33 Beaumont Street - Specialist Dental Practice, Oxford

We are delighted to offer the services of Consultant Maxillo-facial Surgeon, Michael Hodge.

What is oral surgery?

Oral (or Maxillofacial) surgery is the surgical specialty concerned with the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck.

Why might I be referred to an oral surgeon?

Typically oral surgeons undertake dfficult wisdom tooth extractions and also treat and diagnose many diseases of the oral cavity. This includes cysts, disorders that are separate to gum disease affecting soft and hard tissues of the mouth. Other areas covered include dysfunction of the temporomandibular joint, facial pain, oral medicine and head and neck acupuncture.

Many of these problems can be treated successfully within the practice and the majority of the oral surgery procedures we undertake do not require hospitalization.

Useful links:

• British Association of Oral & Maxillofacial Surgeons: www.baoms.org.uk
• British Society for Oral & Maxillofacial Pathology: www.bsomp.org
• British Journal of Oral and Maxillofacial Surgery: www.bjoms.com
• British Dental Association : www.bda-dentistry.org.uk
• British Dental Health Foundation : www.dentalhealth.org.uk
• International Centre for Excellence in Dentistry : www.eastman.ucl.ac.uk/cpd

Our Endodontists at 33 Beaumont Street are Dr Joseph Masih and Dr Rohan Rajasingham.

What is root canal treatment?

Inside the tooth, under the white enamel and a hard inner layer called the dentine, is a soft tissue called the pulp. The pulp contains blood vessels, nerves and connective tissue. The pulp extends from the crown of the tooth to the tip of the roots where it connects to the tissues surrounding the root. The pulp is important during a tooth's growth and development. However, once a tooth is fully mature it can survive without the pulp.

Why is root canal treatment necessary?

Root canal treatment is necessary when the pulp becomes inflamed or infected. The inflammation or infection can have a number of causes including deep decay, repeated dental procedures, or a crack or chip in the tooth. In addition, a blow to the tooth can cause damage to the pulp even if the tooth appears intact. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.

Signs of pulp damage include pain, prolonged sensitivity to heat or cold, discoloration of the tooth, and swelling or tenderness in the nearby gums. Occasionally, there are no symptoms.

How does root canal treatment save the tooth?

The endodontist will remove the inflamed or infected pulp, carefully clean and shape the inside of the tooth, and then will fill and seal the space. Afterwards, you will need to return to your own dentist, who will place a crown or other restoration on the tooth to protect and restore it to full function. After restoration the tooth will continue to function like any other tooth.

Is root canal treatment painful?

Many root canal treatments are performed to relieve the pain of toothaches caused by pulp inflammation or infection. With modern techniques and anaesthetics, most patients report that the procedure is painless and comfortable.

For the first few days after treatment your tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can usually be relieved with over the counter medication.

How much will the procedure cost?

Every root canal treatment is specific to a patient and the complexity of a root canal treatment will vary considerably depending upon a number of factors. These will also influence the number and length of visits that will be required. Some treatments will only require one visit and some will require several. Following referral by your dentist, the endodontist will be able to give you an indication of the number and length of visits and of the approximate cost prior to you attending for treatment.

Will the tooth need any additional treatment?

You should be careful when biting or chewing on your tooth until you have had it restored by your dentist. The unrestored tooth is susceptible to fracture, so you should see your own dentist for a full restoration as soon as possible.

Most endodontically treated teeth last as long as other natural teeth. In a few cases, a tooth that has undergone endodontic treatment fails to heal or the pain continues.

Our Periodontic specialist at 33 Beaumont Street is Dr Clifford Nissen

What is Periodontal Disease?

Periodontitis is inflammation of the of the periodontium, i.e. the tissue holding the tooth. If left untreated it can lead to tooth loss and bad breath. It is a major cause of tooth loss in adults.

Bacteria contained in the plaque on the surface of the tooth causes an inflammation of the gums and if left untreated affects the gums, bones and other supporting tissues of the teeth. It leads to a pocket forming between the root of the tooth and the gum where bacteria can easily proliferate and calculus develop. Although most individuals suffer gum inflammation from time to time, 10% of the population appear to suffer from more severe forms of gum disease.

What causes Periodontitis?

Three major factors are thought to be responsible for periodontal disease, and inadequate oral hygiene is a contributing factor. Family history, stress and smoking are all important risk factors. Certain general diseases such as diabetes may also increase susceptibility.

How do I know if I have the disease?

The signs and symptoms of periodontal disease are extremely variable but can include reddening and swelling of the gums, gums that bleed on brushing together with signs of loose teeth, a bad taste in the mouth and bad breath. However, because pain is rarely a symptom until the disease is at an advanced stage, it is possible to not be aware of the signs.

Treatment of Periodontal disease:

How is Periodontal Disease Treated?

Periodontitis can only be treated by your dentist and hygienist. Because of differences in the severity of the disease only he/she can decide what treatment is needed. Since dental plaque is the principal cause of gum disease treatment is focused on plaque control. This is achieved through improved oral hygiene and the cleaning of the teeth and their roots to remove plaque and tartar from under the gums. The final objective of any treatment is to clean the gum pocket. Sometimes, to reduce sensitivity and discomfort during treatment, a local anaesthetic may be required.

If you are a smoker please ask for help and advice as smoking cessation is also an important part of successful treatment.

Treatment of periodontitis is usually divided into three phases as follows:-

Treatment to Stabilise Your Gum Condition:

At your Initial Consultation we will help you develop the skills required to routinely clean plaque from above the gum level and around all the teeth. Calculus, or tartar, must be professionally removed by a dentists or hygienist. During this treatment phase we record how well you are removing plaque from your teeth. The benefits will include fresher breath, with firmer gums and less mobile teeth.

After an interval of several weeks of healing we assess the response of your gums. This Reassessment Appointment is extremely important as it is then that we can determine how successful our therapy has been and whether further treatment will be required. If this proves to be the case we will explain to you, at this appointment, what is involved and why. We can follow this with a full written treatment plan and an estimate of cost.

Treatment to Correct the Effects of Gum Disease:

Where gum pockets are deep, above 5-6 mm, periodontal (or gum) surgery may be required . This is often the case around the molar (back) teeth, but is not limited to these areas. We always endeavour to avoid the need for surgery, but whether or not we achieve this is dependant upon the success of the Initial Phase - and especially your own personal success with your oral hygiene. It is in your own interest to maintain a good level of oral hygiene so that we can be sure to give any necessary surgery all possible chances of success.

Sometimes it is possible to to regenerate some of the lost gum and bone around the teeth through a small surgical procedure. If this would be of value to you is determined at the Reassessment Appointment. Understandably, many patients are apprehensive about surgery in the mouth. However, gum surgery is a straightforward procedure and is not as drastic as it can at first appear.

After periodontal surgery initial healing is quite rapid (within a week). However, if you require further treatment - from your own dentist for example - it is important to wait about three months in order to allow the treated gums sufficient opportunity to mature.

Prevention and Maintenance Phase:

After your active treatment has been successfully completed it will be necessary for you to see the dental hygienist regularly (either at 33 Beaumont Street, or if you prefer, at you own surgery if you were referred by them). Research has shown that the ideal interval is one appointment every three months for the first year. Provided you maintain good oral hygiene this interval can then be extended to every six months. Sometimes re-treatment of a resistant area is required. Your hygienist will keep the progress of your gum disease under close review.

What we have provided here is by no means a complete explanation of all aspects of treatment. Our periodontal team will keep you up-to-date at all stages of your treatment and explore all treatment options available to you.

Cosmetic Periodontal Treatments

Patients do sometimes have cosmetic concerns relating to their gums. For example, gums may be too thick or too short. These can be corrected by a number of specialised surgical techniques. Successful treatments include silicone gum mask or veneer to hide any unsightly gum recession or gaps between teeth. For more information about this treatment please e-mail our specialist Dr Clifford Nissen.

Useful links:

• British Society of Periodontology : www.bsperio.org
• American Academy of Periodontology : www.perio.org
• British Dental Hygienists' Association : www.bdha.org.uk
• British Dental Association : www.bda-dentistry.org.uk
• General Dental Council : www.gdc-uk.org
• British Dental Health Foundation : www.dentalhealth.org.uk
• International Centre for Excellence in Dentistry : www.eastman.ucl.ac.uk/cpd
• Perio Specialist : www.periospecialist.com

Our Prosthetic specialists at 33 Beaumont Street are Dr Richard Butler, Dr Mehran Sanei and Dr Sheri Razavi

What is Prosthetic Dentistry?

Prosthetic dentistry is the replacement of missing teeth, which may have been lost for a variety of reasons, with either fixed or removable dentures. However, in Great Britain, prosthetic dentistry is usually understood to relate to removable dentures. Until relatively recently, most of the population of the British Isles assumed they would need dentures at some stage in their lives but, with improved oral hygiene, better diet and, particularly, the advent of fluoride supplements, the vast majority will retain sufficient teeth to serve them all their days. Nevertheless, many people still require dentures.

Why might I need dentures?

Natural teeth may have been lost due to caries (dental decay), periodontal (gum) disease, or trauma. If you have lost posterior (back) teeth and still have all your premolar teeth and those in front, you will have what is called the "shortened dental arch" and should manage well. If you have lost more teeth you may well require replacements. Depending upon a host of factors these replacements might be fixed or removable but, for our purposes here, please assume we are talking about removable dentures.

What are Partial Dentures?

As the heading suggests, partial dentures are made to replace a proportion of lost teeth and they have the advantage that support and retention can be derived from adjacent retained natural teeth using design features such as occlusal rests and clasps. Some natural teeth may require modification (mouth preparation) to ensure they are compatible with the denture design and this will be discussed with you. In general, partial dentures are ideally constructed with a metal (cobalt-chromium) base and the superstructure and teeth will be in a high quality acrylic resin. However, on occasions dentures will be made entirely in acrylic resin for clinical or economic reasons.

What are Complete Dentures?

A complete denture replaces all the teeth in one dental arch. For people who are already edentulous (i.e. have no natural teeth), the objectives of prosthetic treatment are similar to those for patients who are having other kinds of dentistry. Specifically, they would wish to have (in orders of importance which vary between individuals), good speech, good appearance, effective chewing and biting, comfort, and the ability to engage in various social and interpersonal activities such as laughing, shouting, kissing, applying lipstick etc., without the dentures becoming dislodged.

Of these, only good appearance can be guaranteed (and then only if sufficient care is taken). The remaining objectives depend upon each patient's anatomy and denture-wearing skill, as well as the skill of the prosthetist and dental technician.

Why do Problems arise with Dentures?

Any type of prosthesis, from a wooden leg to a pair of spectacles, is an alien item and none is more so than a denture which is inserted into one of the most sensitive parts of our body. Moreover, the mouth is a very mobile and functional area which is changing shape all the time eating, speaking, coughing and swallowing so it's hardly surprising difficulties occur. Furthermore, our mouths change shape with time: the human body is terribly economical and once natural teeth have been removed it removes the bone that held them and remodels the area. Thus the ridge on which a denture sits reduces in size rapidly at first but then more gradually throughout life. About 80% of this resorbtion, as it is called, takes place during the first year and 90% has occurred by the end of 2 years. This is why we try to provide simple dentures, which can be easily updated, at first.

How can denture problems be overcome?

Good prosthetic dentistry is a team effort involving patient, nurse, dental technician and dentist. It is also time consuming because attention to detail is paramount in order to produce appliances which can be most easily adapted to by the patient. Having said all this, patients cope well with dentures if they are determined to succeed. This is especially true with partial dentures and complete upper dentures, the former because natural teeth can help to secure them, and the latter because the large surface area of the palate spreads the load and aids retention. Complete lower dentures can present problems because the lower ridge often has a small surface area and an unretentive shape. Good prosthetic technique can usually overcome these difficulties but, for really intractable cases, we recommend the use of implants.

How do implants help with lower complete denture problems?

Lower complete dentures are largely retained by the skill of patients using the tongue, lips and cheek muscles to exert pressure on the denture to resist destabilising forces, for example during speech and chewing. Sometimes this is not enough, especially if the ridge is markedly reduced. We can now place 2 titanium implants in the bone on either side of the lower jaw around the region where the eye teeth have been. These have either a sort of press-stud attachment, or a bar between them, so the denture can click on. Implants take some of the chewing load and are particularly successful at keeping the denture in place during most functional movements of the lower jaw.

Useful links:

• British Society for the Study of Prosthetic Dentistry
• American College of Prosthodontics
• British Dental Association
• General Dental Council
• Royal College of Surgeons of England

Our Restorative Dental Specialists at 33 Beaumont Street are Dr Paul Wilson, Dr Mehran Sanei, Dr Sheri Razavi

Restorative Dentistry (sometimes referred to as crown & bridge work) is the area of dentistry concerned with the rehabilitation of the heavily filled, or otherwise broken down dentition. This is carried out by means of crowns, fixed bridge work, implants (see below) or veneers - or a combination of these techniques.

On occasion root canal treatment is required to assist this process and a degree of cross-referral within the practice may be required.

The ideal candidate for restorative treatment should be in good general and oral health.

Useful Links:

• British Society for Restorative Dentistry : www.bsrd.org
• Specialist Registrars in Restorative Dentistry : www.derweb.ac.uk/srrdg
• Association of Consultants & Specialists in Restorative Dentistry : www.restdent.org.uk
• British Society for the Study of Prosthetic Dentistry : www.bsspd.org
• Association of Dental Implantology (UK) : www.adi.org.uk

Our specialists in Implantology at 33 Beaumont Street are Dr Paul Wilson, Dr Mehran Sanei, Dr Clifford Nissen and Dr Sheri Razavi.

What is a Dental Implant?

A dental implant is an artificial tooth root, placed into your jaw, which holds a replacement tooth or bridge. They are often more 'tooth saving' than traditional treatments since they do not rely on neighbouring teeth for support.

Advantages of Dental Implants

Implants are often the best solution to a missing tooth or teeth:

Aesthetic Advantages:

Implants feel like your own teeth. They integrate into the structure of your bone and prevent loss of the bone after a tooth is removed.

Tooth-saving advantages:

The quality of the adjacent teeth is not sacrificed because they do not have to be cut with the drill to provide support for a conventional bridge. This is of significant long-term benefit to your oral health.

Confidence:

Dental implants will allow you to speak and eat with more confidence and comfort. they are secure and avoid the problems of wobbling dentures.

Reliability:

While never 100%, the success rate of dental implants is high and they are considered an excellent option for tooth replacement.

Am I a candidate for Dental Implants?

The ideal candidate for dental implants will be in good general and oral health. There must be adequate bone available in your jaw, and the best candidate will have healthy gums and be free from periodontal (gum) disease.

What is treatment like?

Implants are placed in your jaw during a small surgical procedure. A general anaesthetic is not normally required. Once inserted the implants must be allowed to integrate with the bone of your jaw, a process that can take up to six months in some cases. During this period the implants are left buried under the gum, and are later exposed at a second short operation before being used to support your new crowns or bridges.

Treatment is normally far less painful and traumatic than you might think. Modern techniques ensure that the insertion of the implants can be carried out relatively quickly and without discomfort.

Useful Links:

• British Society for Restorative Dentistry : www.bsrd.org
• Specialist Registrars in Restorative Dentistry : www.derweb.ac.uk/srrdg
• Association of Consultants & Specialists in Restorative Dentistry : www.restdent.org.uk
• British Society for the Study of Prosthetic Dentistry : www.bsspd.org
• Association of Dental Implantology (UK) : www.adi.org.uk
• British Dental Association : www.bda-dentistry.org.uk
• General Dental Council : www.gdc-uk.org
• British Dental Health Foundation : www.dentalhealth.org.uk

Cosmetic Dentistry at 33 Beaumont Street is peformed by Dr Paul Wilson, Dr Mehran Sanei, Dr Sheri Razavi, Dr Clifford Nissen and Dr Tim Haywood

Cosmetic dentistry is an aspect of restorative dentistry with an emphasis on enhancing personal appearance rather than being strictly essential for oral health (in plain speaking it is optional!), Such treatments include tooth bleaching, the re-crowning of front teeth and/or the use of veneers.