Removal of Teeth

A tooth which is very decayed or damaged, or loose because of gum disease, may have to be extracted (taken out of your mouth). Teeth are sometimes taken out from children’s mouths to help other teeth grow straight, when they are crowded.

A local anaesthetic (an injection in your mouth) will be used to numb the tooth before it is extracted; this is the best treatment for most patients.

While the tooth is being taken out you may hear some noise and feel some pressure as the tooth is being eased out – but not any pain. Sometimes stitches are put into the gum to help the mouth heal.

The dentist will give you a pad of gauze to bite on, to stop any bleeding.

The dentist will give you advice on how to look after the space where the tooth was while it is healing; how to use painkillers so you are not in any discomfort when the anaesthetic wears off; and how to contact the practice if there are any problems.

Braces

Braces are worn to straighten the teeth. Braces that are fixed to teeth, and only removed when the teeth reach the correct position are called ‘fixed braces’, and other braces that can be taken out of the mouth to be cleaned are called ‘removable braces’.

Dentists usually wait till all the baby teeth have been lost, and most of the adult or permanent teeth have come through before starting treatment with braces, so from around age 10 or 11 years. A lot of jaw growth has already taken place by this age, and it is easier to see whether teeth have enough room to come through.

FIXED BRACES

Fixed braces are made of an ‘arch wire’, which is fixed to the teeth by special holding clips (made of metal or clear plastic) called ‘orthodontic brackets’.

The arch wire is bendy, and is specially shaped to fit snugly against the teeth to move them in the right direction.

Brackets are fitted to the teeth with a special ‘cement’, so that they don’t fall off. They can be made of metal or plastic, and have grooves in them for the arch wire to clip into. Elastic bands are usually used to secure the wire to the brackets.

Arch wire and brackets may need to be changed from time to time to keep up with the teeth as they move.

It is very important to keep teeth clean when you have any type of brace, especially a fixed one. Teeth can decay around where the brackets are attached if you are not careful, and your dentist can show you how to clean your teeth properly to stop this happening.

REMOVABLE

Removeable braces are made of a plastic plate with wires and clips attached. They are usually only taken out of the mouth to be cleaned or during some sports.

If you lose or break a removable brace, you will probably need to have another made. Care must be taken when cleaning your brace, as some parts may be quite delicate and could be damaged easily.

Everyone’s brace is made to fit their own teeth, and move the teeth until they are in the correct position.

Restoratoin Work

Damaged or decayed teeth often need some form of treatment to repair them. This treatment is known as restoration work. This part of the site contains information, 3D models and images of crowns, bridges, dentures, implants, fillings and root fillings. The 3D models will show how the restorations are carried out and the work involved. Some of the models can be rotated. You can also play and pause them so that you can read the accompanying text.

CROWNS

The crown of a tooth is the part which is visible in the mouth. An artificial crown completely covers a damaged tooth above the gum line and protects it. Crowns can also improve the appearance of misshapen or discoloured teeth. Crowns are made of metal or porcelain, or porcelain with metal inside for strength. The colour and shape can be matched to your own teeth.

The dentist shapes the tooth so that there is room for the artificial crown to fit over the top. Preparation time will depend on how damaged the tooth is and whether it needs to be built up with a filling first.

The tooth might have to be root-filled first – this is sometimes called ‘removing the nerve’. The crown is sometimes held in place by a peg in the root canal if a lot of the tooth is missing.

Your dentist will use a soft mouldable material to make an exact ‘impressions’ of the tooth that is to be crowned and the nearby teeth. A dental technician uses the impressions to make the crown the exact height and size needed.

A temporary crown made of plastic or metal is put over the tooth until the permanent crown is made. You can chew on a temporary crown but it won’t be as strong as the finished one.

When the crown is ready, the temporary one is removed and the permanent one put it its place. The dentist will make small adjustments to make sure you can bite comfortably.

FIXED BRIDGES

A bridge is one way replacing a missing tooth. It fixes a replacement tooth (or teeth) to the natural teeth on either side of the gap. Some bridges (like the one on the 3D model) have crowns at each end. Others are fixed to the surface of the teeth next to the gap.

Bridges are made of metal and porcelain or sometimes just porcelain. The teeth can be matched to the colour of your own teeth.

The teeth that will support the bridge are prepared to take the fixings and to make sure that the bridge is not too bulky.

An impression is taken of the teeth and any gaps, and the dental technician uses this to make the bridge. A plastic temporary bridge or temporary crown may be fitted in the meantime.

At your final visit, the dentist will check that the bridge fits, make any minor adjustments and then fix it permanently in place. Your dentist or hygienist will show you the best way of keeping your new bridge clean.

DENTURES

A removable denture replaces missing teeth. ‘Partial’ dentures replace a few missing teeth and ‘full’ or ‘complete’ dentures are needed if all the natural teeth are missing. Dentures can improve the way you look, bite, chew and speak and can be made to look as natural as possible.

Acrylic, a type of plastic, is used to make dentures and some will also have metal in them.

The dentist uses a putty-like material to make moulds of your mouth – called ‘impressions’. A dental technician uses them to make models for the denture to be built on. Sometimes, second impressions are taken.

The dentist then takes further measurements of the mouth using wax blocks. These blocks show the technician how your teeth should bite together, and the shape to make the denture.

A trial denture is made and put in your mouth. The dentist will check the fit and make any final changes.

The trial denture then goes back to the technician who permanently fixes the teeth. The denture is then ready to use.

DENTAL IMPLANTS

Implants are posts that are fixed in the jaw and are one way of replacing missing teeth. It is possible to have more than one tooth replaced and this might involve having more than one implant. Implants can also be used to stabilise dentures. The 3D model shows the placement of one implant with a crown on top.

Patients need to have healthy gums, and enough jawbone to support the posts and the replacement teeth. They must also be prepared to maintain good mouth hygiene and visit the dentist regularly.

Implants involve undergoing surgery twice or more over a period of several months.

Bone is exposed in the jaw where the tooth is missing. Then a hole is drilled and a metal post is inserted into the bone. This is usually done under a local anaesthetic, but sometimes sedation or a general anaesthetic is used. The gum is then stitched over the post and it’s left to heal for several months, until the bone has grown around the post, making it secure.

A second operation then happens, in which a replacement tooth is mounted onto the implant post. This requires a small cut in the gum to allow the replacement tooth to be fixed permanently or attached in a way that lets the dentist remove it.

WHITE FILLING

A filling replaces part of a tooth that has been lost because of decay or through accidental damage.

‘Silver’ fillings are made of amalgam – a mixture of mercury with other metals, such as silver, tin and copper. They are very strong, so they are ideal for back teeth, where there is heavy wear from chewing.

‘Composite’, ‘glass ionomer’ and ‘compomer’ are different types of white filling. Unlike silver (amalgam) fillings, white filling material sticks to teeth and can form edges, so it may be effectively used to repair front teeth that are chipped, broken, decayed or worn. It can also be used to cover marks or discolouration that cleaning won’t remove. White fillings come in a range of shades so they can be matched to the colour of your own teeth.

The 3D model shows the placement of a white filling.

White fillings

The dentist will usually numb the area around the tooth with an injection (local anaesthetic).

A drill is used to remove any decay, together with any old filling material. Then the tooth is washed and dried by blowing water and then air onto it (the dentist will be holding something which looks like a water pistol).

A mild acid is then applied to etch (roughen) the surface of the hole. It is then washed and dried again. The etching helps the filling stick better.

A layer of bonding agent is applied to the hole and acts like a cement to help hold the filling in place. It has to be set (hardened) using a bright light (called a curing light).

The filling material is then pushed into the cavity (hole), shaped and then hardened using the same bright light. A drill is used to trim and polish the filling as necessary.

ROOT FILLINGS

Teeth are held in the jaws by their roots. Front teeth normally have one root, but teeth further back have more. At the core of each tooth is a soft mass of tissue called the pulp. Tooth decay or injury can destroy the living pulp and make it is more prone to infection. This can lead to an abscess and toothache.

Root fillings (also known as root canal treatment or endodontics) are carried out to remove damaged or dead pulp. The space left can then be filled to prevent any further infection getting in. An x-ray can show the number and shape of the root canals, and also signs of infection (an abscess) in the surrounding bone.

The diagram shows a decayed tooth with a single root being filled.

You will usually be given a local anaesthetic to numb the tooth. Then an opening is made through the top of the tooth, down into the pulp, using a drill. The dentist then uses narrow files to remove the dead pulp from the core of the tooth and from the root canal.

At this point, the dentist may put in a temporary filling (not shown) and possibly also give you antibiotics if any infection has spread beyond the tooth. If so, you will have to return at a later date, once symptoms have settled, so the dentist can complete the treatment.

In the next stage, the dentist fills the root canal. A filling is then placed on top of this to protect the root filling and, if necessary, the tooth can be crowned at a later date.