Enamel Hypoplasia

I want to give you some information on this topic, as I am seeing more children suffering with this condition. It can be a bit technical, but I wanted to give you some idea of what it is first, so....

The definition of enamel hypoplasia is this is a defect of the teeth in which the enamel is hard but thin and deficient in amount, caused by defective enamel matrix formation with a deficiency in the cementing substance. Usually the condition involves part of the tooth having a pit in it on the biting surface.

These are some examples of what this looks like in patient's teeth

Enamel Hypoplasia is a condition that results in having less enamel than normal. It can affect both baby and permanent teeth. Most of the time it happens before the age of three, when the enamel is still developing and more vulnerable to genetic or environmental factors.

Enamel Hypoplasia can look like a small dent or affect the size and shape of the entire tooth. The defect can also occur on multiple teeth. The appearance varies from white, yellow or brownish colour, with a rough surface. Patients sometimes experience sensitivity and are more susceptible to cavities.

Factors such as infection or fever during pregnancy, premature birth, vitamin A, C or D deficiency, hereditary disorders and some medications taken during tooth formation can affect both baby and permanent teeth. Environmental factors include trauma to the teeth, fluorosis, and exposure to toxic chemicals at a young age.

Treatment options vary from sealing or bonding for less severe cases, to stainless steel crowns that protect more severe cases from sensitivity or wear. In some instances, extractions are necessary and can be replaced by a bridge or an implant.

Fortunately, mild cases of enamel hypoplasia can be controlled by practicing good oral hygiene habits, avoiding sugary foods and getting fluoride treatments. The treatment for Enamel Hypoplasia can vary from child to child, recently I have seen young children with hyoplastic enamel in their first permanent molars, these havent been too severe, so treatment has involved fissure sealants at this stage, fluoride treatment and seeing the patient every six months.

It is really important for your child to start seeing a dentist from the age of 2-3, as if problems such as hypoplastic enamel does occur, then the child is used to the dentist for treatment to be carried out.

Open day on Clear braces

New discovery

I have been looking for new companies to use for providing orthodontic treatment for my patients and at a recent dental exhibition I came across this company called Smilelign. 
They are based in Sheffield and have been providing clear braces for 3 years now.

So I have started using them for fairly simple cases and have found them to be a great hit with the patients and I have been very happy with their service, standard of work and customer support.

Another good reason for using Smilelign is that there is no VAT, so the lab prices are lower and much more competitive then the brand which most people are aware of called Invisalign.

So I thought, now I have found this new lab to have an Open Day to show all my patients the different systems available. This will be at the end of this month.

I have not had an Open Day before, so I am very much looking forward to this. I will be talking about all the systems that I provide, which will include Invisalign, Smilelign, In line and Clear guide. 

The offer is £500 off treatment, so if you know of anyone that might be interested then please send them my way!

I will write a follow up soon, with photos of some finished cases for you all to see.

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.

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. 

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.

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

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.