We were taught at dental school that anything other than a natural tooth with sound, healthy enamel and gums is a compromise to dental health, and can sometimes be the beginning of a long, downward spiral for the affected tooth. This is why we have such a focus on preventive dentistry in our practice. If we can prevent the cavity, prevent the gum disease, prevent the wear and tear, we know that natural teeth can last a lifetime.
Minimal Intervention, Repair And Prevention: A Modern Dental Focus
But of course, teeth and gums often do sustain damage- decay, gum disease, chips, and knocks can all occur. Our approach to many early cavities these days is focused on repair and minimal intervention. This is mainly because our understanding of the biology of teeth and gums has evolved and the materials we have available to restore teeth have improved dramatically. Today we can treat spots of decay by placing tiny white fillings.
New technology, such as digital x-rays, means that we can detect problems early, sometimes early enough to reverse the damage, removing the need to place fillings. For example, if an x-ray shows that the enamel between the teeth is starting to dissolve, the patient can increase (or start) flossing this area. This may well halt the decay in its tracks (because the cause of the damage, bacterial plaque, has been removed). The enamel may be able to recover its strength over time, sometimes with a little additional fluoride in the area.
If the gums bleed when they are brushed, this again is a sign that early intervention is critical: regular professional cleaning supported by meticulous home care can do much to prevent the onset of gum disease and its companions: loose teeth and bad breath (halitosis).
When The Damage Is Severe
If teeth are deeply decayed, or are so heavily filled that they become weakened, or the nerve (pulp) inside is inflamed or infected, greater levels of treatment are needed. This is where we might recommend a filling made of gold or porcelain (also called ‘onlays’, which fortify teeth), dental crowns (which cover and protect the entire tooth) or root canal treatment (to remove the infected nerve, following which a crown may be also be recommended). Dr Teo will discuss the options available following thorough assessment of your mouth.
What Happens If Heavily-Treated Teeth Become Compromised?
We’ve already mentioned that teeth with large fillings or root canal treatment can weaken over time. This is less likely to occur if conditions in the mouth are ideal. But sometimes conditions in a mouth are less than ideal:
- Some people have a heavy bite and may clench or grind their teeth at night whilst asleep. Under such heavy stresses, weakened teeth can chip, crack or break.
- If home care (brushing and flossing) is not done consistently and thoroughly, any tooth can get decay. This is as true for teeth with fillings, root canals and crowns as it is for untreated teeth. Decay can still occur in the tooth under a large filling or crown, and further weaken and damage the tooth.
- Sometimes teeth are damaged by long-term exposure to an acidic environment. There are two main sources of acid in the mouth. The acids can come from the stomach (through gastric reflux, bulimia, morning sickness or similar conditions). They can also come from one’s diet (such as citrus fruits, sports drinks and wine). Acids dissolve and weaken enamel, the tooth’s protective outer layer. If the acidic environment in the mouth is not neutralised, serious damage can occur over time.
Teeth with a history of decay and damage can therefore deteriorate further and the tooth becomes more fragile. There comes a point at which the damage is so great that a standard filling or crown can no longer save the tooth. This is the point at which decisions about the tooth’s future can become difficult.
We recognise that it is important to assess long-term risks and benefits and, in close consultation with the patient, come up with a plan that best suits their wishes, needs and long-term dental health.
Hero-Dontics Is Optional
If only heroic (and probably expensive) efforts will save a tooth with a guarded prognosis, it can be helpful to consider other options. In such situations, Dr Teo will clearly and thoroughly explain the benefits and risks of each treatment option to her patients, listen to the patients’ point of view, and make recommendations. Dr Teo will never push a patient into doing something that they are not comfortable with, and prefers only to undertake ‘hero-dontics’ (saving a tooth at all costs) if this is the patient’s express wish after the risks and potential outcomes have been considered.
Your questions about this topic are welcome: please feel free to contact us on (03) 5298 1020.
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