General Dentistry

Prevention is always better than cure.

We believe that Prevention and Early Disease Detection are the key to stable oral health, that’s why we highly recommend to have your teeth and gums professionally cleaned by a dentist at least every 6 months. That way, no problem goes undetected and is treated at the earliest stage. We don’t like waiting for things to get worse. For each patient, our immediate goal is to detect and cure existing problems, and our long-term goal is to reach that level of stability where no active disease exists and everything is healthy and “under control”…..and that includes your Oral Hygiene practices!

IMPORTANCE

The single best thing that you can do (apart from maintaining good Oral Hygiene practices) to prevent gum disease and tooth decay, is getting your teeth and gums checked and cleaned by a dental professional, at least every six months. Our teeth are one of the most “overused” parts of our body, so we ought to take good care of them. One can only realise how important they are once they are gone, so don’t wait for this to happen, and get your teeth checked regularly!

THE PROCESS

1. Taking Your History

Once you arrive in our clinic (and if you’re a new patient, once you’ve filled up our new patient form), the dentist will greet you and ask you important questions regarding your oral and general health, to which you must answer as accurate as possible. It is important that you notify us of any change in your medical condition or if you’ve introduced any new medication as soon as they happen, so we can update your records accordingly. Make sure that you tell us about any pain or discomfort in or around your mouth that you may have experienced or have been experiencing since your last check up, so we can prioritise treating that problem first.

2. Taking Necessary Records and Examination

The dentist will then proceed to examine your teeth, gums and all surrounding structures. We also examine your jaw joints (TMJ) and related chewing muscles. The dentist will then recommend taking dental records such as dental x-rays, photos and/or diagnostic moulds/impression, according to your needs. Your teeth condition will then be recorded in your dental chart.

3. Scale, Clean, and Fluoride

Your teeth and gums will be cleaned with an ultrasonic scaler, which sends out vibrations and water spray to loosen and dislodge stubborn deposits that are clinging onto your teeth. Then we’ll polish your teeth with a polishing paste. After rinsing all of the paste away, we’ll dry your teeth and apply a concentrated topical fluoride mousse on your teeth. We’ll suction out the excess and we advise you not to rinse, drink, or eat for half an hour after this procedure, to allow fluoride to coat your teeth.

4. Discussion About Your Current Oral Condition and Future Treatment Needs

The dentist will then explain to you his/her findings and will formulate an appropriate treatment plan if necessary. We’ll give you a printed copy of the treatment plan before you leave the office, or we’ll email or post one to you if the dentist needs more time to study your case. Oral Hygiene Instructions will also be reinforced at this stage.

Causes of gum disease

Gum disease is usually caused by a build-up of plaque on teeth and along the gum line. Plaque is a sticky coating containing bacteria. The immune system tries to get rid of plaque with an inflammation response. This is seen by the redness and swelling of the gum around the tooth.

Everybody has a range of bacteria in their mouth. Plaque is constantly being formed by some of these bacteria when they feed on the sugars in the foods and drinks you consume. Plaque provides the perfect environment for the bacteria that can cause gum disease to live and multiply.

Stages of gum disease

The two main stages of gum disease are:

  • Gingivitis
  • Periodontitis (advanced Gingivitis)

Gingivitis

Gingivitis is early gum disease. It affects the surface layers of the gum, particularly where the gum meets the tooth. At this stage, there is no damage to the deeper parts of the gums, teeth or bone.

The signs of gingivitis are:

  • bleeding gums, especially when brushing or eating
  • redness and swelling of the gum.

The good news is that gingivitis can be reversed.

You might think it is best to stop brushing if your gums are red or puffy. Try to keep brushing, as this will get rid of the bacteria and plaque that is causing the problem. Soon the gums should look and feel better. If not, you should discuss it with the dentist.

Periodontitis

Periodontitis is an advanced stage of gum disease that may occur if gingivitis is not treated.

The periodontium is the name given to a group of structures (boney tooth socket, periodontal ligaments, gum tissue, and the covering of the tooth root called “cementum”) that surround and support the teeth, keeping the teeth in place. Periodontitis is the inflammation of the periodontium caused by the bacteria in plaque and the body’s immune response to it.

When the gum is weakened by gum disease, spaces can form between the tooth root and the gum. These spaces are called ‘periodontal pockets’. Bacteria get trapped in these pockets and cause even more damage to the periodontium. Over time, bone is damaged and lost, and larger spaces begin to form between the tooth and the gum.

If periodontitis is not treated, the structures that hold the tooth firmly into the gum can become so damaged that teeth become loose and may need to be removed.

Smoking and poorly managed diabetes are risk factors for periodontitis.

Signs of periodontitis include:

  • bleeding gums
  • swollen gums
  • receding gums (the gum line shrinks away from the tooth making teeth look longer)
  • bad breath
  • a bad taste in the mouth
  • tenderness when biting
  • loose teeth.

Make an appointment now if you think you have any of these signs. We can talk with you about how to care for your teeth. We can also professionally remove plaque and hardened plaque (calculus). Early treatment of periodontitis can save affected teeth.

Prevention of gum disease

Regular tooth brushing helps to prevent gum disease by removing the plaque that causes it. Remember:

  • Brush teeth and along the gum line twice a day, in the morning and before going to bed.
  • Get a professional teeth and gum cleaning AT LEAST every six months.
  • Use a toothbrush with a small head and soft bristles.
  • Over 18 months of age, use a fluoride toothpaste, low fluoride for children aged 18 months to six years of age and standard fluoride for people six years and older.

Eating well can also help prevent gum disease. Sugars provide the food for some types of mouth bacteria to multiply and form a plaque layer on the teeth and gums. A high-sugar diet can contribute to a thick layer of plaque. Avoiding sugary foods and drinks, especially between meals, can help to keep plaque levels under control.

Follow the Australian Dietary Guidelines and enjoy a wide variety of nutritious foods from the five food groups every day, including vegetables, fruit, grain foods, lean meats (or alternatives), dairy (or alternatives). Drink plenty of water.

Tooth Decay (Dental Caries or “Cavities”)

It is the breakdown of tooth structure that happens when bacteria ferments food debris or sugar into acid which then dissolves hard tissues of the teeth. If left untreated, caries will continue to progress deeper into the softer layers of the tooth until it reaches the Pulp (nerve in the core of a tooth, which gives the tooth its vitality). When this happens, Fillings can no longer save the tooth, and either Root Canal Treatment or Extraction will be necessary. For more information about Root Canal Treatment, click here.

Mild to moderate sized tooth decay can be treated with direct dental restorations such as composite resin fillings. If the defect results in loss of a wall or cusp of a tooth, indirect dental restorations such as inlays, onlays, or crowns are recommended.

Restoring Lost Tooth Structure with Direct Restorations/ Fillings

 

 

 

 

 

The decayed part of the tooth needs to be removed to leave a clean, hard, intact tooth structure that is strong enough to support and bond a filling. Mild to moderate defects can usually be restored by placing fillings. Fillings can be Direct (placed on the spot, in-chair) or Indirect (laboratory fabricated, will need a second appointment for cementation into the prepared tooth). Back then, amalgam (“silver”) fillings used to be the gold standard for direct restorations. But after the advent and continuous improvement of adhesive restorative materials, such as Composite Resins, and the increasing hostility of the public to its mercury contents, amalgam is slowly becoming a thing of the past. At Top Class Dental, we only use tooth coloured restorative materials, such as Composite Resin and Glass Ionomer direct fillings.

Indirect restorations are indicated in cases where direct restorations such as composite resin fillings are likely to fail. When the tooth loses more than 40% of its structure to dental caries or breakage, indirect restorations are usually indicated. During your check-up or consultation, our dentist will be able to tell you which type of restoration is best suited for your case.

There are three most common types of Indirect Restorations:

  1. Inlays
  2. Onlays
  3. Crowns

These restorations can be fabricated out of any of the following materials:

  • Porcelain
  • Zirconia
  • Gold
  • Metal

Indirect restorations require two appointments to finish. On the first appointment, the tooth is prepared for an inlay, onlay, or a crown, and an impression (mould or imprint of your teeth) is taken to be sent to the laboratory. We will place a temporary inlay/onlay/crown on the tooth while waiting for the permanent restoration to arrive from the lab. Once received, your restoration can then be fitted and cemented. Some adjustments may be necessary. While minor adjustments can be done on the spot, more complex and major adjustments will need to be sent and done in the laboratory. Rest assured, we’ll make sure that you’re comfortable with the restoration and it fits perfectly to your tooth.

Nobody wants to lose a tooth, that’s why we at Top Class Dental strive to prevent this from happening. But the sad fact is, sometimes, it is just inevitable.

The most common reasons for tooth extraction are (but not limited to) the following:

  • extensive tooth decay
  • severe periodontal (gum and bone) disease around a tooth/teeth
  • extremely mobile tooth
  • tooth that cannot be restored in any way
  • fractured or split tooth
  • failed root canal treatment
  • infection
  • requirement for orthodontic treatment (i.e. to provide space for teeth alignment)

We start the procedure by giving you some topical anaesthetic cream to numb your gums prior to injecting a local anaesthetic. This usually alleviates (if not eliminates) the discomfort of the injection. We’ll make sure that you’re numb enough before we start extraction. Once numb, we proceed to remove the tooth, then clean your socket to remove any residual tooth fragments or infected tissue. Pressure is applied on the extraction site to stop the bleeding, and we’ll get you to bite on a piece of gauze to hold the pressure continuously, for at least 30 more minutes. We’ll also give you written post-operative instructions and home care for you to follow.

Patients with extracted teeth do not normally need to take antibiotics but at the very least patients should take precautions following the procedure to ensure that infection does not occur. Smoking, alcohol intake, vigorous brushing and rinsing, and heavy exercise are discouraged during the post-operative period because they hinder healing and may cause the wound to open.

After extraction, most patients experience little or no discomfort and only minor bleeding. However, some cases develop complications like prolonged healing or dry socket, especially if the extraction was difficult or if the patient did not follow the post-operative instructions. Please ring us if any problem arises after the procedure, or if there is anything that you are not sure of. After hours, if you develop any fever or chills, or feel very unwell, please call 000 or go to the nearest hospital (emergency department).

Complex Cases

Not all teeth can be easily extracted with forceps. Examples are:

  • teeth broken down to the gum level, leaving no crown to grasp on
  • fractured teeth
  • teeth with curved or abnormal roots
  • impacted teeth
  • wisdom teeth
  • malpositioned teeth

Most of these cases will require making a gum incision and sometimes sectioning bone and/or tooth. At Top Class Dental, Dr. Lee routinely uses Waterlase to assist her to do these things, resulting in less bleeding and less post-operative discomfort.

A denture is generally the cheapest option to replace missing teeth. It is either PARTIAL (replacing several but not all teeth), or FULL (replacing ALL teeth). Some dentures are used for an INTERIM/ TEMPORARY period of time, such as while healing after extraction and while waiting for a more permanent restoration such as dental implants or a fixed bridge.

Dentures can also be classified according to the material used for their fabrication. It can be either full acrylic, chrome, or valplast/flexite.

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