TREATMENTS

Question 1

Root canal treatments

Inside the tooth there is a small cavity where the tooth’s nerve and blood supply are located. If the tooth is subject to a major attack of caries (a hole in the tooth) or a trauma (a blow, for instance), the nerve can get damaged. In the vast majority of cases, when the tooth’s nerve is dying, toothache occurs. In dental terms, this process is known as pulpitis - an acute state of infection. In other cases, the dentist discovers that the tooth’s nerve is dead. This is revealed by an X-ray of the tooth or occasionally as a small spot in the mucous membrane next to the tooth’s root. A tooth with a nerve that has suffered permanent damage requires root canal treatment.

This involves the dentist flushing the inner tooth with a disinfectant fluid and cleaning inside the tooth with some small files designed to remove the tooth’s nerve. Once the inside of the tooth has been cleaned and disinfected, we make the root filling, which consists of a rubber material called ‘gutta percha’. This material fills the cavity in the tooth where the nerve was previously located.

Often, the root-treated tooth is first fitted with a plastic filling. But, in the vast majority of cases, at a late stage it will need a crown to protect the tooth to prevent it from breaking.

A root canal treatment often requires several visits to the dentist.
Occasionally it is impossible for the dentist to clean and disinfect the inside of the tooth sufficiently for all the infection to disappear. This is because some teeth have very narrow channels with small side branches that make cleaning impossible. In this case, the tooth will be subject to recurring or continuing symptoms in the form of a throbbing. This will appear in X-rays as a ‘dark glow’ around the root of the tooth. In such cases, retrograde root canal treatment - also referred to as root tip amputation - may be necessary This is a procedure, in which the dentist flaps the gums aside, next to the tooth in question, and removes the inflammation around the root tip as well as a small part of the root. A small filling is then placed in the root. The gums are put back in place and given some little stitches, which the dentist removes after a week.

Answer

Teeth gradually discolor as a result of food particles and the fluid we ingest. If you want to whiten your teeth, it is important to contact your dentist. The dentist will provide individual guidance on how the whitening will be done, and there are some circumstances that make whitening inappropriate in some cases.
Tooth whitening is not provided for patients who smoke or consume large quantities of tea, coffee or red wine. If you have crowns or composite fillings, whitening will not change their color. Teeth discolored after root canal treatment cannot be made brighter by regular tooth whitening, but it may be possible using so-called internal whitening, which is done at the clinic.
At the clinic we whiten teeth by taking impressions for individual whitening trays, which a dental technician then makes. The trays are handed over to the patient with whitening gel and thorough instructions on how to use the product properly. Whitening with individual whitening trays is done in your home.
Tooth whitening is a process, in which discolored particles on the surface of the teeth are removed by means of active ingredients such as hydrogen peroxide and calcium peroxide. If you perform the whitening in accordance with the instructions, your teeth will not get damaged.

Question 2

Composite fillings

Composite fillings are a very common dental treatment. They have many positive aspects, both aesthetic and functional. The plastic is bonded to the tooth by pre-treating the tooth with various substances before inserting the plastic. The plastic is soft when placed in the tooth and hardens with the use of a special light. The plastic is soft when placed in the tooth and hardens with the use of a special light. This contraction provokes symptoms in some people immediately after a composite filling has been done. The symptoms will be sensitivity to cold and discomfort when biting hard. The symptoms are often mild and disappear by themselves after a few weeks.

Composite has its limitations, in that it has to be kept completely dry while filling the tooth. If this is impossible, either we have to find alternative filling materials or the tooth has to have a crown fitted.

A composite filling completed under optimal conditions often lasts a long time.

Question 3

Crowns and bridges

If a tooth is severely destroyed it needs a crown in order to function optimally in the mouth.
In principle, a crown is a ‘shell’ that encircles the tooth. The crown protects the tooth and its ‘hoop’ effect prevents it from breaking. When a dentist is going to make a crown, s/he has to drill the tooth to give it a truncated cone shape. Once the tooth has been given the appropriate shape, the dentist takes an impression.

Based on the dentist’s impression of the tooth, a dental technician makes the crown. The dental technician ensures that the function and appearance of the crown equal those of a natural, intact tooth. A crown can be made in gold or in a tooth-colored material: for example, porcelain.

If you have lost one or more teeth, it/they can often be replaced by a bridge. A bridge cannot be removed from your mouth. It serves as ‘your own teeth’. When making a bridge, the dentist drills one or more of the teeth on both sides adjacent to the area where one or more teeth are missing. The teeth on either side of the missing tooth/teeth serve as bridge piers, keeping the bridge in place.

The dentist drills the teeth to achieve the aforementioned truncated cone shape, while the bridge piers must be parallel to each other. The dentist then takes impressions, which are sent to a dental technician. It is a good idea to use a special type of dental floss - ‘superfloss’ - to keep your bridge clean.

Making crowns and bridges requires several visits to the dentist.

Question 4

Implants

Implant treatment is often the appropriate solution if, for example, a patient has suffered an injury and lost a tooth in an otherwise intact set of teeth, or in cases where a patient for some reason is missing a tooth and the adjacent teeth are intact. Some toothless patients also benefit greatly from implants to maintain a full set of dentures, especially in the lower jaw.
An implant is a titanium screw with a specially treated surface screwed into the jawbone. The gums are folded aside to expose the bone. A hole is drilled in the bone which corresponds in diameter to the screw that will be inserted into the bone. After the implant has been inserted, the gums are folded back to cover the screw. It takes between 3 and 6 months for the implant to heal fully. (This depends on the position of the implant and thickness of the bone, and is assessed on an individual basis) During the healing period, the implant is not visible but covered with gums.

The implant is ‘tissue friendly’ and the bone grows very close to the implant, thereby holding it in place. After the healing period, the small area of the implant that was previously covered with mucous membrane (gum) is exposed and the dentist takes an impression for a crown. A technician manufactures the crown and the dentist attaches the crown to the implant. In the case of implants intended to keep a denture in place, small ball-like connectors are attached to the implants so that the denture stays in place using a special snap system. Implants should be treated like natural teeth and should be brushed every day. Gingivitis and periodontitis (peri-implantitis) may occur around implants.

Generally speaking, implant treatment is a safe treatment with a high success rate. However, it is risky to insert implants in patients with untreated periodontitis or who smoke heavily, since there is a risk of losing the implant.

Question 5

Wisdom teeth

Some young people have problems with wisdom teeth. This is because there is no room for them to fully emerge, so they sit in the mouth half covered by the gums. This can cause inflammation around the wisdom tooth; the gums swell and it is painful. If this happens several times, the wisdom tooth must be removed. In the upper jaw, this usually does not take very long, as the bone is very thin and the tooth can be gently pushed out. In the lower jaw the bone is thicker and it often takes a little more work to remove the tooth. If the tooth is not completely free of bone, surgery will be required to remove it.

This involves making a small incision in the gums, and pushing them aside to expose the tooth. It may be necessary to remove a small amount of bone around the tooth to free it. Once the tooth has been removed, the dentist makes a small stitch that is removed a week later.

Some tips for after the surgical removal of a wisdom tooth:

For a week, rinse your mouth twice a day with chlorhexidine; do not brush your teeth 1 hour before or 1 hour after, since toothpaste destroys the properties of chlorhexidine. Chlorhexidine disinfects the mouth, removing approximately 80-90% of the bacteria in the oral cavity.
During the first days after the procedure, painkillers may be necessary: for example, 600 mg Ibumetin 3 times a day.
Eat soft foods - for example, yoghurt - for the first few days.

After an operation in the mouth, it is normal for some swelling to occur. An ice pack can help if applied immediately after the procedure. Leave the wound alone. Do not poke it with your tongue or fingers. It needs rest to heal quickly.

Question 6

Periodontitis

Periodontitis is a disease that attacks the support tissue of the teeth: in other words, the bone and the fibers that hold teeth in place. If untreated, periodontitis will cause the support tissue of the teeth to break down. The teeth will become lose and may later fall out. During a regular checkup, the dentist or dental hygienist will inspect your gums.

Gum pockets that are 0-3 mm deep are healthy and gum pockets that are 4 mm and above are unhealthy, meaning there is periodontitis. Deep gum pockets usually bleed, since a process of inflammation is underway. Bacteria in the gum pocket slowly break down the fibers and bone that hold the tooth in place. Often the gums recede and the patient may experience sensitive tooth necks. If you have periodontitis, it is vital that your oral hygiene is top notch, and that you use toothpicks and interdental brushes to massage the gums and keep the gaps between the teeth perfectly clean.

Periodontal patients should go to the dentist every 3 months to have their deep gum pockets cleaned. Even with the very best oral hygiene, it is impossible to brush the likes of a 6-mm-deep gum pocket. The reason why dentists advise periodontal patients to have their teeth cleaned every 3 months is that numerous scientific studies have shown that this regularity is the most optimal for keeping periodontitis under control. Periodontitis often occurs in outbreaks, so there may be shorter and longer periods of activity. Regular periodontal treatment is crucial to preserve the teeth as long as possible. Periodontitis is a so-called multifactorial disease. In other words, there are several reasons why it erupts. It may be genetically related, but is often related to oral hygiene.

Some diseases and various forms of medicine have a predisposition to periodontitis. Another very important cause of periodontitis is smoking. Smoking slows down blood flow to the tissue. The bloodstream transports important cells that help protect against infections. If the blood flow is low, there will not be as many of the ‘good cells’ that pass by. Thus, periodontitis may develop faster than in non-smokers.

Question 7

Dentures

If one or more teeth is/are missing, you often need a denture. A denture can be removed from your mouth and requires careful cleaning. There are basically two types of dentures: partial dentures and full dentures.

A partial denture can replace several missing teeth. A partial denture is held in place in the mouth with some small metal braces around some of the teeth remaining in the mouth. The teeth on the denture and the pink that imitates gums are made of acrylic. When making partial dentures, before taking an impression, the dentist has to gently grind the teeth that will keep the denture in place.

As the name suggests, full dentures replace the entire set of teeth. Full dentures are made of acrylic. When teeth are missing, the jawbone breaks down and, in certain cases, can cause problems for a person wearing dentures. In the upper jaw, the full denture usually stays firmly in place with a kind of suction disc effect. In many cases, patients have trouble controlling the lower jaw denture. There is not the same suction disc effect as in the upper jaw. Sometimes it is a good idea to insert implants to keep the denture in place. They serve as a kind of snap system. The implants are fitted with some tiny ball-like connectors that protrude out of the gums, and inside the denture there are little metal cavities for the tiny balls to fit into. For the lower jaw, 2 implants are often sufficient - one on each side to hold the denture in place.

It is important to remember that dentures are foreign bodies that take some getting used to. After insertion, a denture must always be polished to prevent it from causing irritation. This requires several visits to the dentist.

A few tips for cleaning dentures: Use a denture brush, designed to get into most places. Do not brush your denture with toothpaste. Toothpaste is abrasive and may eventually damage the denture. Brush the prosthesis in regular soap with no abrasive agent. If the denture develops tartar, you can place it in a diluted solution of household vinegar for a few hours, and then remove the tartar with a brush.

If you do not keep the denture in your mouth at night, you can place it, for example, on a napkin and allow it to dry. This will kill some of the bacteria on the denture/ You must always clean your denture before re-inserting it into your mouth. It is advisable to sleep without your denture/s from time to time. This gives the mouth’s mucous membrane some air and helps prevent irritation. If redness, tenderness or whitish coating occurs, you must contact your dentist. There may be fungal infection that requires treatment.

Question 8