What does Dental Bonding involve?

Dr Stevie takes care of you through this procedure. He will first apply a gentle solution
to the surface of your teeth. We leave this on the teeth for around half a minute after
which we rinse the solution off with water. This solution will etch the surface of the
tooth to hep the bonding material stay in place. This process doesn’t hurt. The putty like bonding material is then placed on the tooth surface, shaped and sculpted. Aspecial blue coloured light is used to help the material harden and set . Finally the
composite is polished and buffed for a smooth finish

Advantages of dental bonding include:

Cost. The average cost of dental bonding ranges per tooth from £199 – £350
per tooth. There may be additional charges for trial smile.

Speed. Dental bonding typically requires 1-2 visits.

Ease. Injections or anaesthesia is usually not needed, unless bonding is being
used to fill a decayed tooth. Compare to porcelain veneers and crowns, dental
bonding also requires the least amount or no tooth removal.

Disadvantages of dental bonding include:

Bonding material can become stained. Unlike crowns and porcelain veneers,
dental bonding is more prone to staining. Coffee, tea, red wine and cigarette smoke
can stain the material used in dental bonding.. To minimise you’ll need to avoid these
substances for 24 to 48 hours. If you’re a smoker you will want to choose a different
form of cosmetic dentistry.
Less durable. Additionally, the material used in dental bonding isn’t as strong
and long lasting as porcelain veneers and crowns. It can potentially chip. With proper
care though, dental bonding can last 3-7 years. If the material does fracture, there is
likely to be an additional charge to repair it in the future.

Alternative options to Dental bonding:

Porcelain Veneers. Porcelain can be used in a similar fashion to composite.
Modern techniques rarely need to heavily adjust the teeth to ‘stumps’, as many
people are worried about. We carry out many NO-PREPARATION porcelain
veneers. Porcelain provides a stronger, more stain-resistant surface, which will
end to survive 10-15 years. Although usually more expensive, porcelain is often the
cheaper long-term solution for larger smile makeovers.
Teeth straightening ( Orthodontics). Braces have improved enormously in
recent years, and often treatment is completed in
just a few months. Ultra- cosmetic
systems are now available. Braces are used to
correct tooth position problems and will be
discussed as an option at your consultation if
appropriate.

Potential Risks, Complications and Important considerations:

• Is tooth enamel drilled? – In most instances composite veneers are applied with no
obvious drilling to the natural tooth enamel. In the case that there is existing large tooth
position problems, the option of some tooth adjustment will be discussed with you at your
consultation if it results in an improved final alignment. For cases that require tooth
adjustment you will be advised beforehand and any alternative solutions (braces) will be
suggested as an option.

• Will you need an injection? – The majority of all cases are completed pain-free and
without the need for local anaesthetic. Exceptions to this are when we are combining
treatment with some filling replacements or situations requiring gum contouring.

• How will it feel afterwards? As with any changes to the teeth, the composite veneers
will feel new and you may feel aware of the surfaces for a few days. Take extra care on
biting during this period until you are used to chewing with your new smile. The composite
resin is fully hardened instantly on placement and no extra care need be taken in this
respect. You should be able to eat, drink, brush and floss with confidence the same day!

• Sensitivity of teeth

• How long does dental bonding last? As with any cosmetic dental procedure composite
veneers will not last forever, and will eventually need to be replaced. Reasons for
replacement may include chipping, colour fade, natural underlying tooth movement or
veneer loss.
• Can you whiten composite bonding? Although composite cannot actually be
whitened, stain reduction is improved with careful daily cleaning and the occasional use of
dental whitening products. Teeth whitening on any teeth planned to be left untreated is
usually carried out before the bonding appointment, and the veneer shade can be chosen
later. The most suitable system to whiten your teeth will be discussed at your consultation.
All whitening results WILL NATURALLY FADE and occasional whitening top-ups may be
required using at home use products.

• Review appointment. Once bonding placed on teeth a review appointment will be
booked to ensure happy with your results. Should you desire any changes to shape and size
of teeth you must discuss at the review appointment. Additional charges will be added for
alterations at a later date.

• Maintenance of bonding. This is required to retain appearance of composite bonding
as bonding is prone to staining just like natural teeth.

• Shade Match. Before the procedure is undertaken we will endeavour to ascertain the
correct shade of material to suit your needs. Please be aware that once the shade has been
agreed it will be possible to change but will incur extra charges.

•Longevity. It is impossible to place a specific time
criteria on the actual length of time that composite
bonding will last, although 3-7 years is commonly
reported.

•Wearing a Night time appliance. If there is a
predisposed tenancy to clench and grind your teeth at
night, your composite will be at risk and therefore
extremely important to wear the night time appliance
provided.

• Unable to bond composite filling to metal fillings, porcelain/metal crowns. All
metal fillings can be replaced with bonding and existing crowns can be replaced in order to
match new bonding procedure.

Maintenance of Dental Bonding
After your bonding appointment. We ask that you arrange a follow-up review
appointment within the 1-2 weeks after having your bonding placed. This will allow us to
confirm you have had no difficulties and advise you on any ongoing home care. At this
appointment there may be small adjustments requested or required before a final polish is
carried out.
You should brush your teeth as normal the same
day, and at least twice daily from then on. Take
extra care to ensure the edges at the gum line are
cleaned well to prevent any staining or gum
irritation. Flossing is advised, as is the use of a
routine daily mouthwash (e.g. Listerine Total). We
recommend brushing with a good electric toothbrush (e.g. Braun Oral B or Philips Sonicare)
together with a main brand fluoride tooth- paste.
Dental bonding is more susceptible to staining and
chipping than other forms of cosmetic dentistry,
special care is required to keep your bonded teeth looking natural. Here are some tips to keep
your dental bonding in tip top shape;

Things you can do to help:

• Cut down on coffee, tea and red wine.
• If you’re a smoker, you must quit before placing your bonding – not to mention that
smoking also increases your risk of gum disease and oral cancer.
• Since dental bonding can chip, avoid biting your nails or chewing on hard objects, such as
ice, pencils and raw carrots.
• Use an electric toothbrush at least twice daily for 2 minutes to ensure excellent hygiene is
maintained. Floss in between your teeth or use recommended interdental aids.
Things you must do to keep the bonding looking fresh and safe:
Regularly visits to the hygienist to get your teeth and bonding cleaned (every 3-6 months).
Yearly polish by Dr Stevie to maintain bonding shine
Wear a night time retainer to prevent your teeth from moving or chipping.
Finally if the bonding fractures or chips, which can happen at ANY time there will be a
charge for repair of this. I do include 6 month free repairs after the cost of the repair will
normally be the full cost paid again for the tooth again although it does depend on the size of
the chip

FACT: Tooth decay was extremely rare until REFINED SUGARS became a part of our diet.
There are virtually no real conditions, which cause ‘weak teeth’.

You can brush regularly, use interdental brushes daily and lots of mouthwash and these may
help, but only a little if the sugar exposure continues. Seeing the hygienist for cleaning is also
important for gum health but, again, doesn’t help much in the face of frequent sugar intake.
Regular top ups of SUGAR in your mouth will EASILY and COMPLETELY overwhelm any amount
of toothpaste, frequent brushing, mouth washing and other strategies below.

How is decay formed?

Decay in teeth is caused by SUGAR, which combines, with BACTERIA in the mouth on a TOOTH
SURFACE. Bacteria in your mouth convert sugar to acid. The acid dissolves the tooth from the
outside and goes deeper and deeper everyday.
Sugar + Bacteria + Tooth surface = Dental decay

What can I do about it?

The main areas that you can do something about include:
1. Reduce the frequency of sugar intake to no more than four per day
2. ‘Fluoride’ application – protects the teeth
3. Cleaning your teeth (to reduce bacteria)
4. Chewing sugar-free gum (encourages the healing effects of saliva and if it contains
xylitol it can do even more)
5. Regular check ups and hygiene care.

1. Sugar intake

Decay and sugar go hand in hand. No matter what you think or what you have been told, decay
is caused by sugar going into your mouth.
Most sugars are found in processed and manufactured foods and drinks including:

• Sweets and chocolates, cakes, puddings and biscuits, fruit pies, pastries, buns, ketchup,
  ice cream, fresh fruit juice, sugar in tea and coffee, dried fruits, alcopops.
  Your teeth can take up to 4 hits of sugar a day (including drinks and meals). A sugar hit is anything that contains sugar in any form. For example, 3 daily meals (breakfast, lunch and dinner) count as 3 hits of sugar leaving 1-2 for the rest of the day. Going above this increases the acidity in the mouth leading to decay.

What you can do:

• Limit the number of sugar hits to the teeth per day to preferably 4 daily or a maximum
  of 5 but no more.

2. ‘Fluoride’ application

Brushing the insides, outsides and between your teeth for two minutes per day with a fluoride
toothpaste is very helpful

What your dentist or hygienist can do:

• Provide upper and lower fluoride trays, which are designed to fit over all of your teeth.
  You can use them to bathe your teeth in a strong fluoride gel every day or every other
  day for 20 minutes at a time.
• Apply fluoride varnish (strong toothpaste that you leave on) immediately after all of
  your teeth have been cleaned which will give your teeth a fluoride boost.
• Provide ‘fissure sealants’ which seal over the teeth to stop sugar and bacteria getting in
  there.
• Prescribe you super strength toothpaste

What you can do?

• Use a fluoride toothpaste (1350-1500ppm) twice daily
• Spit out your toothpaste, do not rinse with water as this washes off the fluoride so it will
  not work!
• Use mouthwash at a different time to brushing your teeth

3. Cleaning your teeth

Cleaning your teeth removes bacteria and sugar in the mouth and allows you to apply fluoride.

What you can do:

•  Brush your teeth TWICE DAILY – once last thing at night before bed and at one other
  time in the day – this means brushing the front, back AND in between your teeth!
• Consider the use of a rotating head toothbrush and inter-dental brushes
• Seek professional advice on how to clean your teeth and visit your dentist regularly.

4. Chewing sugar-free gum

XYLITOL SUGAR-FREE gum or the use of xylitol sweetener instead of sugar encourages saliva
flow and helps to neutralise acids in the mouth. ‘Orbit Complete’ gum can be bought in most
newsagents and supermarkets and contains 1 gram of xylitol per tablet. It takes 10 minutes for
saliva to be stimulated and for the xylitol to be released.

What you can do:

•  Chew two tablets for a maximum of 10 minutes after meals/food

Remember: You are in control of your dental health.

With each procedure we try our upmost best to achieve the best possible outcome, however we need your help!

All dental work requires a solid foundation. The gums and bone provide the foundations for your teeth and we need these to be healthy before we work on any aspect of your tooth.

What can you do to help us:

1. Brushing your teeth: Brush your teeth twice a day using a fluoride toothpaste. It is important that you brush the gum area as well as the tooth but please do it gently.
2. Interdental cleaning: Unfortunately your toothbrush can not reach the area of gum between your teeth, so we need to use special inter-dental brushes. These come in different sizes and your dentist will let you know which size you need. If you are having difficulty getting these between the teeth (common at the front of the mouth) then please use floss.

   

   Ideally these need to be used between each tooth at least once daily. It would be great if you could do this each day before our next appointment. 

   This will allow us to do our work to the best possible standard

   We look forward to treating you!

When the enamel, or protective surface of your teeth, wears away, it exposes the underlying material, called dentin. This leaves your tooth vulnerable to plaque and bacteria, which cause decay.

What causes tooth erosion?

Calcium is a key ingredient in building strong teeth. Unfortunately, exposing your teeth to acid can leach calcium from your enamel, causing this protective surface to break down. Acid can come from many sources, including the following:

• Whether you choose red, white or rosé, drinking wine will soften your enamel.
• Fruit juice. The most acidic options include lemon, cranberry, orange and apple.
• Citric fruits. Snacking on oranges, lemons and limes can wear down your teeth.
• No sugary sweets are good for your teeth, but pay extra attention to avoid sour gummies and candies.
• Even though sugar itself does not contain high levels of acidity, it promotes the growth of acid-creating bacteria in your mouth, creating an acidic environment.
• Stomach acid. Vomiting and reflux also can cause serious tooth damage when stomach acid comes into contact with your teeth. If you suffer from an eating disorder, acid reflux or a related condition, seek professional help.

What are some signs of tooth erosion?

Acid wear may lead to serious dental problems. It is important to notice the signs of tooth erosion in its early stages (sensitivity and discoloration) before more severe damage occur, such as cracks, pain and decay.

• As your teeth’s protective enamel wears away, you may feel a twinge of pain when you consume hot, cold or sweet food and drink. As more enamel is worn away, teeth become increasingly sensitive.
• Teeth can become increasingly yellow as the thinning enamel layer exposes the underlying dentin.
• Rounded teeth. Your teeth may have a rounded or “sand-blasted” look.
• Your front teeth may appear slightly translucent near the edges.
• Small cracks and roughness may appear at the edges of teeth.
• Small dents may appear on the chewing surface of the teeth, and fillings may appear to be rising up out of the tooth.

What can I do to prevent tooth erosion?

Follow these tips to reduce the effects of acid on your teeth.

• Eat with meals. Instead of snacking throughout the day, save acidic foods for mealtimes. This will reduce their contact with your teeth and help neutralize the acid by eating it with other foods.

Such as Milk, Cheese, Sugar free gum, water

• Wash down with water. Sip water alongside or after the acidic food or drink to wash it out of your mouth.
• Use a straw. If you drink acidic beverages, reduce their contact with your teeth by using a straw and finishing the drink quickly, instead of sipping over a long period of time.
• Look for low or no-sugar drinks. Read nutrition labels to keep down your sugar consumption and consider options like water, tea and coconut water.
• Wait before brushing. Acid softens your enamel, so brushing immediately after eating or drinking high-acid foods or drinks can actually cause damage. Wait at least half an hour and then start brushing. In the meantime, you can always rinse your mouth with tap water

Periodontal disease affects millions of people and it is one of the main causes of tooth loss.

In the early stages Periodontal Disease is a ‘silent’ condition and you may not be aware that a problem exists until the disease is quite advanced, which is why it is very important to have regular check ups so that we can detect any problems in the early stages of the disease.

What is Periodontal Disease?

Each tooth consists of two parts namely the crown, which is visible in the mouth and the root, which anchors the tooth into the bone. Each front tooth has one root whilst the back teeth have one, two or three roots.

The gums are a specialised type of skin that surrounds the teeth and covers the bone holding in the teeth. Often the gums will look essentially normal even though a gum condition is present and this is why a thorough examination by a dental professional is required to detect a gum problem.

Gingivitis is a superficial infection that is limited to the gum tissue and does not affect the underlying bone. The gums may look normal but may have some of the following signs – redness and puffiness, bleeding when brushing and bad oral odour (Halitosis).

When the infection advances and affects the supporting ligament and underlying bone, it is termed Periodontitis (once called Pyorrhoea).

Periodontitis ‘eats away’ at the bone that supports the teeth and if untreated can lead to tooth loss. The gums may appear red and swollen, spaces may begin to appear between the teeth, there may be loosening of the teeth, signs of receding gums and vague aching, itching or other discomfort of the gums.

The good news is that most periodontal diseases can be treated.

What causes Periodontal Disease?

Plaque is a primary cause of Periodontal Disease. It is a sticky, almost invisible film that forms daily on our teeth. Plaque is a continually spreading mass of disease-causing bacteria and their waste products, which grow on the teeth and down in the crevice between the gum and tooth. The bacteria produce toxins (poisons) that damage the gums and underlying bone.

Plaque build-up irritates the gums, and they become inflamed. In time the periodontal fibres that attach the teeth to the bone are destroyed and the underlying bone is lost, the crevice deepens which creates a ‘pocket’ which then fills with more plaque. In large amounts plaque can be seen and can be felt with tongue as a fuzzy, unclean coating on the teeth. If you do not completely remove all the plaque every day by tooth brushing and cleaning in between the teeth, it leads to the formation of calculus (tartar), a stony crust with a pitted, rough surface. You cannot remove calculus yourself- it clings to the teeth with such force that only a dentist or hygienist can remove it.

As the gum disease continues so does the bone destruction. When sufficient bone has been lost the tooth loosens. Finally, deprived of most of the supporting bone, the tooth becomes so loose that is either falls out or must be extracted.

As the pockets get deeper, and the plaque hardens into tartar more plaque accumulates on top.

Tartar moves down to the root of the tooth It is possible to see the calculus that forms above the gum margin however it is the hidden calculus under the gums that does the harm. Calculus greatly complicates the problem of preventing the progression of Periodontal Disease. The toxins produced by the bacteria in plaque not only affect the gum but also destroy the periodontal fibres and will eventually destroy the bone supporting the tooth.

As the gum disease continues so does the bone destruction. When sufficient bone has been lost the tooth loosens. Finally, deprived of most of the supporting bone, the tooth becomes so loose that is either falls out or must be extracted.

In recent studies, health problems have been linked with people who have Periodontal Disease. Studies have shown that bacteria from the mouth can enter the bloodstream which is being increasingly associated with:

• The increased risk of heart disease, fatal heart attacks and strokes
• Make it more difficult for diabetic patients to control their blood sugar
• Lead to reduced birth weight and premature babies for pregnant women

Other factors that contribute to an increased risk of developing Periodontal Disease include:

• Smoking
• Systemic diseases e.g. diabetes
• Many medications e.g. steroids, blood pressure medications
• Pregnancy
• Plaque retention factors e.g. crowns and bridges that no longer fit and overcrowding of the teeth

A periodontist is one of the nine specialties recognized by the General Dental Council.  From the Greek word “peri” meaning “around” and odons signifying “tooth,” a periodontist deals with the gums and supporting structures around your teeth.  A periodontist can be seen in conjunction with your regular dentist for the treatment and maintenance of gum disease.

A periodontist has many treatment options to restore gum disease to health.  Typically, the initial treatment may include a non-surgical method of scaling and root planning. Plaque , tartar, rough cementum and diseased tissue is removed from the surrounding tooth and root surface.  This method is called NSPT (Non-Surgical Periodontal Therapy) in which the bacterial viruses are eradicated to promote healthy re-growth.

If the disease is in an advanced stage, periodontal surgery can be employed.  Some commonly prescribed surgeries include: pocket reduction (also known as gingival flap surgery), regeneration, crown lengthening, bone graft or soft tissue graft.  In these procedures your periodontist will either fold back your gums to remove infection-causing bacteria, eliminate an overgrowth of gum tissue, replace lost bone or cut off tissue from elsewhere in your mouth and attach it to your gumline.

BPE (Basic Periodontal Examination)

The standard World Health Organisation screening process for gum condition is known as the BPE (Basic Periodontal Examination).

The mouth is divided into six sections referred to as sextants. (Upper and lower: front, right back and left back.)

A blunt probe with a 0.5mm ball at the end is carefully and gently placed in the space between the tooth and gum at 4-6 points round each tooth and the deepest pocket in that section of the mouth is noted in a 6 part grid (see example below). The other factors noted are the presence of plaque or calculus above and below the gum margin, and whether the gum bleeds at the slightest touch.

If you are having any problems. Please email or ring up the practice. Below are just a couple of things I thought I may share.

1. Just some tips about using invisalign

With any good habit, it takes time to adopt and adjust to changes in your daily routine. Fortunately, many of our patients tell us that after only a week or two of full-time wear, they are actually more comfortable with the aligners in than out. Full-time wear means wearing your aligners for at least 22 hours a day. You should only remove them for a total of 2 hours per day to eat, drink, and brush your teeth. You will know your teeth movements are progressing well when each new set of aligners fits comfortably on your teeth. In contrast, lack of full-time wear can cause each aligner to fit progressively worse. This will create an eventual need to take new impressions or scans and remake the aligners. This will lengthen your treatment time so we strongly encourage you to be diligent about wearing your aligners. If you do not wear you them as much as you should please wear them for a few days longer

2. If you are having trouble making sure the aligners are seated. One can use these chewies below to basically ensure the aligners are seated well. these are small cylindrical cushions made of a plastic-like material called Styrene Copolymer. By biting down on chewies a few times a day for a couple of mins at a time, you will help seat the aligner, which means the aligner fits tightly against your teeth. Using chewies regularly will increase the likelihood that you will finish treatment on time. They can be reused until they get worn

Orthodontic Aligner Chewies 6 Pack by Smilebitz https://www.amazon.co.uk/dp/B0195NBWHC/ref=cm_sw_r_cp_api_CV5aAbQM74GTD

3.After several days of use, the aligners can get stained. Although not needed, a lot of people like to get these to clean the aligners. This pack below has 96 tabs which says 3 months supply but you would probably only need 2-3 per week. Depending on how clean and fresh you want to keep them so may decide to go for the 36 pack You may not even need any! Some people use them, some people don’t. Completely up to you.

Retainer Brite Cleaning Tablets, 96-ount https://www.amazon.co.uk/dp/B005GRGARE/ref=cm_sw_r_cp_api_rY5aAb2BC5E09

4. Many people struggle getting them in and out the first but by the next ime I see them most people have mastered the art! Occasionally I if you teeth are very crowded to begin with I recommend this tool to help you, as your teeth become more inline it should get much easier.

5 Pieces Aligner Removal Tool Invisible Tooth Removal 20 Pieces Teeth Interdental Brushes Toothpick Brush Cleaners for Invisible Braces Tooth Cleaning Remove Tool: Amazon.co.uk: Health & Personal Care

Things which we are going to do at the next appointments

Invisalign treatment plans are composed of more than just the aligners. To maximize the effectiveness of the aligners, we strategically place attachments on specific teeth. Attachments are small tooth-coloured dots of white filling material called dental bonding. Since aligners are removable, they can slip when trying to make certain movements. In these situations, attachments are used as an anchor to help the aligners get a better grip on your teeth. How visible your attachments are depends on where they are placed and how well the bonding colour matches the shade of your teeth. In general though, they are not easily seen.

We also need to perform interproximal reduction (IPR), which is gentle sanding in between teeth to create more space. The computer modelling tool we use identifies where we need more space for alignment or for the occlusion (bite). It also tells us exactly how much is needed. You can rest assured that IPR is a very safe procedure that gives your teeth the room they need to move into their ideal positions.

If all goes to plan, we should complete the treatment in the number of aligners as shown on the clinicheck. Sometimes things need a bit of fine tuning or some teeth need an extra push. The more you wear the aligners the less chance of this happening. If so we will take new impression towards the end and get some new aligners made.

At the end of the treatment we will make your retainers which will help stop teeth moving. Some people would rather a wire put on the back of the teeth, which we can do but that will be an addiotnal cost

After all the teeth are straight we then can get started on whitening teeth if you desire. A lot of patients  also decide to have “bonding” to change the shape of a few teeth. This is involves no drilling but can really improve the look.

Please enquire if interested