Treatment information and considerations

This covers examinations, cleaning, fillings, crowns, bridges, dentures, root canal treatment and extractions.

Fillings and crowns

• Sensitivity to hot, cold or pressure is common afterwards and usually settles, though it can persist.
• Preparing a tooth for a crown involves removing tooth structure, which cannot be reversed.
• A tooth that has been heavily restored or previously traumatised may later need root canal treatment, or may not be able to be saved.
• Restorations wear, chip, leak or debond over time and will eventually need repair or replacement.

Bridges and dentures

• A bridge relies on the teeth either side of the gap, which must be prepared and which carry the additional load.
• Dentures take time to adjust to and may affect speech and eating at first. Sore spots are common early on and usually need adjustment appointments.
• The jaw changes shape over time after teeth are lost, so dentures need relining or remaking periodically.

Root canal treatment and extractions

• Root canal treatment has a good but not certain success rate. Treatment can fail, and retreatment, surgery or extraction may be needed later.
• A root-treated tooth becomes more brittle and usually needs a crown to protect it, at additional cost.
• Extraction carries risks of bleeding, infection, dry socket, damage to adjacent teeth or restorations, and — depending on the tooth’s position — altered sensation.
• Removing a tooth changes how the remaining teeth meet, and neighbouring teeth may drift over time.

Veneers are thin restorations bonded to the front surface of a tooth. Treatment usually takes place over several visits, depending on how many teeth are involved and the complexity of the case.

Tooth preparation

• Most veneer treatment requires removal of a layer of enamel. Enamel does not grow back, and this step cannot be reversed. Once a tooth is prepared it will require a restoration of some kind for the rest of its life.
• Sensitivity to temperature or pressure is common after preparation and may be temporary or ongoing. In some cases it leads to further treatment.
• In some cases the nerve of a prepared tooth becomes inflamed and root canal treatment is later required.

Durability and appearance

• Veneers can chip, crack or come away from the tooth, particularly if you grind or clench your teeth or bite hard objects.
• Veneers are not permanent. They will need replacing at some point, and the cost of replacement is yours to meet.
• Shade, shape and translucency are matched as closely as the materials allow, but the result may not match what you pictured. Discussing your expectations in detail beforehand matters.
• Veneers do not change colour with whitening. If you whiten your natural teeth later, they may no longer match.

Gums, bite and associated procedures

• Gum irritation or inflammation can occur around veneered teeth, particularly where oral hygiene is not maintained.
• Your bite may feel different at first and may need adjusting over one or more appointments.
• Other procedures are sometimes recommended alongside veneers, such as gum reshaping or orthodontic alignment. Each carries its own risks, which will be explained separately.

Clear aligners move teeth gradually using a series of removable trays. How long treatment takes depends on the complexity of your case and on how consistently the aligners are worn.

Wear and duration

• Aligners only work if worn for the prescribed hours each day. Inconsistent wear, missed appointments or not following instructions will extend treatment and can prevent the planned result being achieved.
• Not every case can be treated with aligners alone. Some bites need braces, elastics, attachments, other appliances or, in some cases, surgery. This may not become apparent until treatment is underway.
• Some medical conditions and medications affect how teeth move.

During treatment

• Tenderness is common for a day or two after changing to a new aligner.
• Aligners can irritate or scratch the gums, cheeks, tongue and lips.
• Speech may be affected at first, sometimes as a lisp, which usually settles within a week or two.
• Increased saliva or a dry mouth can occur, and some medications make this more noticeable.
• Small attachments may be bonded to teeth to help them move, and can come off and need replacing.
• Small amounts of enamel may be removed between teeth to create space. This cannot be reversed.

Oral health and stability

• Decay, gum inflammation and permanent white marks on the enamel can develop if teeth are not cleaned properly during treatment, or where sugary drinks are consumed while aligners are in.
• Where teeth have been crowded for a long time, the gum between them may not fill the space once they are straightened, leaving small dark gaps known as black triangles.
• The roots of teeth can shorten during orthodontic movement. This is usually minor, but in rare cases affects a tooth’s long-term prognosis.
• Existing gum disease or bone loss can be worsened by tooth movement and must be treated first.
• A previously traumatised or heavily restored tooth may be aggravated by movement and in rare cases may be lost.
• Teeth move back. Retainers must be worn as directed, indefinitely, to hold the result. Teeth will shift if you stop.
• Your bite may need adjusting at the end of treatment.

An implant is a fixture placed in the jawbone to support a replacement tooth. Full-arch treatment replaces a complete upper or lower set of teeth using several implants to support a fixed bridge. Treatment usually takes place over multiple visits across several months.

Whether implants are suitable for you is assessed at your first consultation, using an examination and X-rays. Not everyone is a candidate, and where implants are not the right choice we will tell you so and discuss the alternatives, which may include a bridge, a crown or dentures.

Surgical risks

• Implant placement is surgery and carries the risks of any surgical procedure, including bleeding, infection, swelling, bruising and pain.
• Upper jaw: bone is often of lower quality and the sinuses sit close by. The sinus membrane can be perforated, the bone can fracture, or an implant may not achieve adequate stability. Further procedures may be needed, at additional cost.
• Lower jaw: nerves supplying sensation to the lip, chin and tongue run close to where implants are placed. Surgery or post-operative swelling can affect these nerves, causing altered or lost sensation. This is uncommon and usually temporary, but it can be prolonged or, rarely, permanent.
• Adjacent teeth, roots or existing restorations can be damaged during placement.

Healing and implant survival

• An implant must bond with the bone to succeed. Sometimes this does not happen, for biological reasons that cannot be predicted in advance.
• A failed implant must be removed. Replacement may be possible, sometimes only after further bone grafting, and this carries additional cost.
• If implants are not stable enough at the time of surgery, a fixed temporary bridge may not be possible and a removable temporary appliance may be needed while healing takes place.
• A failing implant may cause no symptoms you would notice, which is why regular reviews every four to six months are necessary for as long as you have implants.
• Peri-implantitis — inflammation and bone loss around an implant — can develop over time, particularly where cleaning is inadequate or where you smoke.

Recovery

• Bleeding for 24 to 48 hours after surgery is not unusual.
• Swelling and bruising typically peak around the fourth day before easing. Pain and discomfort may continue for a couple of weeks and are managed with prescribed medication. Pain differs considerably between individuals.
• You may feel tired for the first day or so. Strenuous activity should be avoided for 24 to 48 hours, and sport or gym for up to ten days.
• You will likely need time away from work or usual activities. Arrange for someone to assist you afterwards, particularly if sedation or general anaesthetic is used.
• Soft, cool foods are recommended initially, and longer-term changes to diet or habits may be advised to protect the result.
• You may be asked to stop smoking well before surgery. Smoking is strongly associated with implant failure and infection.

Ongoing

• The bridge or crown attached to an implant is subject to wear, chipping and breakage, and will need maintenance, repair or eventual replacement at additional cost.
• Full-arch prostheses require professional cleaning and periodic removal for inspection.

Where there is not enough bone to support an implant, additional bone may be built up using graft material. In the upper jaw, this may involve lifting the sinus membrane to create space, known as a sinus lift. These procedures are usually carried out alongside or ahead of implant treatment.

Bone loss can follow gum disease, tooth loss, an enlarged sinus cavity, or simply occur over time.

• The sinus membrane can tear during a sinus lift. Small tears are usually repaired at the time; larger ones may require the procedure to be abandoned and attempted again later.
• Sinus infection or ongoing sinus discomfort can develop, though this is uncommon.
• Graft material may not integrate with your own bone, which can delay or prevent implant placement and may require the procedure to be repeated.
• Infection, swelling, bruising and tenderness are possible, and the graft can become infected and need removal.
• Grafted sites take several months to mature before an implant can be placed. Healing time varies.
• Where bone is taken from elsewhere in your own body, that site will also be sore during healing.
• Small granules of graft material may appear in your mouth in the days afterwards. This is expected.
• Stitches are usually dissolvable and commonly remain for two to three weeks.
• Do not smoke until the site has healed. Smoking substantially reduces the likelihood of a graft succeeding.

Whitening uses a bleaching agent to lighten the natural colour of teeth and can reduce staining caused by food, drink, smoking and age-related change.

• Whitening is not suitable for everyone. Teeth and gums must be healthy first, so an examination and clean are needed before treatment.
• Sensitivity to hot and cold during and after treatment is common. It usually resolves on its own, but can be pronounced for some people.
• The bleaching agent can irritate the gums and soft tissues.
• Not all discolouration responds to whitening. Stains from trauma, certain medications or developmental causes may not lighten, and may need a different approach.
• Existing crowns, veneers, bridges and fillings do not whiten. Where these are visible, they may no longer match afterwards and may need replacing at additional cost.
• Whitening is not permanent. Results fade at a rate that depends on your teeth and your habits, and top-up treatment is needed to maintain them.
• Avoiding strongly coloured food and drink for several days afterwards is usually recommended — tea, coffee, red wine, curries, tomato-based and soy sauces among them.
• Over-the-counter and non-dental whitening carries additional risks and is not assessed against your dental health. Whitening at our practice follows an examination.

Sedation is available at our practice for patients who find dental treatment difficult, and for longer or more complex procedures. It is a separate decision from the dental treatment itself, with its own assessment, risks and costs.

• Sedation is not suitable for everyone. Your medical history, current medications, weight, airway and any respiratory, cardiac or sleep conditions are assessed beforehand, and some patients will be advised against it or referred to a hospital setting.
• You will be given fasting instructions. Not following them can mean your appointment is postponed, and can be dangerous.
• Possible effects include drowsiness lasting into the following day, nausea, headache, low blood pressure, and irritation at the injection site.
• Less common risks include breathing difficulty, effects on heart rhythm, and adverse reactions to the medications used. These are the reason monitoring and trained staff are in place throughout.
• You must be collected by a responsible adult and must not drive, operate machinery, sign legal documents or care for others unsupervised for at least 24 hours.
• You may have little or no memory of the appointment. This is an expected effect, not a complication.
• Sedation is charged separately from your dental treatment. Costs are set out before your appointment.

Whatever treatment you are considering, these are reasonable things to ask before you agree to it.

• What are my options, including doing nothing for now, and what happens with each?
• Which parts of this treatment are irreversible?
• How long is this expected to last, and what happens when it needs replacing?
• What will the total cost be, including reviews, maintenance and anything that might come up?
• What does the recovery involve, and how much time should I set aside?
• Who will be carrying out the treatment, and what is their experience with it?
• What happens if something goes wrong, or if I am not happy with the result?
• How many appointments will this take, and over what period?

You are welcome to take your treatment plan away and think about it, and to seek another opinion before deciding. We would rather you were certain.