had stained the back tooth severely and some shadow remains.  The tooth is weak and may ultimately need a crown but this filling is much more conservative.  The front tooth was easily corrected to get a more cosmetic colour match.

 

 

 

 

 

 

 

My own tooth needs a crown due to being on the losing end of an olive pit so I will have some new interesting posts in a couple of weeks when it is done.  🙂


Crooked teeth

December 14, 2009

Not all people want perfect even teeth.  This patient of mine was concerned about the discolouration and poor longevity of the resin bondings that had been done on her front teeth.  While is would be possible to do orthodontics and straighten these teeth, the patients chief concern was to keep her smile looking ‘like me!’ – that is, to maintain the crowded appearance which created character that she had had all her life. 

The most conservative option was new resin bonding to replace the discoloured fillings, but the two smaller lateral incisors had more extensive damage.  We opted for a veneer on one and a crown on the other.  You can see by the following photo that a crown is a more aggressive approach (right) than a veneer (left).  The bondings had been redone at this stage.

I think the final results have been fantastic – it is very difficult to match one tooth and often people get 6 or 8 front teeth done together to make an easier colour match.  Although this was more difficult, it ended up with must less damage to the mouth overall.

I thought I would share it.  Happy New Year!