Treatments

Routine dental checkups are vital to good oral hygiene and are the best way to detect problems at their earliest stages. Early detection and treatment saves unnecessary discomfort, time and money.

What to expect

Your dental checkup includes:

• a visual exam of your mouth, face, jaw and neck

• electronic dental charting

• a gingival pocket exam

• digital diagnostics, as determined by your dentist

Visual examination

During a visual exam, your dentist looks not only for cracked and decayed teeth, but also for growths and sores on the roof and floor of your mouth, tongue, lips, gums, and the mucous membranes that line your cheeks and gums. Then your dentist will check the lymph nodes of your head, jaw and neck for pain, tenderness and flexibility.

Electronic dental records

The records of our patients' dental checkups, diagnostics and treatments are kept electronically. Electronic dental records improve patient safety and give our dentists immediate, comprehensive access to medical histories as well as the results of previous and current exams, diagnostics, treatment plans and progress reports, which helps reduce patient waiting time before and during appointments.

Gingival pocket exam

Healthy teeth require healthy gums. A gingival pocket exam determines the presence or risk of gum (periodontal) disease. During your exam, a hand-held instrument is gently placed between gums and teeth to measure the depth of each pocket.

Digital diagnostics

Digital X-rays detect dental problems that cannot be found during a visual exam. Your dentist will normally get two small X-rays to check for decay in between the teeth (usually taken every year), and an big X-ray that shows your whole mouth to see the roots of all your teeth (usually taken every 3 to 5 years).

Routine scale and cleans are vital to good oral hygiene.

What to expect

Your dental scale and clean includes:

Professional cleaning

Your teeth are cleaned using special instruments (ultrasonic scaler -which uses water- and hand scalers) to remove plaque from above and below the gum line. Afterwards, your teeth are flossed and then polished.

Tooth flossing removes plaque and food particles in places where a toothbrush cannot easily reach - under the gumline and between your teeth.

Tooth polishing makes your teeth look and feel great. It also smoothes tooth surfaces so plaque is less likely to accumulate.

Application of topical fluoride

Topical fluoride is a sticky varnish that helps preventing caries and helps remineralize your teeth. Its application is very simple and quick: it simply gets painted on your teeth with a brush. It leaves some residue on your teeth for some time.

To have the best benefit, it is recommended not to drink or eat anything for up to an hour after the fluoride has been applied and not to actively remove the residues.

Airflow

Using Airflow is also much quicker than regular methods of stain and plaque removal. Airflow can actually help reduce the sensitivity of your teeth. This is due to the bicarbonate in the jet, which can fill any exposed dentine tubules and help re-mineralize teeth.

Airflow teeth cleaning is a great way to maintain good dental hygiene and oral health. It is also one of the best treatments available today for treating and managing gum disease. Additionally, airflow polish is also fantastic for a speedy fix for special occasions such as weddings and holidays.

What are the airflow teeth cleaning side effects?

There is almost no risk of using airflow teeth cleaning, the only known adverse effect is the possibility of causing small lesions in the oral mucosa (small cuts on the surface).

Observational studies have shown that air polishing is three times faster at tartar and debris removal than regular dental practices. Teeth are also cleaned in a much less abrasive manner. AirFlow oral hygiene procedure is also a safe cleaning method before orthodontic appointments. 

What is periodontal disease?

Periodontitis or periodontal disease (also commonly referred to as 'gum disease') is an inflammatory-mediated disease affecting the gum and the supporting structures of the teeth.

Teeth are housed in place by the periodontal ligament to the underlying bone. The periodontal ligament can be viewed as the attachment apparatus of the teeth. Periodontitis is caused by certain bacteria and by local inflammation triggered by these bacteria. With progression, the periodontal ligament, along with the bone housing the teeth, is irreversibly destroyed. 

Gingivitis vs periodontitis

You may have heard of gingivitis which is a mild-to-moderate inflammation of the gum without affecting the attachment apparatus of the teeth, namely the periodontal ligament and the bone. Gingivitis is a reversible condition, whereas periodontitis is not.

The aim of periodontal treatment is to arrest the disease progression, to maintain the health of the periodontium, and to prevent further bone loss around the teeth.

How is periodontal disease diagnosed?

During your routine dental examination, your dentist assesses the health of your gum. This is done by inserting a periodontal probe into the gum on all your teeth. This may cause some discomfort and bleeding, which is normal; most often this is mild gingivitis.

When the probe sinks much deeper than usual accompanied with bleeding, this is an indication of periodontal disease. Your dentist may initial a full periodontal assessment to determine the extent of the disease. Depending on the severity of the disease, you may be managed in general practice or referred to a periodontist, a specialist in gum diseases.

Management of periodontal disease

Active Periodontal Therapy

What does periodontal therapy involve? Simply put, it is akin to cleaning your teeth. Unlike regular scale and clean, periodontal therapy involves deeper cleaning, all the way to the base of gum pocket, in order to remove any deep calculus and, most importantly, disrupt the biofilm (the complex microbial ecosystem) inside the gum. Periodontal therapy in generally done under local anaesthetic for your comfort.

Home Measures 

Any active therapy will not be successful without effective home measures, predominately your own oral hygiene measures. Throughout the management of periodontitis, your dentist will go through effective oral hygiene measures with you and reinforce them. It is important that you implement and maintain these measures as you are responsible on a daily basis to maintain your gum health.

Smoking is one of the strongest disease-modifying factors in periodontitis. The research on the effect of smoking to periodontal health is clear: smoking significantly increases your risk for developing periodontal disease, accelerates its progression, and reduces the chances of arresting the disease upon active therapy. You should seriously consider smoking cessation upon diagnosis of periodontitis.

Supportive Periodontal Therapy (SPT) - Maintenance Phase

This is arguably the most important phase in the overall management of periodontal disease. Unfortunately, once you are a periodontitis patient, you'll forever be susceptible to the disease relapse and progression. This involves reviewing your gum health and your oral hygiene measures, as well as further cleaning, if necessary. The interval for this is generally between three and six months.  

This is what people generally refer to as fillings. The term 'direct' means that the filling is done directly inside the mouth which constitutes the majority of fillings done.

One of the most common reasons you require fillings is tooth decay. Tooth decay eats away your tooth, creating a hole. After cleaning the decay, the clean and prepared cavity needs to be filled.

Tooth decay is, by no means, the only indication for a filling. You may need fillings for

- fissure sealing and preventive resin restoration

- broken-down teeth that may not have decay, in which case the filling is to restore function and/or aesthetic;

- exposed root surfaces due to gum recession, if symptomatic or for aesthetic purposes;

- bonding orthodontic braces;

- splinting mobile teeth; and many more

The most commonly used material for direct fillings is composite resin, which is a tooth-coloured material. 

Some of the limitations of composite resin include, but not limited to:

- staining with time;

- compromised strength in large cavities (in which case indirect fillings are advised);

- possible postoperative sensitivity (less common in contemporary practice); and

- wear with time

Indirect ​restorations are generally for cavities that are too big for direct fillings. The main benefit of these fillings is its strength owing to the material properties. Generally, ceramic or metal-reinforced ceramic is used.

Because the fillings are manufactured outside the mouth using sophisticated technique, the shape and fit of these fillings are far better than those of direct fillings. Conventionally, these fillings are done under at least two appointments:

• The first appointment: the tooth is prepared to receive one of these fillings; impression is taken, which is then sent to a dental laboratory for the filling to be fabricated; the tooth is temporised.

• The second appointment: the indirect filling is inserted.

Some of these fillings can be done on the same day chair-side using CEREC, saving you time coming back for a second visit. During the tooth preparation appointment, we would also scan your mouth. The filling is then designed and milled, which will be inserted on the same day.

Inlays and onlays

This is just like regular fillings, except that the fillings are fabricated outside the mouth. The fit, precision, and strength are superior. 

As described above, these are generally for cavities too big for direct fillings. The bigger the cavities, the harder it is to sculpt the fillings to proper shape and fit directly in the mouth. In addition, the strength of the materials for direct filling (which is plastic materials) decreases with increasing size.

Crowns

This involves preparing the tooth circumferentially. The crown is then cemented onto the prepared tooth, which can be likened to a cap onto a tooth.

This is generally for tooth that has lost much of its structure. Crowns provide all-around protection of the tooth. Some teeth that have been root-canal treated may require crowns to protect them in the long run.

Bridges

This is one of the options to replace one or two missing teeth where the teeth adjacent to the missing teeth either would benefit from crowns or already have crowns. These adjacent teeth are called abutment teeth.

The procedure is just like that for crown, which involves preparing both abutment teeth for crowns. Instead of fabricating a single crown, two crowns are fabricated for these abutment teeth joined together with replacement teeth (pontics) for the space.

Why you may need a root canal treatment

Root canal (endodontic) treatment is performed on a tooth when its nerve has been irreversibly inflamed and/or infected. This is generally termed loosely as tooth infection.

The very outer layer of a tooth is enamel under which dentine lies. Under these protective layers of enamel and dentine lives the pulp which contains blood supply and nerve. This is the reason you can feel sensitive or even pain from a tooth. The pulp has an amazing capacity to fight off an insult, such as that from tooth decay, but only to a certain extent.

When tooth decay has been left untreated for a while, the fighting capacity of the pulp starts to weaken. Eventually, the pulp is overwhelmed by bacteria from the decay, leading to tooth infection. At this stage, to save the tooth, you will need a root canal treatment; otherwise, the tooth needs to be extracted.

Endodontic treatment

Root canal treatment involves multiple stages.

​

Extirpation

This is generally done as an emergency appointment when a patient presents with pain and the findings above are found.

Generally, your dentist will remove any decay from the tooth and any existing fillings from which bacteria might have gotten entry to the tooth in the first place. Access is then gained into the inside of the tooth (root canal system). The canals are then cleaned and disinfected, following which medicament is placed. The tooth is then temporised.

The main purpose of this appointment is to get you out of pain. During the procedure above, your dentist will also determine if the tooth can be saved through a root canal treatment. If the tooth cannot be saved, extraction is then advised. Most often than not, your dentist can tell you from the start whether the tooth is savable or requires extraction. Sometimes, though, is may not be apparent until all decay and existing fillings are removed.

Canal Preparation

When it have been established that root canal treatment is feasible to save the tooth, your dentist, in consultation with you, then moves to this stage.

This stage involves re-gaining access to the root canal system that has been previously disinfected and medicated. The canals are then prepared to certain shapes, sizes, and lengths to allow for filling materials to be inserted (root canal fillings). Following canal preparation, the canals are re-medicated. The tooth is again temporised.

Canal Obturation (Root Fillings)

This appointment constitutes the final stage of the root canal treatment. The root canal system is again accessed. Root fillings are then inserted.

The main reason for this appointment being separate from canal preparation appointment is to allow more healing around the root area to occur.

Following this, the tooth may be permanently restored or temporised, depending on the extent of tooth structure loss.

Tooth restoration following an endodontic treatment

onlay or crowns> (with posts and cores, if necessary).

The most common reason for tooth extraction is tooth infection and/or tooth decay (beyond fillings). Tooth infection can generally be saved with a root canal treatment; in some instances, the decay might be too extensive that extraction is the only option. 

Other indications for tooth extraction include (but not limited to), 

- orthodontic extractions,

- prophylactic extraction of wisdom teeth,

- pericoronitis (gum inflammation around partially erupted wisdom teeth), 

- unsavable tooth fracture, and

- advanced gum disease

The complexity of tooth extraction varies depending on the tooth and its associate root anatomy. Generally, molar teeth are more challenging to extract than their anterior counterparts. Wisdom teeth can have varied root anatomy and can be difficult to extract in general practice. Hence, you may be referred to an oral surgeon or an oral & maxillofacial surgeon for complicated extractions.

Medical history

Dental extraction is a surgical procedure. As such, your medical history is very important to ascertain whether it is safe to do the extraction in general practice.

You must disclose your full medical history to your dentist, including all the medications you are on and your allergies, if any. The most relevant medications you dentist needs to know are blood thinners, such as aspirin, clopidogrel (Plavix), prasugrel (Effient), warfarin, and any of the newer anticoagulants: apixaban (Eliquis), dabigatran (Pradaxa), and rivaroxaban (Xarelto). These medications affect your ability to form stable blood clots after extraction.

Blood thinners, are by no means, the only medications your dentist needs to know. There are many other medications that could potentially impact the outcome of your extraction.

Your allergy history is important because your dentist may need to prescribe you some medicines to which you may have developed adverse reactions in the past.

Your extraction appointment

The most common presentation for dental extraction is as an emergency appointment due to pain.

Having determined that the tooth requires extraction and that it is safe to do it in the chair, your dentist will talk through the procedure with you. You will also be provided with specific instructions you must follow after your appointment.

You will be well anaesthetized for the procedure. Your dentist will perform the extraction to the best of your comfort. Sometimes, a surgical extraction may be required to retrieve the entire tooth, in which case an incision to the gum will be made and some bone removal may be required. Your dentist will explain to you all of these as part of the inform consent.

After your extraction appointment

In addition to verbal postoperative instructions, you will be a given a print-out of postoperative instructions that you must follow.

You may be instructed to take some analgesics and/or antibiotics.

Tooth eruption

When should my child have his/her first dental appointment?

Ideally, your child's first dental visit should be when they have their first tooth or when they reach 12 months old - whichever occurs first. 

Early exposure to the dental environment is important in order to familiarise your child to the dentist and its environment. In addition, a lot of dental problems in the future can be prevented with proper dental care, diet advice, and regular check-up. This will, hopefully, set your child up for future free of dental decay.

Oral hygiene in children

From the time teeth first erupt (about six months old) to 17 months old, teeth should be cleaned by a responsible adult, but without toothpaste.

From 18 months old to 5 years old, teeth should be cleaned twice daily with child fluoridated toothpaste (500-550 ppm) under the supervision of a responsible adult. Apply a small pea-size amount of toothpaste to a child soft toothbrush. After brushing, your child should spit out, but not swallow and not rinse out. 

From six years old onwards, teeth should be cleaned twice daily with standard fluoridated toothpaste (1000-1500 ppm). After brushing, spit out but don't swallow and don't rinse.

Depending on your child's dental caries risk, your dentist may vary the advice above to include toothpaste containing high amount of fluoride. 

Sealants

It is a prevailing wisdom that prevention is better than cure. Dental sealants do exactly that!

Molar (back) teeth can have complicated anatomy of its surfaces, i.e. having deep fissures/grooves and pits. Often, they do to the depth that is inaccessible by the bristle of your toothbrush. In early ages, dental caries often develop from these fissures/grooves and pits.

Dental sealants are flowable tooth-coloured materials placed into these fissures and pits which are then set to harden, therefore sealing the base. The sealed surfaces of the tooth is now fully cleansable.

Generally, dental sealants are placed on permanent molars after they erupt: around 6 years old for first permanent molars and around 12 years old for second permanent molars. Sealants may be placed on other teeth, including primary/baby molars, if indicated.

Dental trauma in children

Children are prone to trauma, such as falls or getting hit while playing. As a result, dental trauma in children can be quite common.

If this were to occur to your child, go to the dentist immediately. It is important to determine the risk, if any, of damaging the adult teeth.

If your child's baby tooth is avulsed (knocked out completely), it is important that you DO NOT put it back in. Seek dental assistance immediately.

Toothache

Toothache is one of the most common presentation for dental emergencies.

If your toothache involves facial and/or neck swelling; fever; shortness of breath; or limited mouth opening, please go to the Emergency Department immediately as this constitutes a real emergency that could potentially be life threatening.

For after hours, and public holiday emergencies please call our office number. 08 9842 9680



You will be asked to leave a message. Please leave your name, telephone number and the nature of the emergency.

Please note each case will be assessed over the phone to establish if it is an emergency.

The after hours fee is an additional $200 plus the cost of the treatment.

The call out fee may or may not apply if the emergency is related to current ongoing treatment.  

Pain related to toothache varies in its severity. The most common presentations are

• Sensitivity to cold food/drinks
• Non-lingering sharp pain to cold (& sometimes hot) food/drinks
• Sharp pain to cold & hot food/drinks that lingers
• Spontaneous throbbing pain that affects your sleep
• Dull ache that comes and goes 

Common causes include exposed root surfaces inducing hypersensitivity, tooth decay, and/or inflammation/infection involving the nerve of the tooth. Treatment varies depending on the diagnosis but you can expect a simple topical fluoride to root canal treatment.

Gum infection and/or inflammation

Pain related to infection/inflammation of the gum can closely mimic that of toothache. It is important to distinguish between the two as the treatment for each is completely different. Your dentist is the best person to assess it and recommend an appropriate management.

Broken tooth/fillings

The most important assessment in this presentation is the extent of the break, depending on which, treatment can be as simple as restoring the tooth back to shape and function through to extracting the tooth.

Trauma

Knocked tooth but not out of socket

Your dentist needs to assess if the tooth is mobile and/or partially displaced from its socket. There is a risk of root resorption and the tooth may need a root canal treatment.

Knocked tooth that is completely out of socket (avulsed tooth)

If you still have the tooth, store it in milk and see your dentist immediately. DO NOT store it in water. You may put it back in if you feel comfortable.

There is a risk of root resorption and the tooth may need a root canal treatment if you wish to save it. (this does not apply to children with baby teeth - see below)

Gum trauma

Sometimes dental trauma may involve gum trauma, such as laceration of the surrounding gum. You may need stitches on the torn gum to let it heal, as well as addressing the tooth involved in the trauma.

Child dental emergency

Most dental emergencies related to children are due to trauma, such as falls. It is important to see your dentist immediately as they need to assess if there is a risk to the underlying adult tooth.

If a baby tooth is avulsed (knocked out completely), it is important that you DO NOT put it back into the socket.

The most likely sequel to dental trauma in a baby tooth is tooth necrosis (non-vital) leading to infection. Pay attention to darkening of the tooth following trauma and the presence of 'gum pimple' above the affected tooth. Bring your child to your dentist immediately if this happens.

Veneers are thin shells of dental material (ceramic or composite resin) bonded to the front surface of your front teeth to improve their the shape, colour, and overall appearance.

Diagnostic process

Your dentist will perform clinical examination and assess your suitability for veneers. If deemed suitable, your dentist may provide you with a mock-up work so that you can see if you are happy with how it would look with the proposed veneers.

Ceramic (porcelain) veneers

Veneers are generally done as indirect restoration, in which case ceramic is used. The process is similar to other indirect restorations, such as crowns, inlays, or onlays. Please see our section on indirect restorations for more details.

Unlike other indirect restorations, veneers are done predominantly for aesthetic purposes. The teeth may be healthy without any decay but the shape, colour, and appearance may not be favourable.

Beware that porcelain veneers are minimally invasive and irreversible procedures. Sometimes, when it is just the colour of your teeth that is unfavourable, you may want to try tooth whitening first. 

Composite veneers

Veneers can also be done as direct restoration, in which case composite resin is generally used. Composite veneers may be done without preparing your teeth, rendering them non-invasive and reversible.

Your dentist will discuss with you an appropriate option depending on your situation.

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