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Details of treatments

Avulsed Teeth

An avulsed tooth is a tooth that had been knocked out by a blow to the mouth or an accident. If the right action is taken as soon as possible the tooth can be replaced into the socket successfully. This way the tooth needs replacement in the socket in under 30 minutes. If you can put the tooth back into the socket firmly and bite on a clean handkerchief for about 15-20 minutes. Go to an emergency dental treatment to solve the problem. If you cannot push the tooth into the socket keep it in milk until you arrive to an emergency dental unit. The dentist will take an X-ray and will check whether it had been reimplanted successfully. This check-up needs to be done several times. If the tooth has re-implanted successfully you may not need any further treatment as long as you keep up your regular check-ups with your dentist. If the tooth becomes loose, it can be splinted to the teeth next to it. This means it will be temporarily attached to keep it firm until your dentist can tell whether it has re-implanted successfully. If the tooth is lost or doesn't implant successfully, it can be replaced at first with a denture. Then, when the socket has healed fully, you can have a bridge or dental implant.

Bad breath

Bad breath can be caused by several things:

• it is usually caused by the smelly gases released by the bacteria that coat your teeth and gums.
• bits of food that get caught between the teeth and on the tongue will rot and can sometimes cause an unpleasant smell.
• strong food like garlic, coffee and onions can add to the problem smoking
• bad breath can also be caused by some medical problems: dry mouth (xerostomia), salivary gland problems or when continuously breathing through the mouth instead of the nose
• other medical conditions such as sinusitis, bronchitis, diabetes or kidney-liver problem also cause bad breath

If you do have bad breath, you will need to start a routine for keeping your mouth clean and fresh. Regular check-ups will allow your dentist to watch out for any areas where plaque is caught between your teeth. Your dentist or hygienist will be able to clean all those areas that are difficult to reach. They will also be able to show you the best way to clean your teeth and gums, and show you any areas you may be missing, including your tongue.

Braces

The time of wearing dental braces depens on how much work there is to do and how far your teeth need to be moved. Fixed braces usually take between 12-24 months, but could take longer if the problem is complex. Removable braces usually take less than a fixed brace. However, removable brace might need to be worn before and after finishing the treatment with a fixed brace.

You will need to have your brace adjusted regularly to make sure it is working properly. Usually every 6-8 weeks you will need a visit to your orthodontist.

You will need time to get used to your brace when fitted. Your mouth will be sensitive at first and teeth may feel uncomfortable because of the pressure put on them. Some parts of the brace may also cause discomfort to your gums and lips, causing sore spots.

Sometimes when a brace is fitted, it may affect your speech and cause problems in pronouncing certain words. Nail biting and chewing your pen or pencil can damage or break your brace.

Eating the wrong foods can damage or even break your brace. For the first few days, it may be better to keep to soft foods.

Whether you have a removable or a fixed brace you should avoid sticky, chewy and sugary foods. Chewing-gum is not recommended as it can stick to your brace. Avoid hard foods such as whole apples, carrots, French bread and crusty rolls. These foods could break the orthodontic wires and brackets.

At first it is best to cut your food into small pieces and keep to a soft diet. Food may build up in the brackets and in between your teeth and will need careful cleaning to remove it. Avoid fizzy drinks and natural fruit juices as these are often high in sugar and can be acidic. This can lead to tooth decay and erosion. Fizzy drinks can also stain the orthodontic brackets. If you do drink fizzy drinks, avoid constant sipping of the drink and use a straw. Water and plain milk are the safest drinks.

Clean your teeth and the brace thoroughly after each meal. Pay special attention to each individual tooth and the gum line around it.

Bridges

Dental bridges literally bridge the gap created by one or more missing teeth. A bridge is made up of two crowns for the teeth on either side of the gap – these two anchoring teeth are called abutment teeth – and a false tooth/teeth in between. These false teeth are called pontics and can be made from gold, alloys, porcelain or a combination of these materials. Dental bridges are supported by natural teeth or implants. What Types of Dental Bridges Are Available? There are three main types of bridges: Traditional bridges Cantilever bridges Maryland bonded bridges

 

Dental bridges literally bridge the gap created by one or more missing teeth.

A bridge is made up of two crowns for the teeth on either side of the gap – these two anchoring teeth are called abutment teeth – and a false tooth/teeth in between. These false teeth are called pontics and can be made from gold, alloys, porcelain or a combination of these materials. Dental bridges are supported by natural teeth or implants.

How Long Do Dental Bridges Last?

Dental bridges can last 5 to 7 years and even longer. With good oral hygiene and regular prophylaxis, it is not unusual for the life span of a fixed bridge to be over 10 years.

Will It Be Difficult to Eat With a Dental Bridge?

Replacing missing teeth should actually make eating easier. Until you become accustomed to the bridge, eat soft foods that have been cut into small pieces.

Will the Dental Bridge Change How I Speak?

It can be difficult to speak clearly when teeth are missing in the front or anterior areas. Wearing a dental bridge with the anterior teeth in their proper relationship will help you speak properly.

How Do I Care for My Bridges?

It is important to keep your remaining teeth healthy and strong as the success of the bridge (depending on the type selected) depends on the solid foundation offered by the surrounding teeth. Brushing twice a day and flossing daily helps prevent tooth decay and gum disease that can lead to tooth loss. Your dentist or dental hygienist can demonstrate how to properly brush and floss your teeth. Keeping a regular cleaning schedule will help diagnose problems at an early stage when treatment has a better prognosis. Selecting a balanced diet for proper nutrition is also important.

Cold sore

Cold sore is a small, painful area of small, fluid-filled blisters where the lip joins the surrounding skin. These blisters are usually painful and dry up to make a yellow crust which heals in a few days. Cold sores tend to last 5 to 7 days and can keep coming back. Cold sores are caused by a virus (Herpes Simplex virus). Cold sores mainly appear when people are ill and sunlight and ultra-violet light can also cause it to appear. It can be infectious and the virus can be passed to other people by close contact. Avoid squeezing, pinching or picking the cold sore as it can spread the infection more. When having cold sore your dentist or hygienist can check first. Dentists usually do not treat patients with active cold sores as it can be really painful and may crack or bleed during dental treatment.

Cosmetic dentistry

Cosmetic dentistry is the term of dental treatments such as straightening, lightening, reshaping and repairing your teeth. Cosmetic treatments include veneers, crowns, bridges, tooth-coloured fillings, implants and tooth whitening.

Cracked teeth

A cracked tooth is a tooth that has become broken.

Many things can cause teeth to crack; such as:

• extreme tooth grinding, which can put the teeth under enormous pressure
• large fillings that weaken the tooth
• chewing or biting on something hard, for example, ice, boiled sweets, fruit stones or meat bones
• a blow to the chin or lower jaw
• gum disease, where there has been bone loss that could make the teeth more likely to suffer from root fractures
• sudden changes in mouth temperature

It is important to have the cracked tooth treated. If they are not treated, cracked teeth can lead to the death of the nerve, and an abscess might grow that could need root canal treatment or extraction. In severe cases the tooth can actually split in two. If this happens your dentist will not be able to save the tooth and it will need to be taken out.

Crowns

A dental crown is a tooth-shaped "cap" that is placed over a tooth – covering the tooth to restore its shape and size, strength, and/or to improve its appearance. The crowns, when cemented into place, fully encase the entire visible portion of a tooth that lies at and above the gum line.

What Types of Crown Materials are Available?

Permanent crowns can be all metal, porcelain-fused-to-metal, all resin, or all ceramic.

1. Metals
2. Porcelain-fused-to-metal
3. All-porcelain

 

How Should I Care for My Temporary Dental Crown?

Because temporary dental crowns are just that – a temporary fix until a permanent crown is ready; most dentists suggest that a few precautions be taken with your temporary crown.
These include:

1. Avoid sticky, chewy foods (for example, chewing gum, caramel), which have the potential of grabbing and pulling off the crown.
2. Minimize use of the side of your mouth with the temporary crown. Shift the bulk of your chewing to the other side of your mouth.
3. Avoid chewing hard foods (such as raw vegetables), which could dislodge or breakthe crown.
4. Slide flossing material out-rather than lifting out-when cleaning your teeth. Lifting the floss out, as you normally would, might pull off the temporary crown.

What Problems Could Develop With a Dental Crown?

1. Discomfort or sensitivity. Your newly crowned tooth may be sensitive immediately after the procedure as the anaesthesia begins to wear off. If the tooth that has been crowned still has a nerve in it, you may experience some hot and cold sensitivity. Your dentist may recommend that you brush your teeth with toothpaste designed for sensitive teeth. Pain or sensitivity that occurs when you bite down usually means that the crown is too high on the tooth. If this is the case, call our dentist. He or she can easily fix this problem.
2. Chipped crown. Crowns made of all porcelain can sometimes chip. If the chip is small, a composite resin can be used to repair the chip with the crown remaining in your mouth. If the chipping is extensive, the crown may need to be replaced.
3. Loose crown. Sometimes the cement washes out from under the crown. Not only does this allow the crown to become loose, it allows bacteria to leak in and cause decay to the tooth that remains. If your crown feels loose, contact us.
4. Crown that falls off. Sometimes crowns fall off. Usually this is due to an improper fit or a lack of cement. If this happens, clean the crown and the front of your tooth. You can replace the crown temporarily using dental adhesive or temporary tooth cement that is sold in stores for this purpose. Contact us immediately. Our dentist will give you specific instructions on how to care for your tooth and crown for the day or so until you can be seen for an evaluation. Our dentist may be able to re-cement your crown in place; if not, a new crown will need to be made.
5. Allergic reaction. Because the metals used to make crowns are usually a mixture of metals, an allergic reaction to the metals or porcelain used in crowns is extremely rare.
6. Dark line on crowned tooth next to the gum line. A dark line next to the gum line of your crowned tooth is normal, particularly if you have a porcelain-fused-to-metal crown. This dark line is simply the metal of the crown showing through.

How Long Do Dental Crowns Last?

On average, dental crowns last between 5 and 15 years. The life span of a crown depends on the amount of "wear and tear" the crown is exposed to, how well you follow good oral hygiene practices, and your personal mouth-related habits (you should avoid such habits as grinding or clenching your teeth, chewing ice, biting your fingernails and using your teeth to open packaging).

Does a Crowned Tooth Require any Special Care?

While a crowned tooth does not require any special care, remember that simply because a tooth is crowned does not mean the underlying tooth is protected from decay or gum disease. Therefore, continue to follow good oral hygiene practices, including brushing your teeth at least twice a day and flossing once a day-especially around the crown area where the gum meets the tooth.

Dental erosion

Dental erosion is the loss of enamel caused by acid attack. Erosion usually shows up as hollows in the teeth and a general wearing away of the tooth surface and biting edges. This can expose the dentine underneath, which is a darker, yellower colour than the enamel. Because the dentine is sensitive your teeth can also be more sensitive to hot, cold or sweet foods and drinks.

Dental hygienist

Dental hygienists play an important role in dental health care and are mainly concerned with gum health, showing people how to take care of their teeth at home. The hygienist's main role in the dental practice is to clean the teeth for the patient. It is most of the cases called scaling and polishing. Their other most important role is to show the patient the best ways to keep their teeth free of plaque. They also give advise on diet and preventive dental care. Scaling and polishing is usually pain-free. If a patient feels discomfort the hygienist can use anaesthetic creams or gives local anaesthetic.

Your hygienist will have shown you how to remove plaque with a toothbrush and fluoride toothpaste. You will also have been shown how to clean between your teeth with floss, tape or little brushes.

There are many oral care products now available including specialist toothpastes, powered toothbrushes and mouthwashes. Your hygienist will recommend those that are best for you.

We recommend you follow three simple steps to help keep your teeth and gums healthy:

• brush your teeth twice a day with fluoride toothpaste
• cut down on how often you have sugary snacks and drinks
• visit your dentist regularly, as often as they recommend.

Dental Implants

What are dental implants?

Dental Implants are artificial tooth roots made of bio-material which is placed in the socket of the lost teeth to carry a tooth replacement. The material is generally pure, unalloyed titanium, which is completely accepted by the human body.

Who is suitable for dental implants?

If you have good general health then dental implants will almost certainly work for you. However, habits such as heavy drinking or smoking can increase the number of problems associated with initial healing and thereafter may negatively influence the long-term health of gum and bone surrounding each implant. Remaining teeth might also be compromised making treatment planning less certain.
If you have any other complicated medical problems then speak to someone with relevant experience - it is rare to have health problems that prevent the use of dental implants.
Healthy, disease-free gum tissues are also necessary. The long term success of a dental Implant depends upon keeping the gums and bone around the Implant healthy. People who have Implants must keep them clean and should return regularly to their dentist for checkups, because any problems that might threaten the health of the implant must be corrected.
 

How many teeth can be supported by implants?

All the common forms of tooth replacement, such as bridges or dentures can be replaced by dental implants.
If you are missing just one natural tooth, then one implant is normally all that will be needed to provide a replacement. Larger spaces created by two, three or more missing teeth do not necessarily need one implant per tooth, however the exact number of implants will depend upon the quality and volume of bone at each potential implant site.
Occasionally, it is even possible to join natural teeth to implants with a conventional bridge.
In the upper jaw, bone density is generally poorer than in the lower and if you have no teeth at all, most treatment providerswill want to place a minimum of 6 implants to support a complete arch of 10 or more replacement teeth.
In the lower jaw, the bone towards the front of the mouth is often very strong and as a direct result, fewer implants may be needed than are required to treat a whole upper jaw. A simple treatment plan to provide 10 or more teeth in the lower jaw might be possible with as few as 4 implants, although it is still more common to use 5 or 6.
 

Are implants dangerous to health?

The materials used chiefly titanium is almost never rejected by the body. These have also never been a report of it being the cause of cancer or any life-threatening disease. 

Can I take the teeth out if they are fixed to implants?

Most artificial teeth attached to implants can only be placed and removed by the dentist. However, if you have complete dentures fixed to the implants by bars, then you will be able to take them out for cleaning.

Do the implants show?

Your dentist will make sure that the implants will not show during all normal movements of the mouth and lips. You will need to be able to see them, so that you can clean them properly.

How much pain will I experience?

Usually minimal to none. While undergoing treatment, you will receive local anesthesia. You may have mild post-surgical soreness for up to 72 hours. An over-the-counter pain reliever will alleviate the discomfort for most patients.

How can I clean the implants?

For most implant-supported teeth you will be able to clean around each supporting implant by brushing and flossing in just the same way that you would around natural teeth and tooth-supported bridges. In some areas special floss, interdental toothbrushes and other cleaning aids may be needed to maintain good oral hygiene. Cleaning is not at all difficult, provided that you do not have impaired use of your hands.
It is reasonable to expect some of the daily hygiene procedures to be a little more complex than around your original teeth - equally expect to spend more time than you may have done in the past if you wish to maintain optimum implant health.

What happens if the implant does not bond (integrate) with the bone?

This happens very rarely. If the implant becomes loose during the healing period or just after, then it is easily removed and healing takes place in the normal way. Once the jaw has healed, another implant can be placed there.
 

How long will the implants last?

During the period after the new teeth are fitted, the success of each treatment stage will be the main factor determining how the implants are performing. Once the implants and surrounding soft tissues are seen to be healthy and the new teeth comfortable and correctly adjusted, it is the quality of your home care and willingness to present for regular maintenance reviews that will have most influence on how long they will last.
When poorly cared for, implants will develop a covering of hard and soft deposits (calculus and plaque) which is very similar to that found on neglected natural teeth. Untreated, these deposits can lead to gum infection, bleeding, soreness and general discomfort, just as can occur around natural teeth. It could probably be said that implants much like teeth will last for as long as you can keep them clean.
Well maintained implants placed into adequate bone can be expected to last for many years and probably for your lifetime. However, just as you would expect conventional crowns, bridges and fillings to need occasional repairs or replacements during their lifetime, your implant-supported teeth may also have similar maintenance requirements over theirs.
 

Dentists

All practising dentists must be registered with the General Dental Council. This is a statutory body, which protects the patient by ensuring that all practising dentists are properly trained.

All qualified dentists will have the letters BDS (Bachelor of Dental Surgery) or LDS (Licentiate in Dental Surgery) after their name. The letters LDS are awarded by the Royal College of Surgeons, whilst the letters BDS are awarded by individual universities. Any dentist qualifying from Leeds Dental Hospital will have the letters BchD after their name. A dentist who has qualified overseas, will possibly have the letters DDS (Doctor of Dental Surgery) which is the equivalent of the letters BDS. These are the main qualifications required in order to practice dentistry.
The dentist may also have other letters after their name, which indicate a postgraduate qualification. The MFGDP(UK) and the MGDS give an indication that they have studied general dental practice beyond the basic qualification level, the MGDS being the senior qualification. However, it is important to remember that you should choose a dentist with whom you feel comfortable with and can trust to work with you to maintain good oral and dental health.

Denture

Dentures are removable dental appliances that replace missing teeth. Unlike dental implants and dental bridges, which are more or less permanently affixed to the bone, dentures are prosthetic teeth attached to a supporting structure. Dentures can be removed at night, for cleaning, or whenever desired. The most affordable dentures are those made with traditional plastic prosthetic teeth, but even more expensive porcelain cosmetic dentures usually cost less than implants.

Overdenture

An overdenture is a type of denture that is secured by precision dental attachments. The attachments are placed in tooth roots or dental implants which have been placed specifically for the overdenture attachment. Types of overdentures include bar joint dentures and telescopic dentures.

If you lose most or all of your lower teeth there is nothing to hold a denture down while you chew. An overdenture fastens a denture to the jawbone much in the way natural teeth are anchored. The adjacent teeth may be altered with locking devices or connecting bars to ensure the denture fits properly. These bar joints support the dentures better than individual implants though implants are still required to support the bars. Generally the more implants the stronger the bar and bars on the upper arch always require more implants than bars on the lower arch due to the lesser bone density in the upper jaw.

When patients have compromised bone density due to age or oral disease a telescopic denture a type of overdenture system is probably the best option. The procedure consists of a double crown system "the telescopic" and involves fitting inner metal crowns and outer crowns on the remaining natural teeth to create a natural looking removable overdenture. Though this is a reliable denture system that ensures even bite stress distribution the procedure is extremely complicated and requires root canal therapy for each remaining natural tooth and the insertion of a metal post to ensure the root is strong enough.
Some of the benefits of overdentures include the prevention of bone loss (dental implants actually strengthen the surrounding bone structure) esthetic appeal improved speech (when compared with other types of dentures) proper jaw alignment and improved chewing efficiency.

Denture cleaning

How to take care of your denture(s) / overdenture(s)?

Below are some handy ideas when cleaning your dentures/overdentures:

1. Use only a soft bristle toothbrush or a toothbrush made specifically for cleaning dentures.
2. Use only toothpaste made for dentures. Regular toothpaste is too abrasive and will damage your dentures.
3. Before you start brushing your dentures, thoroughly rinse them under cool or warm water (when removable). A complete rinsing will ensure that you washed away all food debris.
4. Brush your dentures over the teeth and across the teeth-just like you would if you were brushing your natural teeth. You need to make sure that you cleaned every tooth. Rinse your dentures thoroughly after you're done brushing.
5. Brush your gums and tongue to keep them healthy and to wash away odor-causing bacteria.
6. Rinse your mouth with an antiseptic mouthwash throughout the day and at night before bed to keep your mouth feeling fresh and by rinsing food particles away after mealtimes.
7. Don't forget to visit your dentist on a regular basis to check the health of your mouth, the cleanliness of your dentures, and how the dentures are fitting in your mouth.

Removable denture(s)

You should give you mouth a break from your dentures at least eight hours a day. This will help your gums and bones stay healthy. Keep your dentures moist by soaking them overnight in a denture solution or in a sealed container that's moistened with cotton balls or gauze pads.

Fixed denture(s)*

Those dentures that cannot be lifted with the tongue can stay in the mouth for the night.

Overdenture(s)

The overdenture should be cleaned not only on the surfaces but under the bar as well, with an interdental brush. The overdenture should be kept in for the night and should only be cleaned thoroughly twice a day.

*fixed dentures are a kind of dentures that have some sort of an attachment

Diet

Healthy diet is important for oral health. Eating sugary, acidy food can react with the bacteria in plaque and produce the harmful acids. Acidic foods and drinks can really be harmful to the teeth. The acid erodes the enamel, making the tooth sensitive and unslightly. Food rich in vitamins, minerals and fresh can help prevent gum disease. Still water and milk or diluted sugar-free squashes are the best to drink.

Fluoride

Fluoride is a natural mineral that is found in many foods and in all drinking water. The amount of Fluoride in the water varies from area to area. Fluoride can greatly help dental health by strengthening the tooth enamel, making it more resistant to tooth decay. It also reduces the amount of acid that the bacteria on your teeth produce. Children who have fluoride when their teeth are developing tend to have shallower grooves in their teeth so plaque can be more easily removed. Plaque is a thin, sticky film of bacteria that constantly forms on your teeth. The addition of fluoride to water has been researched for over 50 years and water fluoridation has been proven to reduce decay by 40-60%.

Most toothpastes now contain fluoride, and most people get their fluoride this way. Fluoride toothpaste is very effective in preventing tooth decay. The amount of fluoride in toothpaste is usually enough to lessen the level of decay. In areas where the water supply is fluoridated, fluoride toothpaste gives extra protection. All children up to three years old, should use a toothpaste with a fluoride level of at least 1000ppm (parts per million). After three years old, they should use a toothpaste that contains 1350ppm-1500ppm. Parents should supervise their children's tooth brushing, and use only a pea-sized smear of fluoride toothpaste until they are about 7 years old.

Gum disease

Gum disease describes swelling, soreness or infection of the tissues supporting the teeth. There are two main forms of gum disease: gingivitis and periodontal disease.
Gingivitis means inflammation of the gums. This is when the gums around the teeth become very red and swollen. Often the swollen gums bleed when they are brushed during cleaning.
Long-standing gingivitis can turn into periodontal disease. There are a number of types of periodontal disease and they all affect the tissues supporting the teeth. As the disease gets worse the bone anchoring the teeth in the jaw is lost, making the teeth loose. If this is not treated, the teeth may eventually fall out. In fact, more teeth are lost through periodontal disease than through tooth decay.

The first sign of gum disease is blood on the toothbrush or in the rinsing water when you clean your teeth. Your gums may also bleed when you are eating, leaving a bad taste in your mouth. Your breath may also become unpleasant.

When you have the sign of gum disease you need to visit your dentist to clear the problem as soon as possible. Your dentist will clean your teeth thoroughly to remove the scale. You'll also be shown how to remove plaque successfully yourself, cleaning all surfaces of your teeth thoroughly and effectively. This may take a number of sessions with the dentist or hygienist.

Implant Over-Denture

An implant over-denture connects to implants that have been surgically implanted into jaw bone.

The denture appears like a traditional prosthesis. However, that part of the denture overlying implants is modified to retain various semi-rigid attachments that receive implant extensions projecting above the gum. This arrangement helps keep a denture securely in place while eating, speaking and during other oral activities, but still allows easy self-removal of the denture for cleaning purposes.

There are two phases to this process. The first is a surgical phase consisting of two stages, and the second is a prosthetic phase (making the implant denture).

The surgical phase

1. Surgical insertion stage
   • Implants are completely inserted into precise preparations in jaw bone. While there are various implant configurations, they are essentially cylindrical in shape and made of pure titanium metal. After implants are inserted into jaw bone, gum tissue over the implant is closed with sutures in most cases.
   • While a minimum of two implants may be inserted for an acceptable outcome, a person may be treatment planned to receive three or more - - depending upon individual needs and anatomical limitations. More implants will give additional support and retention to the implant denture.
2. Healing and surgical exposure stage
   • During healing, an existing or temporary denture may continue to be worn after adjustments have been made to adapt to the surgeriesed site. If the existing denture cannot be altered sufficiently, a provisional prosthesis should be fabricated.
   • Implants are left undisturbed beneath gum tissue for at least several months as determined by the dental professional. During this time bone reorganizes and grows around the implant surface, anchoring it securely into the jaw (this is called osseointegration).
     At the end of the healing stage, the top of the implant is exposed by removing gum tissue directly over it. An extension that is then screwed into the exposed implant projects slightly above the gum tissue.
   • After adjustments, an existing denture can be worn over an implant extension while the gum heals. However, the denture must be reshaped to conform to surgical site contours in order to avoid unnecessary pressure areas on the newly surgerized site.

The prosthetic phase (making the implant denture)

• A precision superstructure is fabricated that is screwed into the implant extensions. This superstructure may have various interface configurations ranging from interconnecting metal bars to specially shaped singular extensions.
• A denture is fabricated with special provisions on the inside surface to receive various types of attachments (interlocks). Depending on the attachment, they interact in various ways with the superstructure. For example, a metal or plastic attachment may clip onto metal superstructure bars, a nylon receptacle may receive a specially configured implant extension, and so forth.
• The attachment/superstructure configuration helps to securely maintain a denture while eating and speaking, and still allows a person to comfortably and easily remove the prosthesis for cleaning purposes.

Essential maintenance needs

As might be expected, exemplary oral hygiene is essential to helping prevent the development of disease around implants that could cause their failure.

Implants, superstructure, attachments and the over-denture must be checked and professionally maintained by a licensed dental professional on a regular basis. Attachments often need periodic adjustment or replacement due to wear.

While the implant over-denture approach is complex and expensive, the value received by an individual usually far exceeds monetary considerations.

Inlay or onlay

Inlays/onlays can be used in most areas of the mouth. An inlay/onlay is small and within the biting surface of the tooth. The dentist usually takes an impression of the prepared cavity and send it to the laboratory to make the inlay/onlay. In the meantime a temporary filling will be placed in the cavity. After the inlay/onlay has been made, the dentist will fix it in place with dental cement. This type of filling is more expensive.

Your dentist can now use digital technology (called CAD/CAM) to design and prepare perfectly fitted porcelain inlays in just one or two visits. Porcelain inlays can also be made in a laboratory but this will need at least two visits to your dentist. Porcelain can be hard wearing and long lasting and also has the benefit of being able to be coloured to match your natural tooth. Again, this type of filling can be quite expensive.
Jaw problems

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 (TMJ) 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 an incorrect 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.

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:

• flattened, worn teeth
• broken teeth, fillings and crowns
• loose teeth
• continual sensitivity of your teeth to temperature change
• toothache with no apparent cause.

If you think you have any of these problems, ask your dentist. 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'.
Depending on the problems you are having, it can be possible to spot the signs of an occlusal problem by your dentist. 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 improve 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.

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.

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.

Metal partial dentures

Conventional Metal Removable Partial Dentures

A partial denture is useful for a person missing some teeth, but still having a number of natural teeth.

This device is also called a removable prosthesis, and is a means by which artificial replacement teeth are held in the mouth. The prosthesis is commonly kept in place by means of clasps. These are thin finger-like structures, usually made of a special resilient metal alloy, that rest upon and wrap around some remaining natural teeth. Clasps keep the prosthesis securely in place but still allow a person to easily take it out for regular cleaning and proper brushing of remaining natural teeth.

Some reasons for having a partial denture made

• Replace missing teeth
• Improve ability to chew more naturally
• Chew food with confidence
• Make it possible to eat certain favourite foods
• Maintain a healthier and socially acceptable mouth
• Aids in the preservation of remaining natural teeth
• Often improve speech
• Helps develop a more pleasing and confident smile
• Support the face - - often with a more youthful appearance
• Enhance self esteem
• An economical way to replace missing teeth
• Many times an additional tooth may be added to an existing partial denture if a natural tooth is lost
• Partial dentures are usually easy to repair if they are broken

Esthetics and the conventional partial denture

Generally clasp design is reasonably aesthetic, and often it is possible for them not to be seen. However, depending upon partial denture design, which is based on mouth conditions, there may be some show of clasps. Often this is not an appearance problem. However, if avoiding an unacceptable show of clasps would compromise optimal partial denture design; various special attachments may sometimes be employed to do away with conventional clasps. These attachments are more technically complex and often are referred to as precision or semi-precision attachments.

How long will a partial denture last?

Accidents happen, and the mouth is constantly changing. Partial dentures may no longer fit properly, can break or bend or simply wear out. In fact there is nothing made for the mouth that is permanent. Fractured clasps and so forth may often be repaired.

On average, a partial denture may be expected to last about five years. Depending upon circumstances, a certain removable prosthesis can last a shorter or longer time.

How often should a partial denture be checked?
It is best to have a partial denture, as well as the rest of the mouth, checked at six-month intervals. If left uncorrected, small problems can develop into major ones that could cause disease, loss of teeth or necessitate premature prosthesis replacement.

Partial dentures need to be relined
The jaw ridge a partial denture rests upon is constantly changing. It is normal and necessary to regularly modify how a partial contacts the ridge. This maintenance correction is called relining and on average needs to be performed annually for optimum function. However, this is dependent upon how an individual's mouth changes. A licensed dental professional can best advise when a reline is needed, and when a reline will no longer adequately restore proper function.

Precision and Semi-Precision Metal Partial Dentures

 (Avoiding Conventional Partial Denture Clasps)

Precision and semi-precision partial dentures, like conventional partial dentures, replace missing natural teeth with artificial teeth. However, the means by which they are retained in the mouth is different than conventional clasp prosthesis. To better understand these partial denture types, it is best to first review the basics of conventional partial denture clasps.

How conventional partial denture clasps function

Most partial dentures are usually kept in place by clasps. These are thin finger-like projections of special resilient metal alloy, or, in certain cases, plastic or plastic-like.

• Clasps rest on and around certain remaining natural teeth so that their ends extend into undercut areas below a gentle bulge on the tooth. Sometimes it is necessary to shape a tooth or make a crown for a tooth or teeth in order to develop the right amount and relationship of undercut and bulge for retention.
• When a partial denture is placed in the mouth, clasps gently spring over a tooth bulge and rest in a relaxed state within an undercut.
• A partial denture is held in place during normal eating, speaking and other activities because clasps resist springing back over tooth bulges.
• Clasp resistance to removal is not great enough to prevent a person from comfortably removing their partial denture whenever they choose.

The problem with conventional clasps

Despite numerous successful conventional clasp designs, they do have some drawbacks.

• Clasps may at times become visible. Often this is unavoidable and usually is not objectionable. However, for some individuals the show of clasps is simply not acceptable because of personal circumstances and compromised appearance.
• Certain partial dentures may function better with retentive means other than conventional clasps.
• Remaining natural tooth structures may be inadequate to accommodate conventional clasps. Therefore a crown or crowns may need to be fabricated to correct these deficiencies.

Semi-precision and precision partial dentures

Alternatives to conventional clasp partial dentures fall into two categories, both of which have no clasps to show.

Semi-precision partial dentures are retained in the mouth by means of mechanical interlocking components. A specially shaped extension of the partial denture fits into or on to a complementary receiving area or projection of a natural tooth that has been crowned. The components fit snugly and consist of a semi-rigid metal to other surface interface, which may also be metal or some other resilient material such as nylon.

• Semi-precision partial dentures are retained in the mouth by means of mechanical interlocking components. A specially shaped extension of the partial denture fits into or on to a complementary receiving area or projection of a natural tooth that has been crowned. The components fit snugly and consist of a semi-rigid metal to other surface interface, which may also be metal or some other resilient material such as nylon.
• Precision partial dentures are similar to the semi-precision type except that the mechanical interlocking components are manufactured to extremely high tolerances and are held together by precise alignment and a rigid metal to metal frictional interface of components.

Advantages of semi-precision and precision partial dentures

• A cosmetically enhanced partial denture as compared to conventional partial dentures
• No show of metal clasps
• Blends in with the conformity of remaining natural teeth
• Functions with a more even pressure on remaining natural teeth than conventional partial dentures

Disadvantages of semi-precision and precision partial dentures

• More costly to fabricate
• Usually some natural teeth need to be crowned
• More difficult to fabricate and adjust
• Some components may need periodic replacement

Mouth cancer

Mouth cancer can affect the lips, tongue, cheeks and throat. Anyone can be affected by mouth cancer, whether they have own teeth or not. Mouth cancers are more common at people over 40, particularly men. People can die from mouth cancer if it is not diagnosed early enough.

Mouth cancer can be caused by smoking tobacco or drinking too much alcohol. Alkohol increases the risk of mouth cancer, and if tobacco and alcohol are consumed together the risk is even higher. Over-exposure to sunlight can also increase the risk of cancer on the lips.

The signs of mounth cancer are:

• painless mouth ulcer that does not heal normally
• white or red patch in the mouth

Important to visit the dentist if these sympthoms do not disappear within three weeks. Mouth cancer can often be spotted in its early stages by your dentist during a thorough mouth examination. If mouth cancer is recognised early, then the chances of a cure are good.

Mouthguard

A mouthguard is a specially made, rubber-like cover which fits exactly over your teeth and gums, cushioning them and protecting them from damage. Mouthguards are needed to be worn when playing sport that involves physical contact or moving objects. A mouthguard will protect against breaking or dislocating jaw.
Mouthguards can be made by the dentist, which will fit exactly and protect your teeth and gums.

Oral Hygiene

The health of the mouth can affect general health. Infections int he mouth can cause problems elsewhere in the body. To maintain oral hygiene is a very important duty in everybody's life as it can cause serious problems, such as heart disease, strokes, diabetes, premature and low-birth-weight babies, respiratory (lung) diseases.

When people have gum disease, the bacteria from the mouth can get into the blood streat. It can affect the heart, blood vessels and clots are more likely to form. This can lead to heart attack.

People with diabetes are more likely to have gum disease than people without diabetes. If you are idabetic you heal more slowly so it is very important to tell the dentist you have diabetes as more visits are required to clear the problem.
Pregnant women has to be really careful with gum disease as it is more likely to have a baby that is premature and with a low birth weight.

Gum disease bacteria can also cause bacterial chest infection in a long term. This can result in pneumonia or can worsen existing condition.

The signs of symthoms of gum disease:

• inflammation of the gums (red, swollen, bleeds easily)
• unpleasant taste in the mouth
• bad breath
• regular mouth infections

To prevent gum disease you need to visit your dentist regularly to have scale and polishing and brush your teeth min. 2 times a day to remove plaque from your teeth.

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