Dental implants are titanium replacements for missing teeth which are placed in the jaw bones.  They look and serve just like normal teeth and restore confidence, appearance, speech and function.

Once teeth are lost, the bone in which they were embedded gradually disappears because it is no longer required to support the teeth.  Traditionally, the options to replace lost teeth were removable dentures or fixed bridges.  As with all man-made substitutes for nature’s living tissues, there are drawbacks to these artificial appliances.  Dentures reduce eating efficiency and can suffer from poor retention and stability.  Many people find dentures difficult to control and embarrassing to wear.  On the other hand, bridges may involve cutting away healthy tooth tissue in order to provide support.  This cutting of tooth tissue may lead to later problems with the tooth, or teeth, in question.

Dental implants provide a solution to the problems associated with the replacement of missing teeth by conventional means.  They avoid the need to damage healthy teeth when providing bridges, are more secure than bridges that attach to teeth with ‘bonded wings’ and they can be used to hold a denture securely in place.

At our Practice, dental implants are placed by Dr Robert Bolt who is a Clinical Lecturer and registered Specialist in Oral Surgery. He is both medically and dentally qualified and is Director of the University of Sheffield “One-to-One” dental implantology course. Dr. Bolt is also lead for the University of Sheffield’s undergraduate dental implantology curriculum, and delivers a number of lectures and practical classes to both undergraduate and postgraduate students throughout the year.

Dr. Bolt  is very happy to offer an appointment if you are considering dental implants as an option for replacing missing teeth, or for supporting an unstable denture.  Referrals for dental implants can be made by clicking here.

Invisalign has been used to successfully treat over 500,000 cases and is extremely effective at straightening crooked teeth and closing unwanted gaps between teeth.

How does it work?

Invisalign involves wearing a series of clear, removable, custom-made plastic aligners that gradually straighten your teeth without having to use any unsightly metal wires and brackets that are associated with traditional braces.

Invisible – and removable!

Invisalign aligners are completely invisible – this means no one will know you are having the treatment done – and speech is completely unaffected.

Treatment with Invisalign is generally completed in half the time of conventional orthodontic treatment, and the fact that the aligners are removable means that you can brush and clean your teeth as normal on a daily basis.

The development of Invisalign has made orthodontic treatment accessible to adults who may previously have been put off having orthodontic treatment due to the appearance of “metal braces” and is a non-destructive alternative to veneers.

Most people have fillings of one sort or another in their mouths. Nowadays fillings are not only functional, but can be natural looking as well. Many people don’t want silver fillings that show when they laugh or smile because they are more conscious about the way they look.

What are amalgam fillings?

Amalgam or silver fillings are the metal coloured fillings that many people have. Amalgam was the traditional material used for fillings for many years.

Are they as good as silver amalgam fillings?

White fillings have always been considered less long lasting than silver amalgam fillings. But there are now new materials available with properties comparable to silver amalgam, and these are proving to be very successful. The life expectancy of a white filling can depend greatly on where it is in your mouth and how heavily your teeth come together when you bite. Your dentist can advise you on the life expectancy of your fillings.

Is it worth replacing my amalgam fillings with white ones?

It is usually best to change fillings only when your dentist decides that an old filling needs replacing. If so you can ask to have it replaced in a tooth-coloured material.

Some dentists prefer not to put white fillings in back teeth, as they are not always successful. One way around this would be to use crowns or inlays, but this can mean removing more of the tooth and can be more expensive.

What are tooth-coloured fillings made of?

This can vary, but they are mainly made of glass particles, synthetic resin and a setting ingredient. Your dentist should be able to give you more information about the particular material that they use.

Where can I get them done?

Most dental practices offer white fillings as a normal part of the treatment they give you. However, white fillings are classed as a ‘cosmetic’ treatment, and you can therefore only have them if you pay for them.

Are there any alternatives to fillings?

Adhesive dentistry is another form of this treatment. This involves bonding the filling to the tooth. The dentist has to remove less of the tooth, which is obviously better.

As we have already said, there are alternatives such as crowns and inlays although they can cost a lot more. Veneers can be used on front teeth instead of crowns or fillings.

Tooth whitening is a very safe and effective way of improving the appearance of your smile without causing any damage to your teeth.

Tooth whitening is a very safe and quick way of improving the appearance of your smile without causing any damage to your teeth. Tooth whitening can be done with our own tray whitening system which is highly effective and produces excellent end results.

Tray Whitening

Tray whitening involves the regular application of a whitening solution to custom-made trays (similar to mouthguards) which are then worn every night at home, usually over a period of two weeks.

The trays can then be saved and reused at a later date to “top-up” the initial whitening procedure.

A veneer is a thin layer of porcelain made to fit over the front surface of a tooth, like a false fingernail fits over a nail. Sometimes a natural colour ‘composite’ material is used instead of porcelain.

What are the advantages of veneers?

Veneers make teeth look natural and healthy, and because they are very thin and are held in place by a special strong bond (rather like super-glue) very little preparation of the tooth is needed.

When would I need a veneer?

Veneers can improve the colour, shape and position of teeth. A precise shade of porcelain can be chosen to give the right colour to improve a single discoloured or stained tooth or to lighten front teeth (usually the upper ones) generally. A veneer can make a chipped tooth look intact again. The porcelain covers the whole of the front of the tooth with a thicker section replacing the broken part. Veneers can also be used to close small gaps, when orthodontics (braces) are not suitable. If one tooth is slightly out of position, a veneer can sometimes be fitted to bring it into line with the others.

What about alternatives?

A natural-coloured filling material can be used for minor repairs to front teeth. This is excellent where the tooth supports the filling, but may not work so well for broken tooth corners. There will always be a join between the tooth and the filling material.

Crowns are used for teeth that need to be strengthened – either because they have broken, have been weakened by a very large filling, or have had root canal treatment.

How long will a veneer last?

Veneers should last for many years, but they can chip or break, just as your own teeth can. Your dentist will tell you how long each individual veneer should last. Small chips can be repaired, or a new veneer fitted if necessary.

How are teeth prepared for a veneer?

Some of the shiny outer enamel surface of the tooth may be removed, to make sure that the veneer can be bonded permanently in place later. The amount of enamel removed is tiny and will be the same as the thickness of the veneer to be fitted, so that the tooth stays the same size. A local anaesthetic (injection) may be used to make sure that there is no discomfort, but often this is not necessary. Once the tooth has been prepared, the dentist will take an ‘impression’. This will be given to the dental technician, along with any other information needed to make the veneer. The colour of the surrounding teeth is matched on a shade guide to make sure that the veneer will look entirely natural.

How long will it take?

A veneer takes at least two visits; the first to prepare the tooth and to match the shade, and the second to fit it. Before bonding it in place, your dentist will show you the veneer on your tooth to make sure you are happy with it. Bonding a veneer in place is done with a special adhesive, which holds it firmly on the tooth.

Will I need a temporary veneer between visits?

Because the preparation of the tooth is so slight you will probably not need a temporary veneer. The tooth will look very much the same after preparation, but will feel slightly less smooth.

What happens after the veneer is fitted?

Only minor adjustments can be made to the veneer after it is fitted. It is usually best to wait a little while to get used to it before any changes are made. Your dentist will probably want to check and polish it a week or so after it is fitted, and to make sure that you are happy with it.

Your brace is made up of small brackets glued to your teeth. The brackets are handles used to hold your teeth and straighten them; the archwire, which runs through the brackets moves the teeth. We start with the most gentle archwire and gradually move up through five sizes. The archwire is held in place by tiny elastic bands, which come in different colours.

Will it hurt?

It is usual for the teeth to be uncomfortable for the first few days after the brace is first fitted – stay with a soft diet and if necessary take one or two tablets of paracetamol or ibuprofen.

What if bits break off?

If one bracket comes off then leave it until your next scheduled visit. If several break off then phone for an appointment to have the brace repaired.

Often as the teeth move the archwire sticks out at the back. If this scratches your cheek come in to have the end cut off (ask reception for a packet of wax in case this happens).

How do I clean my teeth?

Since the brace is fixed you cannot remove it for brushing. It is extremely important to spend extra time brushing all around the brace and especially the gums. If the dirt builds up then your gums will bleed a lot (gingivitis) and your teeth will decay. Special brushes and fluoride mouthwashes for daily use can usually be obtained from the receptionist of your dental surgery.

Will there be marks on my teeth when the brace comes off?

Poor cleaning and too many fizzy drinks can cause permanent decay marks. The importance of thorough brushing and the use of a fluoride mouthwash cannot be emphasised enough.

What about sports?

Contact sports such as rugby present a problem since it is difficult to make a gum shield that will fit over the brace. A reasonable solution is to buy a cheap gumshield from a sports shop which can be softened in hot water and moulded over the brace.

How long before the brace is removed?

It usually takes about 18 months, occasionally longer, to straighten your teeth. “Traintrack” braces are very good at straightening teeth so that they look better in months. It is important to remember, however, that if the brace is removed too quickly before the teeth have settled into their new positions, then the teeth tend to go crooked again.

So how are the teeth kept straight after the fixed brace is removed?

Usually we make a removable brace called a retainer to wear at nights for at least 12 months. Sometimes a wire is fixed to the insides of the teeth to hold them straight.

Root canal treatment (also called endodontics) is needed when the blood or nerve supply of the tooth (known as the pulp) is infected through decay or injury.

Why is root canal treatment needed?

If the pulp becomes infected, the infection may spread through the root canal system of the tooth. This may eventually lead to an abscess.

If root canal treatment (RCT) is not carried out, the infection will spread and the tooth may need to be taken out.

Does it hurt?

No. A local anaesthetic is used and it should feel no different to having an ordinary filling done.

What does it involve?

The aim of the treatment is to remove all infection from the root canal. The root is then cleaned and filled to prevent any further infection.

Root canal treatment is a skilled and time-consuming procedure. Most courses of treatment will involve two or more visits to your dentist.
At the first appointment, the infected pulp is removed. Any abscesses, which may be present, can also be drained at this time. The root canal is then cleaned and shaped ready for the filling. A temporary filling is put in and the tooth is left to settle.

The tooth is checked at a later visit and when all the infection has cleared, the tooth is permanently filled.

What will my tooth look like after treatment?

In the past, a root filled tooth would often darken after treatment. However, with modern techniques this does not usually happen. If there is any discolouration, there are several treatments available to restore the natural appearance.

What if it happens again?

Root canal treatment is usually very successful. However, if the infection comes back the treatment can be repeated.

What if I don’t have the treatment?

The alternative is to have the tooth out. Once the pulp is destroyed, it can’t heal and it is not recommended to leave an infected tooth in the mouth.

Although some people would prefer an extraction, it is usually best to keep as many natural teeth as possible.

Will the tooth be safe after treatment?

Yes. However, it is better to restore the tooth with a crown to provide extra support and strength to the tooth.

Where can this treatment be carried out?

Root canal treatment is a routine dental procedure, which your dentist will be happy to do for you.

What about aftercare?

Root-treated teeth should be treated just the same as any other tooth. Remember to clean your teeth at least once a day, preferably with a fluoride toothpaste. Cut down on sugary snacks, and keep them only to mealtimes if possible. See your dentist for regular check-ups.

The letters TMJ are short for of ‘temporo-mandibular joint’, which is the joint connecting your lower jaw and your skull. The movement in this joint lets you open and close your mouth and chew from side to side.

What is dental occlusion?

Dental occlusion is another name for the way your teeth meet when your jaws bite together.

What kind of problems might I have?

If your teeth don’t fit together properly, you can have problems not only in your teeth themselves, but also the gums, the temporo-mandibular joint or the muscles that move your jaw. These problems are called ‘occlusal’ problems.

• Teeth
  Teeth that are out of line, heavily worn or constantly breaking, fillings that fracture or crowns that work loose may all be signs of occlusal problems. Your teeth may also be tender to bite on or may ache constantly.
• Gums
  Loose teeth or receding gums can be made worse by a faulty bite.
• TMJ
  Clicking, grinding or pain in your jaw joints, ringing or buzzing in your ears and difficulty in opening or closing your mouth could all be due to your teeth not meeting each other properly.
• Muscles
  If your jaw is in the wrong position, the muscles that move the jaw have to work a lot harder and can get tired. This leads to muscle spasm. The main symptoms are continual headaches or migraine, especially first thing in the morning; pain behind your eyes; sinus pain and pains in your neck and shoulders. Sometimes even back muscles are involved.

How can I tell if I have a problem?

You may find that you clench or grind your teeth, although most people who do aren’t aware of it. Sometimes can be caused by anxiety, but generally most people clench their teeth when they are concentrating on a task – housework, gardening, car mechanics, typing and so on.

You may wake up in the morning with a stiff jaw or tenderness when you bite together. This could be due to clenching or grinding your teeth in your sleep. Most people who grind their teeth do it while they are asleep and may not know they are doing it.

If you suffer from severe headaches, or neck and shoulder pain, you may not have linked this with possible jaw problems. Or you may keep having pain or discomfort on the side of your face around your ears or jaw joints or difficulty in moving your jaw. These are all symptoms of TMJ problems.

If you are missing some teeth at the back of your mouth, this may lead to an unbalanced bite, which can cause uneven pressure on your teeth.

Together, all these symptoms are called ‘TMJ syndrome’.

How are occlusal problems treated?

See your dentist. He or she may be able to help you or may refer you to a specialist who deals with occlusal problems.

Depending on the problems you are having, it can be possible to spot the signs of an occlusal problem. Various muscles may be sore when tested, or the broken and worn areas of your teeth will show you are grinding your teeth – a common sign of an incorrect bite.

If your dentist suspects that your problems are due to an incorrect bite, he or she may help to diagnose the problem by supplying a temporary soft nightguard or hard plastic appliance that fits over your upper or lower teeth. This appliance needs to be measured and fitted very accurately so that when you bite on it, all your teeth meet at exactly the same time in a position where your muscles are relaxed. You may have to wear this all the time or, just at night. If the appliance relieves your symptoms then your bite may need to be corrected permanently.

• Replacement of teeth
  The temporo-mandibular joint needs equal support from both sides of both jaws. The chewing action is designed to work properly only when all your teeth are present and in the correct position. Missing teeth may need to be replaced either with a partial denture or bridgework.Replacement is not usually done until a diagnosis has been confirmed by using an appliance and this has fully relieved the symptoms. Relief in some patients is instant: in others it can take a long time.
• Medication
  Some drugs can help in certain cases, but this is usually only temporary. Hormone replacement therapy may also help some women.
  Diet and Exercise
  As with any joint pain, it can help to put less stress on the joint. So a soft diet can be helpful, as can Corrective exercises and external heat. Physiotherapy exercises can often help, and your dentist may be able to show some of these to you.
• Relaxation
  Counselling and relaxation therapy may help in some cases. These techniques help the patient to become more aware of stressful situations and to control tension.
• Tooth Adjustment (equilibration)
  Your teeth may need to be carefully adjusted to meet evenly. Changing the direction and position of the slopes that guide your teeth together can often help to reposition the jaw.

Will straightening my teeth help?

If your teeth are too far out of line or in a totally incorrect bite position, it may be necessary to fit an orthodontic appliance to move them into a better position.

How many people suffer from these problems?

Up to 1 in 4 people may have some symptoms. Both men and women are affected equally, although women tend to seek treatment more often than men. The symptoms can often start with the menopause or other hormonal changes.

Many people have imperfect occlusion and missing teeth, yet never have symptoms because they adjust to their problems. Occasionally, in times of increased stress and tension, the symptoms may appear and then go away immediately. Or, your teeth and gums may be affected straight away and instead of headaches, you may suffer:

1. flattened, worn teeth
2. broken teeth, fillings and crowns
3. loose teeth
4. continual sensitivity of your teeth to temperature change
5. toothache with no apparent cause.

If you think you have any of these problems, ask your dentist.

Adults can have up to 32 teeth. The wisdom teeth are the last to come through, right at the back. They usually appear when you are between 17 and 25, although sometimes they appear many years later.

Nowadays people often have jaws that are too small for all 32 teeth – 28 is often the most we have room for. So if all the other teeth are present and healthy there may not be enough space for the wisdom teeth to come through properly.

Do they always cause problems?

No. If there is enough room they will usually come through into a useful position and cause no more problems than any other tooth.

Often there will be some slight discomfort as they come through, but this is only temporary and will disappear once the tooth is fully in position.

What is an impacted wisdom tooth?

If there is not enough room, the wisdom tooth may try to come through, but will get stuck against the tooth in front of it. The wisdom tooth will be at an angle, and will be described by the dentist as ‘impacted’.
 

What problems should I be prepared for?

If part of the wisdom tooth has appeared through the gum and part of it is still covered, the gum may become sore and perhaps swollen. Food particles and bacteria can collect under the gum edge, and it will be difficult to clean the area effectively.

Your dentist will tell you whether this is a temporary problem that can be dealt with by using mouthwashes and special cleaning methods (and possibly antibiotics), or whether it is better to have the tooth removed.

What can I do to help myself?

If your gums are sore and swollen, use a mouthwash of medium hot water with a teaspoonful of salt. (Check that it is not too hot before using it.) Swish the salt water around the tooth, trying to get into the areas your toothbrush cannot reach. An antibacterial mouthwash such as Corsodyl can also reduce the inflammation. Pain-relieving tablets such as paracetamol or aspirin can also be useful in the short term, but see your dentist if the pain continues.

But if it does not help?

If the pain does not go away or if you find it difficult to open your mouth, you should see a dentist. They will be able to see the cause of the problem, and tell you what to do. It may help to clean around the tooth very thoroughly, and the dentist may give you a prescription for an antibiotic.

Are x-rays needed?

The dentist will usually take x-rays to see the position of the root, and to see whether there is room for the tooth to come through into a useful position.

What are the main reasons for taking wisdom teeth out?

• When it is clear that the wisdom teeth will not be able to come through into a useful position because there is not enough room, and they are also causing some pain or discomfort.
• If they have only partly come through and are decayed – such teeth will often be more likely to decay as it will be difficult to clean them as thoroughly as your other teeth.
• If the wisdom tooth is causing a cleaning problem and has no real use.
• If the wisdom tooth starts to ‘over-grow’. This often happens if the lower one has already been removed or is impacted and cannot come through, and the upper one has no tooth to bite against. The upper one will come down too far, looking for a tooth to make contact with.
• If they are painful.

Are wisdom teeth difficult to take out?

It all depends on the position and the shape of the roots. Your dentist will tell you how easy or difficult each tooth will be to remove after looking at the x-rays. Upper wisdom teeth are often easier to remove than lower ones, which are more likely to be impacted. Your dentist will say whether the tooth should be taken out at the dental practice, or whether you should be referred to a specialist (oral surgeon) at a hospital. Very occasionally there is a possibility of some numbness of the lip after the removal of a lower tooth – your dentist will tell you if it is possible in your case.

You will probably have either a local anaesthetic – as you would have for a filling – or sedation. You could also have a general anaesthetic (where you would be asleep), but this will usually be given only in a hospital.

Will it make any difference to my face or mouth?

Taking wisdom teeth out may cause some swelling for a few days. But as soon as the area is healed, there will be no difference to your face or appearance. Your mouth will feel more comfortable and less crowded, especially if the teeth were impacted.

What should I expect after a wisdom tooth is taken out?

The amount of discomfort will depend on how easy it was to take the tooth out. There is usually some swelling and discomfort for a few days afterwards, and it is important to follow any advice you get about mouthwashes and so on, to help with the healing. Some people also find homeopathic remedies help to reduce discomfort. Usual painkillers such as paracetamol, aspirin or ibuprofen will usually deal with any pain. It is best to stay fairly quiet and relaxed for 24 hours afterwards to make sue there are no bleeding problems. There may be some stitches to help the gum heal over. Your dentist will probably want to see you again about a week later to check on the healing, and to remove any stitches.

A bridge is made where a tooth is missing and consists of crowns on either side of the space, joined together by a false tooth within the space.

Why should I replace missing teeth?

Your appearance is one reason. Another is that the gap left by a missing tooth can mean greater strain on the teeth at either side. A gap can also mean your ‘bite’ is affected, because the teeth next to the space can lean into the gap and alter the way the upper and lower teeth bite together. This can then lead to food getting packed into the gap, which causes both decay and gum disease.

How are missing teeth replaced?

This depends on the number of teeth missing and on where they are in the mouth. The condition of the other teeth also affects the decision.

There are two main ways to replace the missing teeth. The first is with a removable false tooth or teeth – a partial denture. The second is with a fixed bridge. A bridge is usually used where there are fewer teeth to replace, or when the missing teeth are only on one side of the mouth.

Can I always have a bridge to replace missing teeth?

Yes, if you have enough strong teeth with good bone support. Your dentist will help you decide the best way of replacing your missing teeth within your budget.

What are bridges made of?

Bridges are usually made of a precious metal base. If the bridge will show, porcelain is then bonded to the base. Sometimes, there are other non-precious metals used in the base to reduce the cost.
 

You need to clean your bridge every day, to prevent problems such as bad breath and gum disease. You also have to clean under the false tooth every day. Your dentist or hygienist will show you how to use a bridge needle or special floss, as a normal toothbrush cannot reach.

Are there other methods for fixing false teeth?

There are other methods, such as using a combination of crowns and partial dentures that can keep the retaining clips out of sight.

These are quite specialised dentures, so you should ask your dentist about them. You can also have teeth implanted, ask your dentist for more information.

Remember that it’s as important to care for your remaining teeth as it is to replace the missing ones.

Are there different types of bridge?

Yes, there are different types of bridge which use different fixing methods. Your dentist will choose the most effective and conservative bridge for your personal situation.