Straight talking

The first thing to understand is that our teeth age just like the rest of us. Over the years, they can deteriorate. This means that the cornerstone of good long-term dental health is having regular check-ups. People tend to think that if their teeth are not hurting then all is well, but that’s not necessarily the case. Plaque build-up, along with other factors, can lead to tooth decay and gum disease. By the time you feel pain, the problem is usually already well advanced.

This means that regular dental examinations are at the heart of preventive dentistry. We will look to identify any issues a patient may not be aware of, such as tooth decay, infection or damaged fillings or crowns, and will offer a treatment plan in a friendly and comfortable environment. 

Once their mouth is what we call ‘clinically healthy’, we move onto the maintenance phase, working with the patient on things like brushing technique, how often to brush and what type of toothbrush to use.

Foundations in place
Getting to this point is hugely important. If someone tells me they want all their teeth straightened and whitened, I won’t make a start unless the mouth is dentally fit. It is like building a house: you need good foundations to be in place.

Cosmetic dentistry can have benefits that go beyond the purely aesthetic. Acquiring the best version of your smile will not only improve your physical appearance but can have a huge impact on confidence and self-esteem. Another major benefit is that having straight teeth allows you to clean them better, which leads to better oral hygiene—with crooked teeth, there are lots of areas that can be difficult to get to. Also, not having straight teeth can cause excessive tooth wear. So, as well as improving a person’s smile, straightening teeth is a preventative measure, ensuring they are much less likely to suffer dental issues in the future.

We use a system called Invisalign, which is based around a series of removable clear moulds called ‘aligners’. As the name suggests, Invisalign offers a nearly invisible way of straightening the patient’s teeth, without using braces. Using x-rays and detailed notes from the team here, the aligners are custom-made specifically for your teeth. These exert very gentle pressure on individual teeth in a specified direction, determined by what we want the eventual position of the teeth to be. The aligners are replaced every two weeks as the teeth move—little by little—towards the projected final alignment. 

A real problem
One problem we see is patients who grind their teeth while they sleep—a condition called bruxism. Over time, this will wear away the hard enamel, then move onto the dentine, which is much softer and wears away much more quickly. Bruxism can even lead to a person losing teeth, so it is a real problem that needs to be addressed when found. If the patient hasn’t already lost too much tooth material, using a night guard is often all that is required. This is a plastic moulding that keeps the teeth apart while the patient is sleeping. In a majority of cases, using the guard will cause the bruxism to stop. 

The reason is not fully understood, but the theory is that something doesn’t quite feel the same on a subconscious level, so the grinding stops by itself. Using the night guard also has other benefits: it relieves pressure on the jaw, which can lead to headaches when the patient wakes in the morning, and it helps alleviate a condition where the jaw clicks as the patient chews, which can be quite painful. Interestingly I often have patients who don’t believe they grind their teeth, and it is only when I show them the wear on the guard they’ve been wearing that they are convinced. If the patient has lost a lot of tooth material, then more extensive work will be required. 

As always, we start the process by bringing the mouth to a state of clinical health.Then we need to create the space to allow me to replace the lost tooth material. We do this by gently realigning the teeth in a process called ‘opening up the bite’. After this, the teeth are restored using either porcelain laminates (veneers) or cosmetic bonding—a dental technique where a material known as a composite resin is skilfully shaped onto your tooth: a fine balance of art and science. I use this technique often to deal with chipped or gapped teeth, or cover staining. The results are always amazing.

This is hugely rewarding work. We have had patients who simply wouldn’t smile because they were ashamed of their teeth, and we gave them a reason to smile. When you get letters from patients saying how much the team’s work has positively impacted on their lives and given them a renewed confidence, it gives me a real sense of pride in the work that we do.

For more information, visit Lister House Dental