Cosmetic Dentistry

What is the purpose of cosmetic dentistry?
Cosmetic dentistry aims to improve the aesthetics of the teeth and face.

Can cosmetic dentistry improve the appearance of teeth?
Yes, it can. Cosmetic dentistry can enhance the appearance of teeth.It can renew and improve the appearance of teeth that are stained, discoloured, or damaged by decay or injury.

What is the purpose of cosmetic dentistry?
Cosmetic dentistry aims to improve the aesthetics of the teeth and face.

Can cosmetic dentistry improve the appearance of teeth?
Yes, it can. Cosmetic dentistry can enhance the appearance of teeth.It can renew and improve the appearance of teeth that are stained, discoloured, or damaged by decay or injury.

Dentist1

Why should I improve my appearance?

  • It is important to like yourself and the way you look.
  • Physical appearance matters to us. Most of us want to look as good as possible.
  • Modern medicine and dentistry make it possible for us to improve the way we look.

Looking and feeling more attractive can lead to an improved self-image, greater self-confidence and a sense of well-being.

What are aesthetic principles?

  • Aesthetic principles are the criteria we use to assess the harmony and attractiveness of the teeth, smile and face.
  • These aesthetic principles are based on size, shape, colour, proportion, and alignment.
  • Teeth must not only have a pleasing shape, colour and size, but also a correct proportion of width to height.
  • They should also match the surrounding teeth in size, shape, colour, and be in proper alignment with them.
  • The proportion of tooth to gum that shows when a person smiles, is also important to the aesthetic quality of the mouth and face.

These aesthetic "principles" are not rules imposed by some know-all authority.
We all recognise when a tooth is too long or if it doesn't "fit in" in some way or another.
These are not hard and fast rules. A smile that is imperfect can still be acceptable or even attractive.

Where do I start?
Have a discussion with your dentist and explain exactly what it is that you don't like about your teeth, mouth and gums.
Ask your dentist what changes can be made.

What first steps will my dentist take?
The first step will be a smile analysis.

What is a smile analysis?

  • The dentist will evaluate all the factors that affect your smile. The following will be considered:
  • How much tooth shows when you smile.
  • The size, colour, shape and position of the teeth.
  • Spaces between the teeth.
  • The condition of the teeth.
  • The amount of gum revealed when you smile.
  • The evenness or unevenness of the gum line.
  • The colour and texture of the gums.
  • The way the lips are supported by the teeth and gums.
  • The way the upper and lower jaws relate to each other.

How can I be sure I will like my changed smile?

  • Some cosmetic dentists have a computer-imaging programme.
  • This enables them to project the proposed changes onto your own photograph.
  • This will give you a good idea of how you will look when the changes have been made.
  • The dentist can also show you "before and after" photographs of other patients who have been successfully treated

My teeth seem too big for my face. What can be done?
Teeth that are disproportionately large can be pared down and fitted with new crowns.
This will make the teeth smaller, and more in proportion to the rest of your mouth and face.

What is a dental restoration?

  • In order to repair or improve the appearance of a tooth, it may be necessary to remove some of the tooth and replace it with a filling, replacement crown, or a veneer. This process is called tooth restoration.
  • Natural looking, tooth-coloured restorations are used in cosmetic dentistry.

How are crowns, veneers and bonding used in cosmetic dentistry?
The restorations used most in cosmetic dentistry are:

  • Replacement crowns (caps)
  • Veneers
  • Bonding
  • Porcelain inlays and onlays

Replacement Crowns
Replacement crowns look attractive and natural, and match the adjacent teeth.

  • The visible part of the tooth above the gum line is called "the crown".
  • If the natural crown is unattractive, decayed or damaged, it can be aesthetically repaired with a "replacement crown".
  • The dentist pares down the original tooth, takes an impression of it, and sends it to a dental technician.
  • The technician uses the impression to make a cast of the prepared tooth.
  • A plaster cast is an exact copy of the prepared tooth and the adjoining teeth.
  • A replacement crown is made to fit the cast, and is sent back to the dentist.
  • The dentist then cements the replacement crown onto the prepared tooth.
  • Replacement crowns are usually made of porcelain, or porcelain fused to metal.
  • A temporary plastic replacement crown will cover and protect the pared down tooth until the permanent crown is ready to be cemented onto it.

Veneer Restoration
The appearance of a tooth can be dramatically improved by replacing only the front visible surface of the natural crown. This procedure is called a veneer restoration.

  • The dentist trims down the front surface of the tooth, and takes an impression of the prepared tooth.
  • The impression is sent to the dental technician who makes a thin porcelain veneer, similar to a false fingernail.
  • As very little tooth material is removed in the preparation for a veneer, a temporary veneer may not be necessary while the porcelain veneer is being made.
  • However, a temporary plastic veneer will be needed to protect the trimmed down tooth if it is sensitive to hot and cold.
  • Finally, the dentist will bond the attractive, natural-looking porcelain veneer to the tooth.

Bonding
Bonding is a method of replacing an unattractive tooth surface with a more aesthetic tooth-coloured material.

  • This material is applied in layers to the tooth surface, fused to the tooth with a special ultra violet light, and then shaped appropriately.
  • The procedure is painless, and can be used to repair damage to front teeth, or to replace old, discoloured or unattractive fillings.
  • Bonding can reduce spacing between teeth by increasing the width of the teeth.

 

Porcelain inlays and onlays
An inlay or onlay is a solid filling made outside the mouth, and then cemented into the tooth.

  • It is long lasting and made of porcelain bonded to metal, or of pure porcelain.
  • This is a superior type of restoration that is used to replace unsightly, discoloured fillings.
  • The dentist removes the unattractive filling, and takes an impression, which is sent to the dental technician.
  • A natural looking replacement filling is then made.
  • A temporary filling will be placed in the tooth to protect it while the restoration is being made.
  • The filling is then placed into the prepared cavity and held in place by cement.
  • Professionally carried out whitening by bleaching can lighten the colour, and improve the appearance of discoloured teeth.
  • The dentist applies the bleaching material to the teeth in trays that fit around the teeth.
  • The patient then continues with the applications at home.
  • Laser treatment for tooth whitening is very successful. A noticeable change of colour can be achieved in a short time.
  • Home whitening can be achieved by using whitening toothpastes and whitening kits.
  • The toothpastes can lighten tooth colour and maintain the lighter colour of teeth that have been whitened by other means.
  • Whitening kits are available from drug stores and pharmacies for home use. Some are claimed to be very successful.
  • Home whitening is likely to be more gradual than the professional treatment.
  • Many people believe that whiter teeth make them look younger and more attractive. It is for you to decide if you wish to have whiter teeth.
  • Unattractive stains on teeth can be removed by whitening.

Porcelain inlays and onlays
An inlay or onlay is a solid filling made outside the mouth, and then cemented into the tooth.

What is available for whitening my teeth?
A few whitening procedures are available to lighten the colour of teeth.

Tooth Whitening or Bleaching

Should I have my teeth whitened?

  • Many people believe that whiter teeth make them look younger and more attractive. It is for you to decide if you wish to have whiter teeth.
  • Unattractive stains on teeth can be removed by whitening.

Can tooth whitening improve tooth colour?

  • Teeth darken and yellow naturally with age.
  • Whitening lightens the colour of teeth.
  • Surface stains on the enamel can be removed by cleaning with abrasives during a regular dental cleaning. This can be combined with bleaching if necessary.
  • Surface stains, and darkening of the body of the tooth can be bleached to a lighter shade.

What are the available methods for tooth whitening?

Professional whitening
Peroxide is the whitening agent that the dentist will use.
A "curing light" is sometimes used with the peroxide to accelerate the bleaching process.
Most bleaching techniques include the use of mouth trays.

  • These fit firmly over the teeth, but do not reach the gums.
  • The trays are filled with a paste or gel containing bleach.
  • The dentist will provide these trays for use in the surgery and for you to take home.
  • The dentist will tell you how to use the trays at home, how often to use them, and for how long to keep them in the mouth.
  • You will stop repeating the treatment when you are satisfied with the colour of your teeth.
  • Additional treatments may be needed to maintain the lighter colour.

Laser treatment

  • Laser treatment lightens teeth very quickly and effectively.
  • It is more expensive than conventional bleaching and not many dentists are able to provide the service.

Micro-abrasion
Some stains in the enamel layer can also be polished away with a mixture of hydrochloric acid and pumice.
This is called the "Micro-abrasion Technique".

  • It is used to remove surface marking caused by infection or injury, and other staining of unknown origin.
  • The micro-abrasion removes a very thin layer of the enamel.

Home whitening
Home whitening can be successful, but professional bleaching will be better controlled, and is therefore preferable.

  • Home whitening kits are available off the shelf at pharmacies and drug stores.
  • They must be used carefully to prevent the bleach from reaching the gums, as it can cause an irritation.
  • The mouth tray containing the bleach should fit snugly over the teeth, but must not reach the gums. It is important to trim the tray carefully in this respect.
  • Correct use will bring the bleaching agent into contact with the teeth only.

Whitening toothpastes
Whitening toothpastes have become popular and are being advertised as the key to whiter teeth. 
They are seen as an easy way to whiten teeth.

  • The whitening procedure becomes part of the twice-daily dental cleaning routine. No extra effort is required.
  • Whitening toothpastes are able to lighten the colour of teeth.
  • They can also help to maintain the lighter colour achieved by professional bleaching.
  • However, tooth whitening with toothpaste is a gradual process.
  • Many whitening toothpastes are effective in removing ordinary surface stains in addition to having a bleaching ability.
  • Most of these toothpastes include abrasive ingredients such as silica to improve their removal of surface stains.
  • Many brands claim to remove surface stains left by coffee, tea, red wine, coloured foods and tobacco. Others claim to clear stains and whiten teeth

How to get the best result from whitening toothpaste.
Here are some tips when using whitening toothpaste.
There are three principles to bear in mind:

  • The less saliva there is on and around the teeth when the toothpaste is applied, the more concentrated and effective it will be.
  • The longer the toothpaste remains in contact with the teeth, the more time it will have to lighten the colour.
  • The more often the toothpaste is used the better.

This is what to do:

  • Prepare the toothbrush by filling the entire length of the brush with toothpaste.
  • Swallow to remove the excess of saliva from the mouth.
  • Dry the teeth with a tissue or cloth, making sure that the outer surfaces of the front teeth are free of saliva.
  • This will bring the teeth into direct contact with the whitening properties of the toothpaste.
  • Begin by first brushing the front teeth and then the other teeth.
  • Leave the toothpaste in the mouth for a minute or more before spitting out.
  • Brush your teeth at least three times a day, repeating the above routine.
  • This should give you the best result from a whitening toothpaste.
  • Ask your dentist to recommend a whitening toothpaste

Which teeth are suitable for whitening?

  • Teeth that have darkened with age.
  • Moderately discoloured teeth.
  • Teeth that are only lightly stained by tetracycline.

Which teeth are not suitable for whitening?

  • Front teeth that have fillings are not suitable for bleaching. The natural tooth and the filling are composed of different substances. It is therefore almost impossible to bleach the natural tooth and the filling to the same shade.
  • Heavy tetracycline staining will not respond to bleaching.
  • Teeth that have had root canal treatments often discolour internally. They may respond to internal bleaching. The tooth is opened and the bleach is applied. It is usually only moderately successful.

Will my whitened teeth retain their new colour?

  • Whitened teeth will only keep their colour if they are maintained by regular brushing, flossing and the use of whitening toothpastes.
  • Six monthly visits to the dentist for scaling and polishing are necessary.
  • More bleaching treatments may be needed if these measures do not maintain the whiteness.

What if my teeth are not suitable for bleaching?

  • Porcelain veneers are the best way to correct tooth discoloration that can not be bleached successfully.
  • Veneers are aesthetic, permanent and durable, and will not lose their colour.

What is Tooth Wear?

  • Tooth Wear is the loss of tooth surface, which is not caused by decay or by an injury. Abnormal Tooth Wear can affect the enamel, dentine and the nerves and blood vessels of the tooth.
  • TSL [tooth substance loss] can affect younger age group and adult. TSL in younger is erosive due to fizzy drinks and old age group is multifactorial.
  • Patient may present with
  • Chipped or worn teeth
  • Sensitivity
  • Pain or infection from a worn tooth
  • Reduced masticatory function
  • Difficulty in phonation
  • Decreasing facial height [worsening appearance of dentition]

Most often patient may not be aware of TSL due to its slow progression. History taking ,examination, Measurement of progression of TSL by study models, pictures, and x rays are essential.

 

Classification

1 Localized 
2 Generalized

There are three categories of Tooth Wear:

How teeth can be worn down by other teeth.

  • Attrition
  • Abrasion
  • Erosion

Attrition

  • Attrition is the mechanical wearing down of the biting and chewing surfaces of teeth.
  • The tooth to tooth contact during chewing grinds down the surfaces.
  • The back teeth become flatter, and the front teeth become shorter.
  • This type of Tooth Wear takes place in all mouths, and is part of the normal ageing process.
  • Severe attrition of the front teeth will have a disfiguring effect on the face. It may infrequently cause sensitivity to sweet, hot and cold food and drinks.

Most often patient may not be aware of TSL due to its slow progression. History taking ,examination, Measurement of progression of TSL by study models, pictures, and x rays are essential.

What is Bruxism?
Bruxism is the involuntary grinding and clenching of teeth.

  • It can take place during waking hours, but occurs more commonly while people are asleep.
  • The causes of Bruxism are considered to be stress, anxiety and the abnormal positioning of jaws and of teeth (malocclusion).
  • The effects of bruxism can be remedied and made more comfortable, by the use of a nightguard.
  • It is made of a soft plastic material and worn when you are asleep.
  • An acrylic bite plate will also have a similar effect.

How is bruxism treated?
Bruxism is treated psychologically, dentally and by medication.

  • The psychological and medical causes are dealt with by psychologists, psychiatrists and doctors.
  • Behaviour modification through relaxation training may be used to treat bruxism.

The dental treatment for bruxism is directed to preventing further damage to the teeth, and to the repair of the worn down teeth. 
The preventive treatment is to use a nightguard.

  • Nightguards can lessen the effects of bruxism:
  • They cannot cure the bruxism as they do not treat the cause, but they can protect the teeth from further damage.
  • Nightguards prevent the upper and lower teeth from grinding against each other.
  • An acrylic nightguard or bite plate may also relieve the symptoms of jaw joint disorders caused by bruxism.
  • Nightguards are provided by the dentist:
  • Impressions are taken of the upper and lower teeth.
  • They are sent to the dental laboratory where the nightguard is made.
  • Nightguards are designed to cover the biting and chewing surfaces of the teeth in one of the jaws, usually the upper.
  • They can be made from a soft plastic or a hard acrylic material.
  • A mouthguard is often supplied with the cast from which it was made.

Where bruxism has resulted in severe attrition, the teeth will need to be restored:

  • Replacement crowns or onlays can be used to restore the worn down teeth.
  • These measures will restore the teeth to their normal size, and the jaws will regain their normal position.
  • The dimensions and appearance of the teeth and face can be aesthetically improved with dental restorations.

Veneer 
A veneer is a thin facing of porcelain, synfony that is bonded to the front visible surface of a tooth.

  • It is similar to a false fingernail.
  • The appearance of a tooth can be dramatically improved by a veneer restoration.
  • It can change the colour, shape and size of a tooth.
  • Discoloured teeth can be permanently whitened with a veneer.

Why choose a veneer instead of a replacement crown?

  • Porcelain veneers and porcelain crowns are the most aesthetic of the cosmetic restorations.
  • The main advantage of a veneer over a crown is in the preparation. A veneer requires only a very thin layer of enamel to be trimmed from the front visible surface of a tooth. The time spent in the dental chair is much shorter as a result.
  • A replacement crown requires the trimming of the whole tooth. A much larger quantity of tooth is lost in this preparation.
  • It is possible and easier to keep the original shape and size of a natural tooth with a veneer. The procedure is as follows:
  • An exact copy of the original tooth is made for the technician to work from.
  • This is done by taking an impression of the natural tooth before the dentist begins the preparation.
  • Every detail of the tooth is copied in this way.
  • A veneer is less expensive than a crown, and makes cosmetic dentistry more affordable.

Abrasion:

  • Abrasion is the wearing away of tooth surface caused by friction.
  • This happens when teeth are brushed too vigorously in sweeping horizontal strokes.
  • The use of a hard toothbrush can also cause the problem.
  • It is often evident on the outer surfaces of the back teeth.
  • A wedge or V shaped indentation of the tooth will be seen at the gum margin.

We recommend two methods for brushing teeth. They both use the same angled position of the brush:

  • Place the brush at a 45-degree angle towards the junction of the tooth and the gum. This is the position for brushing the sides of the teeth.
  • One suggested method is to brush gently in a circular movement.
  • Another technique is known as the gentle scrub method.
  • The brush is moved backwards and forwards horizontally in very short strokes.
  • Each stroke is no more than the width of one tooth.
  • Brush all the tooth surfaces of all the teeth.
  • Brush behind the front teeth with an up and down movement using the end of the brush.
  • Brushing should be unhurried and thorough.
  • Partial dentures should be removed for the efficient brushing of the remaining teeth.

What is the ideal toothbrush?
The ideal toothbrush should meet the following requirements:

  • It should have a head that is small enough, and correctly angled, to reach all the teeth.
  • The brush should be multi-tufted, and have a medium/soft texture.
  • Hard bristles can damage teeth and gums, and are not recommended.
  • The bristles should be made of nylon, and their ends need to be rounded.
  • Bristles made from synthetic rather than natural materials are preferable for hygienic reasons. Natural bristles may be porous and are likely to absorb bacteria.

Electric toothbrushes have proven to be very successful in maintaining good oral health, and removing plaque.

  • The action of the brush is more efficient than the manual brush for cleaning teeth.
  • Electric toothbrushes are recommended for the elderly and people with arthritis or other disabilities, who may find it difficult to manage with a manual toothbrush.
  • Children enjoy the fun of using an electric toothbrush. It will result in a more thorough cleaning of their teeth, particularly at an early age.
  • As they grow older it may be less important to use an electric toothbrush.
  • It is effective with fixed orthodontic appliances.
  • Remember that the cleaning of teeth will only be successful, if the motivation exists to have healthy teeth and gums.
  • Electric toothbrushes may provide interest and motivation for people who are reluctant to brush their teeth properly.

How is abrasion repaired? 
Toothbrush abrasion can be repaired by bonding a tooth coloured filling over the abraded area of the tooth.

Erosion:
Erosion is the wearing away of tooth surface by an acid, which dissolves the enamel and the dentine.

  • Erosion is a common cause of Tooth Wear and is usually preventable.
  • The two sources of acid in the mouth are dietary and gastric.

Erosion of enamel

Foods which have a high acid content, can cause the enamel and dentine to be eroded. The acid dissolves the calcium in the tooth. Foods with a high acid content are:

  • All soft drinks. That includes the carbonated, diet and sports varieties, as well as sparkling mineral water.
  • Soft drinks are a major cause of tooth erosion. The degree of erosion is directly related to the frequency and amount of soft drinks consumed.
  • Citrus fruits: oranges, lemons and grapefruit.
  • Fruit juices.
  • Pickles and vinegar.
  • Yoghurt.

The acid produced in the stomach during the digestive process is sufficiently powerful to dissolve any food, including bone and teeth.

  • When the contents of the stomach are regurgitated the acid comes into contact with the teeth.
  • Any condition that causes repetitive regurgitation or vomiting will result in the erosion of teeth.
  • The dentist if often the first to notice the problem. The back surfaces of the front teeth are the first to be affected.
  • The erosion is seen as a light yellow patch on the tooth. This indicates that the enamel has been dissolved and the sensitive dentine under the enamel has been exposed.
  • This exposure of the dentine, will result in pain from sweet, hot and cold food and drinks.
  • If the erosion penetrates deeper and reaches the nerves and blood vessels, the pain can become severe.

This very damaging type of Tooth Wear is caused by the regurgitation or vomiting of acidic stomach contents. It is evident in the following conditions:

  • Acid Reflux or heartburn.
  • Anorexia and Bulimia.
  • Hiatus Hernia.
  • The excessive consumption of alcohol.
  • Morning sickness in early pregnancy. Chronic indigestion. Over eating.

How can tooth erosion be prevented?

Dietary factors and good oral hygiene

  • Try to reduce the excessive consumption of acidic foods and drinks to more moderate levels.
  • The frequency of intake should also be cut down.
  • Include these foods and drinks as part of the regular meals. This will dilute the acidity of the food in the mouth.
  • It will also limit the time for the damaging acid to remain in contact with the teeth.
  • Oranges and lemons must not be sucked.
  • Sugarless chewing gum is recommended to neutralise the acid by increasing the salivary flow.
  • Toothbrushing after meals with a flouride toothpaste should become a regular daily habit.

Gastric Factors

  • Gastric causes of acidic erosion are mainly features of psychological and general health problems.
  • The dentist has a part to play in their early diagnosis, and the subsequent repair of the damage to the teeth.

How is erosive Tooth Wear repaired?
The loss of the enamel and the resulting sensitivity of the exposed dentine, can be attended to in the following ways:

  • Small areas of erosion can be desensitised by your dentist.
  • Larger areas of exposed dentine can be repaired by bonding a tooth coloured filling material to the tooth.
  • A replacement crown can be fitted over the entire tooth, where the erosion has led to a large breakdown of tooth structure.
  • A root canal treatment will be necessary before the fitting of a replacement crown, if the nerves and blood vessels have been affected.

Classification of treatment of TLS
By Watson and Tulloch in 1985

  • 1 Appearance satisfactory
  • 2 Appearance not satisfactory but no increase in facial height is required
  • 3 Appearance not satisfactory, increase in facial height is required
  • A sufficient space available
  • B insufficient space available

In Brief

  • The causes of tooth wear may be intrinsic or extrinsic and are usually chemical (acidic) or mechanical (frictional) in nature.
  • Several factors may combine to cause tooth wear in any individual patient.
  • Tooth wear, especially tooth erosion is an increasingly recognised clinical problem.
  • Modifying the composition of soft drinks is an important concept in prevention that should be further developed

Tooth Decay
"The use of fluoride-containing dentifrice (toothpaste) is critical for dental caries prevention."
"Over 50% of 5-9 year olds have at least one cavity. This increases to 78% among 17 year olds." - U.S. Surgeon General's Report.

2. What causes tooth decay?

  • Tooth decay is caused by the bacteria in dental plaque.
  • The bacteria feed on dietary sugars and release acids, which dissolve and destroy the teeth.

What are dental plaque, calculus and tartar?
Dental plaque is a thin coating of bacteria and food particles that sticks to teeth.

  • It cannot be rinsed off, but it can be removed by brushing, flossing and dental scaling.
  • It causes tooth decay and gum disease.
  • The longer that plaque is allowed to remain on teeth, the greater are the risks of gum disease.
  • If plaque is not removed, it can harden to form calculus, also called tartar.
  • Calculus should be removed by a dentist or hygienist, as it cannot be removed by brushing.
  • Diets rich in soft, sticky, carbohydrate foods (refined sugars) assist plaque formation

How does decay progress through the tooth?

  • The first layer of tooth to be affected is the outermost, the enamel.
  • It then spreads to underlying dentine.
  • The decay can eventually reach the pulp, which is the name for the nerves and blood vessels of the tooth.

What are the symptoms of tooth decay?
The symptoms of decay will vary according to the extent to which it has spread into the tooth.

  • Decay is quite painless in the early stages when only the enamel is affected.
  • When decay has spread to the dentine, pain can be caused by sweet foods, such as chocolate, sugary snacks and drinks.
  • When the decay spreads deeper, sensitivity can be felt with hot and cold drinks.
  • Severe ongoing pain that is caused by hot food and drinks indicates that the nerves and blood vessels have become affected by the decay.
  • This condition is called a pulpitis.

How does the dentist discover decay?

  • The dentist uses a special fine explorer instrument to discover cavities that have developed.
  • Regular check ups by the dentist, and periodic x-rays will ensure that decay will be detected soon after it has started.
  • X-rays can reveal decay that cannot be detected by visual dental examination.
  • A dull white patch on the tooth could be a sign of early decay.

What measures should be taken to prevent tooth decay?
Tooth decay can be prevented by home care and oral hygiene, professional care and diet control.

Home Care and Oral Hygiene

Regular brushing and flossing are essential:

  • Brush your teeth at least twice a day, after breakfast and before bedtime.
  • Regular flossing will remove harmful plaque from the areas between teeth, that the brush cannot reach.
  • Special brushes and devices, prescribed by the dentist, can help to clean areas in the mouth that are difficult to reach.
  • Your dentist may recommend a mechanical or ultrasonic toothbrush to remove dental plaque.
  • The surface application of fluoride is made with the daily use of fluoride toothpastes and mouthwashes. Fluoride is a chemical that hardens the enamel of a tooth, and increases its resistance to decay. It can also help to stop the early stages of decay.

Professional care

  • Adults and children should see the dentist twice a year.
  • Regular visits to the dentist for professional examination and cleaning are essential.
  • The early detection and treatment of decay and gum disease will only be possible with regular dental inspection.
  • X-rays will help the dentist to find early signs of decay.
  • Fissure sealants can be applied to back teeth to protect them from decay.
  • Fluoride applied to the teeth by the dentist will also help to prevent decay.

Diet Control

  • Reduce the amount of refined carbohydrate in your diet.

This includes the refined sugar found in table sugar, biscuits, cakes, chocolates, sweets, and fizzy soft drinks.

How can decayed teeth be saved?

  • Decayed teeth can in most instances be saved.
  • Early decay is easily treated by first removing the decay, and then replacing the lost tooth substance with a filling.
  • Larger areas of decay can be restored with inlay restorations or replacement crowns.
  • Even when decay has reached the nerves and blood vessels of the tooth, the tooth can still be saved. It is dealt with by having a root canal treatment, followed by restoration of the tooth.
  • The acid in carbonated soft drinks, including diet drinks, is harmful to teeth.
  • Fruit, vegetables and juices, which contain natural sugars are preferable.

Extraction of Teeth

Why must a good blood clot form after a tooth has been extracted?
It is very important for a good blood clot to form after a tooth has been extracted.
It acts as a bandage over the exposed bone in the socket and assists the healing process.

What is done to stop the bleeding after an extraction?
Your dentist will place a wad of cotton wool and gauze over the socket for you to bite on.

  • This should stop the bleeding - There may be a slight seepage for a few hours, but this will pass.
  • If the bleeding does not stop, tell your dentist.

What precautions can be taken after the extraction?
Care needs to be taken after an extraction to prevent the blood clot from becoming infected or dislodged:

  • Do not rinse your mouth on the day of the extraction.
  • The blood clot will have a better chance of staying in place to assist the healing.
  • Gentle rinsing can begin the day after the extraction.
  • Make sure that you rinse all food out of the socket. Food left in the socket may prevent healing by becoming infected.
  • Don't smoke for a few days. It may inhibit the healing process.

What can be done about facial swelling after an extraction?
An ice pack can be applied to the swollen part of the face.
This can be repeated frequently for short periods at a time.

What is Dry Socket?
Dry socket is an infection of the socket after an extraction.

  • The dry socket gets its name from the condition, in which there is not enough bleeding to form a clot.
  • The dental term for it is an osteitis of the socket, which means an infection of the bone in the socket.
  • It is also known as a "septic" socket, which is a better description than "dry" socket.
  • The lower molars are affected more often than other teeth.

What are the symptoms of dry socket?
Pain may start two to four days after the extraction.

  • The pain feels like a toothache but it is much more severe than the original toothache.
  • It can be excruciatingly painful.

How does it happen? 
Dry socket comes about in the following way:

  • Healing cannot take place without the formation of a blood clot.
  • There may be insufficient bleeding to allow the clot to build up. This does sometimes happen after an extraction.
  • Rinsing too soon may dislodge the clot or prevent it from forming correctly.
  • The blood may break down, leaving the bone in the socket exposed.
  • This can happen if the patient is on blood thinning medication.
  • You need to inform the dentist if you are on this treatment.
  • An infection of the socket can follow a difficult extraction, or the extraction of a tooth with an abscess.

What is the treatment for dry socket?
The dentist will attend to the condition:

  • A paste containing an analgesic together with an antiseptic or antibiotic, can be placed into the socket.
  • In addition to packing the socket with a dressing, the dentist may prescribe a separate antibiotic or analgesic, or both.
  • The treatment may need to be repeated until healing is under way, and the pain has stopped.

1. What is an impacted tooth?
An impacted tooth is one that is prevented from growing (erupting) into its correct or normal position. It is usually wedged against another tooth below the gum.

What causes a tooth to become impacted? 
There a many factors that influence the growth pattern of a tooth:

  • The size of the jaw may be too small to allow the tooth to erupt into its correct position.
  • Neighbouring teeth that are out of their normal position, may obstruct the growth path of a tooth, and cause it to become impacted.
  • A layer of bone or a hard cover of gum over the tooth, can also affect the growth process.
  • A tooth may become impacted if it grows in an abnormal direction and position.

Which teeth are most likely to become impacted?
The teeth most commonly impacted are the wisdom teeth, and the eye teeth.

What signs and symptoms are associated with an impacted tooth?
The signs and symptoms of an impacted tooth are:

  • Severe pain can be caused by the impacted tooth exerting pressure on other teeth, and on nerves around it.
  • A partially erupted wisdom tooth may have a flap of gum over it.
  • Food can become trapped between the tooth and the gum. This can cause a severe infection around the tooth.
  • This is called a peri-coronitis, and it can be very painful.
  • It may be painful to open your mouth or to chew.
  • Temporary relief can be provided by taking an analgesic, and possibly an antibiotic.
  • There may be no symptoms from a dormant impacted tooth for many years.
  • A deeply impacted tooth is not visible except on X-ray.

What is the treatment for an impacted wisdom tooth?
When an impacted tooth causes pain, or adversely affects the tooth it has impacted against, it will usually be extracted:

  • The tooth blocking the way of the wisdom tooth can be extracted, thereby creating space for the impacted tooth to grow into.
  • When a wisdom tooth is impacted, the opposing wisdom tooth in the other jaw may not be.
  • The normal wisdom tooth will continue to grow after reaching its normal position if there is no opposite tooth for it to chew against. This is termed over-eruption.
  • In these circumstances it may be wise to extract this tooth before it reaches the gum in the opposite jaw.

What is the treatment for an impacted eye-tooth (canine)?
Since eye-teeth are very important for dental aesthetics and facial appearance, techniques have been developed to correct their positions.

  • The gum is cut open to expose the tooth.
  • The orthodontist attaches a bracket to the tooth, and begins the process of moving it into position with the use of wires, elastics and often the extraction of teeth.
  • These techniques are generally successful but they do take time.

In Brief

  • The causes of tooth wear may be intrinsic or extrinsic and are usually chemical (acidic) or mechanical (frictional) in nature.
  • Several factors may combine to cause tooth wear in any individual patient.
  • Tooth wear, especially tooth erosion is an increasingly recognised clinical problem.
  • Modifying the composition of soft drinks is an important concept in prevention that should be further developed.

Will my whitened teeth retain their new colour?

  • Whitened teeth will only keep their colour if they are maintained by regular brushing, flossing and the use of whitening toothpastes.
  • Six monthly visits to the dentist for scaling and polishing are necessary.
  • More bleaching treatments may be needed if these measures do not maintain the whiteness.

Which teeth are not suitable for whitening?

  • Front teeth that have fillings are not suitable for bleaching. The natural tooth and the filling are composed of different substances. It is therefore almost impossible to bleach the natural tooth and the filling to the same shade.
  • Heavy tetracycline staining will not respond to bleaching.
  • Teeth that have had root canal treatments often discolour internally. They may respond to internal bleaching. The tooth is opened and the bleach is applied. It is usually only moderately successful.

Which teeth are suitable for whitening?

  • Teeth that have darkened with age.
  • Moderately discoloured teeth.
  • Teeth that are only lightly stained by tetracycline.

Can tooth whitening improve tooth colour?

  • Teeth darken and yellow naturally with age.
  • Whitening lightens the colour of teeth.
  • Surface stains on the enamel can be removed by cleaning with abrasives during a regular dental cleaning. This can be combined with bleaching if necessary.
  • Surface stains, and darkening of the body of the tooth can be bleached to a lighter shade.

Veneer Restoration
The appearance of a tooth can be dramatically improved by replacing only the front visible surface of the natural crown. This procedure is called a veneer restoration.

  • The dentist trims down the front surface of the tooth, and takes an impression of the prepared tooth.
  • The impression is sent to the dental technician who makes a thin porcelain veneer, similar to a false fingernail.
  • As very little tooth material is removed in the preparation for a veneer, a temporary veneer may not be necessary while the porcelain veneer is being made.
  • However, a temporary plastic veneer will be needed to protect the trimmed down tooth if it is sensitive to hot and cold.
  • Finally, the dentist will bond the attractive, natural-looking porcelain veneer to the tooth.

Replacement Crowns
Replacement crowns look attractive and natural, and match the adjacent teeth.

  • The visible part of the tooth above the gum line is called "the crown".
  • If the natural crown is unattractive, decayed or damaged, it can be aesthetically repaired with a "replacement crown".
  • The dentist pares down the original tooth, takes an impression of it, and sends it to a dental technician.
  • The technician uses the impression to make a cast of the prepared tooth.
  • A plaster cast is an exact copy of the prepared tooth and the adjoining teeth.
  • A replacement crown is made to fit the cast, and is sent back to the dentist.
  • The dentist then cements the replacement crown onto the prepared tooth.
  • Replacement crowns are usually made of porcelain, or porcelain fused to metal.
  • A temporary plastic replacement crown will cover and protect the pared down tooth until the permanent crown is ready to be cemented onto it.

How are crowns, veneers and bonding used in cosmetic dentistry?
The restorations used most in cosmetic dentistry are:

  • Replacement crowns (caps)
  • Veneers
  • Bonding
  • Porcelain

How can I be sure I will like my changed smile?
Some cosmetic dentists have a computer-imaging programme.

  • This enables them to project the proposed changes onto your own photograph.
  • This will give you a good idea of how you will look when the changes have