A list of common dental terminology, so you and your dentist are on the same page.
- Crowns, Overlays, Veneers
- Fissure Sealants
- Periodontal Disease
- Receding gums (gingival recession)
Composite is the type of material we use for most of the straight forward restorations placed in your teeth. It is our preferred choice over amalgam fillings. Composite is a mixture of 80 percent synthetic porcelain in a matrix of resin. There are many shades to choose from to match your tooth colour. We always use composite together with an etch priming and bonding system to ensure the composite material adheres effectively to the cavity surface.
Advantages over amalgam:
The strength and quality of the remaining tooth is enhanced.
- Less tooth is removed.
- It looks better.
The strength is enhanced because of the chemical combination of the composite resin and the bonding agent applied to the tooth via a primer. Composite is used in small to medium sized cavities. Composite can last 10 years or more. However, the life of the material is somewhat irrelevant as it is the quality of the tooth which is enhanced due to the strengthening nature of this type of restoration.
Some situations can occur which reduce both the life of the filling and the quality of the tooth. Your dentist will advise you if there needs to be a more effective treatment than composite for a restoration procedure.
How long will my filling last?
We consider it is more important how well the filling material improves the quality and the life expectancy of the tooth. Whenever the tooth has a filling material bonded into the cavity then this greatly improves the quality and the life expectancy of both the filling and the tooth.
The dentist will determine if a filling is the most appropriate treatment or if a more robust treatment such as a crown is necessary. It is often the poor quality of the tooth structure which reduces the life of a filling in the tooth.
What variables affect the life and quality of the restoration and the tooth?
- Inadequate oral hygiene care resulting in decay.
- Tooth cracking or fracture due to brittleness relating to age and wear and tear.
- Fracture of the restoration due to heavy loading, i.e. biting something hard.
- Tooth grinding which is often caused by stress.
Can composites be used in all situations?
Composite can be used as a repair material in many situations where the defect is not too large and the quality of the remaining tooth is reasonable.
Sometimes composite is used as a substructure to a more comprehensive treatment involving crown or bridge work.
What are crowns, overlays and veneers?
These are generally natural looking, porcelain, tooth coloured caps that fit over teeth. They are specially shaped by the dentist and dental technician. The difference between each is really only the degree the existing tooth is covered.
Sometimes when a person has a very powerful jaw action a crown may be made from gold alloys which are very unreactive and safe and very strong. These types of crowns are usually only placed over back teeth as they do not look natural.
We consider crowns, veneers or overlays generally the best method to restore and protect the structure of a badly damaged tooth.
When are crowns used and why?
Crowns may be the optimum method of restoring natural tooth shapes when too much tooth tissue has been lost and repair by filling is impractical.
- To restore a very badly damaged tooth following decay removal.
- To protect the remaining tooth structure where a tooth has been weakened by heavy restorations, decay or weakened by cracks.
- To prevent more serious damage occurring when cracks have formed deep in the tooth structure.
- To reduce the chance of nerve damage which could lead to toothache, root canal treatment, or even extraction.
- To improve a smile, by filling spaces, altering shapes and improving colour.
Benefits of crowns:
- Enables the dentist to replace natural tooth shapes when too much tooth tissue has been lost, and repair with a filling is impractical.
- Protects the remaining tooth structure and the nerve in the tooth with strong durable toothlike restorations.
- Reduces food impaction by more adequately restoring natural tooth shapes. Food impaction can often lead to gum disease and tooth decay because the tooth may have been insufficiently restored with a material that is inappropriate for the size of the defect.
- Can help to restore the bite with the opposing teeth in the opposite jaw, and so improve chewing and digestion.
What is a sealant?
A fissure sealant is a thin coating of acrylic-like material which is applied to the chewing surfaces of teeth to create a barrier against the bacteria that cause decay. Teeth often have natural grooves and crevices which collect plaque and bacteria. These areas are often impossible to effectively clean as they are so narrow. Even fluoride containing toothpastes may not win the battle in these difficult areas.
Teeth most often sealed are adult molars and premolars (usually the last four teeth). These are best treated soon after they erupt.
Sealants form a protective barrier by bonding to tooth surfaces and covering the natural depressions and grooves. This barrier protects the enamel from plaque and acids that can break down the enamel causing a cavity.
Fissure sealants may be transparent or tooth-coloured resin based coatings, that perform like the paint on raw timber.
Sealant application does not damage tooth structure or require the use of anaesthesia.
Sealants are safe, painless, and take only a few minutes to apply.
Sealants can help preserve young teeth for many years. Sealants are a very cost effective method of helping prevent tooth decay. Sealants need to be considered in the overall preventive programme together with appropriate oral hygiene instruction, diet control and regular reassessments.
When should I have my child’s teeth sealed?
Sealants should ideally be placed as soon as the tooth in question has come through the gum. The first teeth to erupt at the back are usually the six year old molars and then the premolars. The second molars come through later on at 12 or 13 years.
Regular visits to the hygienist are very important to check that the seal is still intact. The material used is durable but may need touching up from time to time.
Bring your children to see the hygienist as early as possible.
Prevention of unnecessary fillings is very cost effective and will help provide children with teeth that remain unfilled for a very long time.
How does fluoride help?
Fluoride helps strengthen teeth by:
- Reducing tooth decay by inhibiting the action of certain bacteria.
- Strengthening the weak spots (scars on the tooth) in tooth enamel that could become cavities.
- Reducing root surface decay in both adults and children.
- Reducing sensitivity at the gum margins in adult teeth.
When is a fluoride supplement necessary?
Fluoride is an essential trace element which is necessary for the formation of strong teeth and bones. It is important not to have too much or too little.
Most areas in New Zealand lack adequate trace elements especially fluoride. Check with your local council or you dental practice to see if there is a need for increased fluoride protection in your area.
Sometimes fluoride tablets are necessary for children who live in an area without sufficient fluoride in the natural water supply.
Medical science and research shows that fluoride can halt the progression of the early stages of decay, and that it is safe and necessary at the correct levels.
A toothpaste with a low fluoride content should be used until six to seven years of age. After that, an adult strength fluoride tooth paste can be used.
Children should use fluoride toothpaste only when they have learnt to spit the toothpaste out properly, usually three or four years of age. A small (pea size) quantity of toothpaste is recommended for children. If fluoride toothpaste is being swallowed regularly by a child who is taking fluoride tablets this may in fact be too much fluoride.
Parents should brush their children’s teeth or supervise brushing until the child is able to brush effectively, usually until five or six.
Fluoride tablets should be taken under the direction of your dentist, therapist or hygienist.
Gingivitis is an inflammation of the gums (gingiva) caused by dental plaque or other irritants. It may be a sign of malnutrition or a medical disorder. Symptoms include bleeding with brushing and flossing. There is not usually much pain associated with gingivitis.
Sometimes a thin red band can be seen on the gum margin around the teeth. It is caused by the accumulation of bacteria in plaque which causes the gums to become infected and swollen. This condition can lead to a more serious disease known as periodontal disease which includes underlying bone loss.
It is important to treat gingivitis as soon as it is diagnosed.
The treatment is generally quite simple and the success rate is very high.
Usually no lasting damage occurs.
Periodontal disease is second only to the common cold as the most prevalent infectious ailment in the USA. Nine out of ten adults have a type of periodontal disease. It is more prevalent than cardiovascular disease and is the major cause of tooth loss in adults.
Periodontal means ‘located around the tooth’. Periodontal disease refers to any disorder of the gums or the supporting structures of the teeth including the underlying bone.
Gingivitis (inflammation of the gums) is an early stage of periodontal disease. The increased accumulation of bacteria in plaque which causes the gums to become infected and swollen forms pockets between the gums and the teeth. These pockets act as a trap for even more plaque. The gums become red, soft and shiny and can bleed very easily, the roots become exposed, and the teeth will become quite loose. Often people with gum disease will have very bad breath and it is most unpleasant.
Periodontal disease is usually painless and so it is very insidious.
Other factors contributing to gingivitis and periodontal disease include: genetics, mouth breathing, badly fitting fillings (overhanging edges etc), dentures and diet and certain medical conditions and drugs.
If left untreated, gingivitis can lead to pyorrhoea (a more serious form of gingivitis) and periodontal disease. The disease now interferes with the bone supporting the teeth.
Periodontitis is often accompanied by bad breath.
Poor nutrition, certain medical conditions, improper brushing and flossing, poor dental repairs, smoking, excessive alcohol consumption and sugar intake can all play a part in the development of periodontitis.
Smokers are more susceptible to the disease.
Effective plaque removal is the key to healthy teeth and gums. Your hygienist has been specially trained to treat this disease process and will help you to achieve good oral health. A maintenance programme can be implemented to prevent further break down of tissues and loss of teeth. Continuing regular care will always be necessary as the smallest lapse in your cleaning regime or even a cold or the flu can allow the bacteria to start the destructive process again.
Please be aware you are welcome for a professional cleaning before the due reassessment date if you have not been coping with your hygiene regime. Do not leave it too long or the damage will have begun again.
Take time to look in the mirror at home and ask questions when in the dental chair.
Being well informed will enable you to become pro-active in the battle to keep a healthy smile.
Plaque is a mass adhering to the surface of teeth and soft oral tissues. It is made up of a mixed colony of bacteria living in a sticky matrix.
Plaque grows primarily in areas that are the hardest to clean, especially at the gum level and between the teeth.
As plaque develops the bacteria matures and reproduces. New plaque collects on top of older plaque.
Adequate brushing and flossing plaque each day ensures the bacteria do not get the chance to mature and do any damage to the gums, teeth and other tissues.
Receding gums (gingival recession) refers to a loss of gum tissue resulting in exposure of the roots of the teeth. Gum recession is a common problem in adults over the age of 40, but it may also occur starting from the teens.
There are several possible causes for gum recession:
- Aggressive brushing, which causes the enamel at the gum line to be worn away by scrubbing the sides of the teeth in a washboard fashion.
- Inadequate brushing or flossing, which allows bacteria to build up between the teeth, resulting in enzymes eating the bone away from the teeth.
- Periodontal disease.
- Smoking, which affects the mucus membrane lining in one’s mouth and will cause receding gums over time.
- Thegosis or teeth gnashing, clenching and grinding.
- Adult orthodontic movement of teeth.
- Piercings in the lip or tongue that wear away the gum by rubbing against it.
Gum recession is not something that happens overnight. In most cases, receding of gums is a progressive phenomenon that happens gradually from day to day over the years. That explains the fact that it is so common over the age of 40. Because the changes in the condition of the gums from one day to another are minimal, we get used to the gums appearance and do not notice the changes over longer periods of time. Receding gums may remain unnoticed until someone else talks to us about it or until the condition starts to cause other problems.
The following signs and symptoms may indicate gum recession:
- Sensitive teeth – teeth become sensitive to hot and cold or to sweet, sour, or spicy foods. If the cementum covering the root is not protected any more by the gums it is easily abraded exposing the dentin tubules to external stimuli.
- Teeth may also appear longer than normal (a larger part of the crown is visible if gums are receding).
- The roots of the tooth are exposed and visible.
- The tooth feels notched at the gum line
- Change in the tooth’s colour (due to the colour difference between enamel and cementum).
- Spaces between teeth seem to grow (actually the space is the same but it seems larger because the gums do not fill it any more).
- Cavities below the gum line.
If the gum recession is caused by gingivitis, the following symptoms may also be present:
- Puffy, red, or swollen (inflamed) gums.
- Gum bleeding while brushing or flossing.
- Bad breath (halitosis).
In some cases, it is the treatment of gingivitis that reveals a gum recession problem, which was previously masked by the gums swelling.
Treatment should start with addressing the problem which caused the gum recession. If overactive brushing is the cause, you should consider purchasing an electric toothbrush or a softer toothbrush and use a more gentle and appropriate brushing technique.
If poor plaque control was a contributing factor, improved oral hygiene must be performed, combined with regular professional dental cleanings (prophylaxis).
If a more severe calcified form of plaque accumulation called calculus (tartar) was the cause, then a procedure called scaling and root planing will be necessary to clean the teeth and heal inflammation in the gingivae (gums).
If malocclusion (incorrect bite) was a factor a bite splint may be recommended. Our dental hygienists are fully qualified to manage (assess, plan, and treat) the situation that is specific to you.