Teeth Whitening: -

1. What are the likely causes of tooth discoloration?
2. What is Power bleaching?
3. What is home bleaching?
4. What are differences among bleaching systems?
5. How long does the effect of bleaching last?

Bridges: -

1. What is a bridge?

Crowns: -

1. When does my tooth need a crown (cap)?
2. What types of crown materials are available?
3. What steps are involved in preparing a tooth for a crown?

Dental Implants: -

1. Is the concept of dental implants a new one?
2. What factors contribute to long-term success of dental implants?
3. Who can place a dental implant in my mouth?
4. Who can restore the teeth on top of the dental implants?
5. Are there any age limitations for dental implants?
6. What might be some of the factors that would prevent me from being an implant candidate?
7. How often will I need to have my dental implants checked?
8. Is dental implant surgery painful?
9. When can I return to work after implant surgery?
10. What are the benefits of dental implants?
11. What is the relative cost of dental implants?

Immediate denture: -

1. What are the advantages & disadvantages?

Root Canal Therapy: -

1. What does root canal treatment really mean?
2. What does treatment involve?

Teeth Whitening: -

1. What are the likely causes of tooth discoloration?

Surface stains are superficial stains located on the surface of the tooth. Common surface stains are dental plaque and calculus, tars (in tobacco), tannins (in tea or coffee), colored foods such as soy sauce, cola drinks, and the ingredients in some dental mouth rinses when these rinses are used very often.

Internal stains are colored molecules and pigments that have become incorporated into the internal structure of the tooth. This can occurs as the tooth is developing, or after the tooth has been present in the mouth. Some filthy conditions have been associated with changes to tooth structure as it forms.

Advancing age, this leads to greater yellow coloration of teeth, tooth decay or even problems with the dental pulp (“nerve”), after decay, root canal work, or damage to the tooth in an injury.

2. What is Power Bleaching?

During this treatment, which is undertaken in the dental surgery, eye protection is first put on, and then a retractor is placed to hold the cheeks and lips away from the teeth. A material such as a flowing white resin is placed to protect the gums and any exposed root surfaces from chemical irritation from the gel, and from accidental heating if a high intensity light source is to be used. This material is simply peeled away from the teeth at the end of the appointment. The whitening gel is then mixed from powder and refrigerated hydrogen peroxide solution, typically resulting in a final hydrogen peroxide concentration of 35%. The gel is then began, and left in place for some time to allow the oxygen products to penetrate into the teeth. The gel is then washed off and the fresh gel applied. Any leakage of the whitening gel onto the gums can cause irritation, & vitamin E may be applied to neutralize the peroxide and& prevent any long term damage to the gums.

The treatment sequence can be repeated several times in the one appointment. Activation of the gel can use a chemical agent (such as ozone), or high intensity light sources that give controlled heating of the gel and break down the peroxide compounds within it. This response is termed photo-thermal bleaching. One system has been developed which uses visible light energy to energize directly oxygen molecules, a process termed photo-chemical bleaching.

While the effects of power bleaching are immediate, depending on the affect achieved it might be necessary or desirable to repeat the treatment over several appointments to achieve the desired level of whitening. A home product may also be supplied as a follow-up to the treatment, or for maintenance of the result over the ensuing months. In general, for simple age-related shade changes, a 1 hour session of power bleaching using a state-of-the-art system may produce the same tooth whitening affect as using a professional level at-home gel in custom trays over several weeks.

3. What is Home Bleaching?

Home bleaching involves wearing a very thin, transparent plastic tray molded to your teeth, which is used to hold a bleaching agent in contact with the tooth surface. It is normally worn for about ten days. The active agent in the bleach is usually carbamide peroxide. This is a chemical which quickly breaks down to urea and 7% hydrogen peroxide. It is the hydrogen peroxide which lightens the teeth.

4. What are differences between bleaching systems?

	Bleaching agents	Time of Treatment	Results	Notes
Chairside	light activated	45 mins	4-6 shades	Immediate result Long lasting Less fadeback Safe & comfortable Performed by dental professionals
Chairside	Paint on (chemically / light activated)	30-45 min	2-4 shades	Immediate result Long lasting Less fadeback Safe & comfortable Performed by dental professionals
Home	At home trays	30 mins (3-4 days)	2 shades	Self applied Trays used No immediate result
Home	Toothpaste	1 month +	1-2 shades	Self applied No immediate result  Result fade if you stop using the toothpaste Superficial stains only

5. How long does the effect of bleaching last?

It is different for everyone. Our teeth darken naturally with age in a normal way with the passage of time. Things that stain our teeth (surface staining) are caffeine, smoking, red wines. Over a long period of time, these things will change the color of your teeth internally.

Bleaching lasts a very long time. Teeth can still stain, but it can be cleaned off.

Not everyone is a candidate for bleaching though. There are different ranges of colors, Yellows, Grays, reddish-browns. Yellows bleach out very well, but grays and reddish-browns almost never do.

There are no rules to shade; it is a matter of what makes you happy when you look in the mirror.

Bridge Work: -

1. What is a bridge?

A bridge is an appliance permanently fixed in the mouth to replace missing teeth. It uses remaining teeth to support the new artificial tooth or teeth.

Dental Crowns:-

1. When does my tooth need a crown (cap)?

The outside each tooth is made of enamel, which is extremely hard. A crown is recommended if there is:

• Substantial Chips or broken teeth/fillings due to a fall or any other type of trauma
• Tooth decay may also severely weaken a tooth, with a high risk that the tooth may fall apart
• Root canal treatment , where the pulp of the tooth containing nerves and blood vessel is removed, can also weaken a tooth
• Large fillings can reduce a tooth’s strength by more than 70% as shown below diagrammatically and eventually the tooth can break
• Tooth wear over time can dramatically reduce the size of a tooth and even expose the nerve
• Cosmetic needs can also be treated with crowns, restoring tooth strength, function and enhancing the overall health and beauty of your mouth
• Very crooked teeth can sometimes be dramatically improved with crowns if braces or porcelain veneers are not suitable.

2. What types of crown materials are available?

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

Metals used in crowns include gold alloy, other alloys (for example, palladium) or a base-metal alloy (for example, nickel or chromium). Compared with other crown types, less tooth structure needs to be removed with metal crowns, and tooth wear to opposing teeth is kept to a minimum. Metal crowns withstand biting and chewing forces well and probably last the longest in terms of wear down. Also, they rarely chip or break. The metallic color is the main drawback. Metal crowns are a good choice for out-of-sight molars. 

Porcelain-fused-to-metal dental crowns can be color matched to your adjacent teeth (unlike the metallic crowns). However, more wearing to the opposing teeth occurs with this crown type compared with metal or resin crowns. The crown’s porcelain portion can also chip or break off. Next to all-ceramic crowns, porcelain-fused-to-metal crowns look most like normal teeth. However, sometimes the metal underlying the crown’s porcelain can show through as a dark line, especially at the gum line and even more so if your gums recede. These crowns can be a good choice for front or back teeth. 

All-resin dental crowns are less expensive than other crown types. However, they wear down over time and are more prone to fractures than porcelain-fused-to-metal crowns.

3. What steps are involved in preparing a tooth for a crown?

The process of fitting crowns and bridges requires two visits to the dentist and an approximate seven days stay or visiting twice for one or two days.

First visit: Examining and preparing the tooth

At the first visit, your dentist may take a few X-rays to check the roots of the tooth receiving the crown and surrounding bone. If the tooth has extensive decay or if there is a risk of infection or injury to the tooth’s pulp, a root canal treatment may first be performed.

Before the process of making your crown is begun, your dentist may anesthetize (numb) your tooth and the gum tissue around the tooth. Next, the tooth receiving the crown is filed down along the chewing surface and sides to make room for the crown. The amount removed depends on the type of crown used .If, on the other hand, a large area of the tooth is missing (due to decay or damage), your dentist will use filling material to “build up” the tooth to support the crown.

After reshaping the tooth, your dentist would make an impression of the tooth to receive the crown. Impressions of the teeth above and below the tooth to receive the dental crown will also be made to make sure that the crown will not affect your bite.

The impressions are sent to a dental laboratory where the crown will be manufactured. The crown is usually returned to your dentist’s office in 5-8 days. If your crown is made of porcelain, your dentist will also select the shade that most closely matches the color of the neighboring teeth. During this first office visit your dentist may make a temporary crown to cover and protect the prepared tooth while the crown is being made. Temporary crowns usually are made of acrylic and are held in place using temporary cement.

At your second visit, your dentist will remove your temporary crown and check the fit and color of the permanent crown. If everything is acceptable, a local anesthetic may be used to numb the tooth and the new crown is permanently cemented in place.

Dental Implants: -

1. Is the concept of dental implants a new one?

Interestingly, dental implants have been performed for thousands of years. Egyptian mummies have been found with gold wire implants in the jawbones. Pre-Columbian skeletal remains exhibit dental implants made of semi-precious stones. Recently, a Roman soldier was unearthed in Europe with an iron dental implant in his jawbone. In the Middle East, implants made of ivory have been discovered in skeletons from the Middle Ages.

Modern implantology began in the United States at the beginning of the 20th century. However, popularity really grew in the 1980’s with the increased success of the titanium cylinder. Since then, many brand name implants with minor variations have been approved.

2. What factors contribute to long-term success of dental implants?

Long-term success depends on multiple factors. Firstly, success will depend on the quality and quantity of bone. The better the bone and the more available, the greater the chance of long-term success. Secondly, the experience and ability of the dental surgeon will be a factor.  And finally, the quality of the restoration placed on top of the implant will play a big role in long-term success. If the design of the implant crowns or over-dentures are poorly constructed, and biting forces are not balanced, even the best-placed dental implant will have a compromised survival rate.

3. Who can place a dental implant in my mouth?

A periodontist, an oral surgeon, or an implantologist places dental implants. The periodontist and oral surgeon are teamed with a restorative dentist. They will place the implants and then the patient will be seen by a restorative dentist for completion of the crowns or overlying appliance

4. Who can restore the teeth on the top of dental implants?

A general dentist trained to restore implants, an oral implantologist, or a prosthodontist can restore teeth

5. Are there any age limitations for dental implants?

No. Any person at any age can have dental implants since there is enough bone available in which to place the implants.

6. What might be some of the factors that would prevent me from being an implant candidate?

There are some medical factors that may prevent a person from being a good candidate for dental implants. Some of these may be uncontrolled diabetes, chemotherapy or radiation therapy, parathyroid disorders, blood disorders, rare bone disorders or bone marrow cancer. Some physical factors may include insufficient or poor quality bone, low sinuses or nerve bundles.

7. How often will I need to have my dental implants checked?

The success of your implants will depend greatly on how well you maintain them. They will need to be professionally cleaned by a hygienist and examined by your implant dentist every three to four months. This hygienist should be trained in the specific procedure of maintaining dental implants. Also, brushing and flossing daily is necessary for long-term success.

8. Is dental implant surgery painful?

No. An effective local anesthetic is used during the surgery so that you do not have any discomfort during the placement of the implants. The mild discomfort you might experience after surgery can be controlled with medications

9. When can I return to work after implant surgery?

You can go to work the next day, unless some particular surgical circumstance arises. Your implant dentist would discuss all postoperative instructions with you.

10. What are the benefits of dental implants?

Dental implants have given countless patients many amazing benefits:

• You will smile again
• Improved appearance
• Improved comfort
• Improved speech
• Eat better; enjoy more foods, better nutrition
• Convenience
• Improved self-esteem

Dental implants are also a great value for your investment. You will be getting a product that you will be using 24 hours a day, seven days a week, 52 weeks of the year, probably for many, many years of your life.

11. What is the relative cost of dental implants?

As with many surgical procedures, dental implant fees will vary from doctor to doctor. Frequently, a more experienced implant dentist will charge higher fees. Each individual implant dentist will be able to quote you his fees.

It is important to remember that there are three components to a tooth being restored by an implant dentist, and each component has its own fee structure:

• First, there is the cost of the implant surgical procedure itself.
• Next, there is the cost of the post (also called an abutment), which is placed on the healed implant.
• Last, there is the cost of the crown, which is the tooth placed on top of the post.
• Remember, there can be multiple implants and multiple crowns.

 

There may be other costs as well; for instance, the use of synthetic bone material during surgery might be an added fee.

Immediate Denture:-

1. What are the advantages & disadvantages?

An immediate denture is what it says. It is placed immediately after the teeth have been extracted. It cannot and will not function or feel like a denture placed over healed oral tissue. It does provide a certain amount of function and esthetics for the patient.

About six months after receiving your immediate dentures, the dentures will have to be rebased, relined or a new denture will have to be made.

As a note, there is no such thing as a "permanent denture" as your mouth would continue to change shape over time. Well-made dentures can last you five to ten years, but they may need to be adjusted or re-made depending on the healing process.

Advantages: -

Perhaps the most important advantage of immediate denture is that you never need to appear in public without any teeth. Other advantages include:

• The form, size and arrangement of your natural teeth can more closely be duplicated when some teeth remain in your mouth.
• When immediate dentures are inserted, they act as a bandage and help to reduce bleeding.
• Immediate dentures protect the tissues at the sensitive extraction cites from irritation which might result from the tongue and food. This could mean less discomfort for you than with conventional denture construction.
• Immediate dentures can enable you to establish your speech patterns more easily. You do not have to learn to speak without teeth and then re-learn once dentures are made.
• With immediate dentures you can chew better than you could without teeth during the normal waiting period for conventional dentures.
• If dentures do not replace the natural teeth within a short time, the cheeks tend to fall in.
• If you remain without teeth for some time, you may develop oral habits that would interfere with your ability to learn how to use dentures properly.

Disadvantages: -

Like any other procedure, the insertion of immediate dentures does have limitations, of which you should be aware. There are some people for whom immediate dentures are not advisable because of their general health or specific oral problems.

More office visits are required during the first few months, to watch for changes in the gums and in the mouth function. Also the original good fit and occlusion of the denture will be lost as healing takes place. This is normal.

Because of changes in the tissues after removal of the teeth, immediate dentures usually need to be re-fitted by a dentist within several (usually six) months. This involves additional expense. Sometimes new dentures must be made.

In the areas where the last remaining teeth will be removed, immediate dentures will not always fit quite as accurately as conventional dentures made later after gums have healed.

Because some of your teeth are still in place, you cannot see how the dentures will look in your mouth until after the natural teeth have been removed.

Immediate dentures are usually more expensive because of the additional time required for their construction.

Root Canal Therapy: -

1. What does root canal treatment really mean?

Root canal or endodontic treatment is a process whereby inflamed or dead pulp is removed from the inside the tooth, enabling a tooth that was causing pain to be retained.

Dental pulp is the soft tissue in the canal that runs through the center of a tooth. Once a tooth is fully formed it can function normally without its pulp and be kept indefinitely.

After removing the pulp, the root canals are cleaned, sterilized and shaped to a form that can be completely sealed with a filling material to prevent further infection. The treatment could take single or several appointments, depending on how complex the tooth is, and how long the infection takes to clear.

Subsequently a crown or complex restoration to restore or protect the tooth may be a necessary recommendation, as a tooth after undergoing treatment may be more likely to fracture.

2. What does treatment involve?

Root canal treatment may involve one to three visits to the dentist. A general dentist or a Endodontist (a specialist in pulp problems) will remove the pulp of the tooth. They will then clean and seal the pulp chamber and root canals.

STEPS INVOLVED IN ROOT CANAL TREATMENT:

Multiple Visits:

• An opening is made through the crown of the tooth into the chamber where the pulp is found.
• The pulp is removed, and the root canal/s are cleaned and shaped into a form that can be filled easily.
• Medications to prevent infection may be placed in the pulp chamber.
• Your dentist may leave the tooth open in order for it to drain, however often a temporary filling is placed in the crown of the tooth to protect it until your next visit. Antibiotics may be prescribed to help prevent infection.
• The temporary filling will be removed, and after cleaning, the pulp chamber and root canal/s will be filled.
• Finally, your dentist may place a crown (either porcelain or gold) over your tooth.

Single Visit: -

• An opening is made through the crown of the tooth into the chamber where the pulp is found.
• The pulp is removed, and the root canals are cleansed & shaped into a form that can be filled easily.
• After cleaning, the pulp chamber and root canals will be filled.
• Next Visit: your dentist may place a crown (either porcelain or gold) over your tooth.