Treeview Dental Care

Dental Services

Cosmetic Dentistry (click here)

General Anaesthetics (click here)

Root Canal Treatment (click here)

ORTHODONTICS

Orthodontics (which means “straight teeth”) is the area of dentistry which deals with malocclusions (which means “bad bite”). Proper occlusion (the way the upper and lower teeth bite together) is essential for a great smile and correct jaw and mouth function.

Development of the jaws and face and stages of treatment

The development of the face and jaws is a complex interaction between muscles, bone, cartilage and teeth. Orthodontic problems develop due to an imbalance in one or more of these four areas. The timing and type of treatment depends on the age of the patients with treatment on younger patients focusing on prevention and early interception of treatment whilst treatment in older patients is focused on correcting established problems. This is because bony changes and muscle adaptation is easier in younger patients.

Stages of treatment

Why undergo orthodontics with us?

The team at Treeview Dental Care is able to treat a wide range of orthodontic cases because of their understanding of modern orthodontics. By undertaking orthodontic treatment in our general dental practice we will also be able to manage general dental and oral hygiene issues throughout treatment, producing straight, healthy teeth. Orthodontic treatment in our practice is generally cheaper than a specialist orthodontic practice but if you would like a referral to see a specialist please let us know.

What types of treatment are available?

Orthopaedic appliances: These are functional devices which can be either fixed or removable. The aim of these devices includes changing jaw shape and position to create more space for the adult teeth. The picture opposite shows an upper, removable expansion appliance. The appliance has a central expansion which, when turned, widens the upper jaw to correct a range of orthodontic problems.

Brackets: Our practice uses both traditional and modern bracket designs. Traditional brackets use an elastic “O” ring or metal tie to tightly bind the wire into the bracket. This translates to very high forces being placed on the teeth and surrounding bone and blood vessels. Many orthodontists still use these types of brackets. We use a combination of stainless steel, ceramic and acrylic brackets.

Self-ligating brackets are a modern form of bracket which uses light forces on the teeth. This results in quicker and more biocompatible tooth movement due to less damage to surrounding blood vessels. They are very similar in size and shape to traditional metal brackets. To find out more about these brackets please visit the website http://www.damonbraces.com/. At many practices the use of self-ligating brackets has an extra cost but we use these brackets as standard.

Invisalign: Invisalign involves the use of multiple, wafer thin aligners to achieve tooth movement. Invisalign is a highly aesthetic solution for orthodontic treatment and they are suitable for patients of all ages.

What’s involved in assessing an orthodontic case?

We generally require the following information to formulate a tailor-made treatment plan:

Clinical examination: check for signs of abnormal muscle habits, oral hygiene levels, check for decay
Intra-oral and extra-oral photos
Bitewing radiographs: check for dental decay between the teeth (if not already taken)
Plaster models
Lateral Cephalograph: assess jaw bone position (by referral with a radiologist)
OPG: assess tooth development (by referral with a radiologist)

The exact cost of orthodontic treatment is dependent on the difficulty and length of treatment. As a guide, orthodontic treatment can cost between $3000 and $5500 whilst Invislaign treatment can cost between $3500(partial treatment) to $6500(full treatment). Whilst a health fund rebate may be slightly higher for treatment by a specialist, the higher cost generally outweighs the higher benefit.

A precise cost and payment plan will be provided to you once all the orthodontic records have been compiled and the case assessed.

To arrange an orthodontic consultation at Treeview Dental Care, please phone our friendly receptionist on (07) 5576 4900

COSMETIC DENTISTRY

Improve the appearance of your teeth

The goal of cosmetic dentistry is to enhance, improve, or change the appearance of your teeth. In today’s society, appearance is very important. While judgment based solely on appearance may be superficial and not reflective of who you really are, it can still affect how people think of you. When you talk, people focus on your face, your eyes, and teeth. People notice a natural looking mouth, teeth, and smile and an unsightly mouth due to visible cavities, defective fillings, gum disease, or crooked or misshapen teeth will be noticed. People will often form opinions of you based on what they see.

Take an objective look…

You can get an objective look at how other people see you. Get about 45cm away from a mirror.

This is about as close as most people get to you when you speak with them and if you get any closer to the mirror, the light will not be right and you will not get a true picture of how your teeth look. Smile, talk, laugh, and observe which teeth are visible and what they look like. Then ask yourself, “If I could wave a magic wand over my teeth and change anything I don’t like, what would I change?” Write it down, then read on.

Many people think of dentistry as fixing cavities, root canals, false teeth, caps, and gum disease. But you will be fascinated by what we can do to improve your appearance.

Various procedures

Here is just a partial list of dental procedures that can improve the way your teeth look:

Replace discolored fillings in front teeth
Whiten teeth to a lighter color
Straighten crooked teeth with orthodontics or recontouring your natural enamel
Close spaces between teeth
Porcelain or resin veneers to change the shape and alignment of teeth (bonding)
Place tooth-colored fillings in back teeth (instead of silver/metal fillings)
Porcelain or resin inlays or onlays for back teeth
Cosmetic periodontal surgery to even out gum tissue that is crooked
Restoration of worn and short teeth to their proper shape
Fill in toothbrush abrasion notches
Cover missing gum tissue due to recession with soft tissue grafts
Replace missing teeth with bridges or implants
Replace defective and unsightly crowns (caps)
Cover stained root surfaces
Remove stained fracture lines from enamel
Restore chipped teeth (bonding)
Make teeth appear longer
Make teeth appear shorter

Costs for cosmetics procedures

Costs for these cosmetic procedures vary according to the extent of treatment. Tell us how you wish your smile looked. Then we can tell you what we can do, how long it will take, and what it will cost. Most of the time, people are pleasantly surprised to find that the cost is not as much as they thought. If you have dental insurance, you may often find that some of the procedures are a part of your benefit package.

MOUTHGUARDS

Prevent injuries…

Mouthguards are essential to prevent and minimise dental injuries from sporting accidents.
This includes:

Chipped teeth
Dislodged teeth
Broken jaws
Cut lips and cheeks

A mouthguard helps absorb and spread the impact of a blow to the face and mouth which otherwise may have caused dental injury. Dental injury can not only be expensive to repair but can lead to time off school and work and be very painful.

Custom-made mouthguards

Custom-made mouthguards are the best type of mouthguard to prevent dental sporting injuries.
They are:

Comfortable
Tight-fitting and wont dislodge when in use
Allows you to talk easily

The mouthgaurd is made on a plaster model of your teeth which the dentist makes once they take an impression of your mouth with specialized material.
Over the counter mouthguards, where pre-formed mouthguard is heated in water and adapted to the teeth, are less effective then custom-made mouthguards because they tend to be loose and too bulky/over-extended. This makes them less likely to be worn properly and most people don’t wear them at all.

Cost of mouthguards

The cost of a custom-made mouthguard is about $150 but most healthfunds offer a generous rebate.

MISSING TEETH

Missing teeth can be one of the most obvious and embarrassing problems for many people and can severely impact your chewing ability and normal oral function.

There are 4 treatment options when dealing with a missing tooth or teeth:
•   Do nothing and leave the gap(s)
•   Dental implant
•   Fixed porcelain bridge
•   Partial removable denture

Do nothing?

Many patients mistakenly believe that loosing and leaving gap has no consequences…

Most adults can expect to have 32 teeth. The third molars, or “wisdom” teeth, are often extracted because they do not grow into the mouth properly due to a lack of room and it is very unusual to have wisdom teeth replaced. But the other 28 teeth are needed; your mouth and jaw have developed over time to maximize efficiency and function. When you lose a tooth, the efficiency decreases and function suffers. When you lose a tooth, you lose some ability to chew food properly. This may mean that you either place more stress on the other teeth in order to chew all the food you eat, or you do not chew well enough and what is swallowed is not quite ready to be digested. Or you might switch to a diet that consists of softer foods that do not have to be chewed as much and even eliminate certain favourite foods. For each missing tooth, you lose approximately 10% of your remaining ability to chew food.

Other problems also occur. The teeth adjacent to the space left by the missing tooth will eventually shift. If for example, a lower tooth is extracted, the opposing tooth in the upper jaw will grow slowly (or sometimes quickly) longer in a downward direction into the missing tooth space. This is called extrusion or supereruption. The teeth on either side of the missing tooth space will move and tilt off their proper vertical axis and drift into the missing tooth’s space. This can make these teeth more prone to decay and gum disease because it is much harder to keep the teeth clean when they are not aligned properly. Root structure that is normally covered by gum and bone may become exposed. All this can happen if one tooth is lost.

Other major problems can occur if multiple teeth are lost. There is a loss of the arch length, the distance from the back of the last tooth on one side of your mouth to the back of the last tooth on the other side of your mouth. With collapsed bite and loss of vertical dimension, the distance from your chin to the tip of your nose decreases, making your face shorter. Extrusion and movement of your maxillary (upper) alveolar bone until the gum tissue from the upper jaw can touch the teeth or gum tissue of the other jaw causes loss of facial tone and shape. The facial muscles of the cheeks and mouth sink into the edentulous (extraction) site. There can also be severe cosmetic problems when the extracted tooth’s space is visible when you talk or smile.

DENTAL IMPLANTS

A dental implant is a synthetic metallic root substitute that is placed or implanted in the jaw bone. It can be used to replace a single missing tooth, provide an abutment (anchor or retainer), replace several missing teeth, or provide added retention to a removable dental appliance such as a full or partial denture. In fact, if you are missing all of your natural teeth, it is possible to have maxillary (upper) and mandibular (lower) fixed replacements. The replacements do not come out and you cannot remove them yourself. Implants are the best long-term option to replace a missing tooth or teeth as they are fixed in position and extremely strong.

A dental implant consists of three components:

Fixture: Made of titanium, this is the section of the implant which fuses (known as osseo-integration) to the bone, making the implant extremely strong and stable.
Abutment: This is the specialized attachments which connects the prosthesis, through the gum, onto the fixture.
Prosthesis: This is the part of the implant that looks like a tooth or teeth. It can include a crown, bridge or denture.

Dental implants:

Help to withstand greater bite pressure than denture
Prevent bone loss in the jaw (this may reduce the risk of adjacent natural teeth becoming loose)
Prevent the formation of hollowed or collapsed cheeks that can occur after tooth extraction (missing teeth cause bone loss in the jaw)
Are usually surrounded by gum tissue like natural teeth
May prevent gum recession
Unlike bridges, do not require the cutting and reshaping of neighbouring healthy teeth
Are firmly secured in the jaws and are not loose like dentures
Are usually more comfortable than dentures
Usually do not require separate care routines or special cleaning products, as with dentures or bridges.
Like natural teeth, dental implants are cleaned by dental floss and toothbrushing.

BRIDGES

A dental bridge involves using the teeth either side of a gap as supporting pillars to support/suspend fake tooth/teeth in the gap.

The teeth that are to be the supports for the bridge are prepared similar to the preparation of a single crown. The teeth are made smaller by about 1 to 2 millimetres, depending on the part of the tooth being drilled. An impression is made of the prepared teeth and sent to a lab. While the bridge is being made, the prepared teeth are protected by a temporary bridge. Once the final bridge has been put in with final cement, it is not easy to get it off again without permanently damaging the porcelain and metal.

Bridges do require special oral hygiene and care. You cannot normally floss teeth that have been bridged and instead have to use specialized interdental brushes or a product called Superfloss. Bridges are brushed with your toothbrush as per normal.

Advantages of the fixed bridge include proven reliability and longevity, with a well made bridge lasting on average 10-15 years if they are well maintained. Some bridges have been known to last significantly longer than this. Obviously, the natural teeth supported the bridge can become decayed if they are not well looked after and any damage to the supporting teeth generally means the bridge will be lost. Whilst extremely strong, your bridge will be damaged if it is placed under excessive force. Regular dental examinations allow your dentist to monitor your bridge and bite.

PARTIAL DENTURE

Removable partial dentures have been made by dentists and worn by patients for many years.

Partial dentures can be either made entirely out of acrylic or made with a cobalt-chrome metal base with only minor amounts of acrylic. Small metal clasps are used to hold the denture on to the surrounding natural teeth and pink acrylic mimics the gum tissue. The metal clasps are silver in colour and, depending on the individual circumstances, may or may not be visible when you talk or smile. These clasps are absolutely necessary to hold the partial in place. Their location and design are dictated by the shape and position of your remaining teeth and which missing teeth will be replaced. We will show you where the clasps are to be located in your mouth. Most of the time, the amount of preparation (drilling) of your natural teeth needed to ensure successful clasp design is minimal. Often there is no need for a local anaesthetic injection.

The base of the partial denture will rest lightly on your gum tissue. At some time in the future it is expected that you will need adjustments to the base. Usually this means an addition of more pink material to the denture base. Clasp arms will loosen and need to be tightened at various times. Weight loss or gain will also affect the fit of the base of the partial.

Although a partial is less expensive than a fixed bridge, which is metal and porcelain cemented into place, there are several possible drawbacks. The supporting gingival tissue can change over time which may cause the denture to become loose and you may need the addition of extra acrylic to the base of the denture to compensate for this. Matching the plastic denture teeth to your natural teeth or previous dental work is always difficult and sometimes the shade, whilst close, is never quite right. Dentures can cause an altered taste sensation due to the coverage of metal and acrylic across the roof of the mouth and on the gums. Components of the denture may interfere with your bite. All dentures rock slightly due to the fact that the denture rests on your gums, which does compress slightly under pressure.

It is always difficult to know how well a patient can cope with a partial denture. Some patients adapt very quickly and seamlessly to partial dentures whilst others encounter significant and ongoing problems.

ROOT CANAL TREATMENT

The centre of each tooth consists of a chamber, called the pulp chamber. This chamber holds the blood vessels and nerves (known as pulp tissue) which keep the tooth alive and give it sensation to things like heat, cold and pressure. Pulp tissue extends from the pulp chamber down the roots and into the bone via root canals where it connects to larger nerves and blood vessels. Pulp tissue dies for a variety of reasons including bacterial attack (due to a large cavity), an irritating filling, trauma, gum disease and excessive wear and tear. As the pulp dies, dead tissue products build-up in the bone forming an abscess which can result in pain, temperature sensitivity, swelling and can keep you awake at night. The best way to resolve these issues is to have root canal (endodontic) treatment.

Root canal (endodontic) treatment is the process of removing the infected/dying pulp from the tooth and filling the root canals with a sealant material. The number of root canals varies from 1 to 4 and all open into the pulp chamber. During appointments, a thin latex sheet (rubber dam) is used to isolate the tooth from bacteria in the mouth. An opening is created in the tooth to access the pulp chamber and root canals. The canals are cleaned and shaped using very fine instruments (called files) manipulated by hand and drill. The files can range from 17mm-31mm in length and 0.08 to 0.80 mm (80 microns to 800 microns) in diameter.

Full treatment occurs over a number of visits (usually between 2 and 3) to ensure the removal of all debris from the root canals and allow for bone healing. Special antibiotic dressings are placed in the root canals between visits to destroy bacteria and promote bone healing. Temporary fillings are placed in the teeth to seal the internal aspects of the tooth from saliva.

When it has been determined that the canals are free of infection, they are filled with a special rubber-like material and sealant. It may take several months before healing is completed and for the tooth to become totally pain free.

Root canal treatments are successful in over 95% of completed cases. The outcome depends on a wide range of issues but includes the skill of the dentist; the co-operation of the patient; the anatomy of the patient and access to the tooth; the health, well being and healing capacity of the patient; the type and quantity of bacteria present in the mouth and in the root-canal system; the shape of the root canals; position and angulation of the tooth; previous restorations of the tooth and pathology associated with the tooth. You will be informed as soon as possible if difficulties are encountered.

Side-effects

Like all treatment there is a slim chance of an unwanted event occurring. These include:

Fractured instruments: due to the nature of the canals and instruments, it is possible for instruments to break in the canals. If possible these instruments are retrieved and root canal treatment proceeds as normal. If the instrument is stuck permanently, then this will reduce the chances of success. Your dentist will discuss this with you further.

Pain/discomfort: It is common to experience some slight discomfort during and following root canal treatment. This should be easily controlled with anti-inflammatory or pain relief medication. Severe pain is very rare.

Loss of tooth: some teeth do not respond to root canal treatment and need to be extracted.

Infection: it is possible for bacteria to persist in the bone following root canal treatment for a number of reasons. These include exceptionally virulent/strong bacteria and insufficient healing capacity of the patient. This may result in the need for extraction

Discolouration: it is common for root canal treated teeth to darken overtime due to the materials used during treatment. This is often a cosmetic issue which can be individually dealt with.

Altered feeling: it is common to experience varied sensations from a tooth during and following root canal treatment. This generally returns to normal.

Endontist

An endodontist is a root canal treatment specialist. You may need referral to an endodontist if your treatment is too difficult for us to handle or if unexpected events occur during or after treatment. The fees for the endodontist are separate to ours.

Following obturation (filling) of the root-canal system it is common to experience mild discomfort for up to 10 days however in rare cases this can persist much longer. This can be controlled with anti-inflammatory medication. Any increase in pain after the first few days is uncommon and must be reported as antibiotics may be required.

What’s Included in the Cost?

The cost of root canal treatment includes the following:

All radiographs

· the initial diagnostic radiographs
· working and measurement radiographs
· radiographs of the completed root canal treatment

All necessary anaesthesia (local) to “numb” the tooth

Access into the tooth

Removal of the nerve tissue

Cleaning and shaping of the canals

Irrigation of the canals with medicated solutions

Placement of medicated dressings where needed

Filling the canals with root canal filling materials

A temporary filling in the access opening between appointments or at completion of the root canal

Any emergency visits necessary during treatment of the root canal for the tooth being treated

Restoration of the Tooth

Before commencing with root canal treatment it is important to give some thought to the final restoration that will be placed on the tooth. Teeth are weakened following root canal treatment and although a conventional restoration (filling) can restore the tooth in the short to medium term, a long term solution will require a stronger restoration such as a crown or inlay/onlay. Crowns are hard porcelain coverings which cover the tooth similar to the way a helmet covers persons head.

Crowns are extremely strong and are the longest lasting restoration a person can have. Please note that the cost of the final filling in the tooth, regardless of whether it is a crown, onlay or normal filling has a separate cost associated with it.

Alternative Options

There is only one real option to root canal therapy and that involves extraction of the tooth but will obviously create a gap. There are three issues associated with a gap:

Tipping of the adjacent teeth: the teeth either side of the gap will tilt into the space to reduce it but not close it. This results in a food trap which can lead to cavities forming in the surrounding teeth if they are not flossed regularly. It also causes the bite plane to change which can cause overloading of the jaw joint.

Over-eruption of the opposing teeth: the teeth that opposed the missing tooth will begin to move further out of the gum. This alters the bite plane which leads to overloading of the jaw joint.

Aesthetic problems.

There are three main options of replacing a missing tooth:

Dental implant: this consists of a titanium screw which supports a porcelain crown. This is the best option to replace a missing tooth.
Porcelain bridge: this option involves using the two adjacent teeth as supporting pillars and placing porcelain tooth in the gap.
Removable denture: this involves using an acrylic or metal-based plate to replace one or more missing teeth.

If you have any questions about Root Canal Treatment or would like more information please don’t hesitate to ask. Phone (07) 5576 4900

TOOTH WHITENING

Tooth whitening is the use of bleaching agents to lighten the colour of the teeth. The normal colour of tooth enamel (the hard outer surface of each tooth) varies, with most teeth ranging in colour from off-white to light yellow.

Teeth may be discoloured by various factors including:

Surface stains due to lifestyle (for example, smoking, coffee, tea or red wine)
Age
Poor oral hygiene, with irregular brushing and flossing
Certain medicines, for example, tetracycline (an antibiotic)
Dental problems such as tooth decay, tooth injuries, thin enamel, tartar (hardened plaque, also called calculus) and old fillings, which can turn teeth yellowish, brown, grey or black
Excessive fluoride, which can discolour and mottle teeth if taken during early childhood

Teeth discoloured by surface stains or age usually respond best to whitening treatment because the source of the stain/discolouration is close to the surface of the tooth and close to the applied bleach.

Cause of Your Tooth Discolouration

A thorough dental and medical history allows the dentist to diagnose the cause of your tooth discolouration and may influence the decisions on bleaching products. Sometimes, a patient has other dental problems such as decay or gum disease that must be treated either before or after bleaching and your dentist will discuss any additional treatment and costs.

Not everyone is a good candidate for tooth whitening. Factors that could make this treatment unsuitable include:

Discolouration caused by medicines
Severe tooth sensitivity to hot and cold food and drink
Defective or absent tooth enamel
Habitual use of tobacco products such as cigarettes, cigars or chewing tobacco
Gum disease (periodontitis)
Habitual use of some alcoholic drinks
Presence of denture, dental implants, crowns, veneers or fillings
Young age, if permanent teeth are still developing
Pregnancy or breast feeding

Talk to your dentist

Realistic expectations: In general, over 70% of people experience a noticeable and significant colour change, about 20% experience only minor change and 10% experience almost no change. The determining factor is not the bleach concentration but the “bleachability” of each person, which is determined by individual variations in tooth mineral content. We generally find that yellow pigmented teeth bleach better than white, brown or grey teeth. All bleaching processes will involve a re-bound process whereby final tooth colour stabilizes 2-3 days after the last bleach application, but we take steps to ensure that this rebound effect is minimized.

All methods of bleaching will involve some tooth sensitivity and gum irritation however there is no permanent damage to the teeth or gums. Unfortunately fillings, crowns and dentures will not bleach and may need to be replaced at the conclusion of the bleaching process.

Results from professional whitening treatments last between one to three years and most treatments can be reapplied, although most people only undergo one course of whitening treatment. Depending on a person’s smoking, drinking and oral hygiene habits, the results may last for only a few months. Good oral hygiene, regular professional cleaning and occasional bleaching will keep you teeth whiter for longer. Your smile may benefit from other restoration treatments such as veneers, replacement crowns or fillings.

Professional treatments

Your dentist will discuss the best whitening options for you depending on factors including you dental history, the cause of your tooth discolouration and the degree of discolouration. Your dentist may conclude with a topical fluoride treatment and/or a tooth-remineralising treatment to strengthen tooth enamel and reduce the risk of sensitivity to hot and cold.

Light-activated and laser bleaching (in-office bleaching)

Our practice uses the Zoom! method of in-office tooth whitening. Zoom! involves painting high concentrate bleach on the teeth then heating the bleach with a blue UV light, which is often referred to as laser whitening. The advantage of the light is that it quickly heats the bleach to a high temperature, allowing it to penetrate deeper into the teeth. The bleaching process occurs through the release of oxygen from the hydrogen peroxide to bleach the discoloured or stained surfaces. Your gums, lips, cheeks and tongue are protected with specialized rubber and gauze seals to prevent burning. This type of bleaching takes about 1.5 hours to complete.

The cost of Zoom! is $650.

Bleaching trays (at-home bleaching)

This method of bleaching involves the use of medium concentrate hydrogen peroxide placed on the teeth with custom made trays. The trays are worn for anywhere from an hour to overnight for 3 weeks (this process is also known as Take-Home whitening). Due to the lower concentration of the bleach and lake of heat lamp, the oxygen from the hydrogen peroxide is unable to penetrate as far into the teeth and as a result the bleach needs to be on the teeth for longer than Zoom!TM to maximize the penetration of the bleach into the teeth.

The cost of an at-home bleaching kit is $350.

Internal bleaching of a root-filled tooth

Your dentist may suggest internal bleaching for a toot that has turned dark after root canal treatment. Your dentist drills a small hole in to the back of the tooth, removes some of the filling from the tooth’s root canal, and inserts the bleaching product. The hole is closed with a temporary filling. You will need to return to your dentist in about a week to have the bleaching product and temporary filling removed. To achieve a whiter tooth, the procedure may have to be done again. When treatment is complete, your dentist removes the bleaching product and seals the hole with a permanent filling.

Possible complications

All dentist treatments carry some degree of risk. It is not usual for the dentist to outline every possible rare complication. However, it is important that you have enough information to fully weigh up the risks and benefits of treatment. There may be other side effects not listed here. Side-effects of tooth whitening may include:

Minor tooth discomfort or pain
Sensitivity to hot and cold air, liquids and foods
Sore or irritated gums and inner cheeks
Whitened patches on the gum line
Mouth ulcers
Sore throat (rare)
Nausea, if the bleaching agent is accidentally swallowed (rare)

Most side-effects are very mild and generally subside within days of completing bleaching without any treatment.

Non-professional or Over-the-counter treatments

Over-the-counter kits are cheaper than professional bleaching, but any damage they cause may be expensive to repair. For example, some bleaching products contain acids that can dissolve tooth enamel. Unsupervised, long term or repeated use of over-the-counter kits increases the risk of such side effects.

Whitening toothpaste contains abrasive, mild beaches or both that usually are effective only for surface stains such as coffee and red wine.

Various bleaching kits available from your pharmacist include:

Sticky strips worn against the teeth
Special “paint” applied with a brush
“One-size-fits-all” plastic trays that are filled with bleaching gel. Depending on instructions, you use the bleaching kit for a certain period of time.

Bleaching booths at shopping centres use low concentration bleach to try and lighten the teeth. They are manned by staff with little or no dental experience who are not able to assess the true cause of your tooth discolouration or tailor treatment (including scaling and cleaning, bleaching and fillings) to address it. Shopping centre bleaching booths produce a similar short-term bleaching effect as over-the-counter treatments.

VENEERS

Veneers are used to enhance, improve or change the appearance of your teeth. Veneers cover only the single, outside portion of the tooth, the part that shows when you smile or talk. Veneers are prepared and placed on the teeth in a similar way that an acrylic nail is adhered to a natural nail. Veneers are generally made from 2 types of materials, porcelain and composite resin.

Porcelain and resin veneers are placed in order to correct slight or severe defects in tooth alignment, shape, or colour. They are also placed when teeth have been moderately restored and the teeth have been weakened. This is done when there is still enough enamel left for the bonding to be successful. If the teeth are in very poor alignment or there is insufficient enamel remaining, bonding to improve the appearance is not possible. At that point orthodontics or full-coverage crowns must be considered.

The most common use for bonding veneers, either porcelain or resin, is to improve the cosmetic appearance of the smile.

Without question, porcelain veneers look the best and last the longest. They are indicated when the teeth are in fair to good alignment or when a more pleasing tooth colour is desired. They are not usually placed in a patient under 16 years of age.

The Veneers Procedure

The procedure usually requires some slight to moderate tooth preparation (drilling) to achieve the best possible contour and natural appearance of the veneers. Local anaesthesia is administered if required. The procedure requires two separate appointments, approximately 10 days apart to complete because the veneers are constructed in an offsite laboratory. Once bonded into place, the porcelain veneers become very strong and the success rate is high, they can last up to 12 or more years. Anything that will break your natural teeth can break the porcelain veneers, for example, hard lollies, corn on the cob and ice cubes.

Veneers are highly stain resistant. They are a good treatment choice when all the front teeth are being restored. They are more expensive than resin veneers, but they last longer and look better than resin. Porcelain biting surfaces can cause more rapid wear of opposing natural teeth. Porcelain veneers cannot be repaired easily if it’s damaged or if the gum shrinks away from the top edge.

Composite resin veneers are made of the tooth-coloured filling materials. They are placed by the dentist in one visit and require minimal tooth preparation (drilling). Local anaesthetic may be required. Resin veneers are used in similar situations to porcelain veneers however they last only half as long before requiring repair or replacement. They are advised for patients who are still growing. They look very good but are not as good as porcelain. While repairs to the resin veneers are not too difficult, they have a tendency to chip more than porcelain veneers.

Basically, porcelain looks better, lasts longer, is stronger, more expensive, and requires two dental appointments to complete. Resin veneers are less expensive, easier to repair, and better for children. For both types of veneers (but especially porcelain veneers), we generally recommend the use of a nightguard. Nightguard’s are worn at night while sleeping to prevent excessive grinding forces from damaging the veneers and are also good at preventing excessive tooth wear from nocturnal tooth grinding. This is a separate cost to the veneers.

It is very important to come in for regular (6 monthly) check-ups and cleans if either type of veneer is placed. This way, we will be better able to quickly correct any problems that develop.

If you have any questions about porcelain and resin veneers, please feel free to ask us. Phone (07) 5576 4900

WISDOM TEETH

Wisdom teeth (or third molars) are the last teeth to erupt on both sides of the mouth and in both jaws. If the wisdom teeth erupt fully out of the gum and are used in the bite they are generally left in place (we call them ‘functional teeth’). In many cases wisdom teeth do not fully erupt out of the gum as most people don’t have enough room for them.

Hundreds of thousands of years ago the abrasive nature of the human diet made wisdom teeth very important for chewing. The food was very hard and not cooked well which wore the teeth down much quicker than we do today. The jaw bones were also much bigger and stronger than they are today which allowed the wisdom teeth to be functional teeth.

Today, we don’t need the heavy grinding capacity that early humans needed. Food is easier to eat, less abrasive and much softer. Evolution is reacting (slowly) to this fact by decreasing the size of our jaw bones and chewing muscles. The human jaw that once comfortably held 12 molars (32 teeth total) is now often only large enough to hold eight molars (28 teeth total). Unfortunately, our jaws are getting smaller faster than our wisdom teeth are disappearing. The wisdom teeth often do not have enough room to grow properly. Eventually, thousands of years from now, humans will not have wisdom teeth as they have lost their function.

Problems associated with wisdom teeth

A number of problems can be associated with wisdom teeth depending on how far they have erupted from the bone and gum. Dentists classify wisdom tooth eruption as follows:

Fully erupted: totally out of the bone and gum
Partially erupted: partially out of the bone and gum
Soft tissue impaction: out of the bone but caught in the gum
Partial bony impaction: part way out of the bone
Full bony impaction: totally under the bone and gum.

This classification can be further broken down according to the angulation of each wisdom tooth in relation to the other teeth:

Mesially angled: the tooth is angled forward
Normally angled
Distally angled: the tooth is angled towards the back of the mouth.

If the wisdom teeth erupt fully, are functional teeth and you are able to keep them clean, we leave them alone.

However, many problems can develop if the wisdom teeth don’t erupt properly:

Pericoronitis: this is the most common problem with erupting wisdom teeth. Pericoronitis is an inflammation (infection) of the soft gum tissue that surrounds the coronal portion (enamel-covered part) of a tooth. It can be associated with the eruption of any tooth but is most commonly associated with wisdom teeth. The inflammation occurs because the gum flap over the enamel does not seal the tooth from bacteria and plaque which get trapped between the tooth and gum leading to a painful inflammation.
Damage surrounding teeth: a partially erupted wisdom tooth that is touching the molar in front will result in plaque build-up around both. This can lead to decay in both teeth and may result in the need for extensive treatment to save the adjacent molar or an extraction of both.
Crowding: an erupting wisdom tooth can place pressure on the back teeth and push them out of place.
Resorb the tooth in front: This occurs when the erupting tooth eats away the adjacent molar.
Cyst development: an uncommon event, this occurs when parts of the tissue surrounding the tooth begin to grow abnormally. This can result in tooth and bone damage.
The impacted wisdom tooth is a weak spot in the jaw, making fracture more likely in the event of trauma.

Deciding When to Extract?

The decision to leave or remove one or more wisdom teeth requires a careful radiographic assessment and oral examination. Because the wisdom teeth are so positioned so far back in the mouth it is often necessary to be referred for an OPG radiograph (full mouth X-Ray). An assessment of the risks versus benefits of removal will be made about each wisdom tooth. Generally the more impacted and angled a tooth is the harder it is to extract.

Local or General Anaesthesia?

Removal of wisdom teeth can be performed under local anaesthesia (LA) or general anaesthesia (GA). Under LA the extraction site is numb and the patient should only feel pressure as the tooth is extracted. In the case of a GA, the patient is put totally asleep while the teeth are removed. A GA may be required for patients who are extremely nervous, have difficult extractions or require work on other teeth. The decision of LA or GA is case dependent and will be discussed in more detail.

Post Extraction Issues

There are a number of common events that can occur following the extraction of one or more wisdom teeth:

Pain and discomfort: While pain is relative, all people experience some minor discomfort for the first 24 hours after surgery. That’s why we recommend people take some form of mild painkiller (such as ibuprofen or paracetamol depending upon your general medical health, please ask for more information) for the first 24 hours after extractions. If the pain is likely to be more intense we will prescribe a stronger painkiller.
Inflammation: It is common to get inflammation of the gum around the extraction site. Some people may also experience minor facial swelling. If this occurs, it may be appropriate to place intermittent ice packs (20 minutes on, 20 minutes off) for 24 to 48 hours following the extraction.
Nerve damage: While it is uncommon, during the extraction it is possible for some nerves to get stretched and bruised, especially for lower wisdom tooth extraction. This will commonly lead to altered sensation in the lips and tongue. In most cases sensation will return to normal over a period of weeks to months and it is very rare for the sensation not to return.
Sinus problems: The roots of the upper wisdom teeth are located close to a nasal sinus (the two sinuses close to the teeth are the maxillary sinuses). Sometimes during the extraction the floor of the sinus may get damaged. This is generally not a problem but if you notice any unusual signs (such as fluid in your nose or air passing through the extraction site) please let us know.
Dry socket: Occasionally the blood clot will fall out of the extraction site, exposing bone. Sometimes this is uncomfortable and requires a visit to our surgery so we can place a soothing dressing over the bone. A dry socket does not alter healing.
Sore lips and cheeks: Sometimes excessive pressure is placed on the cheeks and lips during the extraction. The cheeks and lips should go back to normal over a few days.
Jaw joint soreness: Existing jaw joint problems can be exacerbated by the extraction of any tooth, not just wisdom teeth. Acute exacerbations of joint problems should settle down over time.
Natural variation in healing capacity: Each person heals differently. Even with a perfect surgical procedure, some people can experience delayed healing for a variety of reasons unrelated to the procedure itself. Our team will support all of our patients through the healing phase, whether they be quick or slow healers.

Our aim is to help you understand the problems that might be associated with wisdom teeth and your various treatment options.

GENERAL ANAESTHETICS

When dental treatment requires general anaethetics

For some patients having dental treatment in the chair is not possible. Whether it be due to extensive treatment, complex treatment, severe pain or difficult access, some patients do require a general anaesthetic, or “getting knocked out”.

We undertake our general anaesthetic procedures at Pacific Private Hospital in Southport. The procedure is a day surgery admission and the anaesthetic is administered by a specialist anaesthetist whilst we perform the dental treatment.

3 separate fees

There are 3 separate fees associated with general anaesthetic treatment:

Dental fees: These fees are payable to us prior to the procedure being undertaken.
Hospital fees: This fee is payable on the day of the procedure to the hospital. Most healthfunds offer generous rebates.
Anaesthetist fee: This fee is payable to the hospital on the day of the procedure. Medicare and healthfunds pay very little towards this cost

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