About the work of a DENTAL HYGIENIST
Dental hygiene is the preventative approach to oral health that will help you maintain healthy teeth and gums for life. The utilisation of dental hygienists at Blackburn Dental Group provides us with a greater opportunity to help you do this.

WHAT IS A DENTAL HYGIENIST?
Dental Hygienists are specially trained members of the dental team who work together with our dentists to provide fully integrated dental care. They play an important role in oral health, by providing individualized preventative treatment and demonstrating correct home care to patients to prevent dental disease and tooth wear.

WHAT IS THE HYGIENIST’S ROLE IN THE DENTAL PRACTICE?
Hygienists perform four main functions:
1. Dental hygiene education tailored to the patient’s needs. This one‐on‐one instruction includes care for your gums and teeth, and information on dietary habits and health conditions which may be adversely affecting your oral health.
2. Collaborate with your dentist to plan an oral health maintenance program, including assessment of your periodontal (gum) health, evaluation of radiographs and review of your medical history.
3. Removal of calculus deposits and stains from teeth.
4. Application of decay preventing agents & recommendation of products for home use.

IS THERE ANY DISCOMFORT?
Usually dental hygiene treatment is pain free. If you find treatment uncomfortable it is important to discuss this with your Dental Hygienist. Various techniques are available to help.

WHY IS HOME DENTAL CARE SO IMPORTANT?
Dental disease can be prevented. Effective home plaque control techniques help to prevent gum disease and tooth decay. Such problems are then less likely to progress into more serious dental ailments, resulting in extensive and costly dental treatment.

WHY DOESN’T THE DENTIST DO THE WORK?
The Dental Hygienist has been specially trained to perform preventive treatment and maintenance of the mouth, teeth and gums. Your Dentist will refer you to a Dental Hygienist for more specialised oral care while they provide complex restorative or cosmetic care.

IS IT EXPENSIVE?
Any preventative care will ultimately lead to savings. Depending on the type of treatment carried out and the length of the appointment, costs may vary. It is important to agree to and confirm the cost of the visit before the Dental Hygienist begins treatment.

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Endodontics or Root Canal Therapy

What is it?
Endodontics or root canal therapy may be required on a tooth if the dental pulp (consisting of the nerve and blood supply within the centre of the tooth and roots) is infected or inflamed. Inflammation or infection can be precipitated by a deep cavity, large deep fillings, trauma, cracks in the tooth, extreme wear or gum disease.

What does it achieve?
Many millions of teeth are saved around the world each year by having endodontic treatment. The aim of endodontic treatment is to clean, shape and sterilize the root canal before filling the canal to prevent further infection.

What does it involve?
Prior to commencing endodontic treatment all decay needs to be removed and the tooth stabilized. This may involve removing all the old fillings and placing a stainless steel band around the tooth. The tooth is also assessed for its suitability for long term restoration. A sheet of rubber (rubber dam) is placed around the tooth to isolate it from the rest of the mouth. Access is made through the biting surface of the tooth to the canals. The canals are measured then cleaned and shaped with hand files and rotary NiTi files. Finally a sedative dressing is placed and the tooth is sealed. At the next visit rubber dam is again placed and the dressing is flushed out. If suitable the canals are filled with a rubber like material called gutta percha. The tooth is then sealed. Further appointments may be required to place the definitive restoration on the tooth. The endodontic treatment is performed with the tooth anaesthetized like when a filling is done so there should be no sensation.

What happens after the root filling?
Success in endodontics involves the complete removal of bacteria from the canal system and surrounding tissues. This resolves the symptoms. Typically a tooth which requires endodontic treatment has had significant loss of tooth structure and so it is weakened. To decrease the risk of the tooth fracturing or splitting your dentist is likely to recommend that a crown is placed on the tooth. The crown acts as a ring around the tooth to help hold it all together. Occasionally a tooth may have darkened before or after endodontic therapy and it may be appropriate to bleach some of this stain from the tooth.

What are the possible risks?
As with all dental and medical treatments, root canal therapy has risks. Possible complications include:
• Complex root and canal anatomy may necessitate referral to a specialist endodontist for root canal therapy. This is more likely with molar teeth.
• Infection. Whilst every effort is made to treat the infection occasionally the canal system will become reinfected and require retreatment or removal of the tooth.
• Fractured or separated instruments. Endodontic instruments are made to the highest standard but they are very fine and so there is the uncommon risk of the instrument fracturing in the canal. In many cases this does not affect the final outcome but it could mean loss of the tooth.
• Weakness and fracturing of the tooth. Root filled teeth may not be as strong as other teeth particularly if they have extensive fillings. There is a risk of the tooth fracturing and so a crown is usually recommended following root canal therapy to reduce the risk of the tooth collapsing.
• Discoloration of the tooth may occur before or after root canal treatment. This may be corrected on an anterior tooth with bleaching or placement of a veneer or crown.

For further information see www.aae.org/patients/patientinfo/faqs/rootcanals/

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Digital Radiographs (X-rays)

At Blackburn Dental Group we have invested in many new technologies in order to provide a better, safer and easier dental service. Digital radiographs (x‐rays) are one of these technologies.

Why do we need dental radiographs?
Dental radiographs allow us to detect decay between teeth and under old fillings much earlier than visual and tactile methods, hence we can catch the decay when it is much smaller. They are required during root canal therapy to verify root lengths and shape. Radiographs prior to removal of teeth warn us of potential difficulties and so we can plan for the appropriate approach. They can alert us to bone loss associated with periodontal (gum) disease. Radiographs are essential prior to orthodontic work to ensure that all the teeth are present and in a position where they will erupt unassisted and to correctly treatment plan the case. Prior to placement of dental implants radiographs are required to evaluate the volume of bone available in which to place the implant.

Why digital radiographs?
A digital sensor, similar to that in a digital camera, captures the image instead of film. We always aim to keep x‐ray exposure to a minimum and as digital sensors require about one tenth of the exposure time of regular dental film the exposure is minute. In fact, you will receive more radiation on a flight to Sydney than you receive with a standard set of bite‐wing digital radiographs. Processing of the digital image only takes a couple of seconds compared with up to 5 minutes with film and we avoid the use of environmentally unfriendly chemicals. The images are viewed on a computer screen at increased magnification making detection of problems easier and demonstration to our patients of these problems far clearer. As the images are stored permanently on our server they cannot be deleted or lost, and they are backed up to secure media nightly. These images do not deteriorate with time like film does. Lastly, we can email or print out images easily for our patients or specialists involved in their treatment.

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What are Dental Implants?
Dental implants serve to anchor replacement teeth firmly into the jaw. This can be a single tooth, multiple missing teeth or the entire dental arch. It is possible because of the discovery that titanium “integrates” into bone, i.e. it forms a biological union which is very strong. Dental implants offer the closest thing to natural tooth replacement, however, they are not appropriate in every situation.

Are dental implants suitable for me?
If you have missing teeth dental implants may be appropriate for you. Xrays and scans will determine if you have adequate bone available. Certain risk factors are associated with
lower success rates, but do not necessarily preclude you from implant treatment. These include diabetes, previous bisphosphanate medication, smoking, and the presence of uncontrolled gum disease.

What is involved?
Placement of dental implants is a minor surgical procedure, usually performed with local anaesthetic. It may involve referral to a specialist oral surgeon or periodontist. A period of
several months is usually required for the implants to fully integrate, after which time the replacement teeth are connected to the implants by your dentist.

As with all minor surgical procedures there is the risk of post-operative infection, and in a limited number of cases the implant may fail to integrate. If this occurs it is generally possible to undertake a repeat procedure successfully.

How successful is the treatment?
There are numerous published research studies confirming the long term success of dental implants. Because of the variables involved in dealing with human beings it is not possible to give any guarantees, however it would be reasonable to expect that an implant‐retained prosthesis would survive for a period in excess of fifteen years.

What problems could I expect?
As with natural teeth, regular check ups, cleaning and maintenance is important. Inflammation can develop in the surrounding gums and bone if dental hygiene is ineffective (peri‐implantitis). If left untreated peri‐implantitis can lead to the loss of the implant and possible the restoration. Occasionally porcelain or plastic on implant prostheses may chip, or screws may loosen. Generally these technical problems are quite manageable.

Examples

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Ceramic Crowns & Inlays, using the CEREC Procedure at Blackburn Dental

CEREC is a unique invention and procedure that allows your dentist to also be a dental technician in the surgery. Two small machines are connected to a computer system, one is a digital camera and the other is a milling machine.

This procedure was developed at Zurich University and has been successfully deployed in dental practices around the world since 1985.

Over the years, software and hardware enhancements have progressed and it is now possible to mill a porcelain crown in about 10 minutes. This crown is then stained, fired and glazed in a porcelain furnace for a further 30 minutes, with the resultant crown ready to be fitted at the same appointment.

The Process – all in the one visit
• This is an advanced dental science and service that we can offer our patients where tooth coloured porcelain restorations can be fabricated in one visit.
• When you have a cracked, chipped or decayed tooth and a crown is recommended, we prepare the tooth by trimming 1.5mm off the circumference and top.
• We then take digital pictures that are fed directly into the computer. This produces a 3D image of the tooth and a 3D picture of the crown.
• This information is then transferred automatically to the milling machine and a blank, readymade ceramic block is clamped into position. The machine then proceeds to mill the crown specifically for you and your problem tooth.
• The milled restoration is bonded directly to your tooth once it has been colour matched, fired and glazed.

It is exciting to be involved in CADCAM dentistry from both a technological aspect and how it benefits our Blackburn Dental patients.

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