Dental treatment under sedation is the use of medication to help patients relax during dental procedures. Patients are usually awake with the exception of those who are under general anesthesia. General anesthesia is not used in general dental practices and you would need to be referred to hospital.
The levels of sedation used include:
- Minimal sedation – you are awake but relaxed.
- Moderate sedation (formerly called “conscious sedation”) – you may slur your words when speaking and not remember much of the procedure.
- Deep sedation – you are on the edge of consciousness but can still be awakened.
- General anesthesia – you are completely unconscious.
The following types of sedation are used in dentistry:
- Inhaled minimal sedation. You breathe nitrous oxide – otherwise known as “laughing gas” combined with oxygen through a mask that’s placed over your nose. The gas helps you relax. Your dentist can control the amount of sedation you receive, and the gas tends to wear off quickly. This is the only form of sedation where you may be able to drive yourself home after the procedure.
- Oral sedation. Depending on the total dose given, oral sedation can range from minimal to moderate. For minimal sedation, you take a pill. Typically, the pill is Halcion, which is a member of the same drug family as Valium, and it’s usually taken about an hour before the procedure. The pill will make you drowsy, although you’ll still be awake. A larger dose may be given to produce moderate sedation. This is the type of anesthesia most commonly associated with sedation dentistry. Some people become groggy enough from moderate oral sedation to actually fall asleep during the procedure. They usually can, though, be awakened with a gentle shake.
IV moderate sedation. You receive the sedative drug through a vein, so it goes to work more quickly. This method allows the dentist to continually adjust the level of sedation.
Dentistry is no longer just a case of filling and taking out teeth. Many people turn to cosmetic dentistry, or ‘aesthetic dentistry’, as a way of improving their appearance from slight twists in their teeth to discolouration. They do this in the same way they might use cosmetic surgery or even a new hairstyle. The treatments can be used to straighten, lighten, reshape and repair teeth. Cosmetic treatments include veneers, crowns, bridges, tooth-coloured fillings, implants and tooth whitening.
Dentures are removable false teeth made of acrylic (plastic), nylon or metal. They fit snugly over the gums to replace missing teeth and eliminate potential problems caused by gaps.
Gaps left by missing teeth can cause problems with eating and speech, and teeth either side of the gap may grow into the space at an angle. Sometimes, all the teeth need to be removed and replaced.
You may therefore need either:
- complete dentures (a full set) – which replace all your upper or lower teeth, or
- partial dentures – which replace just one tooth or a few missing teeth
Dentures can help to prevent problems with eating and speech and, if you need complete dentures, they can also improve the appearance of your smile and give you confidence.
Professional bleaching is the most common form of tooth whitening. Your dental team will apply the whitening product to your teeth, using a specially made tray which fits into your mouth like a mouthguard. The ‘active ingredient’ in the product is usually hydrogen peroxide or carbamide peroxide. As the active ingredient is broken down, oxygen gets into the enamel on the teeth and the tooth colour is made lighter. Once your dental team has started this treatment you may be given the trays to take home and continue the treatment, or you may need more appointments with the team.
This treatment can take around 3 to 4 weeks, depending on how long you keep the trays in your mouth each time, and how much whiter you want your teeth to be. It is important to remember that only natural teeth will be whitened, and that any crowns, bridges or dentures you have will stay the same shade.
Teeth can be straightened with orthodontics (braces). This is usually done during the teenage years, when the jaws are going through a period of growth. However, many adults also have treatment to straighten their crooked teeth or to improve their appearance. The treatment can take much longer in adults and is therefore more expensive. Some people have clear or plastic braces, which are hardly noticeable. If you are considering orthodontic treatment, first see your dental team and get their advice.
Your dental team can talk to you about your treatment options and if necessary refer you to an orthodontist, a dentist who specialises in straightening teeth. There are also now ‘invisible’ braces. Your dentist will make you a series of clear plastic shields (like a mouthguard) which need to be worn all day and gradually move your teeth into a new position.
A dental implant is used to support one or more false teeth. It is a titanium screw that can replace the root of a tooth when it fails. Just like a tooth root, it is placed into the jawbone. Implants are a safe, well-established treatment. It’s probably true to say that implants, much like natural teeth, will last for as long as you care for them. How well you look after your implants – and whether you go for your regular maintenance appointments – will have the biggest impact on how long they will last. If you don’t look after your implants they will develop a coating similar to what you get on neglected natural teeth.
Left untreated, this can lead to gum infection, bleeding, soreness and general discomfort. You could get all these problems with natural teeth. If your implants are well looked after, and if the bone they are fitted to is strong and healthy, you can expect them to last for many years. However, just as with other surgical implants (such as a hip replacement) there is no lifetime guarantee.
For over 150 years standard fillings have been made out of a silvery-grey material called ‘amalgam’. This is considered one of the strongest and longest-lasting materials for fillings. However, many people find it unattractive and some are concerned about possible health risks. White fillings are now a popular alternative to amalgam fillings. The new dental materials mean it is much easier to find a perfect match for the shade of a particular tooth. In most cases, it is quite impossible to see that the tooth even has a filling. Sometimes white filling material can be used to cover unsightly marks on teeth, in a similar way to veneers.
Crowns, Bridges or Veneers:
When a tooth is badly broken or heavily filled, the dentist may need to crown or ‘cap’ it to restore its appearance and strength. The usual method for fitting a crown involves shaping the tooth under local anaesthetic and then taking an impression using a rubber-like material. The impression is then sent to the laboratory along with the details of the shade to be used, and the technician makes the crown. While your crown is being made, the prepared tooth can be protected with a temporary crown. This is easily removed just before fitting the permanent one. In most cases, the temporary crown is in place for about two weeks. Crowns can be made of a variety of different materials, such as porcelain or porcelain bonded to gold. New materials are continually being introduced. It is a good idea to talk to your dental team about which crown would be best for you.
Bridges are ideal for people who don’t like dentures and only have a few teeth missing. Bridges are usually made by putting a crown on the teeth on either side of the gap and attaching a false tooth in the middle. The bridge can’t be removed. These bridges are usually made of precious metal bonded to porcelain. Sometimes other non-precious metals are used in the base to give it extra strength.
Veneers are thin slices of porcelain. These are precisely made to fit over the visible surface of your front teeth, like a false fingernail fits over a nail.
Veneers are an ideal way of treating discoloured or unsightly teeth, closing gaps between front teeth, or repairing chips and cracks. A small amount of enamel is removed from the tooth, usually the same thickness as the veneer will be. The dental team take an impression and send it to a dental technician, who makes the veneer in a laboratory. The veneer is then bonded to the tooth to form a strong and natural-looking repair.
Periodontal treatment is the specialist cleaning of your teeth and gums to help control the bacteria that cause gum disease. Gum disease is caused by the germs (bacteria) which live in your mouth. The bacteria stick to your teeth, irritate the gums and make them bleed. Gum disease can eventually destroy the gum and bone which support your teeth. Some people get more severe gum disease than others. This can have specific causes such as diabetes or smoking, but some people are just more prone to gum disease.
This is where the nerve of a tooth has died and to avoid an extraction sometime it is possible to root fill a tooth.
Minor Oral Surgery:
Some patients may be referred to our Minor Oral Surgery Service if they need dental care which cannot be provided by their regular dentist. If your Dentist believes this is the best option for you, they will refer you to our dentist with a special interest in Oral Surgery. Following this we will offer you an assessment appointment. The term “Minor oral surgery” refers to smaller operations and includes removing wisdom teeth, impacted teeth, and severely broken-down teeth, as well as apicectomies, biopsies and other procedures.
Oral surgery is carried out by “dentists with a special interest in oral surgery” (DwSI) who have gained the necessary skills and experience by receiving training in Oral and Maxillofacial Surgery Departments in hospitals and are all registered with the General Dental Council.
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