Since I graduated from Sheffield University in 2003, there has been significant progress in the field of dental materials and the tools which we have at our disposal to treat dental disorders. The advent of adhesives, increased knowledge surrounding prevention and minimal intervention techniques have been perhaps the most exciting progress made in the past 40 years.
Sadly, it pains me to see the recent increase in quick-fix destructive dentistry being administered to patients who may be unaware of the long-term consequences. Patients with perfectly healthy teeth are having them filed down and having veneers or crowns fitted for cosmetic benefit. In the clinic, I have had to treat problems such as:
- Debonding of crowns and veneers needing recementation
- Snapping of teeth with heavy preparation
- Death of the tooth leading to root canal treatment or extraction
- Gum problems from poorly placed work or poor oral homecare
- Costly replacements when eventually the work fails (all dental work fails eventually)
Carrying out restorative dentistry need not be destructive in nature. I have learnt through experience that preventing problems before they occur is best, and techniques we use in the surgery include:
- Regular check-ups to identify problems early
- Provide regular advice on toothbrushing and dietary changes
- Regular x-rays to find problems which aren’t visible in the clinic
- Professional application of fluorides to reduce the risk of decay
If we do identify a problem, be that tooth decay or a cosmetic problem, it is my belief that the problem should be treated as minimally invasively as possible. For example:
- Treating a small cavity with a bonded white filling instead of a silver filling. Silver filings lead to tooth fracture over many years due to the heavy nature of the preparation and the wedge-nature of the filling.
- Hygienist visits to lift surface staining off teeth in a non-invasive way
- Whitening the teeth to treat discoloured or heavily stained teeth
- Orthodontic (braces or clear aligners) treatment to straighten crooked teeth
- Composite bonding techniques to fix chipped teeth, close gaps
- Replacement of missing teeth with implants or adhesive bridges, thereby avoiding heavy use of the drill on surviving teeth
- The use of tooth-coloured metal-free crowns, inlays and onlays, which require less use of the drill to achieve a satisfactory cosmetic and functional result
Not all of these techniques are appropriate for every patient, so it is important to get an individual consultation to see what options you have.
Since I completed my Master’s in Advanced General Dental Practice in 2015, I have been carrying out these techniques and it gives great satisfaction to my patients and I, knowing that the problems have been fixed in a conservative way. I know that all dental work will fail eventually, but it is my belief that when the work fails, it should be repaired equally as conservatively. By keeping work minimal, we prevent unnecessary loss of teeth.
For example, when a conventionally drilled bridge fails, consequences of failed work can be cosmetic failure, decay at the margins of the tooth-bridge interface, death of the tooth, snappage of tooth or extraction. However, when a minimal “sticky” bridge fails, it usually falls off and can be recemented or remade, at no cost to the tooth.