Treatments

We carry out all dental treatments including preventive, general and cosmetic dentistry, as well as orthodontics. By having an integrated approach and using the most recent and advanced treatment methods and materials, we aim to give you exactly what you need-nothing more, nothing less. 

We comply with, and exceed, Danish and Portuguese hygiene regulations. For example, all our instruments are cleaned and sterilized in a class B vacuum autoclave. Autoclaves that do not produce a vacuum, may not completely sterilize hollow instruments (1). Before sterilization, all instruments are individually wrapped and are only opened when used. We change and sterilize dental turbines and hand pieces between patients. This is not required by current Portuguese hygiene regulations, although it has been documented that just wiping the surface of the instrument with disinfectant as is common practice does not eliminate the risk of cross infection (2).

 One of the most important aspects of dentistry is to inform and motivate patients to prevent diseases of the teeth and gums. We emphasize this part of the treatment. Keeping a good oral hygiene day in day out is not easy for most people. These skills can be improved for example by using plaque-revealing dyes, which will give you feedback about how you are brushing your teeth, and how to improve your technique. For most patients, it is recommended to do professional cleanings with our hygienist at regular intervals. If you wish, we will enroll you in our automatic recall system and send you a reminder by SMS when it is time for your dental cleaning.

We believe it is important to preserve as much of healthy tooth substance as possible, and that any filling should be the smallest possible. We only use composite (white) filings of the highest quality material. We do not make amalgam (metal) fillings. The use of dental amalgam has been banned or restricted in some countries, e.g. in Scandinavia, although its use is still unrestricted in Portugal. Amalgam fillings contain mercury, and a constant released of mercury has been documented from these fillings, although it is unclear, which consequences this has for our general health. Composite filling materials have advantages to amalgam, noticeably the possibility to make aesthetically excellent tooth restorations and the absence of mercury. However, composite filling materials are not perfect. One of the weaknesses of this material is, that it shrinks when it hardens. This can leave the tooth sensitive after a new filling is made, although the use of a liner under the filling significantly reduces or eliminates this problem.
Note that the use of "biocompatible" filling materials sometimes advertised from "holistic" dentists, is a misleading term for the usual composite filling materials. 

 When the nerve inside a tooth die, e.g. from tooth decay growing into the nerve, the canal system inside the tooth will get full of bacteria. These bacteria multiply inside the tooth, and thereafter exit the tooth mainly at the tip of the root through the large perforations where the nerve used to enter the tooth. Our immune system is not able to enter the root to eliminate the bacteria (once the nerve dies there is no blood supply inside the tooth), but once the bacteria exit the root, the immune system will detect them, and will constantly be working to prevent the bacteria invading the tissues outside of the tooth. This condition will not clear up by itself, as the immune system cannot eliminate the source of the bacteria inside of the tooth. This process is mostly accompanied by acute pain initially, but may thereafter settle down as a chronic condition that can last years. This kind of chronic infection has been correlated with several health problems (3), and may at any time give again give rise to acute pain. Thus, once the nerve inside the tooth dies, the tooth needs either to be root canal treated, or extracted. We are in favor of preserving our natural teeth, and will in most cases recommend root canal treatment. However, due to the complicated anatomy of the root canal system, there are cases where root canal treatment will not eliminate all bacteria from inside the tooth, leading to a persistent chronic infection. Other problems, such as root fractures, may also lead to chronic infections. When no treatment can eliminate the infection, the tooth should be extracted. The tooth can then be replaced by a dental implant and crown if needed.
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.

 The improvement of composite filling materials and their bonding to tooth surfaces has permitted larger composite fillings then previously, pushing the limits for when it is necessary to crown a tooth. It is often preferable to make a bigger filling then a conventional full crown, which requires a often substantial preparation (and thereby loss) of healthy tooth. When a crown needs to be made, improvements in ceramic materials and bonding make it possible to make extremely resistant partial crowns, which need much less tooth preparation thereby preserving healthy tooth structure.
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.

  Gum problems are often overlooked in many dental clinics. Unfortunately, it is not uncommon to see new patients presenting in our clinic with undiagnosed periodontal disease, sometimes with the disease so far advanced that teeth are loose. Periodontal (gum) disease is normally a slowly progressing disease, and affects a significant part of the population. It is not a consequence of growing older, although there may be more risk of getting it as you age. Besides the obvious risk of losing your teeth, having periodontal disease may have consequences for your general health. Studies have shown that chronic infections, of which periodontal disease is one, may increase the severity of diabetes, and increases the risk of hypertension and atherosclerosis (3). If you do have periodontal disease, can anything be done about it? Yes. The treatment normally involves deep cleaning of the teeth, instruction in how to improve your oral hygiene, and possibly periodontal surgery. This surgery may or may not involve using guided tissue regeneration to build up the bone that has been lost around the teeth.

  X-rays should only be taken when justified, as it exposes us to ionizing radiation. Sometimes, but not always, X-rays are necessary to correctly diagnose and carry out certain treatments safely and effectively. For example, we consider the practice of indiscriminately taking panoramic X-rays of all new patients as wrong. In many cases a panoramic X-ray can give essential information needed for diagnosis and treatment, but in some patients, where it is very unlikely that a panoramic or intraoral X-ray will show any disease, we do not recommend taking one.
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.