Teeth Reparation

Good overall health starts with a healthy oral cavity. According to WHO, there is an increase in evidence that oral health complications can aggravate general health conditions such as heart diseases, diabetes and pregnancy problems. Thus, a routine dental check-up is very important to detect problems at its earliest stages.

What are Tooth Fillings

Dental caries (tooth decay) is a hole in the tooth due to acids made by bacteria. The dentist will clean the decayed part of the tooth and fill it with a permanent material called tooth filling. It restores integrity, structure, and functionality of the tooth. It can also repair cracks or broken part of a tooth.

WHY DO YOU NEED TOOTH FILLINGS

It is best to get a check-up if you feel any pain or discomfort. We offer emergency appointments for serious cases. If you notice one or more of of these symptoms, you may need a tooth filling.

  • Presence of pain in one or more teeth
  • Brown spots or discolourations at the grooves of your teeth
  • Brown spots or black discolourations at the sides of your teeth
  • A small part of your tooth has chipped off
  • Localised hypersensitivity when drinking cold beverages

GOLD FILLING

Gold is the oldest restorative dental filling material, having been used for dental repairs for more than 4000 years. The use of gold in dentistry remains significant today due to its durability that can last at least 10-15 years and usually longer.

Gold fillings can withstand chewing forces. However, aesthetically, most patients dislike metal fillings and prefer tooth-coloured filling materials. Gold fillings are also the most expensive tooth filling material since it consists 75% gold with the remainder being made up of palladium, silver, and a few other minor metals.

AMALGAM

Amalgam is a tooth filling used probably more than 200 years ago. It is made through amalgamation of various metals such as mercury, silver, tin, and copper. It is often called as silver tooth filling due to its silver metal appearance. Most patients do not like amalgam fillings due to its silver appearance.

COMPOSITE RESIN / WHITE FILLING

This the most commonly used type of tooth filling nowadays. We use tooth-coloured composite to mimic the shade of your tooth. Composite is highly aesthetic and is applied directly to your tooth surface.

AMALGAM (Metal) vs COMPOSITE (White)

Both amalgam and composite are the two most commonly used tooth filling in dentistry. However, what’s the difference? At Milltown Dental Clinic we prefer to use White Composite fillings.

  • Amalgam appears to be metallic while composite looks like normal tooth surface.
  • Amalgam may corrode while composite does not.
  • Amalgam has high wear resistance than composite.
  • Amalgam may stain the tooth while composite would not.
  • Amalgam conducts heat while composite does not.
  • Amalgam is more affordable than composite
  • Amalgam is more suitable to teeth at the back of the mouth while composite is used for teeth in front of the mouth.
Dental Filling Procedure

The procedure in getting a dental filling is quite straightforward, and nothing to be worried or afraid of. It is very important to get a check-up as soon as possible as soon as you feel some discomfort, the longer you leave it, the more chance a more invasive treatment will be needed such as a root canal or even losing the tooth. The procedure is as follows

  • The dentist will examine your teeth by doing thorough dental examination while recording in a dental chart all the teeth that need to be restored.
  • Radiographs might be taken to confirm the depth of cavity. The depth of cavity will determine if the cavity can still be restored by a tooth filling or another treatment option like root canal treatment is more suitable.
  • The dentist will discuss with you the possible treatment plan and the differences between restorative techniques.
  • Using a dental handpiece, the dentist will remove infected areas of the tooth.
  • Local anaesthesia might be administered if tooth sensitivity is unbearable.
  • The dentist will clean the tooth to be filled after all the decayed part have been removed.
  • Then a bonding fluid will be used to ensure that the filling material will not dislodge out of the tooth. After bonding, the dentist will place the desired tooth filling material and shape it like the original tooth.
  • The dentist polishes the dental filling to prevent bacteria attaching in rough areas.

AFTER EFFECTS OF TOOTH FILLING

Slight tooth sensitivity may be felt after having your tooth filled. Usually, tooth sensitivity will resolve on its own and won’t need any pain relievers. Tooth sensitivity usually wears off after a day or two.

If the dentist administered local anaesthesia, numbing sensation might be felt as the effectiveness of anaesthesia wears off.

BENEFITS OF A TOOTH FILLING

The aim of a dental filling is to save your tooth or teeth, restorative dentistry aims to restore your tooth to its former strength and stability.

  • A dental filling is a non-invasive restoration of tooth.
  • Prevents cracking of tooth, which would need a crown to fix.
  • Inhibits infection from reaching the tooth’s canal or pulp, which would need a root canal to fix.

AFTER CARE OF YOUR TOOTH FILLING

If you have your teeth restored with us at Milltown Dental, its important that you take care of your tooth. Remember that tooth filling is just a substitute for the removed part of the tooth and is not as strong as your tooth. Excessive pressure from chewing and clenching can cause tooth fillings to chip or crack.

For instance, composite tooth filling material stains or discolours after sometime. You should avoid heavy-coloured food and beverages like coffee, soda, tea, and food with food colouring. Smoking also affects the shade of composite. If a part of your tooth filling was chipped, return to our dental office immediately. That being said, you should be able to live a normal life and not notice any difference with the dental filling in place.

What is Root Canal Treatment

A simple tooth filling is insufficient once tooth decay extends up to the central canal of the tooth called as pulp. Root canal treatment is a procedure to relieve tooth pain and save your teeth. During root canal treatment, the dentist carefully removes the infected pulp tissue, cleans and disinfects the canal, and places a permanent filling to seal the space.

WHY YOU NEED ROOT CANAL TREATMENT

It is best to get a check-up if you feel any pain or discomfort. We offer emergency appointments for serious cases. If you notice one or more of of these symptoms, you may need a root canal.

  • Extensive tooth decay as seen in your routine dental check-up radiographs.
  • If you feel sharp pain confined in a tooth.
  • You experience severe tooth sensitivity when drinking cold beverages.
  • If tooth pain intensifies when lying down.
  • If you notice a tooth to be greyish which indicates death of tooth tissues.
  • Pimple-like bumps in your gums with or without pus.

If you think you may need one, contact us as soon as possible, early treatment can save the tooth and prevent you loosing the tooth.

WHAT HAPPENS IF YOU DON'T ACT NOW

The earlier the dentist to diagnose the infection and perform a root canal treatment, the higher the success rate will be. Also, as you delay having root canal treatment, the infection progresses into a more advanced stage of developing an abscess and cyst at the root tip which needs an extensive treatment or removal of the tooth. At worst, the infection can spread to other parts of the body since root canal is composed of blood vessels and nerves. Several researchers have linked the bacteria found in the root canal to be the same bacteria damaging the heart tissues which can cause heart diseases.

Root Canal Procedure

Radio-graphs will be taken to check the extent of infection inside the tooth. The dentist will administer local anaesthesia to numb the teeth and gums. A small shield or rubber sheet is placed to isolate the tooth from saliva.

An opening is made through the crown of the tooth through drilling to facilitate the use of small instruments in removing the infected tissues of the canal. Then, antimicrobial fluid will be placed into the canal to kill bacteria and rinse out debris. Once the root canal/s have been cleaned and shaped, the dentist will use a filling material to seal the tooth.

In cases where there is little healthy tooth structure left, a crown is required. Fabrication of crown usually takes a week or more, so, the dentist will place a temporary filling or a temporary crown at the end of your treatment. You will then be requested to come back for the placement of your permanent crown.

RECOVERY

A root canal treatment is a procedure to eliminate pain and not to induce more pain. The root canal procedure itself is painless. Though, you may feel a numbing sensation as the local anaesthesia wears off completely. Also, there might be some slight discomfort after the procedure but usually diminishes after a day.

A root canal treated tooth has a 92% success rate and can last a lifetime with proper care. Practice good oral hygiene by brushing at least twice a day, and flossing at least once a day. Visit the dentist regularly for routine dental check-ups and cleanings.

BENEFITS OF A ROOT CANAL

Root canal treatment is an efficient way to repair a damaged or infected tooth. Removal of the whole tooth is irreversible unless you get a prosthesis. An extracted tooth may limit function and changes in the mouth may occur such as drifting of teeth.

Saving the whole tooth by having a root canal treatment while preserving the normal function of the tooth in the mouth (normal biting force and sensation). Also, the spread of infection to other parts of the mouth is prevented. Most especially, aesthetically it looks better than a prosthesis.

OTHER POSSIBLE TREATMENTS

  • Pulp Capping - if the dentist diagnosed that decay is too close to the nerve without infecting the whole canal, pulp capping is the best alternative to root canal treatment. It is a less invasive way to preserve the tooth. Pulp capping procedure starts with removing the decayed part of the tooth and a small part of the canal tissue (pulp). Then, a medicament will be placed to protect the pulp from being infected. This medicament will also stimulate the second layer of the tooth (dentin) to develop reparative dentin that will protect the pulp. Once the pulp is capped with a medicament, the dentist will place a permanent filling in the tooth. This procedure requires follow-up appointments after several weeks to see if dentin is developing.
  • Extraction - the dentist might opt to extract a badly-broken tooth if the infection has progressed extensively in the bone. This type of infection will most likely not respond to root canal treatment. Tooth extracted can be replaced with a fixed bridge.
What are Inlays and Onlays

Upon visiting our dental clinic, you might have a decayed or chipped tooth which requires a crown, inlay or onlay. Most people are familiar with crown, but not much with an inlay or onlay.

Inlays and onlays are used to restore the chewing surfaces of a tooth at the back (premolars & molars) that is severely damaged wherein a simple tooth filling wouldn’t be strong enough. The dentist will opt for an inlay or onlay instead of a crown if there is still a considerable amount of healthy tooth structures left.

Inlays and onlays are called indirect restorations because it is fabricated in a dental laboratory, unlike a tooth filling which is moulded and placed directly to your tooth on your dental visit. Inlay and onlay are completed after two dental appointments.

WHY WOULD I NEED AN INLAY OR ONLAY

It is best to get a dental check-up if you feel any pain or discomfort or notice any cracked or chipped teeth. We offer emergency appointments for serious cases. Dental Inlays and Onlays are needed in the following scenarios:

  • Large decay wherein a tooth filling wouldn’t be strong enough.
  • Root canal treated tooth with considerable amount of healthy tooth structure.
  • Tooth at risk for fracture.
  • Bite plane correction.

DIFFERENCE BETWEEN AN INLAY OR ONLAY

Both inlay and onlay are fabricated in a dental laboratory which is made of porcelain, gold, or other metal; and are placed on the teeth positioned at the back of the mouth (premolars and molars). The difference of use depends on the amount of tooth structure that has been lost due.

An inlay is an indirect restoration for a large decay which involves the central part of a tooth’s chewing surface and may involve one cusp or tip of a tooth. On the other hand, onlay is an indirect restoration which involves more than one or all tips of a tooth.

Inlay fits in between tips of a tooth while an onlay covers the entire chewing surface of a tooth.

INLAYS & ONLAYS VS TOOTH FILLINGS VS CROWNS

  • Inlays and onlays are indirect restorations which are fabricated at the dental laboratory while tooth fillings are direct restorations which are moulded and placed directly at the prepared tooth on one appointment.
  • Inlays and onlays are indicated for large decay involving the chewing surface and tips of a tooth while tooth fillings are great for repairing small to medium sized cavities.
  • Inlays and onlays are less invasive compared to a crown. It requires minimal reduction of tooth structure compared to crown preparation.

BENEFITS

Porcelain inlays and onlays are fabricated with a shade closest to the tooth’s shade which makes it aesthetically look natural.

  • Inlays and onlays are more durable than placing a conventional tooth filling in a large decay.
  • Inlays and onlays do not affect chewing.
  • Inlays and onlays require less removal of tooth structure making the tooth more stable.
  • Inlays and onlays are less likely to discolour over time as compared to tooth fillings.
  • Inlays and onlays do not expand or contract due to temperature changes, unlike tooth fillings. Thus, fewer chances of cracked tooth.
Inlays and Onlays Procedure

The procedure for inlay and onlay requires two dental visits. You can read below the benefits of getting this treatment, not only can it save the teeth, but it also strengthens it.

FIRST VISIT

At the first dental visit, the dentist will start by numbing the tooth to be treated with local anaesthesia. Then, the tooth will be prepared by removing the infected or decayed portion.

The dentist will use an impression tray that fits on your upper and lower mouth to get a mould of the tooth prepared. Your bite will also be registered using a specific dental paste to guide the construction of tips of your onlay. This impression is sent off to the dental laboratory, where the dental technologists will fabricate an inlay or onlay that will fit the tooth prepared.

While waiting for the fabrication of the inlay/onlay, the dentist creates a temporary filling or cover for your tooth to protect it until your next appointment. You should avoid eating sticky food, drinking extremely hot or cold beverages, and engaging in physical sports.

SECOND VISIT

The dentist will remove the temporary restoration to place the fabricated inlay or onlay. Fitting of the restoration will be checked. Once inlay/onlay fits correctly, the dentist will use a bonding paste to cement the restoration permanently to the tooth.

Before the treatment ends, the restoration will be polished to ensure a smooth finish.

AFTER EFFECTS & AFTER CARE

Just like any other dental treatments, the numbing sensation can be felt until the local anaesthesia completely wears off. No pain or sensitivity will be felt after the procedure. You must continue having routine dental check-ups and cleanings, and do regular tooth brushing and flossing of your teeth.

What is a Dental Crown

Dental crown, also known as “tooth cap”, is a fixed prosthetic that is cemented onto a tooth. Crowns are used to cover the entire damaged tooth. Unlike removable prosthesis, dental crowns are cemented and can only be removed by a dentist.

WHY WOULD I NEED A DENTAL CROWN

A crown is recommended in the following scenarios:

  • To replace a large filling when there’s not enough tooth structure remaining.
  • To restore a chipped or fractured tooth.
  • To prevent a tooth from fracturing.
  • To cover a discoloured or irregular-shaped tooth.
  • To cover a root canal treated tooth.
  • To cover an implant.

WHAT ARE THE TYPES OF DENTAL CROWN

There are various types of dental crowns available. Come see the dentist at Milltown dental clinic and we will thoroughly analyse your situation, and suggest the best type of treatment to suit you.

  • Stainless Steel Crowns are prefabricated crowns used temporarily for permanent teeth. It is commonly used in children’s teeth since it will be replaced by a permanent.
  • Metal Crowns are typically made of alloys with high content of gold, platinum, cobalt, chromium, and nickel. It can resist biting and chewing forces and last the longest compared to other types of dental crowns. Its metallic colour is the only disadvantage of having metal crowns.
  • Porcelain-fused-to-metal Crowns has two layers: an inner metal layer and an outer porcelain layer. The shade of the porcelain layer is matched with the teeth’s colour to appear like a normal tooth. Porcelain-fused-to-metal crowns is an excellent choice for the back teeth (molars) wherein the metal layer increases the strength of the dental crown. However, sometimes the metal layer may appear as a dark line, especially at the gum line making it less aesthetic if placed at the front teeth.
  • All-ceramic or All-porcelain Crowns are the most aesthetic type of all dental crowns. It is the best option in restoring front teeth since it is made of an all-porcelain material which makes it appear like a natural tooth. Also, it does not have a metal layer, unlike porcelain-fused-to-metal crowns which makes it aesthetic.

BENEFITS OF A DENTAL CROWN

There are many reasons to get a Dental Crown, some of these are listed below:

  • Dental crowns support a tooth that has been damaged by decay or fractured.
  • It protects a root canal treated tooth.
  • It improves the appearance of a tooth by changing its colour and shape.
  • It is more resistant to stains than white tooth filling material.
Dental Crown Procedure

Dental crown will be completed after two appointments. On your first dental visit, a radiograph will be taken to examine tooth and bone structure. It will also show the extent of decay to be removed. Then, the dentist will administer local anaesthesia to numb the tooth and gums. In some cases, a retraction cord or gel will be placed at the gums to make a space between the gums and the tooth.

The dentist will remove the decayed part. Then, different instruments will be used to file and shape the tooth to a certain size. If the tooth is severely damaged, the dentist may need to shape your tooth with a filling material to make it large enough to receive a dental crown properly.

After the tooth is filed into the proper shape, the dentist will take a mould (impression) of the tooth as well as the other teeth surrounding it. The impression taken will be sent to the dental laboratory so that the permanent crown can be made accordingly.

At the end of your first dental appointment, the dentist will cement a temporary crown made of resin. It will protect your tooth until the placement of a permanent crown.

Once the permanent crown is ready, you will be scheduled for your second appointment. On your second visit, the dentist will remove the temporary crown and thoroughly clean the tooth prior to placement of the permanent crown. After checking if the permanent crown fits perfectly, it will be cemented permanently to the tooth using a dental bonding paste.

AFTER EFFECTS

After the procedure, a numbing sensation is felt until the local anaesthesia completely wears off. It may take some time to get used to permanent crowns. You might feel something “different” when talking or eating. However, after a little time, the crown should look and feel normal like a regular tooth.

AFTER CARE

Crowns can last a lifetime if taken care of properly. The most important step is to practice good oral hygiene at home. Brushing your teeth at least twice a day and flossing at least once a day is the best way to keep your gums and teeth healthy. See your dentist regularly for routine dental check-ups and cleanings. And lastly, to prevent damage to your new crown, avoid biting on hard foods or objects.

Tooth Extractions

Dental extraction is needed when a severely damaged tooth becomes irreparable. It has two types: simple extraction and surgical extraction.

A simple extraction is performed on a tooth with intact tooth crown above the gum line. It involves loosening of the tooth from the bone with the use of hand instruments to facilitate easy removal of the tooth from the socket.

On the other hand, surgical extraction is necessary when there’s little, or no tooth structure can be seen above the gum line such as having root fragments or impacted tooth. Surgical extraction is a more invasive procedure than a simple extraction. It is a method where a tooth is removed by doing an incision, retracting the gums (flap), and removing part of the bone. Don’t feel anxious, local anaesthesia or sedation will be administered for this procedure to be painless!

DO I NEED TO GET MY TOOTH REMOVED

At Milltown Dental Clinic we always aim to save your teeth and restore them. Sometimes this is not possible and the tooth needs to be removed. Here are some cases which may indicate a need for surgical extraction:

  • You have a severely damaged tooth that is non-restorable with a tooth filling, crown, or root canal treatment and has little to no tooth structure left above the gum line.
  • A radiograph revealed that there is a permanent tooth which failed to erupt in the jaw or impacted tooth.
  • Simple extraction can end up with a surgical extraction when a tooth breaks off into parts during the procedure.
  • Tooth ankylosis or a condition wherein the tooth fused to the bone.
  • Tooth with long, curved, or crooked roots. Forcing to remove the tooth with long, curved, or crooked roots through simple extraction can lead to tooth/bone breakage which delays healing.

WHEN REMOVAL IS MORE BENEFICIAL

The dentist will analyse whether the tooth can be repaired or must be removed using diagnostic tools such as radiographs. A tooth is considered salvageable when there is enough tooth structure to support dental restorations and a healthy bone around it.

For instance, a severely damaged tooth with little tooth structure left is almost impossible to hold a restoration properly. Thus, removal of the tooth is the best option. Another example of a tooth that needs to be removed is a horizontally impacted wisdom tooth that causes severe pain and damage to the tooth beside it. An impacted tooth has no function at all; thus removal is appropriate.

WHAT IF NOTHING IS DONE

You might think that problems in the mouth would not affect your overall health. Certain conditions (i.e. Tooth abscess), if left untreated, can cause a negative impact on your overall health. For instance, an abscess from infected upper tooth can cause cheek swelling, brain abscess, or sinus infection while an abscess from infected lower tooth can spread and cause swelling of the lower jaw (Ludwig’s Angina) which can obstruct the airway.

Since each tooth has blood vessels and nerves connected to the main circulatory system, there are higher chances of infection spreading to the heart and lead to a condition called endocarditis.

It’s better to repair damaged or infected tooth when it’s still treatable or remove it if untreatable already than wait for it to worsen and cause life-threatening problems.

BENEFITS OF SURGICAL EXTRACTION

Having a tooth removed professionally is important for many reasons. Also if a tooth is impacting other surrounding teeth, the extraction may be more complicated. Having a tooth removed in a professional surrounding has many benefits.

  • The dentist has a better vision of the surgical site.
  • There is less trauma to the jawbone and soft tissue which speeds up healing.
  • The dentist will be able to remove complicated cases like an ankylosed tooth (fused to bone) with less force and less damage to the bone.
  • The dentist will be able to remove an impacted tooth.
Procedure of an Extraction

The dentist will start by administering local anaesthesia to numb the tooth and gums. In some cases, anxious patients have the option for sedation. Once the local anaesthesia is potent already, the dentist will do an incision in the gums and make a flap or retract it away from the bone. If the tooth to be removed is covered with bone, a minimal amount of bone will be drilled to have access to the infected tooth.

Once the dentist has complete access to the tooth, it will be removed using different hand instruments. After the tooth has been completely removed, the dentist will irrigate the site with a solution to remove debris and infection. And lastly, the dentist will bring back the gums to its normal position and stitch it in place to promote better healing.

AFTER CARE OF SURGERAL EXTRACTION

With surgical extractions, you’ll have one or more stitches in the surgical site. It is very important for you to follow the dentist’s aftercare instructions such as:

  • Bite down on gauze pad provided by the dentist for 30 minutes after procedure to control bleeding
  • Apply an ice bag to the cheeks of the treated side after the procedure. Apply ice for 10 minutes every hour for the first.
  • Take prescribed antibiotics and pain relievers on time. Do not stop taking antibiotics earlier than the number of days prescribed by the dentist.
  • No strenuous activities are allowed for the next 5-7 days after the surgery.
  • Keep your head elevated using at least two pillows high for the first two nights. Do not sleep on the surgical side.
  • Avoid hot food and beverages.
  • Avoid eating hard and raw food.
  • Do not take any alcoholic beverage while taking medications.
  • Smoking after surgery is prohibited. It may cause delayed wound healing, possible bleeding and infection.
  • Keep up with your home oral hygiene. Brushing is allowed, but avoid scrubbing the surgical site. If you need to gargle, let the fluid flow from side to side and allow it to drip. Do not spit hard.

POSSIBLE / EXPECTED SIDE EFFECTS

A problem called dry socket develops in 2%-5% of people who had a surgical extraction.

Dry socket is when the blood clot at the surgical site fails to develop or dislodges by gargling. Blood clot serves as a protective layer over the underlying bone and nerve endings. Dislodgement of blood clot will expose the surgical site where food debris gets stuck and can cause severe pain and bad odour.

Nerve injury is also an example of a possible complication if the tooth removed is near the surgical site. It is rare, but if it happened, it is usually temporary.

If the tooth removed has an opposing tooth, the tooth above or below will likely move out of the socket after some time. Hence, the importance of replacing an extracted tooth with a prosthesis immediately.

If you have any queries in relation to restorative treatments then do not hesitate to contact Dr Tom Munroe at ( SMILE@milltowndentalclinic.ie).

MILLTOWN DENTAL CLINIC

Milltown Centre,
Bóthar Bhaile an Mhuilinn,
Dublin 6

Eircode: D06 E8W2
View Map

Office Hours: 01 260 3741
Emergency: 086 801 2940

E-mail: SMILE@milltowndentalclinic.ie

Opening Hours:
Monday 08:30 - 17:30
Tuesday 08:30 - 13:00
Wednesday 08:30 - 17:30
Thursday 08:30 - 17:30
Friday 08:30 - 13:00

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