General Dentistry

Overview

General dentistry includes the followings:

Dental Examination At Surbiton Dentist

What Happens During A Visit To The Dentist?

Once you have decided that you would like to be a patient of the Surbiton Smile Centre, your next step would be to book a check-up, earlier rather than later and preferably before any problems arise. On your first visit to us, we will take a full health history. On subsequent visits, if your health status has changed, it would be important to inform us of any alterations to your medications or treatments that you might be undergoing.

A Full Dental Examination Will Be Carried Out As Follows:

Our Dentist will perform a thorough clinical examination of your teeth, gums and mouth, looking for any signs of disease or other problems. She will also take some X-rays, especially on your first visit.

Digital -X-Rays

Depending on your age, risks of disease and symptoms, it is very likely that our dentist will recommend taking an X-ray. X-rays can diagnose problems otherwise unnoticed, such as damage to jawbones, impacted teeth, abscesses, cysts or tumours, and also notification of decay between the teeth. The Surbiton Smile Centre uses X-ray machines that emit virtually no radiation, in other words, no more than you would receive from a day in the sun or a weekend watching TV.

As a precaution,if you are pregnant, you should inform us, as X-rays should only be taken in emergency situations for expectant women.

Our dentist may want to take a Panoramic X-ray. This type of X-ray provides a complete view of your mouth, in one single image, the upper and lower jaws, your Temporomandibular (TMJ) joints, all your teeth, the nasal area and sinuses. This helps us to understand your bite and the relationship between your different teeth. The Surbiton Smile Centre is equipped with this latest technology.

Remember our goal is to help you maintain your good oral health and prevent problems from becoming serious by identifying and treating them as soon as possible. Some of the following issues will be discussed with you if they are found to be relevant:

  • Oral Hygiene
  • Tooth Decay
  • Gum Disease
  • Orthodontist Treatment (if required)
  • Gum disease Treatment (if required)
  • Teeth whitening (if required)
  • Temporomandibular joint problems (TMJ)
  • Broken fillings, or poor fitting fillings and crowns
  • Root Canal Treatment (Endodontic)
  • Cosmetic Treatment (if required)
  • Implant Treatment (if required)
  • Denture Treatment (if required)

After a full dental examination, our dentist will provide you with a full treatment plan and estimate for any treatment you may require.

Please be rest assured that most dental visits are just of a check-up nature. Regular check-ups (ideally every six months) will help your teeth stay cleaner, last longer and can prevent painful problems from developing.

White Fillings / Composite Bonding

White fillings, also known as composite bonding, are considered a direct technique toward improving your smile. White fillings are used for teeth that are slightly cracked, chipped, discoloured or misaligned.

Dr. Soltani, our Surrey cosmetic dentist, will coat your teeth with a thin layer of acrylic resin and sculpt it into the desired shape. The acrylic is matched to the colour of your natural teeth. The results will be amazingly natural.

These fillings can often be completed in a single visit and can significantly change the appearance of your smile. The result is similar to porcelain veneers, but less expensive.

However, plastic resin is not as strong as tooth enamel and is more likely to stain, chip or break than natural teeth. Veneers are a more long-lasting solution for chips and gaps.

Dental Crowns & Bridges

Both crowns and most bridges are fixed prosthetic devices. Dentures, for example are removable devices which you can take out and clean daily. On the other hand,crowns and bridges are cemented onto existing teeth or implants and can only be removed by a dentist.

How Do Crowns Work?

A crown (sometimes called a cap) is used to completely cover a damaged tooth. Besides strengthening a damaged tooth, a crown can be used to improve the tooth’s appearance, shape or alignment. A crown can also be placed on top of an implant to provide a tooth-like shape and structure for function. Porcelain or ceramic crowns can be matched to the colour of your natural teeth. Other materials include gold and metal alloys, acrylic and ceramic. These alloys are generally stronger than porcelain and may be recommended for back teeth. Porcelain bonded to a metal shell is often used because it is both strong and attractive. At the Surbiton Smile Centre, we may recommend a crown to:

  • Replace a large filling when there is not enough of the tooth left
  • Protect a weak tooth from fracturing
  • Restore a fractured tooth
  • Attach a bridge
  • Cover a dental implant
  • Cover a discoloured or poorly shaped tooth
  • Cover a tooth that has had root canal treatment

Case Study A:

Ceramic crown with E-Max ceramic material from IVoclave Vivadent (Swiss company) By Dr Simin Soltani.

What Material Is Used For Crowns And Bridges ?

The most advanced material for bridges is metal free, using high-end Zirconi or E-max material IVoclave Vivadent (Swiss company).

Dental Bridge

Traditionally other material used for crowns would be either metal porcelain fused to metal crown or Gold which is still useful in some special cases.

How Do Bridges Work?

A bridge may be recommended if you are missing one or more teeth. Gaps left by missing teeth eventually cause the remaining teeth to rotate or shift into the empty spaces, resulting in a bad bite. The imbalance caused by missing teeth can also lead to gum disease and temporomandibular joint (TMJ) disorders.

Bridges span the space where the teeth are missing. They are cemented to the natural teeth or implants surrounding the empty space. These teeth, called abutments, serve as anchors for the bridge. A replacement tooth, called a pontic, is attached to the crowns that cover the abutments. As with crowns, there is a choice of material for bridges. Our Dentist will help you decide which to use, based on the location of the missing tooth (or teeth), the function, aesthetic considerations and cost. Porcelain or ceramic bridges can be matched to the colour of your natural teeth.

How Are Crowns And Bridges Made?

Before either a crown or a bridge can be made, the tooth (or teeth) must be reduced in size so that the crown or bridge will fit over it properly. After reducing the tooth or teeth, our Dentist will take an impression to provide an exact mould for the crown or bridge. If porcelain is to be used, our dentist will determine the correct shade for the crown or bridge to match the colour of your existing teeth.

Using this impression, a dental laboratory makes your crown or bridge, in the material our dentist specifies. A temporary crown or bridge is put in place to cover the prepared tooth while the permanent crown or bridge is being made. When the permanent crown or bridge is ready, the temporary crown or bridge is removed, and the new crown or bridge is cemented over your prepared tooth or teeth.

How Long Do Crowns And Bridges Last?

While crowns and bridges can last a lifetime, they do sometimes become loose or fall out. The most important step you can take to ensure the longevity of your crown or bridge is to practise good oral hygiene. A bridge can lose its support if the teeth or bone holding it in place are damaged by dental disease. Always keep your gums and teeth healthy by brushing with fluoride toothpaste twice a day and flossing daily. As ever you should see us regularly for check-ups and professional cleaning. To prevent damage to your new crown or bridge, avoid chewing hard foods, ice or other hard objects.

Bruxism

If you find yourself waking up with sore jaw muscles or a headache, you may be suffering from bruxism – the grinding and clenching of your teeth. Bruxism can cause teeth to become painful or loose, and sometimes parts of the teeth are literally ground away. Eventually, bruxism can destroy the surrounding bone and gum tissue. It can also lead to problems involving the jaw joint, such as temporomandibular joint syndrome (TMJ).

How Do I Know If I Have Bruxism?

For many people, bruxism is an unconscious habit. They may not even realize they are doing it until someone comments that they make a horrible grinding sound while sleeping. For others, a routine dental check-up is when they discover their teeth are worn or their tooth enamel is fractured.

Other potential signs of bruxism include aching in the face, head and neck. At the Surbiton Smile Centre, we can make an accurate diagnosis and determine if the source of facial pain is a result from bruxism.

Signs:

If you notice any of the following symptoms, you may be experiencing bruxism:

  • Rhythmic contractions of the jaw muscles
  • A grinding sound at night
  • Jaw muscles that are tight or painful
  • Long-lasting pain in the face
  • Occasional swelling on the side of your lower jaw caused by clenching
  • Temporomandibular Joint Disorder (TMD)
  • Tooth sensitivity

How Is Bruxism Treated?

1. Discuss Matters With Us

The appropriate treatment for you will depend on what is causing the problem. By asking careful questions and thoroughly examining your teeth, we can help you determine the potential source of your Bruxism. Based on the amount of tooth damage and its likely cause, we may suggest:

2.Consider A Mouthguard

Wear a mouthguard while sleeping. Custom-made by us to fit your teeth, the mouthguard slips over the upper teeth and protects them from grinding against the lower teeth. While this is a good way to manage bruxism, it is not a cure.

3.Develop A Positive Attitude (Eliminate Negative And Stress Causing Thoughts)

Find ways to relax. Everyday stress seems to be a major cause of Bruxism, so anything that reduces stress can help, whether it is listening to music, reading a book, taking a walk or having a bath. It may help to seek counselling to learn effective ways for handling stressful situations. Also, applying a warm, wet flannel to the side of your face can help relax muscles sore from clenching.

4.Talk To Us About Your Jaw Alignment

Reducing the “high spots” of one or more teeth to even your bite. An abnormal bite, one in which teeth do not fit well together, may also be corrected with new fillings, crowns or orthodontic

Bruxism can happen during both the day and night, although sleep-related bruxism is often the bigger problem because it is harder to control.

The main cause of bruxism is unknown, but possible causes might be the psychosocial factors; stress and anxiety. No specific drugs exist to treat this problem. The only treatment that is proven to be effective is the bite or splint. This is a type of shield, when positioned between the upper and lower teeth, protects the tooth enamel and encourages realignment of the jaw, at the same time minimising the effects of bruxism.

Dry Mouth

Known by its medical term, Xerostomia. Dry mouth is when you do not have enough saliva to keep your mouth wet and moisturized.

How Do I Know if I Have Dry Mouth?

Everyone’s mouth feels dry from time to time. It is when this sensation never goes away that informs you that you may have a problem with saliva production.

Symptoms of dry mouth include:

  • A sticky, dry feeling in your mouth
  • Trouble swallowing
  • A burning sensation on your tongue
  • A dry feeling in your throat
  • Cracked lips
  • Reduced ability to taste things or a metallic taste in your mouth
  • Mouth sores
  • Frequent bad breath
  • Difficulty chewing/speaking

Causes

Dry mouth can occur when the glands in the mouth that make saliva are not working properly. Some common causes include:

  • Stress

Certain medications can cause side effects in the mouth. Dry mouth being the most common. Be sure to tell us about any medications that you’re taking, even medicines that you purchase without a prescription.

These are the types of medications that may cause dry mouth:

  1. Antihistamines
  2. Decongestants
  3. Pain Killers
  4. Diuretics
  5. High Blood Pressure Medications
  6. Antidepressants

Other medications may cause abnormal bleeding, inflamed tissues or ulcers, mouth burning, numbness or tingling, movement disorders and taste alteration. If you experience any of these symptoms, consult us or your GP.

  • Cancer therapy (radiation/chemotherapy)
  • Autoimmune disorders such as Sjogren’s syndrome
  • Smoking
  • Immune Disorders

How to stop the dry mouth

There are a number of steps you can take to help minimize dry mouth, including:

  1. Sipping water or sugarless drinks often and during meals
  2. Avoiding drinks with caffeine, such as coffee, tea and some sodas
  3. Chew sugarless gum or suck on sugarless hard sweets to stimulate saliva flow: citrus, cinnamon or mint-flavoured sweets are good choices
  4. Ask us for our recommendations about products for dry mouth.

Complications of Dry Mouth

If the dry mouth condition happens all or most of the time, it can be uncomfortable and may have serious consequences for your oral health. Drying irritates the soft tissues in the mouth, which can make them inflamed and more susceptible to infection. Without the cleansing effects of saliva, tooth decay and other oral health issues become much more common. It is important that you take good care of your teeth and gums. Brushing twice a day, flossing or using an interdental cleaner once a day to remove dental plaque and food debris from between the teeth where your toothbrush cannot reach.

Cracked Tooth Syndrome

Cracked tooth syndrome occurs when a tooth has a crack that is too small to show up in an X-ray or is under the gum and therefore challenging to identify. It most often appears on molars.

What are the Signs that your Tooth is Cracked?

A crack in your tooth can be hard to detect simply because these fractures are often invisible to the human eye. In fact, hairline cracks may not even appear on X-rays. So how can you tell if your tooth is fractured? Look out for localized pain that flares up when you bite into food or when you expose your teeth to hot or cold temperatures. The pain or discomfort will not be constant, as with a cavity.

What Causes a Tooth to Crack?

Several behaviours and incidents can lead to a crack, also known as a fracture, in one of your teeth. In some cases, simply chewing on a hard object or type of food such a biscuit or ice can cause a crack to develop. Habits that are sometimes related to stress, including tooth grinding or jaw clenching, can also make your teeth more susceptible to fractures. Occasionally, an accident or forceful trauma may lead to a cracked tooth.

How to Treat Cracked Tooth Syndrome

At the Surbiton Smile Centre our Dental team will recommend the best treatment depending on the severity and location of the tooth fracture. Treatment options include:

  • Bonding
  • Crowns
  • Root canal
  • Tooth removal

Tooth Sensitivity

Tooth sensitivity occurs when the enamel that protects your teeth gets thinner, or when gum recession occurs, exposing the underlying surface, the dentin, thus, reducing the protection the enamel and gums provide to the tooth and root.

If hot, cold, sweet or very acidic foods and drinks, or breathing in cold air, makes your teeth or a tooth sensitive or painful, then you may have sensitive teeth. Tooth sensitivity can come and go over time.

How to prevent sensitivity

See your dentist at the Surbiton Smile Centre to check your teeth for a cavity, cracked tooth, misalignment, or gum disease

Root Canal Treatment / Endodontics

Root canal treatments is a dental procedure used to treat infection in the root canal system. It is a treatment to repair and save a badly damaged or infected tooth instead of removing it. The term ‘root canal’ refers to the canals inside the root of the tooth.

The Tooth Consists Of The Following:

  • Enamel: The hard-outer coating
  • Dentine: A softer material that supports the enamel and forms most of the tooth
  • Cementum: A hard material that coats the root’s surface
  • Dental pulp: The soft tissue at the centre of the tooth

The pulp extends from the crown — the visible part of the tooth — to the tip of the tooth’s root in the jawbone. The pulp contains nerves, blood vessels and connective tissue.

A single tooth can have more than one root canal and Molar teeth in particular have several roots. When a tooth is cracked or has a deep cavity, or if there is a leaking filling or perhaps the tooth is damaged as a result of a trauma like an accident or fall, bacteria can enter the pulp.


If it is left untreated, bacteria and decaying material can cause a serious infection or a tooth abscess, leading to pulp death, bone loss or loss of the tooth itself. Signs and symptoms may include swelling around your face and neck, a hole in your tooth, toothache /tooth pain, gum swelling, temperature sensitivity, headaches, pain when biting or chewing, swelling of the gum near the affected tooth, pus oozing from the affected tooth, facial swelling and the tooth becoming a darker colour.

It is important to see our Dentist if you have a problem with your tooth as soon as possible in order to avoid possible nerve damage and thus avoid root canal treatment.

Signs You Might Need A Root Canal:

Indications For Treatment Include:

  • Prolonged sensitivity to heat or cold
  • Tooth decay – if a tooth is very rotten, its nerves and blood vessels can die, leading to a painful abscess
  • Discoloration of the tooth
  • Swelling of the gum adjacent to the tooth
  • Tenderness of the tooth especially to biting or adjacent gums. Sometimes there are no symptoms and the first sign of a problem maybe radiographic evidence corroborated with additional diagnostic testing by the dentist

The Root Canal Procedure:

First Stage: Cleaning The Canal /Canals

To treat the infection in the tooth canal, the bacteria existing there needs to be removed. This can be done in following way ;

Using a dental tool that is shaped like a long slim round file the bacteria is removed. The root canal is then filled, and the tooth is sealed with a filling and a crown. In most cases the inflamed tissue around the tooth will heal naturally.

Root canal treatment usually takes two visits, but sometimes additional visit are required as some teeth may prove difficult to treat. First, you will a have dental X-ray to check the extent of the damage. You will also receive a local anaesthetic to control the pain. This pain can be more severe if the tooth has developed an abscess. Then a rubber sheet (called a rubber dam) is placed around the tooth to keep the tooth clean and free from saliva. The tooth decay is removed, and an opening is made through the crown of the tooth to gain access to the pulp chamber. Using a small dental instrument, the infected or diseased pulp is removed.

During the procedure our dentist will use a series of root canal files to reshape the canals. The root canals will be flushed and cleaned with antiseptic liquid several times during the treatment. Where applicable each canal will be enlarged to allow better access for cleaning and flushing and the filling in of the canals at a later stage.

This part of the treatment may take several hours to complete, and it may need to be carried out in several visits. If this is the case, a dressing (medication) will be placed inside the cleaned canal to kill the infection and the tooth will be provided with a temporary filling.

In severe cases, where the infection has spread behind the tooth and you have a large swelling which is fluctuating, the tooth may be left open in order to allow the infection to drain away, normally for a period of 24 hours.

Our Dentist will prescribe you an antibiotic when you have a fever, large swelling and severe pain due to the infection. The premolar teeth and the back molar have between 2-4 roots and each root has 1-2 canals. The teeth in the front and the cainan have one root and one canal. The more canals a tooth has, the longer the time becomes to treat the tooth.

 

Second Stage: Filling Of The Canal /Canals

After cleaning and drying, it will be time to fill each root with a sealer paste and rubber material. The tooth will be restored with a filling material on that visit.

Final Stage: Crowning The Tooth

The root filled teeth are more fragile after root canal treatment and need to be protected from future damage in the form of a fracture. Our Dentist will normally recommend you have it crowned as soon as possible. If the tooth fractures, it will make it impossible to save the tooth again.

If the remaining tooth structures are not enough to support a crown, the tooth must be built up with a small metal post prior the crown treatment.

The crown is a cap which will covers the tooth. To be able to fit the crown the tooth will be made smaller and re-shaped. A mould will be taken to have the crown made to fit over the tooth.

The crown can be made from the following materials:

  • Gold crown
  • Metal fused porcelain
  • zirconia crown (metal free crown)

After root canal treatment you will be advised to follow good dental and oral hygiene, in order to ensure that your restored tooth lasts a long time. If you experience pain in the first few days after root canal treatment, you can take painkillers, but if the pain or pressure lasts a few days, then please make sure you contact the Surbiton Smile Centre immediately.

Revision Of Root Canal Therapy

Even though endodontic treatment is one of the most successful and predictable procedures in modern dentistry, failures can occur. Some indications of failure include swelling, soreness or the persistence of abscess at the root tip as identified in an X-ray. When this happens, a root canal revision procedure, also referred to as “re-treatment,” may be warranted.

Reasons For Root Canal Re-Treatment:

  • Retained microorganisms (bacteria) in the root canal
  • Breakdown or corrosion of root canal filling materials
  • Contamination from decay or leakage from a failing restoration
  • Inoperable canals because of calcification or unusual anatomy
  • Sometimes tissues fail to heal for unknown reasons

Although retreatment is technically more difficult than the original root canal, it can usually rescue a failing condition without having to consider surgery. We at Surbiton Dentist especially well equipped to handle these difficult conditions because of our additional training and experience.

Endodontic Surgery

Conventional root canal treatment is not always sufficient to correct every patient’s condition. Occasionally, endodontic surgery is required. This is because a previous treatment has deteriorated or because anatomic considerations such as the shape of the tooth or canal space make the traditional root canal treatment especially difficult to complete.

After Care Of Root Canal Treatment

If you experience sensitivity following a root canal session, we recommend you take an anti-inflammatory drug such as ibuprofen to reduce inflammation, which will in turn reduce pain. You may also want to apply ice to the outside of your face next to the tooth, keeping the head elevated.

Under no circumstances should you apply heat to the outside of your face. Consistent medication is the key to comfort. It is essential to follow your dentist orders by taking prescribed medications to alleviate pain and to help prevent or fight infection. If discomfort lasts more than a few days or if you have severe pain or swelling, call our office. We will suggest medication or other steps to make you more comfortable

Frequently Asked Questions About Root Canal Treatment

How Many Appointments Are Needed?

Sometimes Root Canal Treatment can be completed in just one visit, but normally it takes two or three appointments depending on the individual tooth anatomy and other circumstances.

Does Root Canal Treatment (Endodontic Treatment) Hurt?

Quite often this treatment is needed to relieve the existing pain that already exists. With modern techniques and the use of local anaesthetic, the procedure is pain free. If the tooth has a severe infection, it may take longer for the tooth and gum to become numb. In such a case our Dentist will inject further local anaesthetic.

Will I Suffer Pain After The Treatment?

It is possible that you may feel some discomfort afterwards. Taking normal painkillers will usually soothe the pain. If this does not do the trick, and the pain persists, you should contact us as soon as possible.

How Much Does This Type Of Treatment Cost?

The cost of Root Canal Treatment varies and is dependent on how severe the underlying problem is. For example, the molars have three to four canals and are therefore more difficult to treat. If you have a tooth with a severe abscess, then several visits might be required to achieve a good result. Factors such as these will increase the cost.

Are There Any Alternatives To Root Canal Treatment?

There is only one alternative to this type of treatment and that is an extraction. Unfortunately, not all damaged teeth can be repaired (restored) and hence an extraction is sometimes necessary. The resulting missing gap is then filled by a removable denture, a fixed dental bridge or a dental implant.

Is Root Canal Treatment Always Successful?

This procedure has a high success rate, as long as it is performed to a high standard. At the Surbiton Smile Centre, we will ensure that this is the case. But occasionally no matter how high the standard of care is, the root filled tooth never heals up, which will result in the loss of that tooth. Also, Root Canal Treatments can fail if the tooth develops further decay, or the existing restoration fails resulting in leakage, or the tooth suffers later from a crack or fracture. A further possibility maybe due to the difficult anatomy of the tooth which made it difficult to clean the narrow and curved canals to eliminate the bacteria entirely.

What After Care And Review Do, I Need?

You must visit us at least once a year to make sure the tooth is healing up. This really should be part of your regular six-monthly visits that form part of your routine check-ups.

What Is Root Canal Retreatment?

Root canal treated teeth can last for a long time but sometimes the treatment fails, or the patient’s symptoms persist. This can happen immediately after the completion of the root canal treatment, but if it does happen then quite often it is much later.In such an instance, the treatment must be performed again, and that procedure called root canal retreatment.

Who Can Perform Root Canal Treatment?

All our Dentists at the Surbiton Smile Centre can carry out this procedure. Obviously, retreatment is more complicated and time-consuming and may require the use of a microscope.

Further In-Depth Information Regarding Root Canal Treatment

1 – Problems With The Nerves Inside The Tooth (Pulp) And With The Tissue Around The Tooth:

  • a) exposure to the internal part of the tooth (dentin)
    • The caries is the most common cause of the nerve(pulpal) irritation because it stimulates the cells in that part of the tooth whichthen produce inflammation inside the nerves.
    • Other possible factors are: Tooth wear, gum recession, tooth fracture, preparation for crown and filling can cause pulp(nerve) irritation due to dentin exposure.
    • Bacteria can also penetrate towards the pulp along the dentinal Tubules.
  • b) Nerve exposure(pulp exposure) inside the tooth
    • Caries is the most common cause of nerve exposure inside the tooth.
    • The bacteria in caries will set up pulp inflammation and as the pulp becomes exposed to more toxin, bacteria will penetrate into the pulpal tissue.

A tooth fracture can be responsible for pulp exposure resulting in the injury or demise of the pulp.

  • Nerve problems inside the tooth (pulpal pathology)
    • Inflammation in nerves, abscesses and nerve death (pulp necrosis) are the most common diseases seen in the pulp.
    • Bacteria may establish entry into the pulp through vascular means. Bacteria may originate from any part of the body andpass through the blood stream and then settle in an area of pulpal inflammation.
  • Calcification of nerves inside the tooth
    • All pulps of vital teeth are stimulated to slow calcification. Traumatic injuries can bring about very rapid and almost complete calcification. If no plural or atypical pathology occurs, the tooth needs only to be watched.Other causes for rapid calcification are deep caries, deep irritating fillings, and trauma of occlusion.
  • Internal Resorption
    • At times a traumatic injury that may cause calcification of the pulp is also capable of producing internal resorption.The resorption causes perforation of the tooth which then results in pulpal (nerve)contamination and thereby pulpal necrosis.
  • External Resorption
    • External resorption is the result of a chronic periodontal problem which can damaged the wall of the tooth and effect the pulp(nerves inside the tooth).
    • A resorption around the apical part of the root is a result of traumatic injuries or trauma of occlusion or orthodontic procedures.
  • Problems around root of the tooth
    • The inflammatory by-product which is the result of a chronic or acute pulpal problem may drain into a variety of anatomical structures including the mucosa surfaces and dental fistula.
  • Periodontal and endodontic lesion
    • Sometimes problems around the teeth originate via an endodontic or periodontal problem around the tooth.
    • A combination of endodontic and periodontal therapy is needed to correct any lesions.

2 – Endodontic Treatment

  • Protection of dentin
    • To protect the dentin during the restoration procedure a base should be placed under the restoration.
  • Coverage of the pulp
    • Pulp capping is the protection of a small pulp exposure by stimulating secondary dentin with a sedative dressing. Calciumhydroxide pasties are placed in direct contact with the exposed pulp. Even after the formation of secondary dentin pulpal pathology and pulpal necrosis may develop.
  • Pulpectomy of Apexification
    • A pulpectomy is the removal of the coronal portion of the pulp and placement of calciumhydroxide over the assumed healthy pulp.
    • Apexification is the removal of a vital pulp and the placement of calcium hydroxide in the total canal. Both methods are to induce apical closure and the continued development of an immature tooth.
  • Pulpectomy and Root Therapy
    • Pulpectomy consists of the complete debridement of the pulp tissue and the shaping of the entire root canal system obdurate three dimensionally. This endodontic therapy is the most predictable.
  • e) Endodontic Surgery
    • Periapical surgery is indicated when a routine endodontic procedure cannot be performed as in the following scenario:
    • Broken file inside the canal and there is a radiolucency (ie it is a sign of infection)around the root.
    • Calcified canal with an infection around the root.
  • Bleaching
    • Vital bleaching is the lightening of a tooth that has usually been stained by Tetracycline during the development of the tooth.
    • Vital bleaching is the lightening of a tooth that has been endodontically treated. The non-dentinal tubules have been stained by pulpal haemorrhage or dental products. Superoxol(30-35 present hydrogen peroxide) is used as the oxygenating bleaching agent therapy.
  • Retreatment of endodontically treated teeth
    • Retreatment is the undoing of the root canal filling and often the restorative part of the tooth.
    • Basic endodontic principles are then followed to change the success of treatment.

3 – Basic Endodontic Concept

A careful and complete diagnosis must be made on each and every suspected tooth.

Diagnosis

The sequence of endodontic problems diagnosis is as follows:

Medical history:

Patient with pace maker: Dentist must refrain from a procedure that would interfere with pacemaker function: e.g. pulp testing sonic devices like apex locator, electro surgery etc.

Dental history:

Purpose: Quite often the problem tooth can be localised by taking the dental history.

  • What is the patient’s past total dental treatment?
  • What is the main complaint?
  • What is the main history of the complaint?
  • Has the patient had any recent fillings?
  • Were there any unusual problems concerning the tooth such as pulp capping or pulpectomy procedure, or a large restoration performed?
  • Has the tooth been subjected to a sharp blow in an accident of some kind?
  • Has a swelling or a gum boil around the tooth ever been noticed? If yes what did the patient do?
  • Has there been any drainage from the tooth or gum?
Subjective Symptoms:

The following are typical question that may be asked:

  1. Is the pain present now?
  2. What type of pain (sharp-dull) are you experiencing?
  3. Is the pain localised or diffused?
  4. Is there a throbbing?
  5. Is the pain intermittent or continuous?
  6. Is the pain increased by cold, heat, pressure, mastication, lying down, sweet or sour?
  7. Do you have to take anything hot or cold to bring on the pain?
  8. Is the pain spontaneous?
  9. Does it go away by itself or do you have to take medication?
  10. Does hot and cold make it feel better?
  11. Does the tooth feel loose? If yes when did you first noticed it?
  12. How long does the pain last?

Purpose: Careful questioning of the patient must be conducted to evaluate the patient’s problem completely. A tentative diagnosis can often be made from these subjective symptoms.

Clinical Observation:

These are the objective signs observed by the dentist in an around the mouth. It is important to note the following:

  1. Extra oral swelling
  2. Lymph nodes involvement
  3. Intra oral swelling
  4. Fistula(sinus tract) intra oral and extra – oral
  5. Tooth discolouration
  6. Traumatic injuries such as crown and root fracture
  7. Presence of deep caries lesion
  8. Recurrence caries beneath a restoration
  9. Type and extent of restoration
  10. Developmental stages of restoration
  11. Gingival recession
  12. Colour of gingival tissue
  13. Temperature elevation
  14. Traumatic occlusion
  15. Loose, leaking or fractured restoration
  16. Mobility

Purpose: Often problematic teeth can be localised, and the dentist may see other contributing factors involved. Judgement is made on whether the involved tooth is worth salvaging.

Clinical Test:

These tests are mandatory to confirm any tentative diagnosis that has been made so far. All eight of these tests must be used and in certain case further selective tests must be used:

  1. Electric pulp test
  2. Thermal test
  3. Percussion test
  4. Palpation
  5. Mobility
  6. Periodontal evaluation
  7. Occlusal evaluation
  8. Radiographic
Careful Interpretation Of The Radiograph Should Be Made:

Outside of root:

  • Length of the root
  • Curvature of the root
  • Root formation

Inside of root:

  • Internal anatomy
  • Calcification
  • Branching of the canal
  • Resorptions
  • Pulp stones
  • Foreign body
Further Selective Tests For Difficult Diagnoses:
  1. Test cavity preparation(where the tooth is crowned, and sensitivity testing is difficult)
  2. Anaesthetic tests
  3. Transillumination
  4. Biting
  5. Staining
  6. Gutta percha tracing with radiograph

Purpose: The status of pulp and periapical tissue can be evaluated, and diagnosis can be confirmed.

Test For Crack Tooth Syndrome:
  1. Transillumination
  2. Biting
  3. Staining

The cracked tooth syndrome refers to a crack within the crown of the tooth without any pulpal involvement.

It usually manifests itself as sensitivity to a certain biting pressure. It becomes very painful when biting in one direction. Also,an extreme reaction to cold sets it off.

A different diagnosis must be made between sinusitis, nerve pain, overloading contact, grinding problem, or TMJ problems.

Any large amalgam filling which does not protect the cusp should be suspected.

The older the patient or the greater the intercuspation and wear, the greater the possibility of a crack.

One should always think of a cracked tooth when all other tests prove negative.

Diagnosis:

Differential diagnosis of anatomical land marks or pathological lesion from inflammation around the root

Following procedures required:

    1. Take several X-rays from different angles .A radiolucent area caused by pulpal lesion will not show on the x-ray.
    2. If the Laminadura around the tooth is not broken, it is a strong indication that there is no infection around the tooth.
    3. Take electric test: If the vitality of the tooth is established, the lesion on the X-ray could be a cyst or other pathological lesion (refer to other specialist).
Refer Pain:
  • Pain can refer from sinus to upper molar and premolar.
  • Pain in upper molar jaw can be referred to Lower molar.
  • Pain from lower molar can refer to ears.
  • Pain from Temporomandibular joint refers to teeth.
  • Pain from facial muscle can be referred to teeth.
  • Angina pain can be referred to lower left mandible.
  • Tooth pain can express itself in headaches.
  • Pain referred from Trifacial neuralgia.
  • Pain from psychosomatic origin

TMJ / TMD

Do you know what TMJ and TMD stand for?

The temporomandibular joint (TMJ) is the joint that connects the jaw to the temporal bones of the skull. Temporomandibular joint disorder, known more commonly as TMD, occurs when there are problems with the muscles and jaws in the face.

Dislocation of The Temporomandibular Joint (TMJ)

What Is It?

The temporomandibular joint (TMJ) is located just in front of the lower part of the ear. This joint allows the lower jaw to move. It is a ball-and-socket joint, just like the hip or shoulder. When the mouth opens wide, the ball (called the condyle) comes out of the socket and moves forward. It goes back into place when the mouth closes.

The TMJ becomes dislocated when the condyle moves too far. Then, it can get stuck in front of a section of bone called the articular eminence. The condyle cannot move back into place. This happens most often when the ligaments that normally keep the condyle in place are somewhat loose. The surrounding muscles often go into spasm and hold the condyle in the dislocated position.

Symptoms

The jaw locks in an open position and you cannot close your mouth. You may have discomfort until the joint returns to the proper position.

Diagnosis

At the Surbiton Smile Centre we will base our diagnosis on the position of your jaw and whether you are able to close your mouth. X-rays will confirm our clinical diagnosis.

Expected Duration

The problem remains until the joint is moved back into place. However, the area can be tender for up to a few weeks.

Prevention

TMJ dislocation can continue to happen in people with loose TMJ ligaments. To keep this from happening too often, we will recommend that you limit the range of motion of your jaws. For example, if you have this problem you should place a fist under your chin when yawning in order to stop your mouth from opening too widely.

Conservative surgical treatments can help to prevent the problem from returning. Some people have their jaws wired shut for a period of time. This causes the ligaments to get tighter and restricts their movement.

In certain cases, surgery may be necessary. One procedure is called an Eminectomy. It removes the articular eminence so the ball of the joint no longer gets stuck in front of it.

Treatment

The muscles around the TMJ need to relax so that the condyle can return to its normal position. To make this happen, some people need an injection of local anaesthetic in the jaw joint. This may be followed by a muscle relaxant to stop the spasms. The muscle relaxant is given intravenously (into a vein in the arm).
If the jaw muscles are relaxed enough, a doctor or dentist can move the condyle back into the correct position. He or she will pull the lower jaw downward and tip the chin upward to free the condyle. Then the ball is guided back into the socket.

Rarely, someone may need to have the dislocation fixed in the operating room under a general anaesthetic. In this case, it may be necessary to wire the jaws shut or use elastics between the top and bottom teeth to limit the movement of the jaw after the dislocation has been fixed.

You should follow a soft or liquid diet for several weeks afterward. This reduces jaw movement and stress. Avoid foods that are hard to chew, such as tough meats, carrots, hard biscuits or ice cubes. Also, be careful not to open your mouth too wide.

When to call a Professional

If your TMJ becomes dislocated, visit your doctor, the Surbiton Smile Centre or hospital emergency room right away to have the joint put back in place. You may be referred to an oral and maxillofacial surgeon for treatment.

Prognosis

The outlook is excellent for returning the dislocated ball of the joint to the socket. However, in some people, the joint may continue to become dislocated. If this happens, you may need surgery.

What is TMD?

TMD, or temporomandibular joint disorder, means that the hinge connecting the upper and lower jaw is not working properly. This hinge is one of the most complex joints in the body, responsible for moving the lower jaw forward, backward and side-to-side. Any problem that prevents this complex system of muscles, ligaments, discs and bones from working will feel like your jaw is popping or clicking or even “getting stuck” for a moment.

The exact cause of a person’s TMD is often difficult to determine. Your pain may be due to a combination of factors, such as genetics, arthritis or jaw injury. Some people who have jaw pain also tend to clench or grind their teeth (Bruxism see our website for further information), although it must be said that many people habitually clench or grind their teeth, but never develop TMD.

In most cases, the pain and discomfort associated with TMD is temporary and can be relieved with self-managed care or nonsurgical treatments. Surgery is typically a last resort after conservative measures have failed, but some people with TMD may benefit from surgical treatments.

How is TMD treated?

While there is no single cure for TMD, there are different treatments you can follow that may reduce your symptoms dramatically. At the Surbiton Smile Centre, we may recommend one or more of the following:

  • Try to eliminate muscle spasm and pain by applying moist heat or taking medication such as muscle-relaxants, aspirin or other over-the-counter pain-relievers, or anti-inflammatory drugs.
  • Reduce the harmful effects of clenching and grinding by wearing an appliance, sometimes called a bite plate or splint. Custom-made to fit your mouth, the appliance slips over the upper teeth and keeps them from grinding against the lower teeth.
  • Learn relaxation techniques to help control your muscle tension in the jaw. We may suggest you seek training or counselling to help eliminate stress.
  • When the jaw joints are affected and other treatments have been unsuccessful, jaw joint surgery may be recommended.

Symptoms

There are many sign and symptoms of TMD. It is hard to know for sure if you have a relevant one,as one or all of these symptoms can also be present for other problems.

At the Surbiton Smile Centre, we can help make a proper diagnosis by taking a complete medical and dental history and performing a detailed investigation with the use of associated X-rays.

Signs and symptoms of TMD may include:

  • Pain or tenderness of your jaw
  • Your jaw “gets stuck” locked or goes out of place
  • Headaches (often like migraines), earaches, pain and pressure behind your eyes
  • Pain in one or both of the temporomandibular joints (TMJ)
  • Aching pain in and around your ear
  • Difficulty chewing or pain while chewing
  • Facial pain, ear pain and/or jaw pain
  • Trouble chewing and biting
  • Swelling of your face
  • Tenderness of jaw muscle.
  • Pain brought on by yawning, opening the mouth widely or chewing.
  • Locking of the joint, making it difficult to open or close your mouth
  • A sudden change in your dental occlusion (the way the upper and lower jaw fits together).

TMD can also cause a clicking sound or grating sensation when you open your mouth or chew. But if there is no pain or limitation of movement associated with your jaw clicking, you probably do not need treatment for a TMJ disorder.

Causes

The Temporomandibular joint (TMJ) combines a hinge action with sliding motions. The parts of the bones that interact in the joint are covered with cartilage and are separated by a small shock-absorbing disk, which normally keeps the movement smooth.

Painful TMJ disorders can occur if:

  • The disk erodes or moves out of its proper alignment
  • The joint’s cartilage is damaged by arthritis
  • The joint is damaged by a blow or other impact
  • If you grind your teeth
  • General wear and tear of the joint
  • A blow to the head or face
  • Stress
  • An uneven bite

In many cases, however, the cause of TMJ disorders are not clear.

Diagnosis

The proper diagnosis of TMD:

At the Surbiton Smile Centre our dental staff will carry out a proper and thorough medical and dental examination and may take certain X-rays (panoramic) to evaluate the jaw joint and surrounding structure and also check your occlusion. Our Dentist may check the muscles and tissues of your head and neck to test for inflammation. Certain exercises and movements may be involved, and you may get a referral to an oral maxillofacial surgeon or further evaluation and diagnosis.
While there is no single cure for TMD, there are different treatments that may reduce your symptoms dramatically. Our Dentist may recommend one or more of the following:

  • Try to eliminate muscle spasm and pain by applying moist heat or taking medication, such as muscle relaxants, aspirin, other over-the-counter pain-relievers or anti-inflammatory drugs.
  • Reduce the harmful effects of clenching and grinding by wearing a night guard or splint. Custom-made to fit your mouth, the device slips over the upper teeth and keeps them from grinding against the lower teeth.
  • Learn relaxation techniques to help control muscle tension in the jaw. Our Dentist may suggest you seek training or counselling to help eliminate stress.
  • Transcutaneous electrical nerve stimulator (TENS) uses low-level electrical currents to relax joint and facial muscles and provide relief. Low-level laser therapy will assist in helping the neck to move more freely.
  • A dentist may prescribe non-steroidal anti-inflammatory drugs to relieve pain and swelling.

How to ease TMD symptoms yourself:

TMD Exercise:

A: First, stand in front of a mirror:

  1. Open and close your mouth slowly.
  2. Keep your head straight. If you suffer from TMJ dysfunction, your jaw will usually open to one side.
  3. Concentrate very hard on opening your mouth straight. This will be difficult at first because the muscles on one side of your mouth or jaw are weak and will not function properly.
  4. Keep trying and you will get there. Be patient! After all you are undoing many repetitions of opening it wrongly.
  5. Open and close your mouth correctly 10 times, then take a rest.
  6. Do 10 repetitions of this TMD exercise 3 times a day. This exercise will help the jaw re-learn to open and close correctly. Repetition is the key to the re-training of your jaw.To ease muscle pain around your jaw due to tight jaw muscles, try this following TMJ exercise:
  7. Slowly open your mouth as wide as you can, and then slowly close it.
  8. Slowly open your mouth to the right as wide as you can, then slowly closes it.
  9. Slowly open your mouth to the left as wide as you can, then slowly close it.
  10. Repeat this sequence 5 times, 3 times a day or until you feel a degree of relief from your jaw pain. If at any stage your symptoms increase seek professional help.

B: Other remedial actions:

  1. Eat soft food
  2. Take paracetamol or ibuprofen
  3. Hold an ice pack or heat packto your jaw, whichever feels better for you
  4. Massage your jaw muscles
  5. Try to relax
  6. Do not chew chewing gum
  7. Do not bite food with your front teeth
  8. Do not open your mouth too wide
  9. Avoid nail biting
  10. Avoid clenching your teeth. Apart from when eating, your teeth should be apart
  11. Do not rest your chin on your hand

Here is some advice:

Try and develop an awareness of your tension-related habits. For example, clenching your jaw, grinding your teeth or chewing pencils. This will help you reduce the frequency of these habits.

When to see a GP

You should seek medical attention if you have persistent:

  • pain or tenderness in your jaw, or
  • if you cannot open or close your jaw completely.
  • Your GP, the dental staff at the Surbiton Smile Centre can discuss possible causes and treatments for your problem.
  • You are unable to eat or drink
  • the pain is affecting your life
  • the pain is affecting your sleep
  • the pain and discomfort keep coming back

Risk factors

Factors that may increase the risk of developing TMJ disorders include:

  • Various types of arthritis, such as rheumatoid arthritis and osteoarthritis
  • Jaw injury
  • Long-term (chronic) grinding or clenching of teeth
  • Certain connective tissue diseases that cause problems that may affect the temporomandibular joint

Tooth Decay

Why Oral Health And Overall Health Are Linked

Just like your gut, your mouth is home to millions of bacteria. These bacteria, under ideal circumstances, are beneficial and help us stay healthy. For instance, bacteria in the mouth can convert the nitrates in green vegetables into nitric oxide, a chemical which helps our blood vessels dilate and lowers blood pressure. But because of poor dietary habits in the West, many of us foster the growth of less beneficial bacteria in our mouths – the kind of bacteria which attack the gum lining and surface of our teeth, leading to gum disease and tooth decay.

Researchers believe that saliva may be a mild antiseptic – an evolutionary defence against tooth decay. However, the production of saliva can be compromised in some people taking certain medications, including commonly prescribed antidepressants, painkillers, and antihistamines. A reduction in saliva means less liquid to neutralise the acids produced by bacteria, potentially leading to a higher likelihood of cavity formation.

Poor oral health is linked to a variety of medical conditions. As well as cardiovascular disease, researchers suspect that poor oral health is partly responsible for low birth weights and premature births in pregnant women, diabetes, osteoporosis and Alzheimer’s disease. Gum disease, for instance, may be linked to diabetes because of the increased chronic inflammation decreasing the effectiveness of insulin in the body. (Inflammation makes it harder for insulin to push glucose into cells). Problems with oral health may also result as Alzheimer’s disease progresses.

Researchers believe that saliva may be a mild antiseptic – an evolutionary defence against tooth decay.

Tooth Extraction

Tooth extraction involves having one or more teeth completely removed from your mouth by a dentist. This can be done at one appointment or over a few sessions (if more than one tooth needs to be taken out). You may or may not want, or need to have the teeth replaced. Your dentist will explain all the options available to you.

There are a number of reasons why your teeth may need to be extracted. Some of the most common reasons include:

  • Severe gum disease (periodontal disease) – when bacteria build up on your teeth and damage the bone that holds them in place, the teeth may become loose.
  • Tooth decay – if a tooth is very rotten, its nerves and blood vessels can die, leading to a painful abscess.
  • A broken tooth that can’t be repaired.
  • Crowded teeth – if you have a small jaw or lost your milk (baby) teeth early, your teeth may be crooked and you may need to have one or more removed so that the rest can be straightened.
  • Wisdom tooth problems – if there isn’t enough space in your mouth for your wisdom teeth they may become impacted (stuck behind the tooth in front) and need to be removed.

What Are The Alternatives?

If you don’t want to have your tooth taken out, sometimes alternative treatments are available at Surbiton Surrey dentist.

Painkillers or antibiotics may ease any pain and swelling, but these will just relieve your symptoms in the short term and won’t get rid of the underlying problem.

If you have crooked teeth, it’s sometimes possible to have them corrected without extractions. An orthodontist (a dentist who specialises in straightening teeth) will be able to explain the treatment options available to you.

If an infected tooth is identified early enough, you may be able to have root canal treatment instead of having the whole tooth removed.

Preparing For A Tooth Extraction

Your dentist will ask about your dental and medical history. It’s important that you mention any medical conditions, allergies or recent operations. You should also tell your dentist if you use an inhaler or are taking any medication, including the contraceptive pill or over-the-counter medicines such as aspirin. If you’re particularly anxious about having treatment, your dentist may give you a sedative – this relieves anxiety and causes temporary relaxation without putting you to sleep.

In certain situations, you may need to go into hospital and have treatment under general anaesthetic. This means you will be asleep and feel no pain while your tooth is being removed.

What Happens During A Tooth Extraction?

So that you don’t feel any pain during or immediately after the procedure, the Surbiton Smile dentist will give an injection of local anaesthetic into your mouth, which completely blocks feeling from the area. After the anaesthetic has taken effect, the dentist will widen the socket (the area your tooth sits in) using a tool called an elevator or a pair of special forceps and move the tooth from side to side until it is loose enough to be removed completely. During the procedure you will feel some pressure in your mouth and hear some noise. You should not feel any pain. In more difficult and rarer cases, your dentist may not be able to reach the root of your tooth, which in that case a small cut is made in your gum. If necessary for the Surbiton dentist then drill away some of the bone so the tooth root can be removed.

What To Expect Afterwards

There will be some bleeding and your dentist may put in stitches. After the extraction, you will be given a piece of soft padding to bite on to stop the bleeding.

If you have had your tooth removed under local anaesthesia, you will need to stay at the dental surgery until the bleeding is controlled. This will probably take about 10 to 15 minutes. You may need pain relief to help with any discomfort as the anaesthetic wears off.

If you have had general anaesthesia or sedation, you will need to arrange for someone to drive you home. Try to have a friend or relative stay with you until the next day. Both sedation and general anaesthesia temporarily affect your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents until your dentist tells you it’s safe. This will be at least until the next day. Wait until the local anaesthetic has worn off before having hot food or drinks – you might burn your mouth or chew the inside of your cheek while it’s still numb. Once you regain some feeling, stick to lukewarm, soft food and try not to chew in the part of your mouth where the tooth has been removed. Try not to drink alcohol or smoke for the first 24 hours after the extraction – this may cause further bleeding. It’s best not to rinse out your mouth or do any exercise for the first few hours after the extraction. This is because any blood clot that may have formed could be disturbed and the bleeding could start again. After the first few hours, it can be helpful to rinse out your mouth with salt water (half a teaspoon of salt in a glass of warm water) a few times a day.

It’s important to keep your mouth as clean as possible so continue brushing your teeth after the extraction. If you had stitches during the procedure, you may need to go back to your dentist to have them removed. Otherwise you probably won’t need a follow-up appointment. Smoking is not permitted for the first seven days after extraction, because smoking prevents the healing of the socket, which will be very painful and it will be costly to stop the pain.

You may have some discomfort and swelling for a few days afterwards, and your jaw may feel a little stiff. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always follow the instructions in the patient information leaflet that comes with any medicine and ask your pharmacist for advice. It’s normal for you to notice some slight bleeding for the first couple of days after having a tooth removed. Rinse the excess out of your mouth and then bite down on a clean pad of material such as a handkerchief. If the bleeding doesn’t stop within 15 to 30 minutes, contact your dentist for advice.

Complications

Tooth extraction at is common procedure and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side effects and the risk of complications.

While such complications are not common, some people may develop some, after extraction of teeth. Usually, complications arise in patients with difficult root morphology or strong supporting tissues. Likewise, teeth with weak crown surfaces, with deep caries and brittle teeth may also cause complications during or after the extraction procedure. While some of the complications arise during the procedure itself, others develop after the procedure, sometimes, within a few days too. Contact your dentist immediately if you experience:

  • Prolonged bleeding
  • Swelling
  • Severe pain
  • High temperature (fever)
  • Dry socket

One of the most common problems that can occur after tooth extraction is called a dry socket. This is when there is no blood clot so the tooth socket doesn’t heal as quickly as expected. This usually happens within two to four days after the extraction and is extremely painful. Call your dentist who will rinse the area, put a dressing on it, may give you antibiotics and keep you under observation until the problem is resolved.

Contact Surbiton Smile Centre today

Please get in touch if you are concerned about any aspect of your dental health. We will treat you fairly and honestly - and we look forward to being able to help you.

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