General Dentistry

In the early stages, tooth decay may not cause any pain. Your dentist can detect these cavities by examining the tooth surface and taking x-rays. Tooth decay is easier to treat in the early stages and it is therefore essential that you visit the dentist regularly for examinations.

If the cavity progresses, you may experience:

• Toothache – pain which may be specific to one tooth or generalised and is either constant or sporadic in nature. The pain may keep you awake at night and the tooth may be sore to touch.

• Sensitivity – pain which is caused by temperature changes in food and drinks and/or by sweet foods/drinks.

• Discolouration of teeth – teeth may appear darker brown/grey in colour

• Bad breath (halitosis)

• Bad taste in your mouth

The dentist will assess how advanced the tooth decay is and will explain recommend treatment options. For early stage tooth decay, the damage may be reversed by changes to your diet and tooth brushing habits. Your dentist may recommend a prescription toothpaste and may apply a fluoride gel to the tooth decay.

If tooth decay is more advanced, treatment options may include:

• Filling (removal of decay and restoration with a dental material or cap (crown),

• Root canal treatment (if tooth decay has spread to the pulp (nerve) then the nerve needs to be removed),

• Extraction (if there is extensive decay and the tooth cannot be saved, it may need to be removed).

Tooth decay is entirely preventable. It can be avoided by:

Thoroughly brushing your teeth twice a day using fluoride toothpaste and by cleaning in between your teeth using floss or interproximal brushes. Please see our information leaflet on tooth brushing.

Reducing the amount of sugary foods and drinks and snacking throughout the day

Visiting your dentist regularly for examinations. Your dentist will advise you as to how frequently you should visit based on the condition of your mouth.

Gum disease is one of the most wide-spread diseases across the world and can affect anyone. Milder forms of the disease can be seen in approximately 80% of people by the age of 60, however some people are more predisposed to aggressive forms of the disease, which is seen in approximately 15% of the population. Factors which can increase the susceptibility of severe gum disease include: smoking, diabetes, poor diet, stress, certain medications and obesity.

There appears to be a genetic link with periodontal disease and individuals with a family history of gum disease may be more at risk of developing aggressive forms of the disease.

Most people are unaware that they have gum disease as it is often painless. It is therefore essential that you visit the dentist regularly as they are able to readily identify early symptoms of gum disease. In the early stages of gum disease, gums may appear red and bleed whilst brushing. This is called gingivitis. If left un-treated periodontitis develops and this affects the gums, bone and other supporting tissues of the teeth. Signs and symptoms of periodontitis include:

Bad breath (halitosis),

Spaces between teeth,

Shrinking (receding) gums,

Bad taste,

Collection of pus (gum abscess),

Loose teeth,

Loss of teeth.

Please make sure you tell your dentist about any medical condition as it may change the way your dentist manages your gum disease.

Treatment will focus on removing plaque from around your teeth and your dentist will advise you on how best to achieve this. Your dentist will teach you specific oral hygiene methods to control bacteria that collect on your teeth. Gum treatment will only succeed if good oral hygiene practices are carried out at home.

Your dentist may advise you to have professional cleaning of your teeth such as a scale and polish or root surface instrumentation. Dentists, hygienists and therapists are able to provide both scale and polishes and root surface instrumentation.

A scale and polish involves removal of plaque and calculus (tartar) that can build up on your teeth.

Root surface instrumentation may need to be carried out if you have bacteria under your gum line on the roots of your teeth. This is sometimes referred to as a ‘deep clean,’ and patients may require local anaesthetic to numb the area prior to treatment.

Occasionally, if you have severe gum disease, more complex treatments are required and your dentist will advise you accordingly.

Is there anything I can do to prevent gum disease?

It is important to visit the dentist regularly as gum disease is completely treatable if diagnosed early enough. Maintaining good oral hygiene practices at home is essential to prevent gum disease. You should brush twice a day and clean between your teeth as this is where most gum disease starts. You can achieve this through interdental brushes or floss. If you have any concerns you should speak to your dentist as they will show you how to clean your teeth effectively.

If you smoke, then stopping or reducing smoking will help your gum disease. Smoking is one of the biggest risk factors for gum disease. It makes the disease process more damaging and less responsive to treatment. Smokers are also more likely to have a recurrence of gum disease following treatment. Your doctor can direct you to the stop smoking service.

For NHS patients with an out of hours emergency, please telephone NHS 111 to find an out of hours dental emergency service near you.

For Denplan patients with an out of hours emergency, please telephone Denplan’s Emergency Helpline on 0800 844 999 and speak to an advisor. Denplan will subsequently contact practice principals Dr Kate Preston and Dr Kate Shaw who will (if available) offer telephone advice and/or open up the surgery. If both practice principals are unavailable or if you are more than 40 miles from the practice, Denplan will help locate an emergency dentist for treatment.

If you are abroad, you can see any dentist in an emergency and are covered for necessary temporary emergency treatment up to your policy limits. Denplan does not have registered dentists overseas so we recommend that you ask your hotel concierge, tour operator representative or any family, friends or colleagues for a recommended dentist in the area. If you need help or advice ring Denplan’s 24-Hour Worldwide Emergency Helpline on +44 1962 844 999. Ensure you keep the receipt for your temporary treatment to claim back when you return. You can find a claim form on www.denplan.co.uk/claimforms.

In most circumstances, if you have a problem with your mouth or teeth then you should seek care from a dentist as doctors aren’t always equipped to deal with dental emergencies. There are however certain situations when you should go to A&E. These include:

Severe pain/swelling which is affecting breathing or ability to swallow,

Heavy bleeding,

Injuries to the face, mouth or teeth.

If you are uncertain as to whether it is appropriate to attend A&E, please contact the practice for advice or NHS 111.

There are a number of situations when your dentist may recommend you have a crown as they can restore the anatomical shape of a tooth, improve function and aesthetics. They are a brilliant way to repair teeth and can be used to:

Protect a week tooth from fracturing,

Restore a broken tooth which may have been weakened by tooth decay or by a very large filling,

Hold a dental bridge in place,

Cover a misshapen tooth.

Improve cosmetic appearance.

If you need a crown, your dentist will discuss all available options with you so that you can make a decision which is right for you. Types of crowns include:

• Porcelain

• Ceramic

• Zirconia

• Metal,

• Composite Resin

• A combination of materials.

Your dentist will consider certain factors when selecting the material for your crown. These include:

• Whether the tooth is at the front or back of your mouth

• How much tooth will be visible when you smile

• The position of your gum line

• How much natural tooth is remaining

Treatment typically takes place over two appointments.

During the first appointment, your dentist will examine and prepare the tooth in readiness for the crown. This sometimes involves taking an x-ray and impressions (moulds) of your teeth. Your dentist will file down the tooth and take a final impression before cementing a temporary crown over the tooth to protect it from damage. If your dentist is providing you with a white crown, they will colour match the crown to your surrounding teeth as closely as possible. Impressions will then be sent to the lab where your crown will be made. It can take several weeks for the crown to be manufactured.

During the second appointment, your dentist will remove your temporary crown and will try the permanent crown. This is to ensure you are happy with the fit and appearance. The crown will then be cemented in place.

Your dentist will suggest you take the following precautions to protect your temporary crown from damage:

Avoid eating hard or sticky foods which have the potential to break or pull off a temporary crown,

Avoid staining foods such as curry and wine as this can affect the colour of a temporary crown,

Chew on the opposite side of your mouth to avoid the crown and reduce risk of fracture,

Clean the temporary crown twice a day using your manual or electric toothbrush. If you use floss, slide the floss out from between the teeth, rather than lifting it in an upwards motion, to reduce the risk of dislodging the crown

After having a crown fitted you may experience some issues such as:

Discomfort or sensitivity. Once the anaesthetic has worn off, your new crown may be sensitive to hot and cold temperature changes. Your dentist may recommend you brush your teeth with sensitive toothpaste and apply It topically to the tooth like cream several times a day. You may experience discomfort whilst biting together, which could indicate that the crown is too high in your bite. Your crown can be adjusted by the dentist if this is a concern. Sometimes discomfort can be due to an irritated nerve following treatment. Your dentist may need to carry out root canal treatment in order to save the tooth.

Chipping of the surface of the crown. Crowns made with porcelain can sometimes fracture. If the chip is small, the crown can be smoothed or a temporary white (composite) filling can be used to repair the chip. However, if there is an extensive chip, the crown will need to be replaced.

Loose crown. Occasionally, the cement used to glue the crown to your tooth washes away with time resulting in a loose crown. If a loose crown can be re-cemented, your dentist may send it to the lab to be cleaned, which usually takes 24 hours. It is important to see your dentist if you have a loose crown, as it can allow bacteria to enter and form decay.

Dark line around crown and gum margin. This can happen when your gums recede around a porcelain -fused to metal crown. Although this is not a problem in itself, you may find this not cosmetically appealing and can speak to your dentist about available treatment options.

If you experience any problems with your crown, please contact the practice to arrange a review appointment on 0151 342 828 or by email at info@heswalldental.co.uk.

Crowns are available privately and on the NHS, if the procedure is considered to be clinically necessary. On the NHS, your dentist will offer you the type of crown they deem to be clinically necessary and if you are an NHS paying patient, you will be subject to a band 3 charge. Private crown prices can be found on our Private Dental Charges List.

You may need root canal treatment for several different reasons. These include:

Extensive tooth decay,

Gum disease,

Severe tooth-wear,

Trauma to the teeth and mouth, either recently or a long-time ago,

Historical dental treatment, most commonly having a tooth crowned.

There are a few symptoms that may mean you need a root canal treatment. These include:

Severe pain, particularly when chewing or biting, or pain that does not respond to pain-killers,

A cracked or broken tooth,

Pimples, swellings or changes in the colour of the gum next to a tooth,

A swollen face,

The tooth becomes a darker colour.

Treatment may be completed over multiple visits. Usually, at least two appointments are required. Most patients experience relief of their symptoms after the first appointment.

Step 1: A local anaesthetic is used during the treatment to keep you comfortable and pain-free. Your dentist will protect the tooth by covering it with a thin latex-free sheet, known as a dental dam. This allows the dentist to keep the tooth clean.

Step 2: Your dentist will make an opening in the top of your tooth to locate the infected pulp. It should feel no different from having a filling performed. The canals are then cleaned and shaped using small files. A disinfectant is used to flush out any debris and make sure the canals are clean.

Step 3: Once the canals are free from infected pulp and have been disinfected, your dentist will fill and seal the canals with a rubber-like material called gutta-percha. An adhesive cement is used hold the gutta-percha in place and ensure that the root canal is completely sealed.

In-between appointments your dentist will use a temporary filling to close the opening they made in the top of the tooth. Your dentist may also take X-rays of your tooth during the treatment.

After root canal treatment you will be free of pain and infection. Removing the blood supply makes the tooth more fragile, however, and it may become more prone to breaking. Your dentist may recommend that you subsequently have a crown (cap) placed over the tooth to protect it.

The risks of root canal treatment can occur during or after treatment.

During treatment:

You may experience some sensitivity if the pulp is very inflamed, or it may take several visits to resolve your symptoms.

You may have more canals than roots which can be difficult to diagnose and treat.

If the pulp has been inflamed for a long time, root canals can become blocked with hard debris that cannot be fully removed and therefore your tooth cannot be effectively disinfected.

Sometimes the small instruments used to clean and shape the root canals can separate within the canal.

Rarely the disinfectant can irritate the jaw bones and soft tissues of the mouth.

After treatment:

You may experience some sensitivity for a few days after treatment, which can usually be treated with paracetamol and ibuprofen.

The tooth may become discoloured which may be a problem if it is a tooth at the front of the mouth.

The tooth can fracture.

The tooth can become re-infected and the symptoms of pain and swelling return.

Although most teeth can be treated, occasionally, a tooth is not suitable for root canal treatment. These include:

Teeth with very curved roots,

Severely broken-down teeth where the crown cannot be restored after root canal treatment,

Teeth with root canals that are not accessible or blocked,

Teeth with fractured or broken roots,

Teeth that do not have adequate bone support due to periodontal disease.

If your tooth is difficult to treat, your dentist may recommend that you are referred to see a private specialist, or in some cases they may recommend that the tooth be extracted.

The alternative to root canal treatment is to have the tooth extracted. Once the tooth is removed you will be left with a space. Your dentist will discuss options to restore that space if you chose to have a tooth extraction. Subject to an extensive examination and these can include:

A dental implant,

A dental bridge,

A denture.

Root canal treatment is available on the NHS within a Band 2 course of treatment. A crown, which is likely to be recommended after root canal treatment falls within the more expensive Band 3 course of treatment.

Root canal treatment is also available privately. It is covered within the monthly payments for Denplan Care Contract holders. For private pay as you go patients or for patients who fall outside the scope of practice of a general dentist (where there may be difficult root anatomy), treatment costs will vary according to your individual needs, the tooth being treated and the complexity of the treatment. Your dentist will be happy to discuss your clinical needs and offer you a quote on this basis.

Sedation can be arranged for patients who suffer with dental anxiety.

In most circumstances teeth can be restored but occasionally an extraction may be recommended if your tooth has gone beyond a state or repair. Indications for tooth extractions are as follows:

Pain,

Extensive decay,

Infection of the tooth or gum,

Tooth fracture,

Gum disease,

Dental trauma,

If your teeth are severely crowded and space must be created for tooth movement prior to orthodontic treatment.

Before a tooth is removed, your dentist will review your medical history and take appropriate x-rays to assess the position, length and shape of the tooth. Your dentist will use this information to assess the degree of difficulty and decide whether the tooth can safely be removed in practice or on referral by an oral surgeon.

Before an extraction:

You will be advised to eat before your dental extraction. This is because local anaesthetic will be used to numb your tooth and you will not be able to feel pain for several hours following treatment. Avoiding eating during this time will prevent you from traumatising your lips and cheeks.

Do not plan any social engagements following an extraction as it important to rest after treatment.

During the appointment:

If you are anxious, your dentist can apply topical anaesthetic to numb the gum before administering local anaesthetic

Local anaesthetic will be administered by your dentist to numb your tooth and gum

The tooth will be loosened using specialised instruments called elevators before removing it with dental forceps

Your dentist will ask you to bite on a bite pack firmly for several minutes to allow the wound to clot

Your dentist may place stitches in the gum to encourage wound healing. These stitches are dissolvable and you will not need to return to have them removed. They can take up to 8 weeks to completely dissolve

Immediately after the appointment:

Before you leave after having a tooth removed, we will ensure that you have started to heal.

Please rest for the remainder of the day. We would like you to take things easy and avoid anything that may raise your blood pressure, such as sport.

Remember that whilst you are numb you cannot feel the temperature of food and drink. Please be careful when eating or drinking until the anaesthetic has worn off.

It is normal to taste blood. Do not rinse your mouth for the next 24 hours as this can interfere with the healing process and may cause bleeding.

It is normal for the socket to bleed, particularly after the anaesthetic has worn off. If this happens, please remember that PRESSURE STOPS BLEEDING. Do not panic, either use the bite packs provided or roll up a clean lint free cotton handkerchief and bite on it where you are bleeding for 20 minutes. Take this time to sit and rest. If the bleeding persists, please phone the practice for advice. If out of hours, please contact Revive on 0161 476 9651 or attend your local A+E department.

It is normal to have sensations associated with healing. You can take painkillers if necessary. Remember to AVOID ASPIRIN-BASED PAINKILLERS as this will encourage bleeding.

Do not smoke or drink alcohol for the next 24 hours. Both can affect the healing process and increase the risk of developing inflammation and on occasion infection in the socket.

Brush your teeth as normal but avoid the extraction site.

After 24 hours:

It is normal to have some swelling and/or bruising following an extraction. This should subside within 3 – 7 days, but if you have any concern please contact the surgery.

You may wish to gently rinse your mouth using a warm, salty mouthwash. Using one teaspoon of salt in a tumbler of warm water gently tilt your head to swill the extraction site. You can do this three or four times a day for at least two days.

For the following 3 to 7 days:

You should be feeling better day by day. If you are experiencing anything other than healing sensations, please call the practice as you may need to have the extraction site reassessed by a dentist. Please remember that most cases of post extraction pain that require treatment do not require antibiotics. We will however ensure that you receive the most appropriate care.

There are several risks which can occur during the procedure and these include:

Tooth fracture

Sometimes, if the tooth is very weak or has an unusual root anatomy, it can fracture below the level of the gum leaving a retained root. Most of the time the retained root can be removed by your dentist who will use specialised instruments. If it cannot be retrieved, your dentist will decide whether it is small enough to leave in situ, or whether it would be in your best interests to have the root surgically removal with a specialist oral surgeon.

Trauma to the surrounding tissues i.e., the lips, cheeks or tongue

Occasionally the surrounding tissues are traumatised with the pressures of the extraction forceps.

Damage to surrounding teeth

Adjacent teeth can be subject to pressures during an extraction and if they are heavily filled there is a risk that their fillings will become dislodged.

Oral-antral communication

Oral-antral communications are common complications that can happen when you have an upper back tooth extracted. It is a communication (hole) between the maxillary sinus, which is an air space within your cheek, and the mouth. Oral-antral communications are more likely to occur when upper back teeth have long roots or when they are infected. If an oral-antral communication is suspected, the communication will be closed with dissolvable stitches, you may be prescribed antibiotics, pain relief and nasal decongestants to help with healing.

There are several risks which can occur after tooth extractions and these include:

Pain

This is normal after dental extractions and you should expect pain from the site for three to seven days.

Bleeding

Your dentist will make sure that your wound has started to clot before you leave the practice. It is common however to experience bleeding when your anaesthetic starts to wear off.

Bruising and swelling

You may experience bruising and or swelling of the face and neck. This will reach a peak after 48 to 72 hours after the extraction.

Infection

The socket can become infected if after care advice is not followed. Those with lowered immune systems are more likely to develop an infected socket, such as those with diabetes, HIV, cancer or renal transplant patients. Smokers are at an increased risk of an infection.

Dry Socket

This occurs due to a breakdown in the wound healing process and usually presents as severe, constant pain 2 to 4 days after an extraction. It is more likely to happen if you smoke.

Stiffness of the jaw

Mouth opening can be limited or there may be pain whilst opening for three to four days following an extraction.

Bad breath

You may experience bad breath; this is unlikely to last more than a week.

The alternative to an extraction is to either leave the tooth, although this puts you at risk of pain and infection, or root canal treatment.

Extractions are available privately and on the NHS. On the NHS you will be subject to a band 2. Extractions are included in the Denplan Care Contract. For private pay as you go patients, the charge for an extraction can be found within our Private Dental Charges List.