Basic Information on Dental Caries (Decay)
What is it?
Dental caries occurs when certain bacteria in the mouth has access to sugar over a period of time. A tooth with a cavitated dental caries lesion should be restored sooner rather than later. Delays will increase the risk of further damage which may mean the need for root canal treatment (if the tooth is still restorable) or extraction.
The main causes of dental decay are inadequate cleaning of teeth and/or excessive exposure to sugary food or drinks.
What treatment do you recommend?
Generally, with a small cavity, we recommend a direct restoration (white filling) that can be completed in one visit.
With larger cavities that affect about half the tooth, we recommend an indirect restoration (onlay or crown) that normally require two visits to complete. Such restorations are stronger and therefore more durable.
Additional notes
The two main causes of restoration failures are dental decay and fractures. Therefore, to maximize the longevity of the restorations, you must have good dental habits (i.e. good oral hygiene, healthy diet and regular dental check and clean visits) and avoid excessive forces on the teeth (e.g. chewing hard food such as nuts, removing bottle caps with your teeth and managing night-time grinding or clenching).
Basic Information on Periodontal Disease
What is it?
Periodontal disease is a chronic complex multifactorial infection. The main factors include the presence of dental plaque, dental calculus (tartar) and host susceptibility.
The disease initially presents as inflamed gums that bleed easily when brushing or flossing your teeth. As the disease progresses, one may notice recession of the gums that exposes the root surfaces of affected teeth. If periodontal disease is left untreated, it may lead to the loosening of teeth and/or painful gum infections that are usually best treated by extractions.
There is increasing evidence that suggests periodontal disease may be linked to diabetes, heart disease, pregnancy complications and other medical conditions. Research in these areas are ongoing.
Periodontal disease is usually a slow-progressing disease that is asymptomatic, very much like heart disease. Most affected patients are not even aware that they have a problem.
What treatment do we recommend?
Depending on the severity of the disease, treatment may involve scaling, polishing and oral hygiene instructions only for mild cases.
In advanced cases, treatment will involve deep scaling and root planing under local anaesthesia. For severe cases, referral to the periodontist (a specialist) is indicated.
Additional notes
Periodontal disease is a chronic disease - there is no cure. Our treatment goals are to control the disease and to prevent its progression. Good oral hygiene is the basic requirement to manage the disease. Regular ongoing professional maintenance (e.g. 3 to 6 monthly recall check-ups, scaling and polishing) is recommended.
Risk of periodontal disease increases if you are a smoker, have uncontrolled diabetes or have a family history of periodontitis.
Basic Information on Crack-lines
What is it?
Crack-lines on teeth are a common finding during an examination and can be attributed to the combination of years of daily wear and tear, preference for hard food, teeth grinding or clenching during sleep, trauma, large fillings, stress and lifestyle habits.
In most cases, crack-lines are very fine and asymptomatic, and are not a problem. However, these fine cracks do not heal (just like cracks in glass) and has the potential to get worse over time. The early symptoms (which may take years to develop) are usually some sensitivity to something sweet or cold and occasional tenderness on biting something hard or tough.
Possible risks with crack-lines include dental decay and minor or major tooth fractures.
What treatment do we recommend?
For the symptomatic crack-lines, treatment is recommended to resolve the symptom(s). However, please note that treatment outcomes are unpredictable and can range from resolution of the symptom(s) with a simple filling or complex treatment (such as root canal treatment and a crown), or possibly needing to extract the tooth if symptoms persist. This unpredictable outcome is due to the unknown extent of the crack-line(s) which we cannot assess prior to treatment and that the symptoms are a poor indicator of the severity of the cracks.
For the asymptomatic crack-lines, we face the same unpredictable outcomes. Our opinion here is that intervention may be advisable if the affected tooth is important for function or appearance, if there is obvious staining in the crack-line(s), or if the the crack-line(s) can be seen to extend towards the root of the tooth.
Additional notes
Some preventive measures which may help slow down crack propagation - avoid chewing on hard food or substances, wear an occlusal splint if you grind or clench your teeth during sleep, and wear a mouthguard if you participate in contact sports or engage in weightlifting.
Basic Information on Non-Carious Cervical Lesions (NCCLs)
What is it?
NCCLs are defects on teeth near the gums. The wedge-shaped loss of tooth structure resembles the mark that an axe leaves on a tree when chopping it. The lesions can be attributed to a combination of internal stresses on the tooth (from high biting forces, usually associated with grinding or clenching during sleep) and/or external wear forces (from aggressive tooth brushing or regular dietary acidic exposure).
In most cases, NCCLs are asymptomatic or they may become symptomatic occasionally. If left untreated, the lesions will gradually over time (usually years) become more widespread or extend deeper into the teeth.
What treatment do we recommend?
For the minor or superficial lesions, we recommend managing the symptoms and monitoring only. This usually involves using toothpaste for sensitive teeth.
For something more than a minor lesion, a bonded filling is recommended.
Additional notes
If NCCLs are not monitored regularly, they may become severe lesions with little symptoms and the tooth may require more complex treatment like root canal treatment or possibly an extraction.