B'H
Dental treatments - philosophy
We pride ourselves of a minimal invasive treatment approach. We aim to perform treatments in a way that will preserve as much tooth substance as possible, leading to a better survival rate for the tooth nerve and for the tooth itself.
This means that whenever possible we will
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prefer a direct composite restoration over making a crown,
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offer refurbishment and repair of fillings and restorations over complete renewal and replacement,
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recommend fissure sealants over fillings for superficial tooth decay.
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We follow evidence- and clinically-based recommendations for detecting and diagnosing early/non-cavitated caries lesions, for risk assessment and for disease management.
It is widely accepted that non-cavitated caries lesions can be managed non-invasively in the majority of cases. The spectrum of measures to control early caries includes guiding the patient towards a tooth friendly diet and appropriate removal of the dental bacterial plaque, usage of fluorides at home and in the dental surgery as well as use of sealing techniques.
We strive to teach our patients excellent brushing and eating habits that will keep teeth and gums healthy and preserve life long good aesthetics and function.
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When treating children and adolescents it's the aim of the practice to follow The European Academy of Paediatric Dentistry (EAPD) policy documents for Best clinical practice. This means for example:
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Performing caries risk assessment at a child’s first dental visit, and reassessments on a regular basis.
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Offering preventive measures that can arrest early caries and improve individual and public dental health.
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Use of visual and radiographic caries detection to locate, assess and monitor non-cavitated caries lesions in primary and permanent teeth.
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Use of appropriately administered local analgesia for effective pain-control when treating children.
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Referral of traumatised immature permanent anterior teeth for specialist care.
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Treatment risks and consequences
Treatment: Fluoride varnish
Description: Fluoride varnish is used to delay dental decay. Fluoride varnish can also be used to ease sensitivity.
Risks: None if the maximum doses are not superseded.
Possible side effects: Allergy to ingredients.
Consequence of treatment: Treatment with fluoride varnish reduces the risk of teeth needing fillings.
Consequence of no treatment: Higher caries progression rate and risk of need for fillings.
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Treatment: Fissure sealant
Description of treatment: Sealing of chewing surfaces with a low-viscous composite.
Risks: The treatment requires good moisture control. Lack of moisture control will most likely cause the sealant to break off.
Possible side effects: Allergy to ingredients.
Consequence of treatment: The tooth is easier to keep clean. The treatment reduces risk of need for fillings.
Consequence of no treatment: Higher risk of cavities on chewing surfaces.
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Treatment: Local anesthesia
Description of treatment: Injection of local anesthetic
Risks: Haematoma (bleeding from a perforated blood vessel), paraesthesia (altered sensation that extends beyond the expected duration of anaesthesia).
Possible side effects: Allergy to ingredients.
Consequences of treatment: Pain free treatment.
Consequence of no treatment: Treatment painful or not possible to carry out.
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Treatment: Filling in primary tooth (baby tooth)
Description of treatment: Removing unhealthy tissue from the tooth and replacing with glasionomer/compomer filling material.
Risks:
Broken tooth/broken filling.
Decay next to filling.
The nerve in the tooth can become exposed during removal of the unhealthy tissue and the tooth will need root treatment or extraction.
The nerve can be damaged from the decay or filling procedure followed by pain / infection and the tooth will then need root treatment or extraction.
Possible side effects: Allergy to ingredients.
Consequences of treatment: Keeping the primary tooth until the permanent tooth is ready to come through.
Good oral hygiene is required for a good prognosis for the treatment.
Consequences of no treatment: Further progression of decay and risk of pain and infection. Higher risk of early tooth loss followed by later crowding of the permanent teeth and need for Orthodontic treatment (braces).
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Treatment: Root treatment on primary tooth (baby tooth)
Description of treatment: Removal of most of the nerve tissue on a primary tooth by cleaning the nerve chamber but not the roots. Filling with analgesic cement and glasionomer/compomer filling material.
Risks: Infection, tooth breaking, decay next to filling. Risk of tooth loss.
Possible side effects: Allergy to ingredients.
Consequences of treatment:
Keeping the tooth until the permanent tooth is ready to come out.
Reduces risk of pain, fracture and infection due to decay.
Good oral hygiene is required for a good prognosis for the treatment.
Consequences of no treatment: Progression of decay and risk of pain, infection, fracture, early loss of tooth with further risk of crowding of permanent teeth and need for future Orthodontic treatment (braces).
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Treatment: Hall crown (steel crown)
Description of treatment: cementing steel crown on top pf decayed primary tooth
Risks: infection if the nerve has already suffered damage prior to treatment
Possible side effects: temporary change in bite, will sort itself out within a couple of weeks
Consequences of treatment:
Keeping the tooth until the permanent tooth is ready to come out.
Reduces risk of pain, fracture and infection due to decay.
Good oral hygiene is required for a good prognosis for the treatment.
Consequences of no treatment: Risk of pain, infection, fracture, early loss of tooth with further risk of crowding of permanent teeth and need for future Orthodontic treatment (braces).
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Treatment: Silver Diamine Fluoride treatment
Description of treatment: off label (alternative) use of SDF (sold as a desensitizer product) used to stop caries progression in the primary tooth (baby tooth). Can be used when the child is unable to cooperate for any other treatment.
Risks: black staining of caries lesion/baby tooth. Caries progression despite SDF treatment.
Possible side effects: allergy to ingredients.
Consequences of treatment: Arresting caries and keeping the tooth until the permanent tooth is ready to come out. Reduces risk of pain, fracture and infection due to decay. Good oral hygiene and low sugar intake is required for a good prognosis for the treatment.
Consequences of no treatment: Progression of decay and risk of pain, infection, fracture, early loss of tooth with further risk of crowding of permanent teeth and need for future Orthodontic treatment (braces).
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Treatment: Composite fillings in permanent teeth.
Description of treatment: Removal of the unhealthy tissue and replacement with a tooth coloured filling material (composite).
Risks:
Broken tooth/broken filling.
Decay next to filling.
Discoloration of composite.
The nerve in the tooth can become exposed during removal of the unhealthy tissue and the tooth will need root treatment or extraction.
The nerve can be damaged from the decay or filling procedure immediately/later followed by sensitivity / pain / infection and the tooth will then need root treatment or extraction.
Possible side effects: Allergy to ingredients.
Consequences of treatment: Better chance of keeping the tooth.
Good oral hygiene is required for a good prognosis for the treatment.
Consequences of no treatment: Further progression of decay and risk of pain and infection. Higher risk of early tooth loss followed by later crowding of the permanent teeth and need for Orthodontic treatment braces). Progression of dental decay. Risk of pain and infection. Risk of loss of tooth.
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Treatment: Root canal treatment on permanent tooth
Description of treatment: Removal of the nerve tissue by cleaning the nerve chamber and roots with burs, root files and irrigation with disinfectant. Filling with root filling material.
Risks:
Perforation of root during treatment, not being able to access all canals or access beyond a sharp root bend, allergy to irrigation solution, damage to skin/oral mucosa due to accidental spillage of irrigation solution, paraesthesia if irrigation is inadvertently extruded beyond the root canal, broken root files/instruments if not able to remove to be left in the roots with a lesser good prognosis for healing, unable to root fill due to calcified canal, under or overfilling of roots, pain, tooth breaking, tooth loss, darkening of tooth, persistent or recurrent infection/abscess and need for re-treatment/surgical treatment/extraction.
Root filling success rate approx 70% when carried out by a General Dentist.
Possible side effects: Allergy to ingredients.
Consequences of treatment: Better chance for keeping the tooth. Reduces risk of pain, fracture and infection due to decay. Good oral hygiene is required for a good prognosis for the treatment.
Consequences of no treatment: pain, infection/abscess, tooth loss.
After treatment: Root-filled teeth are more likely to break than healthy unrestored teeth and should therefore have a crown or a composite filling after treatment.
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Treatment: Extraction of tooth
Description of treatment: Removal of the tooth.
Risks: Broken tooth. Tooth grown in to bone. Not possible to remove all parts of the tooth/roots and having to refer to hospital for surgical removal (long wait).
Possible side effects: Risk of perforation to sinus (some upper permanent molars). Risk of prolonged bleeding. Risk of pain/infection after extraction.
Consequences of treatment: Reduced risk of infection from decayed tooth. Reduced risk of pain from decayed/infected tooth.
Consequences of no treatment: Higher risk of pain and infection from decayed/broken/infected tooth.
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Treatment: Crown
Description of treatment: Preparation of tooth and fit of crown to cover the tooth
Risks:
Reversible/irreversible nerve complications after treatment and need for root treatment.
Porcelain bonded crowns often leave a grey margin at the gum.
Possible side effects
Decay in relation to crown.
Consequences of treatment: Tooth will be protected from chipping.
Consequences of no treatment: Tooth can easier break.
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Treatment: Post-core
Description of treatment: Post in root after root treatment to support a crown or composite build up if there is not much tooth left.
Risks:
Fracture of root whilst drilling for post or when placing post leaving the tooth unrestorable.
Possible side effects
Later root fracture leaving tooth unrestorable.
Consequences of treatment: Able to keep the tooth and have tooth restored with composite or crown.
Consequences of no treatment: Restoration will not stay/not possible to restore tooth.
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Treatment: Periodontal root scaling, with ultrasonic scaler, with or without laser
Description of treatment: Scaling and cleaning of root surface with use of hand instrument and ultrasonic scaler.
Risks:
Soreness after treatment.
Teeth may temporarily become looser.
Gums receding and thus form gaps between teeth making teeth appear longer with food packing.
Possible increased sensitivity of the exposed root surfaces to hot, cold and sweet food/drinks.
Possible side effects: Soreness of gums. Sensitivity. Receding gums.
Consequences of treatment: Stabilisation of the disease and reduced risk of tooth loss. Good oral hygiene is paramount for a successful treatment outcome.
Consequences of no treatment: Larger and faster progression of gum disease/periodontitis.
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Treatment: Periodontal surgical root scaling
Description of treatment: Incision of gum, cleaning the root surface and suturing of gum.
Risks:
Prolonged bleeding. Secondary infection. Teeth can feel looser immediately after treatment.
Possible side effects
Sensitivity after treatment. Recession of gum.
Consequences of treatment: Possible to clean root surfaces with a direct view. Better chance of stopping further progression of the gum disease/periodontitis.
Good oral hygiene is paramount for good healing after surgery and for a successful outcome of the treatment.
Consequences of no treatment: More difficult to clean root surfaces when hidden under the gum. Progression of disease more likely.
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Treatment: Tooth whitening
As in all aesthetic enhancement procedures, there are variables and end results of tooth whitening are not guaranteed. In most cases your teeth will become several shades brighter. The type of discoloration affecting your teeth, your dietary habits, maintenance and overall condition of your teeth may affect the outcome of the treatment and the term of the results.
Whitening procedure is not recommended for pregnant or lactating women or children.
Potential side effects and possible alternatives include but are not limited to:
1. Tooth sensitivity may occur during tooth whitening. This is a temporary side effect and usually resolves itself. It may be relieved by a mild analgesic such as Advil, Tylenol or Fluoride treatments in conjunctions with whitening.
2. Leaky, faulty restorations or cavities must be treated before beginning or
continuing with the procedure.
3. Exposed root surfaces, grooves, notches or depressions where the teeth meet the gums, will be isolated from whitening gel, yet may be sensitive during and/or shortly following treatment.
4. Dental restorations such as bridges, caps, veneers and fillings will not lighten with your tooth whitening and may need partial or complete replacement to match the new shade of your teeth.
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