Tuesday, 2 December 2014

A very interesting case for you to see, please see the change and let me know what you think

Two years ago I had a consultation with this patient. he wanted to improve his smile. We discussed numerous treatment options and we decided to first of all straighten his teeth with clear braces. the product chosen was invisalign. After about 15 months of wearing these, the teeth were looking better and the overjet reduced.
The next stage was to carry out some in surgery bleaching to lighten the teeth and new impressions to make a diagnostic wax up.
A diagnostic wax up is when study models are made from the impressions and wax is used on the teeth to have treatment. In this case, we were deciding on porcelain veneers in both the upper and lower arches. This would span from the upper second premolar to the other second premolar. Which in total would be 20 veneers.
For such a large case, I would always recommend a wax up, so that the patient is aware of exactly what is going to be done and how the work will look at the end of the treatment. And even with explaining and seeing the diagnostic wax up, it is common for patients not to fully realize what a huge job they are about to embark on!

 Pre operative photo of my patient two years ago
 Diagnostic wax up to show the patient how the teeth will look after crowns and veneers are fitted.
This shows the patient how the teeth will be trimmed 



 The actual preparations in the patient's mouth

 Below are the temporary crowns and veneers that were fitted for 10 days, whilst the permanent work was being made in the lab.



As you can see this is the end result. The patient wanted quite a light shade, in reality the teeth took a few weeks to settle down. he had some post operative sensitivity and getting used to the feel of his new teeth.
I finally made some upper and lower retainers to protect the work and so far so good!

Hope you enjoyed reading this case and do let me know if you have any comments.


Monday, 22 September 2014

Mouthguards: Do they help or not?

All sports activites do have a certain risk of orofacial injuries. This can be from falling over, to collision with a hard ball or surface. So there is  a very strong argument for wearing a mouthguard to help distrubute forces and protect the teeth and jaws. Mouthguards are made from a type of plastic which allows them to be fairly elastic and this will in turn distribute the forces throughout the mouth.

How does a mouthguard work?

The plastic helps to distribute the impact energy, how this is done will depend on the direction of the impact. If the impact is on the base of the lower jaw, called the mandible, the forces are going upwards through the jaw then the mouthguard will help by acting as a cushion and stop the upper and lower teeth from hitting each other and thus preventing crown and root fractures. 

If the injury is from the front, the material will help to distribute forces but this may still not be enough to prevent the teeth from fracturing but will certainly help the situation.


Types of mouthguards

There are three types of mouthguards available to children and adults.

1. Stock ones made in three sizes. The advantage is that it is low in cost, but rarely worn due to poor fit!

2. Mouth formed one, which are made of hard plastic on the outside and soft on the inside. The material is placed in hot water and then when slightly cooler this is placed in the patients mouth and moulded to their mouth. This is better at protecting the patient but not with high impact sports and the fit can also be a problem. The advantage would be low cost.

3. Custom made mouthguards are the most effective in protecting with all contact injuries and the fit will be very good. These mouthguards can be made when a patient is wearing orthodontic braces and will be made to fit over the brackets. There are lots of different colours and designs, which is fun for the children to choose. They are straightforward to make, which involves taking impressions of the teeth and sending this to the appropriate lab.

From my experience I would advice mouthguards from an age when contact sports are being played. They should be custom made to fit to the patients mouth with comfort and this will provide maximum protection to the patient.



I made this mouthguard for my nurse's son.

Please contact me if you would like anymore information on this or would like one made.







On a separate note, we have exciting news for the practice! We have just been nominated for practice of the year and our hygienist has been nominated for staff of the year too. 


Monday, 18 August 2014

Trauma case this week

Trauma case this week


I had a very sweet 9 year old boy attend this week with a fractured upper right central incisor.
He had been playing on a see saw in the playground, when the metal part of the see saw hit him in the mouth causing half of his tooth to fracture. This happened whilst on holiday in Wales and his grandmother tried to make an appointment to get his tooth seen to.
Unbelievably not one dentist in the area had an emergency appointment that day and some even stated the next available NHS appointment would be in 6 months! A dentist did see him the next morning and put a temporary covering on the tooth.
I then saw him a few days later and after establishing the tooth was healthy, his medical history was clear, I restored this tooth.

Due to the size of the fracture I did administer local anaesthetic to make sure there was no sensitivity for him. Then I restored the tooth using a layering technique of a solid and liquid type of white filling material. This is called Venus heavy bodied composite and tetric flow light bodied. The tooth was polished and post operative instructions were given.
Impressions were also taken to make a sports guard for him to wear when running around or playing sports to try and protect this restoration, as this is almost half the tooth now.

Long term treatment plan for this boys will involve routine radiographs as he gets older to check the vitality of this tooth ( to see if this tooth is still alive ). Unfortunately restorations do not last forever so as an adult I suspect he will require a crown to protect this tooth.








Wednesday, 9 July 2014

Another Cosmetic case to show you

I want to show you this case of a 17 year old girl that I completed last week.
She attended six months ago complaining of not being happy with the look of her upper teeth. She didn't like the gap between her upper central incisors.
We discussed the options she had available. This would either be a quick fix of upper veneers or clear braces. I was keen for her not to have veneers as I felt she was too young to have teeth prepared and cut for veneers. So we decided to go ahead with clear braces. The type used was a brand called Insignia. These braces tend to just move anterior teeth, so for this case, this is perfect.

The clear aligners were worn for six months without issues. Afterwards I tidied up the upper central incisors with very small anterior composites on the edges.

She was very happy with the result and has now had upper and lower fixed wires placed and also she will wear night time removable retainers.

After teeth are moved it is VERY IMPORTANT to retain these teeth in the new position, if not the teeth will relapse back to the original position within a few months if NO RETENTION is provided. 

Retainers can also be fixed or removable. Both have advantages and disadvantages. The advantage of fixed wires is that they are there permanently and will be consistently retaining the teeth. the disadvantage is that it is not possible to clean the teeth interdentally with floss, so oral hygiene can be compromised.

The advantage of removable retainers is that you can maintain your normal oral hygiene routine and the flip side is you have to be motivated and remember to put these in!

Hope you enjoy this blog and photos. Do contact me if you have any questions or would like a consultation about anything you would like changing in your mouth.




Pre operative
Post operative

Tuesday, 13 May 2014

Tips on your child's FIRST TRIP to the dentist





A child's first visit to the dentist can be a huge experience, with different people, new surroundings, sounds and sights to deal with. Regular visits to the dentist from the age of 2 and a half to 3 years of age is a good idea to help promote good oral health for the future and to allow six monthly check ups not to be feared by the child!

Here are a few tips to get you and your child started:


1. START YOUNG
In the UK it is deemed that a child should start attending from the age of 2.5-3 years of age or when all the deciduous teeth have fully erupted. This is very important to allow the child to develop a good relationship with the dentist, to have trust and build up confidence. Some people feel that deciduous teeth are not important, but this is not the case and they are there to maintain space for the future adult teeth to erupt into the correct position. If a child just attends when in pain then a bad relationship will occur from a young age and each visit will end up being a stressful one. Caries can be caught early if the child has regular visits and oral hygiene can be monitored.


2. USE THE CORRECT LANGUAGE TO THE CHILD
If a parent is anxious of dentists, this can transfer to a child, as they are keen listeners and will pick up on anything that worries the parent. I think it is good to use simple language about going to the dentist, such as " the dentist will be counting your teeth and washing away all those naughty bugs " 
Try not to mention the words pain or hurt and never say to your child that the dentist is just going to look at your teeth, as this may not be the case once the child is in the dental chair.

3. DO NOT USE THE DENTIST'S VISIT AS A PUNISHMENT
If you threaten your child by saying I will take you to the dentist if you are naughty then this will not do well for their visits in the future! Make sure your child sees the dentists as being somewhere safe and potentially fun.


4. PREPARING YOUR CHILD FOR THEIR DENTAL VISIT
 Before their first dental appointment you can start preparing your child by either carrying out role play and pretending to be the dentist and acting out what will happen in the chair. Count their teeth, perhaps ask your child to show you how they brush their teeth. Books with good illustrations about a trip to the dentist, would be a good idea too.


5. ROME WASN'T BUILT IN A DAY
 Be prepared for your child to be a bit resistant to treatment or even sitting in the dental chair, even after all that great explaining, role playing and reading books before hand! Your child may still not fully understand what is being asked or discussed and get nervous about this. This is okay and trust will be being built at each appointment until they love coming and will just run into the surgery and jump in the chair.


6. MAKE SURE YOUR CHILD KNOWS THAT COMING TO THE DENTIST IS VERY IMPORTANT
 Your child should try to understand, with time, that seeing a dentist is very important to maintain good oral health and that this will always happen every six months.

Monday, 17 March 2014

Veneer case

Recently completed case

I started treating this very nice patient in 2012. His main complaint was that he wasn't happy with his smile and he would like whiter looking teeth and straighter ones.

He thought veneers on all his upper and lower teeth would be the answer, which in some cases this might be the case, but in this instance I suggested this would not be a good long term result due the amount of crowding he had.

The treatment plan was to first straightening his teeth with clear braces. I used a product called Invisalign to do this and due to the amount of crowding, it took over 1.5 years to move his teeth. Once the teeth were in a better position then I started on the cosmetic treatment.

I firstly made diagnostic wax up of his teeth to show what his teeth would look like with veneers and crowns. then I bleached his teeth with both in surgery bleaching followed by home bleaching, which he did for about two weeks.

Then came the very long 5 hour appointment where I prepared 10 of his upper teeth for veneers and one crown on the upper left central incisor. The veneers spanned from upper left second premolar to upper right second premolar. After treatment, I took impressions which was sent to the lab for the work to be made and the technician also came to visit him. He checked the profile of the patient and also took a shade of his teeth.

Before he left I made a temporary crown and veneers, which were lightly cemented on.

Ten days later, the work returned from the lab and I prepared to fit the work. Local anaesthetic was placed to reduce any chance of sensitivity with the teeth prepared. The temporaries were removed and teeth cleaned and the work was placed to check for the fit and appearance. All looked very good and each veneer was cemented using a cement called Nexsus. Everything was polished and any final adjustments made.

The patient was delighted with the final result and now he has lower implants and a few lower aligners to go to complete his treatment



Wednesday, 5 March 2014

Recent case to show and techniques used

Recent case to show and techniques used

Last week I treated a very nice gentlman who wanted to replace these amalgam restorations into tooth coloured ones.


I want to show you the procedure I used and should be adopted when removing any kind of restoration. This will provide safety for the patient and good visibility for the dentist.
The pink stuff you can see is called rubber dam.

A rubber dam or dental dam is a rectangular sheet of latex used by dentists, especially for root canal treatment, but also for things like tooth-coloured fillings. 



Why use a raincoat for your teeth? (Rubber dam)

  • You don’t have to worry about your tongue getting in the way
  • It protects your throat from little bits of tooth debris
  • If you are prone to gagging, it helps to protect your gag reflex area from being triggered
  • It protects the lips and cheeks by keeping them out of the way
  • It keeps the tooth dry – very important nowadays because many materials need a dry clean environment for tooth-coloured fillings to bond properly
  • It can create a distance between yourself and the treatment: 
Many people have a fear of the rubber dam because they are worried that they won’t be able to breathe and/or swallow. In the normal way (with the usual rubber dam design, where the sheet is put on a frame), there is lots of room around the sides, so you will be able to breathe through your mouth:

 After the rubber dam had been placed, the old amalgam restorations were removed and underlying caries.


The cavities were then lined with a liquid material called fuji II, this has fluoride and allows to bring strength directly to the dentine for upto one year after placement. This type of material is set hard with a blue light for about 20 seconds. The composite ( tooth coloured material ) is then placed in small increments into the cavity and cured at each stage by the blue light. This allows the material to become hard. The final restorations can be seen below. They were then polished and the occlusion ( bite ) of the patient finally checked after the rubber dam was removed and the teeth were given their final polish.