Dental Accident & Emergency

A dental accident & emergency can happen at any time......... So I'm watching TV when I get this text from my fantastic dental technician David De Wet of Oral Art. Just one look at at the attached photo & I knew that this young chap from Takapuna (and his parents & his twin sister) would be very uspset. Fortunately he had already seen a dentist who had checked for any nerve exposures. Thank goodness there weren't. He arrived at my practice with the piece of fractured tooth in a little bag of water to keep the tooth fragment hydrated. Mum filled out an ACC form & we were off.

Amazingly this 10 year old had no pain. After taking a digital x-ray & checking that his tooth was still alive (which it was) I checked to see if the two halves of his tooth would fit together - They did perfectly. Things were looking good. I now put my dental bonding hat on & thoroughly cleaned both the tooth in Takapuna Chaps mouth & the tooth fragment using a gentle spray of powder & sand (this is called dental air abrasion). This creates a superb surface for gluing or dental bonding. I used a clear dental veneer cement to carefully rebond chip A to tooth B.

I think the end result is most pleasing & this lovely family from Takapuna, North Shore, let out a colective sigh of relief.

So if this happens to you or a family member, it is possible to reattach your tooth fragment using dental bonding. If possible try & find the piece of broken tooth & bring it a long. 

If the whole tooth is knocked out you need to get to a dentist as quickly as possible.

Things to do if a whole tooth is knocked out -
1) If someone feels confident, the best thing to do is pick the tooth up by the crown (never hold the tooth by the root) & push it back into the socket if it is clean
2) Then get to a dentist or failing that a hospital A&E ASAP
3) If the root of the tooth is not clean, whilst holding the tooth by the crown, run the root under a jet of water ie tap water or squirt water from a drink bottle, until all the debris has been removed, then push it back into the socket
4) Get to a dentist or failing that a hospital A&E ASAP
5) If you can't get to a dentist quickly you can make a splint by wrapping tin foil over the damaged tooth and its neighbours to help hold it in place & then get to a dentist
6) If you can get to a dentist & don't feel confident about putting the tooth back into the socket, the tooth needs to be carried correctly to the dentist or A&E. If the patient is able to/old enough to understand what's going on, the best place to keep the tooth is in the patients mouth under the tongue
2) If this is not possible then put the tooth in milk
3) If this is not possible then put the tooth in water

If you chip your tooth & don't have the fragment the tooth is often repaired using dental composite resins / white fillings & dental bonding.  

If you break your tooth in a more structural way an option may be to place a dental tooth veneer or dental crown to strengthen your tooth, & improve it's appearance

One of the main functions of any dental practice is the treatment of dental emergencies & we are here to help the good people of the North Shore with all their dental requirements - From Devonport and Belmont up through Takapuna, Castor Bay,Mairangi Bay & Browns Bay as well as Albany, Northcote, Hillcrest & the Whangaporoa Peninsula and beyond.

What Types Of Dental Crowns Are Available?

Dental crowns, dental overlays or dental veneers can be made to create beautiful natural looking teeth whilst also strengthening the underlying tooth.

So what types of dental crowns are available at Milford Dentists, North Shore, in Auckland?

The types of dental crowns that are available

Emax crowns on front teeth

1) All ceramic dental crowns & dental overlays & dental veneers made from different porcelains – There are many different types of porcelain to make dental restorations from. In my opinion, Emax porcelain is the most incredible & exciting material for making dental restorations & it has been my crown material of choice since 2008.

Because this porcelain mimics actually tooth structure, it makes beautiful natural looking crowns. It is incredibly strong (3-4 times more fracture resistant than a porcelain fused to metal crown). As well as being super fracture resistant it can be bonded to a tooth. This laminate effect makes the restoration even stronger

• This bonding means the crown is highly unlikely to be dislodged
• The bonding technology significantly reduces post placement symptoms
• This bonding also helps hold fractured teeth together preventing cracks from getting bigger

Because the crown overlay is bonded to the tooth it requires less tooth to grip onto which means overlay preparations are very conservative ie more of your tooth is saved.

Porcelain Fused to Metal Bridge

2) Porcelain crowns fused to an inner metal thimble (PFM's). This type of crown was the most frequently placed for decades. There is still a place for this type of crown but it has mostly been superseded by Emax crowns and overlays. PFM’s can be placed

- In cosmetic situations where the teeth surrounding the tooth to be crowned also have PFM’s

- Over a dental implant

As part of a dental bridge where the metal connectors in the centre of the bridge are required for strength. The porcelain is fused on the outside of the metal framework

Gold Crown

3) Metal crowns made of gold or semi-precious alloys. In areas where a tooth is subjected to a lot of chewing forces – for instance on the second permanent molars, these restorations are often a good option

4) Composite resin crowns can be placed as temporary crowns, overlays or dental bridges. They tend to wear out quite quickly which is why they are not used in a permanent situation

Zirconia Crowns

5) Zirconium crowns are even stronger than Emax crowns, however, they do not look as beautiful. An option is to place them on teeth which traditionally would have had a gold or semi-precious crown

Read more in our blog on "cost of Dental Crowns" 

Posted by Andrea

Milford Dentists is proud to help the good people of the North Shore with all their dental requirements; especially in our mission to help you strengthen & beautify your teeth - From Devonport and Belmont up through Takapuna, Castor Bay, Mairangi Bay & Browns Bay as well as Albany, Northcote, Hillcrest, the Whangaporoa Peninsula and beyond give us a call - 09 4896575.

8 Reasons Why You Need A Dental Crown

Here are 8 reasons why having a dental crown can improve how your teeth work. A Dental Crown, Dental Overlay or Dental Veneer - 

1. Strengthens a tooth acting like a crash helmet or thimble to hold things together
2. restores the shape of a tooth to help with eating and or decrease food trapping
3. replaces worn tooth
4. improves a tooth’s appearance
5. can be part of a dental bridge to hold a fused false tooth in place
6. Is used in dental implant dentistry to replace a missing tooth
7. Is used to help hold a denture more securely in the mouth with a special attachment.
8. To stop "Cracked Cusp Syndrome" symptoms - see below

Here are common situations where a dental crown may be a good option

If a tooth has a large filling: A large filling equals over 50% of the tooth being replaced by filling material. The remaining tooth structure is in a weakened state & vulnerable to snapping or cracking or secondary tooth decay. 

 SameDay Emax Porcelain Overlay Crown replacing massive failing Mercury dental amalgam 

A Root canal treated tooth: When a tooth is root canal treated it is significantly weakened. To access the root canals an access cavity is made right through the middle of the tooth. Often teeth requiring root fillings are having this treatment because they are already heavily filled and in a weakened state with tooth cracks. Overlaying this weakened tooth structure with a dental crown goes a long way to protecting the tooth from further failure

Root filled tooth that is weakened & highly prone to snapping unless overlayed with a crown or overlay

A tooth with cracked tooth syndrome: Tooth cracks that spread through the enamel into the dentine towards the nerve in the middle of the tooth are painful when chewed on. Often the pain only happens when biting on a certain point whilst eating something like grainy breads or seeds. The little hard piece of food sits right at the wrong place on the tooth and chewing wedges the fractured tooth crack open causing pain. If left untreated the crack propagates & eventually the tooth will break in two. Sometimes pain to hot & cold is also experienced. A dental crown or overlay holds the crack together. This stops the tooth fracture moving & growing & stops the sharp pain on chewing (unless the crack has already reached the nerve)

If a tooth has cracks in it: More often than not structural tooth fractures i.e. cracks that go through the enamel & into the dentine don’t actually hurt. However they are still weakening the tooth & the end result will be cracked cusp syndrome and or the tooth breaking apart. Crowns & now more often overlays strengthen the tooth by these cracks together. Read more on options if you have old Mercury Amalgam Fillings & want to prevent tooth cracking.

Teeth that have broken cusps:

Due to all of the above ie heavily filled teeth & tooth fractures, often cusps will snap off. This often happens when people are eating innocuous things like soft bread. They come to see me with the piece of tooth, bewildered & wanting to know why this happened – “I was only eating soft bread or yoghurt or rice bubbles or some other soft food, why has this happened?” Well the cracks have been propagating painlessly for years & the cucumber sandwich was the last straw.  Cusps frequently break off teeth due to trauma or large existing fillings. The cusps take most of the chewing stresses whilst eating & can be protected and or replaced with a dental crown or overlay.

Teeth that have excessive wear:

People who have shorter teeth because they
1) grind their teeth2) have eroded their teeth with acid caused by gastrointestinal acid reflux (GERD), bulimia, or an acid dietThis wear can sometimes lead to loss of a great deal of enamel in vulnerable areas resulting in small easily worn teeth & a collapsed bite. Restoring these teeth by increasing the height to its original dimensions & covering the softer dentine with a crown is an option

Teeth that have an undesirable appearance: 

The appearance of a tooth can be unacceptable because of the following
1) Colour
2) Shape
3) Spacing

Dental crowns, dental overlays or dental veneers can be made to create beautiful natural looking teeth.

Other occasions when Crowns are placed:

1. Dental implants - Crowns are the final piece placed on a dental implant used to restore spaces where teeth have been lost
2. Dental bridges - A dental crown is one part of a fused structure called a dental bridge. Commonly the two teeth on either side of a gap where a tooth has been lost are crowned & a false tooth is used to the two crowns & cemented in place
3. Dental splinting - If teeth are loose or there is food trapping , dental crowns can be fused together & cemented on multiple teeth thus splinting them together & providing more stability.

If you would like more info on Dental Crowns read our blogs - What is the Cost of a dental Crown? and 8 Reasons Why You Need A Dental Crown

Posted by Andrea

Milford Dentists is proud to help the good people of the North Shore with all their dental requirements; especially in our mission to help you strengthen & beautify your teeth - From Devonport and Belmont up through Takapuna, Castor Bay,Mairangi Bay & Browns Bay as well as Albany, Northcote, Hillcrest, the Whangaporoa Peninsula and beyond give us a call - 09 4896575.

Cost Of Dental Crown

Here are the costs for Dental Crowns and Overlays at Milford Dentists as at the time of posting this blog. 

Cost of Dental Crowns at Milford Dentists 2014/2015	NZ Made	Overseas Made
Emax Crowns and overlays	$1540	$1340
Empress Crowns & Overlays	$1540	$1140
Porcelain Fused to Metal Crown	$1540	$1240
Zirconia Crowns	$1540	$1340
Gold Growns & Overlays	$1540 + Gold	$1340 + Gold
Metal Crowns	$1240	$1040

What is the Cost of a dental Crown? At Milford Dentists, North Shore, we are asked this question a lot & if this question isn’t asked you can bet someone is thinking “what is the cost of this Dental Treatment?” As a dentist I have to assume that people want the best dentistry & the best dentist to fix their teeth here in Auckland; but the cost of dental fillings, dental crowns, dental implants, dental veneers etc  is always going to be a factor in what treatment someone may end up having. 

Here the definition of a clinical crown - With a healthy tooth, supported by healthy gum & bone, everything that is above the gum line is called the clinical crown.

Here is the definition of a Dental Crown - A dental restoration that completely or partially covers the clinical crown & that is cemented in place is called a dental cap, dental crown, dental overlay or porcelain dental veneer. Read our Blog on "8 reasons why you need a Dental Crown" for more informations & background on crowns.

What types of dental crowns are available? Read our blog

1) All ceramic dental crowns & dental overlays & dental veneers made from different porcelains

2) Porcelain crowns fused to an inner metal thimble

3) Metal crowns made of gold or semi-precious alloys

4) Composite resin crowns

5) Zirconium crowns

Cost of a dental crowns at the time of writing this blog  are as follows

Beautiful Emax overlay dental crowns & dental veneers: At the moment the most common crown placed at Milford Dentists is an Emax overlay costing $1540. This is either made on site with  E4D CAD/CAM technology and fitted on the same day or made by our excellent NZ Dental technicians.

Empress Crowns:  Empress restorations cost $1340. They are as beautiful as Emax restorations but are three times more likely to fracture. Because of this you have to make the porcelain thicker which means more tooth removal. This porcelain is cheaper to buy & the actual process of making a crown with it takes less time. There is a 5 year warranty for Emax restorations made in New Zealand and a 1 year warranty for NZ Empress restorations

Porcelain Fused to Metal Crowns  (PFM) – These restorations are very rarely made at Milford Dentists now as Emax has superseded this restoration, however there is a place for them on dental implants & dental bridges. They cost the same as Emax crowns if constructed in New Zealand. PFM’s generally take 10 working days to make. This generally means wearing a plastic temporary crown for a couple of weeks

Gold Alloy & semi-Precious alloy crowns: There is still a place for metal crowns for people who chomp their teeth together heavily or grind their teeth at night. If constructed in New Zealand a gold crown at the moment costs around $1540. The cost can vary with the price of gold. Placing a semi-precious metal crown on a tooth can reduce the cost by up to $300

Zirconia Crowns: Zirconium is an interesting material. It is super strong & can be made in tooth shades however it is not as beautiful as Emax aesthetics wise. It is therefore used mostly on back teeth. It is extremely wear resistant & if it is not highly polished it will wear away the tooth it is biting on a bit like mahogany rubbing on balsa wood. Same costing as the New Zealand made Emax crowns.

The above costs can be reduced still further by $200-$300 should you opt to use an overseas dental laboratory to have your crown made. There is a 1 year warranty for these restorations

Regarding Cosmetic Dentistry: As far as costs & cosmetic dentistry is concerned, this generally adds to the fee for a dental crown, dental veneer or overlay. It is important if you want to improve the appearance of your teeth that you get what you are expecting & also get what you want ie a beautiful long lasting result. There is a process in achieving this called digital smile design followed by construction of a temporary “trial smile”. You get to see what your teeth will look like before we even touch your teeth. Final restorations can also be tweaked with shape, shade & characterisation changes or even remaking the restoration so we get the perfect result. This all takes time.

Posted by Andrea

Milford Dentists is proud to help the good people of the North Shore with all their dental requirements; especially in our mission to help you strengthen & beautify your teeth - From Devonport and Belmont up through Takapuna, Castor Bay,Mairangi Bay & Browns Bay as well as Albany, Northcote, Hillcrest, the Whangaporoa Peninsula and beyond give us a call - 09 4896575.

7 Reasons Why Fastbraces Might Work For You

Fastbraces® Highlights

1. FAST – treatment time that is measured in months instead of years!
2. EASY – retainers for only 15-20 minutes a day
3. SAFE –  Tested by leading Universities in the U.S., Europe, and South America
4. QUALITY – The original, certified by the Inventor and made in the U.S.
5. SIMPLE – Almost always Non-Extraction treatment
6. CLEAN – possibly less decay around brackets due to short treatment duration
7. CLEAR – aesthetic ceramic brackets available with a tooth colored wire

Technology that creates beautiful smiles in a Fast and Safe manner 
Fastbraces® are designed to straighten teeth in a short time period of 3 months to about a year! The teeth are moved differently and safely, creating a beautiful smile that you have always dreamed of!

How it Works
Fastbraces® Technology was developed with safety in mind allowing the system to be fast and affordable without compromising patient care. Fastbraces® Technology uses a unique, patented bracket design that is triangular shaped. The triangular shaped bracket allows for the use of just one wire. Now, patients can get a beautiful, straight smile in as little as a few months. Some patients see results in just a few weeks!

The Research
Fastbraces® Technology has shown optimal performance in the following areas:

1. Low frictional forces. 
2. Pain reduction statistically.
3. Less root resorption statistically. 

Read more about Fastbraces® Technology by clicking Fastbraces® Orthodontics , Q and A Orthodontics And Fastbraces Why, How Long, Does It Hurt? & see examples of before and after Fastbraces® cases in our gallery 

Posted by Andrea & Karen

Milford Dentists is proud to help the good people of the North Shore with all their dental requirements; especially in our mission to help you with your orthodontic needs - From Devonport and Belmont up through Takapuna, Castor Bay,Mairangi Bay & Browns Bay as well as Albany, Northcote, Hillcrest, the Whangaporoa Peninsula and beyond give us a call - 09 4896575.

What Are The Benefits Of Dental Implants Over Other Treatments?

7 Reasons Why A Dental Implant May Be A Good Option For You

What are the advantages of dental implants over dentures and bridges?

1. 

   A dental Implant is pretty much the next best thing to replace a missing tooth - Once dental implants are fully integrated into your jaw; they function just as well as your own natural teeth: you can eat the foods you want and speak with complete confidence.
   
   With dentures, eating hard foods such as an apple can be a problem: either the dentures come loose or patients cannot withstand the hard biting forces as this pressure causes pain as the denture pushes into the gum. Irritation and inflammation of the gums is a common problem amongst denture patients.
2. Dental Implants protect and keep your jaw bone healthy and as a result keep your face looking younger - Normally, the bone tissue surrounding the root of your tooth is maintained by your body’s natural renewal process. 
   
   However, if you lose a tooth, you will be left with a hole where your tooth root used to be and the bone around this area will slowly begin to disappear (atrophy) which may change the shape of your jaw. 
   
   A dental implant placed in this space is the only restorative option that can actually stimulate bone growth and production, preventing loss of valuable bone structure. In some patients where bone loss has already occurred over time, bone augmentation may be required before placing a dental implant. Bone loss is a problem for people who have dentures, and as the shape of the jaw slowly changes, the dentures need to be adjusted or re-made to fit the new shape of the jaw. This bone loss can also make a person look older, as the mouth can sag in this area.
3. 

   Dental implants allow you to keep your teeth where they belong – in your mouth. Unlike dentures that should be left out of your mouth for eight hours a day and might slip or fall out, Dental Implants are firmly & permanently attached in your mouth. Think about a picture hanging on a picture hook or Jandles/flip flops = dentures  versus a picture that is bolted to the wall or laced up boots = dental Implants.
4. Improved dental hygiene - Unlike Dental Bridges and dentures, which require special cleaning instructions and extra attention, dental implants just need regular brushing, flossing and hygiene appointments, just like your natural teeth.
5. No need to drill or remove any healthy tooth structure - When replacing missing teeth with dental bridges, the teeth adjacent to the gap need to be prepared and healthy tooth structure is removed to accommodate a crown or bridge abutment to fit over the top of the tooth.
   
   In the future, if one of the supporting teeth is damaged, the entire bridge restoration will also be compromised, whereas with an implant, the restoration is independent of any of your other teeth. By replacing lost teeth with Dental Implants, no support is required of the adjacent teeth, and your natural teeth do not need to be prepared or altered in any way.
6. Dental Implants just look better - If placed correctly, a Dental Implant should blend beautifully with your surrounding natural teeth.
7. Dental Implants are a very predictable way of replacing missing teeth. Dental implants have a track record of reliable, long-term successful outcomes. They are often considered “more predictable” than other treatments to replace missing teeth, compared to Dentures & Dental Bridges

NB Dentures can be supported by implants, which will greatly improve function, enabling patients to eat the foods they want with complete confidence and not having to worry about bone loss and loose dentures falling out. Check out our Dental Implant before and after pictures of completed cases on our  Denture Gallery Page

Posted by Andrea and Tristan 

Milford Dentists is proud to help the good people of the North Shore with all their dental requirements; especially in our mission to help you with missing teeth - From Devonport and Belmont up through Takapuna, Castor Bay,Mairangi Bay & Browns Bay as well as Albany, Northcote, Hillcrest, the Whangaporoa Peninsula and beyond give us a call - 09 4896575.

White Fillings To Mask Dead Black Or Grey Teeth - Case Study 1

4 Reasons Why Teeth Die And Go Black Or Grey

A dead or non vital tooth will often discolour or darken. Here's why.

1. Because the tooth has been hit hard and this percussion injury has killed the blood supply feeding into the tooth
2. Because the tooth has been snapped/fractured by trauma and the exposed nerve becomes infected with bacteria and dies
3. Because of tooth decay - once the tooth decay reaches the nerve the bacteria kill the nerve
4. And occasionally because of high temperatures created trying to fix a decayed badly broken down tooth

Case study - This lovely lady from Takapuna has been coming to Milford Dentists for a longtime. She asked me if I could improve the appearance of her two grey teeth. Both teeth had big big fillings, the nerves had died & both had been root filled (or endodontically treated). 

She did not have the budget for dental crowns so we opted to (inexpensively) mask the visible parts with a veneer build up of white composite filling material. If you imagine painting over something black to make it look white you need a white opaque layer

1. Closest to the tooth I bonded a very thin opaque layer which totally blocked out the grey tooth. But now I had 2 bright white teeth shining at me
2. I now placed a thicker layer of a natural tooth coloured composite resin that had a lovely opacity similar to tooth dentine. This layer looked good but the tooth still looked dull and lifeless
3. Finally I added a more translucent layer of white filling that mimics how enamel looks to make the teeth really shine

Here are the before  white fillings placed on the upper and lower premolar -

Here is the before and after photo

As with most dental repairs, although the results are not permanent and eventually require replacement, composite resin fillings are very durable and can offer what we at Milford Dentists believe is a safe, stable, effective solution for the repair of teeth in a lot of situations. 

Talk to us today to learn more about the benefits of white composite resin fillings.

Posted by Andrea Clarke BDS

Milford Dentists is proud to help the good people of the North Shore with all their dental requirements - From Devonport and Belmont up through Takapuna, Castor Bay,Mairangi Bay & Browns Bay as well as Albany, Northcote, Hillcrest & the Whangaporoa Peninsula.