Category Archives: Old Orchard Dental Practice Blog

You may have seen over the weekend that a few of the papers ran a story claiming that dental fillings can cause decay. 

But what is the truth of the matter?

The story links to a recent paper that shows where a filling is placed, the adjacent tooth surface runs a 60% chance of developing decay. This much is true, and has been known for a long time, but to say that fillings cause the problem is misguided. It’s a lot more complex than that, and there are several factors that lead to this issue.

1. Plaque stagnation

It is known that dental decay frequently starts between the teeth, at the point where plaque is present and unable to be cleaned. The plaque produce an acid when exposed to sugar, and given enough time and enough exposures, decay sets in. This is between the teeth – so it is common to see BOTH teeth affected. Even with one filling placed, it is possible that the decay still continues to affect the adjacent tooth because of plaque stagnation. So the best thing to do is limit sugar exposure and make sure that the plaque is removed between the teeth.

2. Scuffs during the procedure

It is known that scuffs to adjacent teeth happen frequently during preparation for fillings. This has been known for a long time, and studies show that this can happen in up to 85% of preparations. Enamel damage can predispose the tooth to decay, but the acid from bacteria is still needed.

Fortunately, we have been using a simple device known as a WaveGuard for years to prevent this. This is a simple wedge that has a metal guard to prevent damage to the next tooth.

WaveguardUsing strong magnification helps also, and the use of a microscope really helps to improve accuracy during preparation.

3. Poor contact points in the filling

When a filling is placed where the contact point is either too open or of a poor form, plaque stagnation can increase in this area and lead to more decay. That is why we use what are known as sectional matrices, and where the contact is very wide, it is recommended that you have an inlay placed rather than a filling. This is a lab made restoration that allows us to control the contact point much more delicately and ensures that food and plaque trapping is kept to a minimum.

 

So while the reports raise an interesting and valid point, it would be foolish to think that fillings cause decay. These problems have been known about for a long time, and we have already taken steps to reduce the chances of decay in adjacent teeth following fillings. Of course, the best thing is prevention, and it would be far better to not get decay in the first place. This can best be achieved by controlling sugar intake to no more than 4 times a day (and watch for hidden sugars!), and using a fluoride toothpaste twice a day.

 

Sedation dentistry

Sedation dentistry

We know that for some people, there is literally nothing worse than having dental treatment, but we are introducing a sedation service, where you will be able to have the dentistry you want, to get your mouth as healthy as you would like, while you are almost asleep.

Dentistry while you sleep

Dentistry while you sleep

What is sedation dentistry?

Sedation dentistry is where we use a small amount of an intravenous relaxant to make you drowsy and relaxed. While you will still be awake, you will feel like you are almost asleep, allowing you to get all the dental treatment that you want to make your mouth healthy or to improve the appearance, or to replace missing teeth with dental implants.

You will also forget about most of the experience, and get back to normal approximately 24 hours after treatment.

Most people are suitable for sedation dentistry, but if you have any doubts, the next step is to contact us to check if you are suitable.

Will I still be awake?

While you will still be awake, you will be very relaxed and almost asleep. You will still be able to respond to instructions, and we will still get you fully numb to make sure that you don’t feel anything. Sedation is also known as “twilight anaesthesia” as you will be close to sleep, but not quite fully unconscious.

And, you will forget most of the procedure as well.

How long does it last?

Dental sedation will depend upon the procedure. Generally it will last as long as we need to for the procedure, but if you are sedated we would ideally like you to have as few visits as possible. This means that we generally have longer appointments where we get more done.

You will have a slightly wooly feeling for 1-2 days after the procedure. It is also important to note that you should not drive or sign any legal documents for 24 hours after sedation. You will not be insured if you do drive in this period.

Same day Cerec crowns, inlays, onlays, veneers

Cerec restoration

Cerec restoration in place


Cerec crowns

Sometimes, coming back for multiple appointments can be inconvenient.

At The Old Orchard Dental Practice, we know that it can be frustrating having to take additional time off work for a fit appointment. That is why we are pleased to announce that we expect to have a Cerec system in place very soon which will mean that you can have crowns, inlays, onlays and veneers made in a single visit, from a strong block of porcelain or composite.

These are bonded in place using biomimetic principles, and means that you can have the crown fitted at the same appointment as the preparation.

These are metal free, and are highly aesthetic. We will also have a glazing unit to make the appearance even better.

 

The process

A Cerec crown, inlay, onlay or veneer is prepared in exactly the same way as usual. After preparation, optical “impressions” are taken. This involves coating the teeth in a fine powder before using a scanner to load the images into a computer. A design is then produced, and the design is then precisely milled from a solid block of the desired material. While this is happening, you can sit back and enjoy a coffee.

After milling, the restoration MUST be bonded into place using the correct adhesive system.

The results

I have placed several hundred Cerec restorations, and can honestly say that the process is easy, quick and straightforward IF the dentist has invested the time and energy in getting to know the system well. It’s like anything else, if you don’t put the effort in, you don’t get the results.

There have been numerous studies done on the longevity of Cerec inlays, and they actually outperform every other restoration, so not only does it look great, it also lasts a long time as well.

Tooth whitening Edinburgh

Tooth whitening

Tooth whitening and what it can do for you

A lot of people are unhappy with the colour of their teeth. Tooth whitening has been around since the late 1800s, but only in the last few years has it reached the point where we can get reliable, predictable results.

Your teeth will naturally become yellower with age, as the outer shell of enamel becomes thinner and you pick up staining from tea, coffee or red wine.

If we use tooth whitening, your teeth will develop a more youthful appearance.

Enlighten tooth whitening

I have used several different tooth whitening systems, such as Zoom whitening, Britesmile, and many of the tray-based systems, and I can confidently say that NOTHING on the market beats Enlighten.

I have been using it for the last 6 months and have never been disappointed by the results.

Many people worry that the whitening doesn’t give the results they want, or have been disappointed by other systems and the regression: see what Lisa had to say after having Enlighten whitening in the following video.

Will tooth whitening work on fillings or crowns?

Categorically, no. There will be no whitening of synthetic materials. It simply doesn’t happen.

This is a claim that we have seen repeated by several “tooth whitening salons” and it is simply untrue.

Will it be painful?

Tooth whitening is normally a straightforward process with no pain. However, there can be an increase in tooth sensitivity during the process, and this normally disappears after the process is complete. This is normally easily controllable by using a paste containing ACP, such as Enlighten’s “Tooth Serum”.

During the in-surgery treatment, you may get what are known as “zingers” which give a small pulsing sensation during the treatment. The feeling is like a mild electric shock, but disappears very quickly.

What about using a laser?

So-called “laser” tooth whitening actually uses a light to “activate” the gel. Does it work? The evidence says no – it doesn’t really do anything. However, we know that simply drying the teeth for an hour or so will give a temporary whiteness, and often so-called “laser” whitening is simply a way of forcing you to keep your mouth open for an hour or so. Your teeth may look the right colour to begin with but will regress very quickly. This approach is fine if you want whiter teeth for a day, but the effects are short lived. Enlighten whitening gives long lasting results without regression.

What about buying gels?

Under recently introduced laws, it is illegal for non-dentists to sell you tooth whitening gels that contain more than 0.1% hydrogen peroxide. There are no other agents that can safely whiten your teeth – so while you may be able to buy chlorine dioxide gel, it is very damaging to your teeth. Similarly, many salons have tried to get around the rules by using sodium perborate – well… Actually this was used in dentistry previously, but it was abandoned due to being toxic. Furthermore, it is also still illegal as it releases hydrogen peroxide.

How much does it cost?

Enlighten tooth whitening costs £450, and this includes the making of very close fitting trays, which you can still use after the treatment. The results are guaranteed and Enlighten will provide additional gels if you do not reach the guaranteed shade.

I have yet to use the guarantee.

Over the longer term there is a need to top up, and so long as you still have the trays, you can buy the gels from us to do this – there is no need to do the whole process again, unlike other systems.

Cosmetic dentistry Edinburgh

Cosmetic dentistry

Cosmetic dentistry is something that can have a profound impact on someone’s life.

There’s no doubt about it – if you are ashamed by your smile it can make you hide yourself from the public, and this can have serious consequences.

Fortunately, there are ways of achieving a fantastic smile without compromising the health of your teeth.

Cosmetic dentistry can give anyone a fantastic smile. It is however important to know where you want to be so that we can plan your perfect smile.

Cosmetic dentistry and dental veneers

In the 90s and early 2000s, cosmetic dentistry was largely based upon using new, dentine bonding processes to replace enamel with porcelain, and this approach was encouraged by organisations such as the BACD and by reality TV shows such as 10 Years Younger. While it is possible to give a fantastic smile by doing this, it is important to know that the enamel is like the seal on the tooth, and removing it opens the tooth up to decay. But, due to a poorly understood process, bonding porcelain to dentine results in a higher failure rate than bonding to enamel – and crucially, this occurs YEARS down the line, so at fit of veneers, everything may look fantastic, but in the longer term you may be left enamel-less and with broken and fractured veneers. The failure rate more than DOUBLES when bonded to dentine rather than enamel.

(For the dentists who read this blog, this is due to the activation of matrix metalloproteinases in the collagen hybrid layer. This can be minimised by using a non-acidic bonding agent, or a three step system. One-stage dentine bonding agents are dreadful and should be avoided – that 20 seconds you save will come back and bite you!)

Veneers have their place in dentistry, but as a profession we are moving away from them and towards making the best of the teeth that you have.

This means that we:

1. ALIGN
2. BLEACH
3. BOND

So firstly, we correct the position of teeth. Then we correct the colour. And finally we add on any part that have been worn.

And that’s it. The modern cosmetic approach, giving long lasting, beautiful smiles without taking away any of your tooth.

You don’t need any root canal treatments, or any drilling away of tooth with this approach. In fact, you don’t need any injections for this, it is a straightforward process and can normally be completed over 4-6 months.

 

 

Thankfully, the BACD is now promoting a much more conservative philosophy and avoiding the over-use of veneers that is still sadly so prevalent among dentists.

Some typical veneer preparations of questionable need:

Is this really what you want done to your teeth? Veneer preparations result in the loss of large amounts of tooth tissue

Is this really what you want done to your teeth? Veneer preparations result in the loss of large amounts of tooth tissue

Using the Inman Aligner for Align-Bleach-Bond

Using the Inman Aligner for Align-Bleach-Bond – no needless destruction, no anaesthetic, long lasting.

 

If you already have dental crowns and veneers

If you already have dental veneers or crowns, then I’m afraid the damage may already be done and the enamel may already have been removed. In that case, it is important to get the best possible fit for any cosmetic treatment. It is therefore important that you go to a dentist who uses high magnification so that the best possible result can be achieved.

If you already have a mix of materials in place, any replacements should be made from the same or similar materials. Modern materials can give fantastically strong crowns and veneers made of similar materials and giving a fantastic appearance.

Cost of cosmetic dentistry

Perhaps the most important thing here can be summarised by John Ruskin:

“It’s unwise to pay too much, but it’s worse to pay too little. When
you pay too much, you lose a little money – that’s all. When you pay
too little, you sometimes lose everything, because the thing you
bought was incapable of doing the thing it was bought to do. The
common law of business balance prohibits paying a little and getting a
lot – it can’t be done. If you deal with the lowest bidder, it is well
to add something for the risk you run, and if you do that you will
have enough to pay for something better.”

Obviously the cost of cosmetic dentistry varies depending upon what is needed. But if you choose to cut corners, it WILL cost more in the long term. And it may not actually save you any money by going down the quick-fix route – often, Align, Bleach, Bond works out much cheaper than the veneer approach. And it lasts a lot longer, and is easier to repair if there is a problem.

Typical costs for Align, Bleach, Bond treatment are £3,500, but it depends upon your circumstances.

Cosmetic dental veneers and crowns cost £350-£1,000 per tooth.

We can help you to arrange interest free finance for this through Dental Finance to spread the cost over up one year interest free of over up to 5 years with interest at 9.9%APR

The next step – know where you are going

In order to give you the best possible outcome, it is important to know where you are going from the start. If this is the Align Bleach Bond route, the first step is to have a computer simulation made to demonstrate where your teeth may be positioned. Cosmetic imaging may also be used.

For veneers and crowns the process is a little different. This involves a “wax-up” whereby technicians will assess what is possible and make a wax model to demonstrate. This can be used to make a “trial smile” which you can wear for a couple of days before deciding if cosmetic dentistry is right for you.

The cost for this first stage is typically £300, but it is a very important stage that is often overlooked to get quick results. It is worth repeating – quick results, where corners are cut, result in more failures.

If you have any questions about cosmetic dentistry, please do not hesitate to contact us on 0131 516 9080.

Dental Implants

What are Dental Implants?

Dental implants are artificial replacements for the roots of teeth. They are normally made of titanium, and integrate into the jawbone to replace the missing roots of teeth. Once dental implants are fully integrated, they can be restored, either using dental crowns, bridges or they can be used to secure a denture.

Dental implant

Dental implant

What can be replaced with dental implants?

Dental implants can replace single teeth by using a crown, or multiple teeth using bridges, or an entire arch using crowns, bridges or dentures.

If you have a lower denture that is loose, a commonly used option for replacing a lower denture is to use two dental implants with ball attachments. As lower dentures can be a nuisance and are renowned for being unstable, ball attachments stop movement and keep the dentures in place.

But dentures can also be replaced with full arch bridges. These give very strong, secure results and provide a good appearance. This is the closest result to natural teeth.

What is the process for dental implants?

The process for placing and restoring dental implants varies, depending upon what is required for each individual case.

Sometimes some augmentation is required before implants are placed. After any augmentation is done, the dental implants are placed into the jaw and typically allowed to integrate for 3 to 6 months before impressions are taken. This is to allow new bone to form around the dental implants.

After this time, a series of appointments are needed to take impressions, record the way your teeth bite together and to ensure a good fit of the final restoration.

Will I be able to eat with dental implants?

Yes! That is one of the main advantages of dental implants! Many people find that they can’t eat as well after losing teeth. Dental implants restore your ability to eat much better than dentures.

Will dental implants cause problems with my other teeth?

No! One of the main advantages of dental implants over conventional dental bridges is that it DOESN’T do any harm to your other teeth. In fact, other teeth can move about after you lose a tooth. A dental implant will prevent movement of the other teeth and reduce the risk to other teeth.

 

There is an abundance of information available from the ADI here: http://www.adi.org.uk/public/implant/index.htm. The ADI is a group set up to improve knowledge about this fantastic treatment within the UK.

Microscope dentistry and what it means for you

What is microscope dentistry?

I have been using a microscope for all aspects of dentistry for the last 2 and a half years, and there are very few things that have changed my work so much.

Microscope dentistry is the use of a special microscope to give very high magnification for dental procedures. In a job where the size of the area we work on is measured in millimetres, precision is important. Gaps of 50 microns are likely to lead to failure of the work we are doing, so clearly the ability to see well is important.

Dental microscopes also give very strong lighting – this is very important when we are working in what is essentially a dark environment. Traditional surgery lights work reasonably well, but are often not strong enough for microscopic work, and also can leave a shadow if not at the correct angle.

My dentist wears magnifying glasses – is that similar?

Magnifying glasses, or loupes, are a step in the right direction but give nowhere near the magnification given by a dental microscope. To give you an idea of what is visible, have a look at the pictures below.

I used loupes since being a student, in fact I have never worked without magnification. Loupes are typically available in 2.5-3.5X magnification for general use, and 6X for more specialist procedures.

Microscopes vary, but my microscope goes from 3-30X, with most routine examinations involving teeth being looked at under 20X magnification. Microscope dentistry gives so much more than loupes. There is a steep learning curve for the dentist BUT it is well worth it – it makes it so much easier to get good results.

My colleague Dr. Andre Haigh maintains a very useful website related to microscope dentistry - http://www.magnificationindentistry.com/ - which details the use of magnification in dentistry.

But surely it can’t make that much of a difference?

To put it in perspective, these are some pictures of the same tooth, taken this morning.

Tooth under 3X magnification

Tooth under 3X magnification

At 20X magnification, a crack is becoming visible on the back surface of the tooth

At 20X magnification, a crack is becoming visible on the back surface of the tooth

The crack is very clearly visible. An X-ray confirmed the presence of decay in this area.

The crack is very clearly visible. An X-ray confirmed the presence of decay in this area.

These photos quite clearly demonstrate the advantages in diagnosis – once you can see problems clearly, it is the first step in dealing with them.

Please note that the first image is already magnified to a similar level as dentists using loupes see – how anyone can diagnose without some form of magnification is beyond me – well, actually, it isn’t – diagnosis relies upon problems being at an advanced state before action is taken. Microscope dentistry means that you get small problems dealt with before they become big problems.

For dental treatments, working under high magnification is an absolute godsend. It has been estimated that working on one tooth results in damage to the adjacent tooth in approximately 64% of cases. Working under very high magnification reduces the chances of this happening – but I also use guards to protect the next teeth.

Dental dam

What is a rubber dam?

Dental dam in place

A rubber dam or dental dam is a sheet of a rubber-like material that is clamped around teeth to keep them isolated.

This has several roles – firstly the dental dam helps to protect the cheek, tongue and soft tissues from dental instruments. It also helps to keep the teeth dry, which is very important for modern adhesive dentistry – even the water drops from breathing can have an impact on how strong the bond is.

And here’s the really important one – it helps to prevent fluids from either going into the mouth, or onto the tooth from the mouth. This is particularly important when doing root canal treatments – as saliva is absolutely packed full of the bacteria that can cause root treatments to fail. There is also evidence that composite restorations placed under rubber dam have a better lifespan than when done without a dam.

Rubber dams have been used in dentistry since 1864. This is not something new, but it is far from commonplace.

Why to use a rubber dam

With the advantages listed above, I guess a more pertinent question is “Why not?”

Generally it is down to the dentist.

Why dentists DON’T use the rubber dam

When I was doing my Vocational Training, I remember that one of my study group did an audit within practice to see the reasons behind not using one.

Perhaps most telling was the list that it generated –

  • Time-consuming – in reality, if you are using it every day, it actually saves time.
  • Fiddly – Sometimes it can be, but if you use it every day, day in day out, it becomes second nature.
  • Don’t need it – the evidence is that there are better outcomes, even with the same dentist doing the treatment, when the rubber dam is used
  • But perhaps the most telling response summarises it nicely- “Can’t be arsed

    I use it because it makes my work easier and less stressful, as well as giving better outcomes. Sure, I could work without it, but a small percentage of failures due to not using a dam is simply not worth the risk. We want you to have the best outcome.

    Biomimetic Dentistry

    What is Biomimetic Dentistry?

    Biomimetic onlay

    A biomimetic dental onlay


    Biomimetic dentistry is a minimally invasive way of treating teeth that have become weakened or decayed. This practice helps to conserve the teeth and to keep them as strong as possible through sealing out bacteria and protecting the nerve and inner part of the tooth. Traditional dentistry techniques have often meant decayed or damaged teeth are drilled and filled, are crowned, or invasive root canal therapy is performed. This often means a substantial amount of the tooth is lost forever. In contrast biomimetic dentistry only replaces those areas of the teeth that are damaged, conserving the healthy parts of the tooth.

    Why is Biomimetic Dentistry so Different?

    The word biomimetic means to mimic nature, as natural teeth are perfectly designed for the job in hand. The practice of biomimetic dentistry rebuilds damaged areas with materials designed to closely replicate the way natural teeth perform. The materials used flex with the tooth, reducing the likelihood of fractures.
    In contrast the materials used for crowns and many traditional fillings are hard and inflexible. The remaining tooth structure is often weakened by the forces created when biting and chewing, and this can lead to it cracking. A cracked tooth will require extraction, meaning both the crown and the tooth will be lost. Alternatively the biting forces can weaken the bond between the crown or filling and the natural tooth, allowing bacteria to penetrate the tooth, creating infection and decay.

    Repairing your Teeth Conservatively

    Biomimetic dentistry virtually eliminates the need for root canal therapy, and replaces lost or damaged areas of tooth with correctly designed inlays and onlays that are securely bonded onto the tooth. These restorations are made with technologically advanced resin and ceramic materials, and can generally be completed during just one dental visit. There is very little or no tooth sensitivity following the procedure as the inner parts of the tooth, including the nerve are sealed and protected, helping to promote the long term health of the tooth.