A general check up (every 6-12 months) ensures your dentist detects any problems in their early stages, before they become more severe. Treatment in the early stages is generally easier and much cheaper. In addition to assessing your tooth and gum health, your dentist may take x-rays to assess the dental pulp and roots of your teeth and look for any early signs of oral diseases that can affect your general health. During your check up your dentist may recommend a professional clean. This will remove calculus (tartar, calcified plaque) that has built up on your teeth.

There are two types of filling, direct and indirect restorations. Direct restorations occur in a single visit and are placed directly into a prepared cavity by the dentist. The material used is usually a plastic resin and it is set using a UV light. Indirect fillings occur over multiple visits and involve the creation of inlays and onlays, crowns or veneers that the dentist fits over your tooth. Materials used for fillings: Amalgam fillings: Amalgam fillings are a blend of metals such as silver, copper, tin and mercury. The mercury intake into the blood from a single amalgam surface is 0.2% of the World Health Organization (WHO) recommended daily intake. Amalgam fillings have been widely used for over 150 years and are cost effective, strong and durable. Cerec®: Cerec® is a material used for indirect fillings that can be set in a single visit. Cerec® fillings provide a natural appearance and are strong, durable and provide more opportunity to conserve your tooth structure. Using a Cerec® machine and CAD-CAM software your dentist takes an optical impression of your tooth to produce the restoration and they will then bond this to your tooth. For more information please view the SD Cerec® website. Composite fillings: the most widely used because of their natural appearance and they can be matched to the shade of your teeth. They are made from plastic resin and filler and are bonded to teeth. They are not as strong as amalgam and do not last as long. Glass ionomer fillings: not as strong as composite fillings, these are used along the gum line, in children’s molars and to cement dental crowns. They are made from polyacylic acid and resin.

Although at home tooth whitening treatments are available from pharmacies you are best to visit your dentist to ensure an effective and consistent result. Some teeth may not be suitable for whitening and not all of your natural teeth will be the same colour.

Tooth extraction involves the removal of damaged, decayed or infected teeth. Healthy teeth may be removed that the mouth does not have space for, or in preparation for orthodontic treatment, or to remove teeth that are impacted or partially impacted and at risk of causing infection. Your dentist will apply a topical anaesthetic to numb the surface of your gum, followed by a local anaesthetic injection to numb the tissue around the tooth to be removed. If the tooth has not broken the gum line an incision may be required. Following extraction a blood clot usually forms within one hour and may take up to one week to heal. Over the following 1-2 months the socket will gradually fill in with gum tissue. Your dentist will refer you to an oral & maxillofacial surgeon if an extraction is outside of their expertise.

The sooner periodontal disease is diagnosed and treated, the easier it is to manage symptoms, remove risk factors such as smoking and prevent permanent damage. Periodontal treatment aims to minimise or eliminate infection and restore the appearance of teeth and gums. Treatment involves a variety of non-surgical and surgical treatments. Non-surgical treatments include improving personal oral care, professional cleaning and root planing. Surgical treatments include pocket elimination and periodontal flap surgery, and guided tissue regeneration (GTR). For more information please view the New Zealand Society of Periodontology website. Root planing (deep cleaning) Root planing is an extension of a professional clean whereby your gums are numbed with anaesthetic and your tooth is cleaned deeper under the gum line to remove plaque and calculus. This is done to provide a smooth clean tooth and root surface so that the gum tissue surrounding it has the opportunity to heal. Root planing may also be done in conjunction with antibiotic treatment. Pocket elimination and periodontal flap surgery Pocket elimination and periodontal flap surgery is performed in patients with moderate to severe periodontitis, or in patients who do not respond to regular professional cleans and root planing. Patients with periodontitis form pockets between the teeth and gum as the gum recedes. These pockets are an ideal place for bacteria to thrive as they are difficult to clean, so further tissue degradation occurs and the pocket becomes larger, until in advanced periodontitis there is not enough gum left to support the tooth and it must be extracted. During the pocket elimination procedure the periodontist will fold back the gum tissue adjacent to the pocket, and clean the tooth surface and gum tissue lining the pocket. The gum tissue that has been folded back is then used to fill in the pocket and stitched into place. The gum tissue should reattach to a healthy tooth. Periodontal flap surgery involves the periodontist folding gum tissue away from the teeth, so teeth roots and supporting bone is exposed. The periodontist will remove inflamed tissue and remove plaque and tartar by scaling and root planing. Gums will then be reattached to teeth and held into place using stitches. Your periodontist may use additional intraoral bandages. Guided Tissue Regeneration (GTR) surgery GTR is a treatment that assists gum regeneration and attachment to teeth. The technique involves the periodontist gently removing the gum tissue from the tooth root and cleaning the tooth root to remove bacteria and calculus. A thin membrane is then applied to the damaged tooth root and gum. These form a protective barrier and assist in regeneration of the gum and bone. The gum is then reattached to the tooth and held in place with stitches.

Bridges A dental bridge is a false tooth or teeth that are fused between two porcelain crowns to fill in an area missing teeth. Your dentist will take a mould of your mouth and a dental technician will make your bridge so it matches the colour of your natural teeth. Bridges are important not only for improved cosmetic appearance but to keep existing teeth in position and prevent gum disease and tooth decay. Dentures (false teeth) Dentures are removable replacements for missing teeth made out of acrylic resin and sometimes porcelain to provide a more natural appearance. Your dentist will generally recommend dentures if you are not a suitable candidate for dental bridges or dental implants. Dentures will improve the appearance of your mouth and help strengthen muscles controlling your expressions, as well as improving chewing and speech. There are two main types of denture; complete and partial. Complete dentures are best if you have lost or are going to lose all of your teeth. If you still have a lot of healthy teeth, a partial denture is best. To make your denture your dentist will take a mould of your mouth and a dental technician will make your denture. You may need multiple visits to get an optimal fit.

Cosmetic dentistry combines a variety of techniques with the aim of giving you improved confidence and a better, whiter smile. Techniques include cosmetic contouring and reshaping, bonding, veneers, crowns, crown lengthening, bridges and tooth whitening. Cosmetic dentistry is not a recognised specialisation by the Dental Council of New Zealand (DCNZ) and may be carried out by any general dentist. For reconstructive dentistry that is outside of their practice scope or expertise, your dentist will refer you, depending on your circumstances, to an oral & maxillofacial surgeon, orthodontist or prosthodontist. Cosmetic contouring and reshaping Tooth contouring or reshaping generally does not require anaesthetic and can usually be done within 1-3 dental visits to correct minor problems with crooked, chipped, cracked or overlapping teeth. Your dentist will x-ray your teeth to ensure there is enough bone to do the procedure. They will sculpt your teeth and may use a sanding drill or laser for the surfaces and abrasive strips for the sides of your teeth. Your teeth will then be smoothed and polished. Your dentist may also use techniques such as bonding and veneers.

Crown lengthening involves removing excess gum and bone tissue to expose more of a natural tooth. This can be done to one or many teeth. Crown lengthening may be done to improve the appearance of your smile or may be required to expose enough of a decayed or broken tooth, so that another cosmetic procedure such as bridges, crowns, veneers or inlays and onlays may be done.

Dental caries (dental cavities, tooth decay) is the most prevalent oral disease. Bacteria in your mouth form a sticky film on your teeth called plaque. The bacteria digest food, particularly sugars, and release acid. Over time the acid dissolves the enamel and dentine on the outer layers of your tooth to create a hole or a cavity. It is important to visit your dentist regularly so cavities are detected early. In their early stages cavities are usually painless and easy to repair. Pain is not felt until they are large and are affecting nerves, or damage the structure of your tooth so badly a tooth fracture occurs. Left untreated tooth decay will destroy the pulp within your tooth and eventually the tooth will fall out. Untreated tooth decay can also result in the development of an abscess and serious illness. Once a dental caries has developed your dentist will need to remove the decay from the tooth and place a filling. More severe decay may require a crown or inlays or onlays to repair the structure of the tooth. If the nerve in the tooth has died a root canal treatment is usually recommended. Early Childhood Caries Early childhood caries (ECC) refers to caries that occur in the teeth of infants and young children and can lead to the destruction of their teeth. From approximately 6 months of age, or the age that teeth start to appear, children are at risk of developing ECC, generally as the result of prolonged exposure to sugar. ECC can be prevented by avoiding giving sweetened drinks to children or not allowing a baby to go to bed with a bottle of milk or juice.

Gum tissue at the site of the implant is opened up to expose the bone. The bone is drilled and a titanium implant is inserted where the root of your tooth had been. Once the bone and gum has healed (3-6 months), the post is attached to the implant and the crown is placed over the post and cemented into place.

Molars (teeth at the back of the mouth used for chewing) often have grooves or fissures. These can be difficult to clean and food particles can be trapped here. Bacteria may grow and release acids that can decay your tooth. Your dentist can apply a protective plastic covering (sealant) to the fissure to help prevent tooth decay. For more information please view the New Zealand Dental Association website - Fissure Sealants.

Periodontitis involves the gums and support tissues of the teeth. Periodontitis develops from gingivitis, where the surface of the gums is inflamed due to toxins released by bacteria in plaque. This immune response can lead to degradation of teeth and gums along the gum line and the formation of small pockets in the gums. Bacteria can become trapped in these pockets and colonise the space, so further tooth and gum degradation occur. Once degradation has occurred in the ligaments and bone that support and hold the teeth the damage is permanent and irreversible. Teeth are lost and abscesses may form. Not everyone who develops gingivitis will develop periodontitis, but all people with periodontitis began with gingivitis. People who are more prone to developing periodontitis include those with a family history of the disease, people with poor oral hygiene, smokers, pregnant woman, diabetics, people on certain medications and those with compromised immune systems. Periodontal treatment is usually provided by a periodontist. For more information please view the New Zealand Society of Periodontology website.

Gingivitis is a mild form of gum disease characterised by red, swollen (inflamed) gums that may bleed when teeth are cleaned. It is caused by bacteria in dental plaque releasing acid and enzymes that irritate the gums and stimulate an inflammatory response. If untreated, gingivitis can develop into the more severe periodontitis. Gingivitis can usually be reversed by improving personal oral care (regular brushing and flossing) and a professional clean. For more information please view the New Zealand Society of Periodontology website.

During sport and other activities your teeth can be knocked out completely from your gums. In some instances your dentist can put them back in. For information on how to reduce the probability of long term damage view the resource from the Ministry of Health website, First aid for knocked-out teeth.

Visiting the dentist can be a source of anxiety. Your dentist may be able to provide sedation or nitrous oxide (laughing gas) to help you feel calm. Fortunately, with advances in dentistry, your dentist can manage the discomfort during procedures to make the experience as pain free as possible. Your dentist will usually apply a topical anaesthetic to numb the surface of your gum and then inject a local anaesthetic that works for up to 2 hours and numbs the tissue deeper within the gum. In certain circumstances your dentist may recommend the use of a sedative or general anaesthetic so you are asleep and do not remember the procedure.

Your dentist or dental hygienist will recommend you have a professional clean every 3 -12 months. Bacteria in your mouth form a thin film, called plaque, on your teeth. Over time the plaque and minerals in the saliva in your mouth form a hardened deposit called calculus (tartar). Regular brushing and flossing slows the build up of calculus but its removal requires a professional clean. If not removed calculus and plaque can lead to tooth decay and gingivitis (early gum disease). During a professional clean your dentist or dental hygienist will scale and polish your teeth using a variety of instruments. Scaling involves removing plaque and calculus from teeth and around the gum line. Polishing smoothes the surface of your teeth. A professional clean is usually painless, although you may experience some minor discomfort or sensitivity. Discuss this with your dentist as they may be able to administer pain relief.

Bonding Bonding is done to restore chipped or broken teeth, to fill in gaps or to shape and recolour your teeth. The dentist will do this using a composite resin and then apply a bonding material to restore the appearance of your teeth. Crowns Crowns cover the entire surface of your tooth. They are used to protect existing teeth and/or improve their appearance. They are usually made of porcelain and may have a gold core. To fit the crown your dentist will reduce the size of your existing tooth to make enough space for the crown and then make a mould for the dental technician. Your dentist will fit you with a temporary crown until the dental technician has made yours. Your dentist will cement the crown into place. Inlays and Onlays Inlays and onlays are similar to direct restoration/fillings, except rather than the filling being placed in a single dental visit, the dentist takes a mould of your existing tooth and the inlays and onlays are created by a dental technician. The dentist will fit and bond this into your existing tooth at your second visit. Inlays and onlays can be made from gold, porcelain, Cerec® or resin materials. Cerec® fillings can be applied in a single visit. Inlays are bonded into the centre of the tooth while onlays include restoration of one or more cusps (points) of the tooth or full coverage of the biting surface. Veneers Veneers are thin pieces of porcelain or plastic that are permanently fitted to the front of your teeth. They can improve the appearance of your teeth by covering teeth that are discoloured, chipped, crooked or to cover gaps between teeth.

The core of a tooth contains connective tissue, blood vessels and nerves, collectively known as dental pulp. At the top of a tooth it is found in the pulp chamber and within the root of a tooth it is found in root canals. If the tooth pulp is damaged or infected your dentist may recommend a root canal filling. Traditionally these teeth were extracted. Your dentist will take an x-ray to determine the health and location of the dental pulp. They will drill a hole through the top of your tooth to access the root canals. The root canals are cleaned and shaped with a dental file and washed with a sterilising solution. The root canals can then be filled with a permanent filling. A crown may be added for further protection and to improve your tooth’s appearance. For more information please view the New Zealand Society of Endodontics website. Root canal retreatment In a small proportion of people who receive a root canal filling, the treatment fails or the symptoms of infection and inflammation can persist. This can occur soon after treatment or many years later. Treatment usually involves removing the root filling material and repeating the root canal treatment. For more information please view the New Zealand Society of Endodontics website.

Wisdom teeth are the third molars right at the back of your mouth. They usually appear during your late teens or early twenties. If there is not enough room in your mouth they may partially erupt through the gum or not at all. This is referred to as an impacted wisdom tooth. Due to their location wisdom teeth can be difficult to clean and are more susceptible to decay, gum disease and recurrent infections. They can cause crowding of teeth and, on rare occasions, cysts and tumours develop around them. Your dentist will advise if some or all of your wisdom teeth need to be removed. Wisdom teeth will usually only be removed if your dentist believes they will be a significant compromise to your oral health. Impacted tooth extraction Your dentist may recommend extraction if you are at significantly greater risk of infection or tooth decay. Impacted teeth may be removed by your dentist or they may refer you to an oral & maxillofacial surgeon. An incision (cut) is made in your gum and access to the impacted tooth cleared by pushing aside gum tissue and, if necessary, removing some bone. The tooth is removed whole or in pieces and the gum stitched together over the hole.