1) General Examination: Your dentist should check your medical history at each appointment to make sure there are no new medical conditions; major surgeries, changes in medication or allergies that can affect you mouth or delivery of your dental care.
Your dentist should check your face and neck for any lumps or lesions. Other things that may be noted are if your jaw joints click or pop and if your neck has any swellings or enlarged lymph nodes.
Your dentist will assess the following:
- How well you are cleaning you teeth and gums
- The pink soft tissues in you mouth will be checked for ulcers, lesions and any signs of oral cancer. (NB. If you have an ulcer in your mouth that has not healed after 3 weeks you must contact you dentist immediately).
- Check each individual tooth for any cavities or decay and that the tooth is sound.
- The gums pockets will then be checked with a probe to make sure there are no signs of gum disease and a score should be noted recording this.
- The way you bite should also be recorded as some people can erode their teeth down from clenching and grinding if noted your dentist may advise a specialist referral or the fabrication of a mouth guard to prevent this.
- Your dentist may take x-rays (radiographs) in general at least every 2 years (this may vary depending on your levels of decay/gum disease and if infections or pathology are noted). The aim is to check for any cavities in your teeth and/or gum disease and ascertain if any further treatment is needed.
2) Fillings: If you develop decay your dentist will advise a filling, in which they will remove the decay and place either a white or silver filling in. In some cases if the filling is very deep or close to the nerve your dentist may place a calcium or fluoride dressing at the base of cavity. If deep generally the sensitivity will calm down over time but if very severe your dentist may warn that the nerve inside the tooth will need removed (please refer to root canal therapy).
Advantages of a white filling over a silver filling:
Modern white fillings can now totally replicate the same colour and shape as an original tooth while silver fillings can darken and stain a tooth over time. The main advantage of a white filling is that it can ‘stick’ to the remaining tooth meaning less of the tooth is cut away, while a silver filling requires grooves and undercuts to be cut to hold it in place. The cost of a white filling is generally higher as it is technically more demanding and the time and cost of materials are higher than that of amalgam.
3) Root Canal Treatment: If decay, infection or trauma spreads to the nerve of a tooth your dentist will advise you (if the tooth is salvageable) to either have root canal treatment or failing this tooth removal.
Many patients can become very nervous when this procedure is mentioned to them, if anything the process should be relatively painless if anaesthetized fully although patients are generally warned of tenderness post operatively for 2-3 days. The process normally takes a couple of appointments from start to finish but this can depend on the number of canals and the complexity of the treatment.
The aim for the dentist is to remove the affected pulp (nerve) and then clean and shape the canal to allow room for the canal to be filled (normally with an inert rubber filling called gutta percha).
Once the root canal is completed the next important step is to seal the tooth with a filling and ideally a crown especially on the molar teeth. The benefit of this is to prevent the canals from becoming inflamed or infected again and a crown can protect the tooth from fracturing especially if a large filling is placed over the root canal.
If the tooth has previously been root filled or has complex root anatomy (due to canal curvature or narrow canals or limited access), your dentist may need to refer you to a specialist in root canal treatments called an Endodontist.
4) Extraction (Tooth Removal):
A tooth may need removed for a number of reasons such as:
- Abscess or Infection or Pathology related
- Tooth has become excessively mobile
- Tooth has a deep crack inside it (refer to cracked tooth syndrome)
- Tooth is heavily broken down and deemed un-restorable
- Tooth needs extraction for orthodontic purposes (braces)
This is process generally involves local anaesthetic making the tooth numb, you should not feel any sharp pain during the procedure but may feel pressure as your dentist elevates the tooth.
Surgical Tooth Removal:
Sometimes if a tooth is heavily broken down or filled some of the tooth may break when pressure is applied, this is very common and one should not be alarmed by the sound.
In this situation the tooth may need surgical removal where the gum is retracted and some of the bone around the tooth is removed to gain more access to the broken tooth in order to elevate it out. Once removed dissolvable stitches are normally placed to restore the gum back in its original position, the stitches do not need removal as they general resorb in 7-10 days. Your dentist should guide you through post-operative care once the tooth has been removed. Generally it takes on average 6 months for the bone and gum to fully heal after an extraction