We all have different wishes and priorities for our dental treatment. Some want a bright Hollywood smile. Some want their teeth to look natural. Some are not bothered by a few missing teeth. Some just want their teeth to be healthy. Some only want to avoid toothache. Some want to keep their own teeth. Some can spend a lot on dental treatment. Some have limited resources. Some are very afraid of going to the dentist. Some don’t mind going. Some go for checkups at regular intervals. Some only go when they have a toothache.
Whatever your dental wishes and priorities are, they are all valid and important, and will be the basis for your treatment. We will always let you know, if we believe that your wishes are not in your best interest, and explain why. For example, only going to the dentist when you have a toothache may result in tooth decay developing to the point that the tooth will need to be root canal treated, significantly reducing the prognosis for the tooth, and possibly negatively affecting your general health. We will give you our opinion as to which treatment is in your best interest, which for us means keeping your teeth, gums, and entire organism healthy, and your smile looking its best.
When a problem can be treated in more ways, we believe it is important to explain the advantages and disadvantages of choosing one treatment over another, as well as the costs and duration of the treatments. We encourage our patients to get actively involved in deciding which treatment is the right one for them.
In the following we briefly present some aspects of our treatments, and treatment philosophies, that we believe are important:
Note that the use of "biocompatible" filling materials sometimes advertised from "holistic" dentists, is a misleading term for the usual composite filling materials.
Root Canal Treatments
Thankfully, the techniques used for root canal treatments have developed significantly in the past 20 years. For example, the canals used to be cleaned with hand files using X-rays to determine where the canal ended. Now we use an apex locator, which electronically determines the length of the canals, ensuring that the files get exactly to the end of the canal system but do not exit the tooth, which can lead to pain once the anesthesia wears off. The old hand files have been replaced by machine operated rotary files of extremely flexible nickel titanium, ensuring that curved canals can be treated, and that disinfecting liquids can effectively rinse the canal system to remove bacteria from inside the tooth. Thorough rinsing, which is of the utmost importance for the prognosis, is ensured using negative pressure at the root tip, eliminating the risk of the rinsing solution getting outside of the tooth, where it can provoke tissue damage. Generally, these improvements mean the treatments can be carried out quicker, more comfortably, and with better prognosis then previously.
prosthetics (crowns, bridges, dentures)
The improvements in ceramic materials also allow for even bigger bridges to be made purely in ceramic, without having any metal as in conventional metal-ceramic bridges. The use of tooth supported bridges has declined due to the use of implants to replace missing teeth, but bridges still have their use in certain situations.
Likewise, the use of partial and full dentures is declining due to the use of implants. However, partial dentures are an economical solution to replace missing teeth, and if the denture is well designed and fits precisely, is well accepted by most patients. Full acrylic dentures tend to work less well over the years, as the gums shrink. This may be possible to improve by rebasing the dentures (adapting them to the changes in the gums) and/or using 2 dental implants per jaw to support the denture using a ball and socket type mechanism.
If a tooth needs to be extracted, the best way to replace the tooth is most often with a dental implant. A dental implant is a special titanium or titanium alloy screw inserted in the jaw bone, which serves as an artificial root. There have been significant advances in the implant field in the last decade, such as implant immediate placement and loading. Often when a tooth fails, eg. due to root fracture or a failed root canal treatment, the tooth can be extracted, an implant placed immediately, and a temporary crown made immediately, all in the same consultation.
We use implants from the Swiss brand Straumann, which is one of the market leaders. Straumann manufactures possibly the best implants on the market today, e.g. due to their patented use of implants made from an allow of Titanium and Zirconium, which are significantly stronger than the traditional pure titanium implants.
Should you take X-rays at routine checkups? There is no doubt that for some patients, routine X-rays every 3-4 years or so is valuable to detect e.g. tooth decay or infections. Not all cavities are easily detected in the mouth, and detecting decay before it damages the tooth nerve can avoid more serious problems which could potentially have implications for your general health.
How much radiation do you get from a small normal (intraoral) X-ray or a panoramic X-ray? First, you get the lowest dose possible as we use the latest generation of digital sensors to capture X-rays. These sensors allow using much less radiation then is needed for X-ray film. The effect of ionizing radiation on living tissues is measured in Sievert. Here are some examples of doses: Yearly background radiation: 2-3 mSv, transatlantic flight 0.08 mSv, dental intraoral x-ray 0.005 mSv, 100g Brazil nuts 0.01 mSv, panoramic X-ray 0.025 mSv (4). As can be seen, the values for dental X-rays are relatively low, so we need not fear taking an X-ray when it is necessary.
1. Sterilizing dental dental handpieces. JADA 1992;123(10):44-7.
2. Lewis DL, Boe RK. Cross-infection risks associated with current procedures for using high-speed dental handpieces. J Clin Microbiol. 1992 Feb;30(2):401-6.
3. Zoellner H. Dental infection and vascular disease. Semin Thromb Hemost 2011;37(3):181-92.
4. Public Health England. Ionising radiation: dose comparisons. Published 18 March 2011.
Ionising radiation: dose comparisons - GOV.UK