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If part of a tooth has been lost through decay or damaged due to an accident, your dentist may put in a filling. A filling will plug the hole and stop any future pain or discomfort. A filling can be made out of a variety of materials. The most common of these are amalgam (silver) or composite (white).

Silver fillings are made of a material called amalgam, which is a mixture of mercury, silver, tin, copper, and other metals. Amalgam fillings are very hardwearing which is why they are often put into the back chewing teeth.

Some people opt for white fillings which match the colour of the natural tooth better. White fillings are becoming more popular, but, for the back teeth, they are only available privately. If you need a filling in one of your front teeth, you can get a composite filling on the NHS.

To learn more about fillings click here to visit the BDA's 3D mouth website
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  Root Canal Therapy
 

Sometimes, damage or decay gets deep into the tooth and can affect the root. If left unchecked, this could mean that the tooth either falls out or has to be removed by your dentist. Root fillings - also known as root canal therapy - can ensure that you keep your tooth.

We will take an x-ray of the tooth to check the shape of the root canals and to see whether there is any added infection around the root. After putting you under local anaesthetic, the dentist will go through the top of your tooth into the pulp - the bit right in the middle of your tooth that holds the nerves and blood supply. We will then remove the dead bits of the pulp and check for any infection. If the infection has spread beyond the tooth, he may have to give you a temporary filling and some antibiotics until it clears up.

After the pulp has been removed, we fill the gap with a rubbery material and put normal filling on top.

One thing worth noting is that under the NHS regulations, we are not allowed to place a private white filling on top of an NHS root canal treatment at the back of the mouth (premolars/molars). This means that if it is a back tooth and you require a root canal therapy it must be done privately  along with it subsequent white filling on top.  This regulation falls under the “same tooth rule” for the mixing of NHS and private treatment.

To see an animation of a root filling click here to visit the BDA's 3D Mouth website

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  Apicectomy
 

Deep inside the tooth is a soft mass of tissue called the pulp. If the tooth is damaged - either by injury or decay - it may cause the pulp to get infected. If this happens, we may carry out a root canal treatment, but if the infection spreads to the end of the root and into the bone, we may have to perform an apicectomy.

During this treatment, which is done under local anaesthetic, we make a very small cut in the gum, clean out any infection and then put a small filling at the end of the root canal to stop any future infection. Once this is done, we stitche the gum - and, because the cut is made as far away from the tooth as possible, there is little chance of visible scarring.

Apicectomies are only carried out when root canal treatment has failed.
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Dental abscesses can be painful but they can be treated relatively easily. A dental abscess is formed when the dental pulp in the middle of the tooth dies and the pulp chamber becomes infected. The build-up of pus can raise the tooth up within the socket, making it feel tender when you bite down.

Tooth abscesses can make your jaw ache and feel tender when you chew. If the abscess bursts, the pain may go, but you should still seek treatment. It's important that you see your dentist to make sure the problem doesn't come back. Your dentist will discuss with you the possibilities of placing a root filling in the tooth to prevent this from happening.

Abcesses occur when tooth decay is left untreated and reaches the dental pulp (the inside of the tooth which holds the blood supply and the nerves), which then becomes infected and dies. The bacteria then spread into the root of the tooth to form an abscess. Avoiding treatment or putting it off may be one of the reasons for an abscess starting.

Dental abscesses are fairly easy to diagnose - for example, you may find that pain is worse if you are pressing or chewing on the affected tooth. If the pain is less easy to define,  we will tap the teeth to determine which one is tender.  We may use an x-ray as part of the diagnosis, although the early stages of an abscess may not show.

To be able to treat a tooth with an abscess we will first need to deal with the infection. The abscess is often drained and then root canal therapy commenced. If the infection from the abscess is severe, then we may prescribe antibiotics first. As we will have had to drill into the tooth for the root canal treatment, we will then restore it with a normal filling or crown.
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A crown is like a special sleeve made of metal or porcelain, or both, that goes over a damaged or weak tooth.  We will match it up to the shape – and, in the case of porcelain crowns, colour - of your other teeth so it will look natural. The crown will probably last for many years, depending on the health of the tooth underneath.

We will shape the tooth so that, with the artificial crown, it will be the same size as a normal tooth. Preparation time will depend on how damaged the tooth is and whether it needs to be built up with a filling first. The tooth might have to be root-filled first - this is sometimes called 'removing the nerve'. The crown is sometimes held in place by a peg in the root canal if a lot of the tooth is missing.

A soft mouldable material is then used to make an exact 'impressions' of the tooth that is to be crowned and the nearby teeth. A dental technician uses the impressions to make the crown the exact height and size needed. A thin cord or paste may be used to hold the gum away from the tooth so that the impression is accurate round the edges.

A temporary crown made of acrylic is put over the tooth until the permanent crown is made. You can chew on a temporary crown but it won't be as strong as the finished one. When the crown is fitted, your dentist will make small adjustments to make sure you can bite comfortably. The crown is tried on first, and then glued into place. To learn more about crowns click here to visit the BDA's 3D Mouth website
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  Porcelain Dental Veneers
 

Dental veneers are wafer thin shells / laminates of porcelain that fit over the front surfaces of your teeth. Many people compare veneers to false fingernail for your teeth. The beauty of veneers is that they can be fabricated to any size and shape with surface characteristics that make them look natural and fit in with your surrounding teeth. With dental veneers we can create a bespoke smile.  Dental veneers can be used to correct several problems including:

  • Covering discoloured teeth,
  • Repairing badly worn, chipped or fractured teeth
  • Making slightly crooked teeth look straighter
  • Closing gaps (diastemas) between your teeth
  • Transforming your smile with a smile makeover

Preparation for the veneer is a relatively simple procedure and can be done in a couple of visits to the dentist. We will remove a tiny amount of the tooth's surface so that when the veneer is applied it doesn't feel bulky. We will then take an impression  that will match the size and shape of the rest of your teeth. On your second visit, the newly-made veneer will be stuck on with special glue. The veneer can be made to have a similar shape to the original tooth if desired (eg: only the colour of texture was the initial problem) or sculpted to look dramatically different.

It is worth noting NHS veneers are only usually allowed on the upper front six teeth

The art of “smile makeovers” using veneers is not within the NHS remit, but those patients seeking this will be offered cosmetics out-with the NHS.
 
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A dental bridge is a restoration that consists of more than one crown joined together to close a gap (missing teeth) between two supporting healthy teeth.

The bridge may use the tooth next to the gap or both teeth either side of the gap, should it be necessary

The more modern “adhesive bridge” may often be used as it requires minimal drilling and is often the bridge of choice in lightly restored mouths of younger patients.
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There are often stories in the newspapers about the safety of amalgam or silver fillings, linking them to health problems such as migraines and multiple sclerosis. There is very little evidence to support these stories and the Department of Health and its experts advise dentists and the public that amalgam fillings are perfectly safe.

A very small number of people may find that they are sensitive to the various component parts of the amalgam. For this reason, amalgam fillings will not be given to them and existing fillings may be removed. This is very rare, but if you are concerned, ask your doctor to carry out a mercury sensitivity test.

If you find ulcerated patches on the skin or mouth, you may be allergic or sensitive to the mercury in your amalgam fillings. In this case, visit your doctor who will test you for mercury allergy. If you test positive, your dentist may suggest that you have your fillings removed and replaced with a non-amalgam variety. This allergy is very rare, however.

We will consider on a tooth by tooth basis, replacement of amalgam fillings of those patients who wish such action. Clearly this work will lie outside the NHS and most patients are more than happy to pay for this treatment be it for aesthetic concern or simply the fact the do not wish amalgam restorations full stop.

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