What we do

Preventative

  • Dental examinations

  • Tooth cleaning

  • Oral hygiene instruction
  • Fissure sealing
  • Fluoride treatments
  • Treatment of sensitive teeth
  • Biteguards to prevent jaw pain and tooth wear

  • Sports gum shields

  • Solutions to bad breath

Restorative

  • Dental implants
  • Tooth coloured resin fillings
  • Crowns
  • Bridgework
  • Root canal treatments
  • Full and partial dentures
  • Treatments for gum disease
  • Fluoride releasing cement fillings
  • Gold restorations

Aesthetic

  • Tooth whitening
  • Tooth coloured resins to reshape teeth
  • Porcelain veneers
  • Air polish to remove stains

Nervous Patients

Where required, we can arrange for a highly trained and experienced anaesthetist to attend the Practice to provide conscious sedation.

Specialist referral

For specific treatments not carried out at the Practice, we have close working relationships with the very best specialists in the following fields:

  • Orthodontics
  • Oral surgery
  • Complex root canal treatments
  • Complex gum treatments

Management of Cracked Teeth

In the main, it is back teeth that develop cracks, i.e. the molar and premolar teeth.

It is thought that cracks usually develop either because the teeth are under increased loads or because they have become weakened as a result of previous tooth decay or root canal problems. As the front teeth can wear a little throughout life the back teeth can be put under greater lateral load during chewing or clenching which can contribute to crack formation.

Sometimes these cracks are discovered when teeth are being restored with fillings or crowns. More usually, teeth become painful on chewing certain foods or with cold. It is very uncommon for cracks to show up on x-rays unless the tooth has split completely along the crack line.

If left untreated several problems can occur. The crack may cause a large piece of the tooth to detach which sometimes renders the tooth unrestorable. If the crack runs centrally in the tooth it may allow bacteria to enter the pulp which can lead to tooth ache and eventually infection. In extreme situations the crack may cause the tooth to split top to bottom.

If the crack is under a single cusp then a large filling overlaying this cusp may suffice. If the crack runs more centrally then a laboratory made crown is usually the best option to splint the tooth together. The strongest crowns are metal, followed by porcelain. The decision on which crown to use is often a balance between strength and aesthetics. Because we cannot be sure that the crack has not communicated with the pulp of the tooth, if the tooth is symptomatic before it is prepared for the crown it is often sensible to leave the temporary crown in place for a period of observation before fitting the definitive crown. Sometimes the pulp either does not settle or becomes inflamed after the tooth has been prepared for the crown or after the definitive crown has been fitted. In these cases root canal treatment is often indicated.

Unfortunately we can’t be sure how long a cracked tooth is likely to survive. Even after extensive treatment we can never be 100% certain that the crack will not continue to propagate and that ultimately the tooth will end up needing to be extracted. A crown can act as a mechanical device for bracing the cracked tooth but cannot treat the biological consequences of a crack.

Managing Tooth Wear

People may be concerned about
• The appearance of their worn teeth
• Sensitivity associated with hot or cold drinks
• Difficulty or soreness whilst chewing
• The lifespan of their teeth

Prevention
• Treatment is focused on preventing any further tooth surface loss.
• Use fluoride daily to help strengthen the teeth.
• In those who grind or clench their teeth, an appliance can be made to fit over the teeth
to protect them.

Restoration
• Bond tooth-coloured filling material to your worn teeth (The “Dahl Technique – see below) to rebuild the natural shape.
• Prepare the teeth for laboratory made indirect restorations.

This technique has been successfully used for over 30 years. The great advantage is that it is a less destructive treatment option as there is little or no preparation of the teeth. It is possible to build the teeth up with a tooth-coloured filling material that is bonded to the tooth or metal coverings that are bonded to the biting surfaces of the teeth.

How will it feel?
• Initially the teeth treated will feel high in the bite and your other teeth will not be in contact. It usually takes patients 1-2 weeks to get used to the new bite.
• It is unusual for patients to experience pain during this treatment, however the bite may feel a little uncomfortable initially.
• Your other teeth will come back into contact over a period of 3-6 months, however in some patients this can take up to 1 year.
• In very rare instances the other teeth fail to come back into contact. If this occurs it may not concern you, so no further treatment is necessary. In some patients we may have to bond fillings to some of the other teeth as well.

How long will it last?
The resin material is softer that natural tooth, porcelain or gold and so will wear at a faster rate than those materials. It does however have one major advantage which is its ability to be repaired. I would estimate a life span on around 10 years with only minor repairs being required during that time though obviously this varies between individuals.

Gum Disease and Hygiene Therapy

Gum disease is a bacterial infection of the tissues supporting the teeth. It can be a reversible inflammation of the gums only (Gingivitis) or a progressive inflammatory disease of the deeper supporting tissues including the ligament and bone (Periodontitis).

Most people have some degree of gingivitis, though this is often mild. The more severe type of gum disease is seen to some extent in around 90% of the population but around 10% of the population are particularly susceptible and demonstrate severe destruction of the supporting tissues which can lead to the loss of the teeth. People who have gum disease and also smoke experience more severe destruction.

Bleeding gums, unpleasant taste or odour, loosening or drifting of the teeth are all signs of gum disease. In smokers however, the lack of bleeding may mask the presence of disease.

Since the disease is caused by bacteria the mainstay of treatment is exemplary brushing and flossing to remove the bacteria daily. Most patients find that in order to achieve this very high level of oral hygiene they require the advice and support of a dental hygienist who is specifically trained to help prevent and treat problems of the gums. As part of this in addition they will periodically remove those bacterial deposits which have hardened to become tartar. Some patients with very advanced gum disease may require treatment from a Periodontist, a dentist who specialises in the treatment of gum disease.

Patients with a fair level of oral hygiene and not suffering from progressive gum disease should visit their hygienist about every six months to maintain a peak level of oral hygiene. Those patients with less-than-ideal oral hygiene or who are suffering from progressive gum disease should visit their hygienist every three to four months.

Upper Acrylic (Michigan) Splints

At times some patients have over-active jaw muscles that can lead to
• Pain and tenderness of the jaw joint, muscles and surrounding tissues
• “Head-aches” caused by chronic muscle tension
• Wear of the biting surfaces of the teeth
• Fractures of the teeth or restorations
• Reversible mobility of the teeth

Over 90% of us have a small discrepancy between the positions our jaw joints would have us close our mouth and how the shape and position of our teeth makes us close. As a consequence, certain muscles are overworked to “steer” the jaw into the tooth dictated position. Most of the time this causes no problems but when some people become tired, anxious or stressed they are prone to clench or grind their teeth whilst awake or asleep, which can lead to damage or mobility of the teeth. The overactive muscles can also build up toxins, which cause inflammation and pain.

By providing a smooth, flat surface to bite on, the custom-made splint allows the lower jaw to close in the position dictated by the jaw joints and so allows some relaxation of the over- active jaw muscles. Because the splint is made from a hard acrylic it will splint the teeth to resolve mobility and will act as a barrier between the tooth and so prevent tooth-to-tooth wear due to grinding and clenching.

Each splint is custom made to fit only your teeth and jaws. To achieve this, accurate impressions are made of your teeth. Next, a small plastic platform is made to fit your front teeth. This helps record the jaw muscle position by separating the teeth. A wax record of the jaw positions is then taken along with a “face-bow” recording, which allows us to record the distance from your jaw-joints to your teeth. A technician then uses all this information to build your splint, which usually takes about a week.

Initially your bite will feel high when the splint is worn though you will soon get used to the new bite. It is normal for the splint to feel tight on the teeth initially or after long periods without wear. The more you wear the splint the quicker it will alleviate your symptoms. Most people wear their splints only at night, but you can also wear it at other times when you may grind or clench the teeth, i.e. whilst driving on long journeys, whilst reading etc.

Brush the splint with a toothbrush and toothpaste once a day after wear. You can keep the splint in peak condition by soaking it in a denture-cleanser once a week. Store the splint damp in the case provided to prevent it drying out and cracking.

Information for Patients Considering Dental Implant Treatment

Dental implants are titanium replacements for missing natural tooth roots, to which we can attach crowns, bridges or even removable dentures. The first step in the process is to assess the available bone and the proximity of any sensitive anatomical structures. This is achieved by a 3D CT scan of the area. Often the CT scan will reveal sufficient bone but occasionally this may need to be supplemented before or at the time of implant placement either using bone substitutes of animal origin, small amounts your own bone or a combination of the two.

Sometimes, due to limited bone dental implants need to be placed close to anatomical structures such as nerves, blood vessels or the nasal sinuses. The use of the CT scan means that we can plan in advance how close we are likely to be to these and I will advise you of any elevated risk to these structures in your particular case.

Before placement we will give you antibiotics and anti-inflammatories to minimise any postoperative discomfort. To provide the best possible conditions for the placement we will convert the surgery into an operating area and use full surgical gowns and drapes. We then ensure that the area of the mouth is fully anaesthetised before the implant is placed. You will feel no pain during the surgical procedure, just some vibration, water spray and noise. Usually we will place some stitches and review you one week later to remove these. As with any surgery you may experience some post-operative pain, bruising, swelling or infection though I would stress that most of our patients report uneventful healing with the vast majority needing painkillers for only the first 24 hours.

Sometimes we are able to place a temporary crown on the implant straight away. Other times we may either place a short cylinder on the implant or cover it back over with the gum and wait a couple of months before either placing a temporary or even taking impressions to make the final restoration.

Once integrated, implants are very reliable with success rates in excess of 95% at ten years. However, this is a medical procedure, and implants can fail to integrate with your body early in the treatment or fail later biologically through a process similar to gum disease. Early failure can usually be addressed through replacement of the implant. The best protection from late biological failure is to maintain excellent oral hygiene and visit the hygienist on a regular basis. It is important to appreciate that implants require both good daily brushing as well as the use of additional cleaning aids such as floss or interdental brushes.

Occasionally, chipping of the crown on top of the implant can occur. This will not affect the underlying implant and if minor can simply be smoothed. Should the porcelain on the crown crack more extensively, then ultimately a new crown may be required. Loosening of the crown may occur though this is generally straightforward to remedy during a single appointment to retighten the crown to the implant.

Should you decide to proceed with implant treatment then we can discuss the specifics of your particular case in greater detail.

Complaints

General Dental Council Contact Details (GDC)

The GDC regulates all dental activity in the UK and can be contacted here.

Our Complaints Policy

We aim to provide the highest levels of care and patient satisfaction. However if you are unhappy with any aspect of your treatment with us, please contact Tina Frost our practice manager on 020 7580 1017 or info@jamesbakerdentist.co.uk to discuss.

Our full complaints policy can be downloaded here.

Should this not resolve your issue to your satisfaction then we recommend consulting the Dental Complaints Service (General Dental Council) on 020 7887 3800 or www.gdc-uk.org