Ask the Dentist > Absolute Dental Care - Carlow

1. Do you see Medical Card holders and what is available on medical cards?

Hi there,
Yes, we do see medical card patients.
Unfortunately, in April 2010, the HSE changed the medical card system to that of an emergency dental service only. So, if you have a valid medical card, you can get one examination a year and two fillings as part of emergency dental care.
Please call the practice on 059 913 1958 for more details and we will look after you
Cleanings are no longer covered on the medical card.

At what age should I start bringing my child into the dentist and how best do I look after his teeth?

The answer to this varies from dentist to dentist, but we recommend that you bring your child in by the age of one year old. It is important that your child has a healthy mouth to comfortably eat and also speak and to give them confidence in their appearance. Most children should have seen a dentist by the age of five.
Research also shows that the most common cause of children missing school is dental problems. By coming in to see the dentist at an early age, the dentist can spot problems early before they are a problem to the child and also issue valuable advice tailored to your childs individual dental status.
We recommend that babies teeth and gums are cleaned after feeds using water only with a soft brush or washcloth. Children between one and two years of age use a soft toothbrush or clean washcloth only with water twice a day. After the age of two, a fluoride toothpaste is recommended, but limiting the amount to a small pea, on a soft brush. Children must brush twice a day
(morning and just prior to bed time)and adults should ensure that the paste is spat out after each brushing session so that none is swallowed.
Chidren should not eat sugary snacks and limit eating sugary food to meal times. Certainly, children should not eat sugary food before bed time. Children must also be careful on their intake of acidic drinks as these are a major source of erosion to teeth. By visiting the dentist, any problems with tooth decay or tooth erosion can be spotted early and therefore treated early.

Can I have my records deleted from a dental practice?

Thanks for your question. The answer is 'no'. The records that a practice has regarding your dental visits are obliged to be kept. They are in the ownership of the practice and, as such, you cannot ask for them to be deleted. You may, if you wish, have access to your records and radiographs. A copy can be sent to you if you request them in writing. Some practices make a small charge for this to cover the cost of making records.

Do I need to come for an examination? I'm not getting any trouble at the moment

This is a very common question we receive. As healthcare professionals, we would advocate that you visit us for examinations (check ups) regularly. It's like getting your car serviced regularly but only more important. There are a number of benefits to regular examinations.
1/ Diagnosing dental disease early. When we see that there is a dental problem, it can be solved so much more easily when it is a small problem - and it can be painless. When a problem goes on for too long, often you end up with toothache, a tooth ends up needing root canal treatment, breaks or requires to be removed. We would think that in this day and age people shouldn't be losing teeth due to an easily preventable disease
When a dental problem is caught early it is also cheaper to fix. The cost of having a simple filling can be cheaper than an extraction, is cheaper than replacing the tooth if it has to be removed and certainly cheaper than root canal treatment.
2/ Assessing whether it is of benefit to see the dental hygienist. Dental decay is the most common disease in the world - fact. Periodontal disease (disease of the gums and supporting tissues) is almost as common.The amount of oral bacteria and plaque in your mouth doubles every month, so regular visits to the hygienist will help reduced periodontal disease and hence avoid getting loose teeth or teeth falling out.
3/ Detection of Oral Cancer. For us, this should be a compelling reason to have regular examinations. Oral cancer receives little media attention compared to malignant melanoma, cervical and breast cancer. Yet Oral cancer causes more death than these other well known cancers. The death rate is so high because it does not get diagnosed early enough. Survival rates for oral cancer are very good when diagnosed early. Unfortunately, by the time it is diagnosed it is at an advanced stage. Women are continually advised to screen for breast cancer and cervical cancer, yet the easiest screen for oral cancer is to see the dentist on a regular basis who will screen for oral cancer as part of the examination - it only takes 90 seconds

Do yo do veneers at your practice? If so, how much do they cost?

Yes we do veneers at our practice. At the time of answering this question they cost E650. However, it is always best to get an assessment of your oral condition first to decide whether a veneer is the best option or indeed, if a veneer will work.

Does teeth whitening damage my teeth?

No, definitely not. Teeth whitening works by the whitening gel working its way through the natural pores within the enamel of the teeth. Once the whitening gel gets to the stain within the tooth, it breaks it down and this what whitens the teeth. This is a non-destructive process compared to paring down teeth to put on veneers or crowns.

Does your dental practice provide an emergency service

Hi there, thanks for your question.
If you are a patient of this practice and you have a dental emergency within normal opening hours it is best to phone us up as soon as possible (on 059913 1958)so that we can get you in on the same day or at a time that's easiest for you. We always try to see you if you are not a patient of the practice, However, sometimes this is not possible and it may be easier and quicker to get into a different practice to solve your problem. If you have are a patient of the practice and have an emergency outside practice hours you may phone the practice for our emergency arrangements. Usually we are able to advise what the best thing to do is. If it is imperative that the surgery must be opened to provide you with treatment a fee of �100 is charged for opening the practice and thereafter you will be quoted as to how much the remedial treatment will cost. If you are not a patient of the practice we will advise you as to the best options available to you. As all dentists have to comply to Dental Council instructions and be available out of hours, your usual dentist should have an emergency arrangement in place.

Everytime I chew on my back tooth I get a sharp pain but otherwise it seems OK. The same thing happenned to a tooth on the other side last year, but it broke and I don't want this to happen again.

It sounds very much like you may have a crack in your tooth.
Cracks can often develop under old silver fillings, particularly large fillings. When you bite on the tooth the crack opens up and when you release the bite the crack closes. It is often when you release the bite when the pain occurs.
The pain of having a crack in the tooth is quite annoying. If the crack continually keeps opening when you bite, the tooth can fracture. Unfortunately the tooth sometimes cannot be fixed. Also, if the crack has been there a long time the nerve in the tooth can die, causing more severe pain and lead to the tooth needing an extraction or root canal filling.
These problem teeth can be treated by several methods.
Often the filling can be removed and at the same time, the crack removed and then the tooth filled with a new silver or white filling. If it is not possible to remove the crack then a white filling can be placed into the tooth. Because these white fillings 'bond' to the tooth they splint the tooth together so that the crack cannot open up again. The best long term solution is to have a crown mae for the tooth. This splints the tooth very robustly so that the crack cannot open up again.
As with all dental problems, it is best to visit the dentist as soon as you realise there is a problem as this may save the tooth needing a root canal filling also.

Hello would you please give me information on getting a new set of dentures (full set top and bottom) how long it takes how many visits would be needed and about how much would it cost please.

Hi there. Usually it takes five appointments to make a new set of complete dentures (1. First impressions, 2. Second accurate impressions using customised impression trays, 3.Bite recording appointment, 4.Trial fit of new dentures in wax and 5. Final delivery and fit of new dentures). Most dental practices allow 7-10 working days between appointments so it could take up to six weeks for the dentures to be fitted. However, due to our strong relationship with our lab we can usually make the dentures within 2-3 weeks depending on how flexible you are for coming in. The cost at the moment for new complete dentures is E850. There is a full five percent reduction for paying in advance or if you download a voucher you can get ten percent off your first appointment. Patients on our Discount Plan get a full twenty percent off.

I am getting married next year but my front teeth are crooked. Should I get dental veneers or teeth straightened with braces?

The answer to this depends on several factors.
If your teeth are very crowded it is best that you consider braces. It is unlikely that veneers will give a satisfactory result and you would end up with teeth that have tips that are very thick in some parts and very thin in others.
If the amount of crowding you have is minimal, then you have a choice between braces or veneers. If the teeth are not particularly discoloured or 'out-of-shape' then braces would work well. You could consider 'six month braces' to get them moved quickly. If the teeth are fairly discoloured (for example, if they have had past root fillings) or if the teeth are small or misshaped then veneers would probably work well as they would solve the two problems (dark teeth and misshaped) at the same time and the teeth would not need to be excessively 'filed' down.

I brush, floss and see the dentist regularly but still seem to get cavities. Why could this be?

Many people ask the same question. Although you can look after your teeth really well and visit the dentist on a regular basis, you could still get tooth cavities if your teeth have deep grooves/fissures.
All premolar and molar teeth have fissures/grooves on their biting surfaces and sometimes on their outer aspects. Some front teeth also have these grooves, especially the inside aspects of the upper incisor teeth.
These can be quite fine and deep. If this is the case, food can easily get caught in them. This is difficult to clean and then decay can begin in these areas.
If the dentist notices deep grooves in the teeth he will recommend that these teeth be 'fissure sealed'. Fissure sealants are opaque or clear resins that flow into the grooves of the teeth and bond there. This prevents food from lodging in them. The procedure is very straight forward and usually no anaesthetic is required. It is a very cost effective way of ensuring that certain teeth do not get decayed.

I have a gap behing my upper left canine tooth. How can I replace the gap?

Generally speaking, a consideration must be made as to whether you want something 'fixed' in your mouth that cannot be taken out or if you will be happy considering something 'removable' (ie that can also be removed from your mouth).
If you don't mind a removable option, then you could consider a denture (either acrylic or cobalt/Chromium). This is a good option if there are other gaps around your mouth that can be filled at the same time. Cobalt/Chromium dentures are more stable, better fitting, and less movable than acrylic dentures.
Fixed options include a dental implant or some form of dental bridge. Implants depend on enough bone to be available. To provide a bridge in this area, you would probably require a fixed bridge. However, if the two teeth either side of the gap are non-treated teeth then it would be risky preparing these good teeth as they could end up becoming non-vital(the nerve in the teeth could die) and then you wouldneed root fillings which would further weaken the teeth.

I have been considering having a dental implant done. My work colleagues tell me that I would have to go into Dublin to have the work done, but this is too far for me as I live in Wickow. Do you do implants at your practice?

We do do implants here at the practice in Carlow. If you are interested we can send you information on implants. However, the best thing to do is phone our practice and book in for an examination and assessment for implants.
Prior to having an implant done, we would need to assess how much bone you have in your jaw as there needs to be enough to support the implant. We also need to assess the appearance of the gum in the area the implant is going into to be sure the dental implant will have a good appearance.
Some patients need extra bone placed under the gum if there is not enough for the implant, but we can discuss this at your assessment. We usually need to take a special x-ray (called a panoramic x-ray)and make models of your teeth as part of the assessment.

I have been told that I have 'gum disease' but I do not know exactly what this means. How can it be treated?

Gum disease generally falls in two different classes - gingivitis (inflamation of the gums alone) and 'periodontal disease'. Gingivitis is redenning and bleeding of the gums only and is easily reversed through good brushing and flossig habits. Most dentists and hygieninsts recommend a 'Bass' technique of brushing which involves angling the bristles of the brush to the gums and using a circular motion to remove the plaque. Incidentally, at Absolute Dental Care, we highly recommend using an electric toothbrush. If scale (hard calcium deposits) have built up around the teeth, it is fairly simple to remove by the dentist or hygienist.
Periodontal disease is a progression of gingivitis and involves a breakdown of the tissues that support the tooth. These are the tissues that invest the tooth which include the periodontal membrane, 'cementum' and alveolar bone. Their breakdown is not easy to reverse and ultimately, without treatment lead to loosening of the teeth and their premature loss. The early stages of periodontitis are a pocket forming around the tooth due to the ligament around the tooth breaking away. Once these pockets get deep (we usually say over 4mm) it becomes difficult cleaning the bacteria away and the gum disease is unstable so that the disease is more likely to get worse compared to if the pockets were under 4mm. If treatment is not instigated then there is a risk that bone will be lost around the tooth.
Treatment for periodontitis involves seeing the hygienist, who will be able to remove the bacteria from below gum level to try and arrest the disease. There may also be deposits of scale under the gum line which hinders the cleaning process. The hygienist will also remove these.
Unfortunately, because the nature of gum disease and periodontitis is uncertain to many people, the reasons to see a hygienist become unclear. It is important to remember that appointments with the hygienist are not simple 'cleaning' appointments. They are therapeutic with the aim of arresting periodontal disease by removing bacteria below the gum line. Simple 'cleanings' only remove plaque and scale above the gum line and do not cure periodontal disease. Scaling and Polishing ('cleanings') are available free under the PRSI scheme for qualified patients twice a year if they do not have periodontal disease. This is where pocketing around the teeth is under 3.5mm. It is not available free under the PRSI scheme where periodontal disease is present (if pocketing is over 3.5mm. Medical card holders with periodontal disease are seen by the hygienist after approval from the health authority is gained for the treatment of this condition.

I have been told that my breath smells. What are the causes of this and how can I address this problem?

The causes of bad breath are many and varied but it can be a very embarrassing problem to have. People with bad breath are often unaware of this problem and others often find it difficult to tell them about it.
The causes of bad breath range from eating food with strong odours (such as garlic)to diseases/disorders of the gastro intestinal tract. These might include indigestion or acid regurgitation. People with dry mouths (often caused by medication) can sometimes also suffer from bad breath. In the case of gastrointestinal disorders it is usually best to get the advice of your doctor for a remedy.
The most common reson for bad breath seen at the dental practice, however, is 'periodontal disease'. This is inflamatory disease of the gums and supporting tissues of the teeth caused usually by accumalation of dental plaque. If it goes unchecked it causes premature loss of teeth. Good brushing technique and flossing helps to keep this problem controlled. However, in its advances stages, treatment by a dental hygienist is essential as removal of bacteria and scale below the gum line is required.

I have heard that the silver, mercury fillings are bad for your health. Is this true?

This is a good question to ask. There have been several investigations and studies on this topic and so far none has shown that the mercury in fillings causes any health problems. Mercury vapour from any silver fillings do enter the body throughout the lifetime of anyone with silver fillings but again this has not been shown to be a problem. One must be careful having old silver fillings removed as the removal of old amalgam fillings leads to a release of mercury vapour - more so than if you had left the fillings in Here, at Absolute Dental Care, Carlow, we take the ultimate care to remove amalgam fillings safely. The alternative fillings - the composite 'white' fillings, are not necessarily safer from a biological view. Studies in the past show that oestrogen-like material from the fillings can enter the body and studies are ongoing into the link between them and cancer. So far the studies do not show a need to ban either amalgam or composite.

I need a new partial denture, but I don't know which is best. How can I decide?

Partial dentures usually need replacing after 5 years of use. Often this is because they get worn, begin to get loose, stain, 'sink down' or break.

Essentially there are two different types of denture - Acrylic and Cobalt chrome.
Acrylic are the standard 'plastic' type of denture. They rely on the tissues of the mouth for support (rather than the teeth) so they can start 'sinking' into the gums after a while. They tend to attract plaque more than the cobalt chrome dentures and do not usually fit as tight. They can look good and, if there are any loose teeth in the mouth, they can be added to quite easily. They are economical to make.

Cobalt chrome (metal based)dentures , on the other hand, usually have a tighter fit and don't attract as much plaque. Because they rely on the teeth for support, they do not 'sink' into the gums as such. Their appearance is good, but they are not as easy to add to. Because of this, it may be best to get any crowns etc done prior to this type of denture to ensure that no teeth 'break' whist this type of denture is worn. Overall, it is a superior alternative to the acrylic denture and, as such, is more expensive.

I need new dentures but I don't know which type to get - Acrylic or metal-based?

That's a good question Essentially, you are right. There are two types of denture used to replace missing teeth. Both can work well and act to give you more confidence. The more common type are acrylic (plastic) dentures. These work best in the upper dental arch as they can be well supported by the palate. The appearance of them is very good and if teeth need to be added to it later, this can be easy to achieve compared to metal based dentures. The downside to them is that they depend on the soft tissues in your mouth to rest upon. The soft tissues in your mouth are not well suited to this task. They also collect a lot of plaque in your mouth and so you are more prone to tooth decay and gum disease.Their other major downside is that they are not as firm in your mouth compared to the metal-based dentures. Added to this, they can feel uncomfortable as they are thick and have to cover a wide part of the palate.
Metal based dentures - Cobalt chrome dentures - rely on the natural teeth to rest upon. Natural teeth are less movable compared to your soft tissues and are well suited to taking the load of your bite when transmitted through the denture. Metal dentures fit really well and are much more firm in your mouth compared to their acrylic counterparts and hence, can give you more confidence. Added to this, they are thinner and do not have to cover a large part of your palate and they collect less plaque around them, so are healthier for the remaining teeth. The downside of the metal dentures is that they take a bit longer to make and are more expensive compared to plastic dentures. If teeth need to be added to this type of denture, it is not always easy and is often not the best denture to make if the remaining natural teeth are loose or affected by gum disease.

I read somewhere that unhealthy gums are linked to heart disease and other problems. Is this true?

There have been several studies done showing a link between cardiovascular (heart) disease and periodontal (gum and supporting tissues) disease. At the present, however, it is difficult to isolate the exact reason for the connection.
Most studies show that patients whose bodies show a reaction to bacteria involved in periodontal disease have an increased risk of heart disease and hence, more prone to heart attacks. It may be that prolonged exposure to the body to periodontal bacteria from the gums may lead to the heart disease. There is also a substance produced by the body called 'high sensitivity c-reactive protein'. This is a strong predictor for cardiovascular disease and acute gum disease causes an elevation of it in the body.

So it seems that most people are aware of the role of diet and exercise in reducing cardiovascular disease but it may well be that brushing and flossing of the teeth may be just as beneficial at reducing heart disease.

Research is on-going on the role that periodontal disease plays in other general diseases. Apart from cardiovascular disease, periodontal disease may also be linked with chronic kidney disease, diabetes, stroke and rheumatoid arthritis.

To help maintain good help of the gum tissues, regular brushig and flossing is recommended as well are regular visits to the dentist.

I would like to have a tooth cleaning but I keep getting told that I need an examination first. Can you just do the cleaning for me?

Hi there. Thanks for your question. This is quite correct. Strictly speaking, a tooth cleaning or scale and polish is a prescribed procedure. So unless an examination is first carried out it would not be possible to know how extensive your gum disease might be. Without this knowledge, the correct treatment could not be performed. A dental examination is in your best interests if you have not had one within the last year as it would diagnose the type and extent of gum problems you have, any areas that might need particular attention whilst cleaning and whether you might require further gum treatment apart from a scale and polish.
There is an ethical obligation placed upon all dentists to have first carried out an examination prior to performing a cleaning and our governing body - The Dental Council - is quite clear on this.

I'm concerned about going to the dentist with this swine flu epidemic going on. Can you reassure me that I will be OK?

We can certainly reassure you. I know that the school season has now gone into full swing and that there are predictions that the H1N1 virus flu (swine flu) will increase in number as well as the normal flu.
Modern day dentistry has practically elimainated the chances of you catching any diseases such as swine flu from the dental practice. We take every available precaution to avoid transmission of diseases, meaning you are very safe attending the practice.
To ensure maximum safety, all surgery surfaces are wiped down with hospital standard disinfectant. Several of the instruments we use are disposable and those that are not are sealed and vacuum sterilised under steam pressure to thoroghly sterilise them. The instruments are not removed from their packaging until absolutely necessary. Antibacterial soap and alcohol area available in all surgeries. As an added precaution we ensure that all commonly touched door handles are wiped with a disinfectant wipe every few hours and there is an antibacterial hand scrub for patient use immediately upon entering the building and upon exit. Most patients avoid going to the dentist if they are ill - prevention is better than cure. So, as you can see, the chances of picking any illness up at the dental practice is very small. I hope this reassures you.

I'm getting married later in the year and would like my veneer changed as it has discoloured. Would I need any other work to get my teeth looking great?

It is common for patients to want their teeth to look great for their special day. It is advisable to get your dental care in good time prior to your wedding especially if cosmetic dentistry is required.
After a thorough examination we can discuss what your needs are regarding cosmetic dental care.
Certainly, if your veneer is discoloured, we can change this for you so that it blends in well with your natural teeth. However, ideally, we would make sure your gums are in good health first as these form the framework/backdrop for your teeth.
Once your gum health is optimised and any other routine dental work is complete, you may want to discuss having some tooth whitening (dental bleaching) done or any old silver fillings replaced by modern white fillings. If you do opt for tooth bleaching then you should get this done prior to any white fillings being done or your veneer. This enables the new dental work to blend in with the whitened teeth.
It is important to plan well for this before the wedding so that you can have a great smile for the wedding

I've noticed my gums have been receding for a while now. Why is this and what can I do about it?

Receding gums are not uncommon. Sometimes this can lead to an appearance around the neck of the teeth that many people do not like. There are also a few other reasons to be concerned about if you notice the gums receding. When the gums recede, the root of the tooth becomes exposed. Roots are soft compared to the hard, white enamel covering the crown of the tooth. This means that they are more prone to wearing down, particularly from toothbrushing. This is known as tooth brush abrasion. Severe toothbrush abrasion can weaken the tooth and cause it to fracture - altough this is rare. Exposed roots also tend to be sensitive compared to the enamel because 'dentine' (which is what the root is made of) is exposed to the oral environment. And dentine is sensitive. This is known as dentinal hypersensitivity.
Gum recession occurs naturally with the passage of time - 'getting long in the tooth' is a commonly heard phrase.
However, recession can occur due to overzealous toothbrushing using the wrong technique. It is important not to use a hard brush and to avoid brushing in a horizontal manner. The correct technique is to angle the brush to where the gum meets the tooth and perform circular movement using a medium or soft brush.
One of the most common reasons patients get gum recession is as part of an overall 'periodontal disease'. Patients with periodontal disease get receding gums because the bone support of the teeth shrinks back and when this happens the gums often follow this pattern. To avoid this getting worse, it is important to follow an appropriate periodontal programme set by the dental team to help remove the harmful plaque from the mouth - both above the gum line and below. The last thing most patients want is to lose any teeth sooner than they should
If you find the appearnce of the gingival recession unsightly then you should discuss this with us so we can inform you of other options.

If I whiten my teeth will my fillings become lighter also?

Although teeth whitening makes natural teeth whiter, it does not affect fillings in your teeth. So any silver or black amalgam fillings will not become whiter. The same goes for white composite fillings. They will not change colour if you bleach your teeth or do teeth whitening. Because of this, after you do teeth whitening, white fillings on your front teeth may need to be replaced if they do not match the colour of your newly whitened teeth. The same applies to crowns also.

My 3 year old daughter fell and hit her front tooth. It looks to have pushed into the gum. What will happen now?

It is important to bring your daughter in for an assessment. When a 'baby' tooth pushes up into the gum, there are two scenarios/ 1/ The tooth may be displaced so that the root of the tooth comes forward and may even pierce the bone in front of the root. 2/ The root may be displaced backwards towards the developing permanent tooth behind it.
If the former happens, then we usually leave the tooth as it may re erupt downwards. If the tooth is displaced towards the developing underlying permanent tooth, it is often best to have the tooth removed to minimise damage to the permanent tooth.
When the permanent tooth erupts sometimes it can erupt tilted backwards or come through with a brown discolouration where the baby tooth impinged upon it.
For now keep your daughter on a soft diet for 10-14 days and clean around the gum with dilute corsdyl to remove plaque.
Watch out to see if the tooth changes colour or loosens or if the gum around the tooth swells as this is often a sign of infection.

My daughters baby teeth had lots of decay. How can I protect her adult teeth?

Tooth decay is debilitating and painful at any age. If your daughter was prone to tooth decay in her 'baby' teeth then it is more likely that her permanent teeth will be prone to decay and extra precautions should be taken to prevent it in her permanent teeth.
Good dietary habits are essential. This means she should avoid any sugary foods in between meals and also avoid sugary food just before bedtime.
If she is able to rinse her mouth out well then she could also use a daily fluoride mouthrinse as well as her flouride toothpaste.
It is important that she brushes her teeth for a whole two minutes twice a day - once in the morning and just before bedtime.
Another important measure is to have her first permanent molars fissure sealed. Ideally this should be done within the first year of their eruption. If she appears to be very prone to tooth decay, she should also get the second permanent molars fissure sealed to protect those teeth also.

My one year old daughter has a decayed upper front tooth. What treatment is available for a one year old?

Decay on front teeth in a young child like this is quite uncommon. It does occur sometimes if children go to bed with a bottle containing fruit juice, milk or milk formula, prolonged or on-demand breast milk, honey, milk or water with added sugar or pacifiers soaked in honey/sugar.
Children should be examined by a dentist from a very early age as this problem can be diagnosed early. When baby teeth become decayed the knock on effects can be serious. Teeth can become painful making it difficult for babies to eat. Teeth can break easily. If decay causes the teeth to break or they have to be removed if can lead to speech problems. Loss of teeth can also lead to spacing problems of the teeth. Abscesses can lead to malformation of the underlying permanent teeth. Prolonged bottle feeding can displace other staple dietary requirements and lead to mild malnutrition. Also as a child with decayed front teeth compares him/herself to other children they can begin to get psychological problems about their appearance. These factors are often underestimated.
Your child should have a dental examination to assess the extent of the tooth decay. If possible it should be removed (depending on cooperation) and filled. If this is not possible, it may be possible to place high concentration fluoride over the decay to attempt to arrest the decay.
We will discuss with you the appropriate diet to avoid decay, but you should clean your child's teeth after every meal. Also, if your daughter has a bottle of sweetened fluid on going to bed, try to wean her off this habit or replace the fluid with plain water. If you are breast feeding, breast milk is usually the best fluid for babies to drink but you should get medical advice as to when best to introduce solids as even breast milk can cause tooth decay due to the lactose content. It is probably a good idea to monitor your child's diet also to isolate any foods that may be leading to tooth decay.
Please call us on 059 9131958 for advice but we would advise you bring your child for an examination.

My upper front tooth has been dark since I had a root filling years ago. How can I get it looking better?

There are several ways of getting a dark root filled tooth looking lighter in colour.

The tooth can be bleached internally. This is quite a simple procedure and usually works very well. Bleaching material is placed into the tooth on top of the root filling and sealed in place for one to two weeks. At a review appointment, if it is decided that the tooth may go lighter still, then more bleaching material can be sealed in. After two sessions of bleaching, the tooth is unlikely to lighten further.

Nowadays, another popular way to lighten teeth is the so-called 'inside/outside' bleaching method. Here, a removable tray is made that fits over the tooth to be bleached. A hole is made at the back of the dark tooth and then at home bleach is inserted into the hole and into the tray, which is then placed over the tooth whilst you are sleeping or for a few hours. Usually a very good result is obtained within two weeks.

If the tooth is unlikely to lighten up with bleaching methods then a veneer (thin porcelain facing) can be placed over the dark tooth. The other option is a crown. This would be particularly good if the tooth has been heavily filled as it would help protect the tooth from breaking.

My veneer fell off. Can I have a new 'composite veneer'? Will it discolour?

Sometimes veneers fall off, but it is more common that they fail by fracturing. This can sometimes occur if your bite has not been perfectly assessed before providing veneers or if the veneers are very thin and have fractured on cementation.
Quite commonly, when veneers fall off, a replacement veneer is sought. However, having the veneer replaced by a composite restorative material (white filling material) is now a viable option. The cost of doing it this way is usually a third of the price as getting a new porcelain veneer. They are built up on the tooth free-hand and so the shape can be controlled and adjusted whilst placing it. These composite veneers do discolour quicker than porcelain veneers. However, modern composite materials polish very well, look very nice and have good colour stability. This could not have been said about 15-20 years ago. They also last a long time when planned carefully and bonded strongly to the tooth in a dry environment.

Should I stop taking my aspirin before my dental extraction?

Many patients are taking aspirin nowadays (or an equivalent like plavix or both) as an anticoagulant measure. It helps prevent blood clots and so is useful in preventing so-called 'thrombo embolic events'- i.e blood clots that can travel in the blood system and lodge in certain veins and arteries causing problems such as stroke. It is often given to patients who have had a heart attack.
In theory, taking aspirin, can reduce the ability of a good blood clot to form after a tooth is extracted and it is for this reason that, in the past, patients were advised to discontinue taking aspirin a few days prior to a dental extraction.
However, there is little documented trials or studies that confirm patients who take aspirin are at an increased risk of uncontrollable bleeding after an extraction of a tooth. On the other hand, the risk of getting a thrombo embolic event from discontinuing aspirin has a much more severe consequence than continuing taking the aspirin prior to the extraction.
Most dentists would advise, as we do, that aspirin should not be discontinued prior to your dental extraction because of the potential hazards of a blood clot forming within the blood system.
You should continue taking your aspirin. If, after taking the tooth out, there is more bleeding than expected, the socket can be packed with a special 'haemostatic' agent and additionally, the socket can be stitched if required to control bleeding. This is usually all that is required.

What has happenned to the GMS (medical card) scheme?

The GMS scheme for Medical Card holders has been radically altered since April 26th 2010. The scheme only concentrates on the provision of emergency dental treatment and allows holders to have one examination a year.

Medical Card holders are no longer able to have routine fillings, cleanings, 'deep cleanings' or dentures. Although there is uncertainty as to what constitutes an 'emergency', Medical Card holders are now limited to having tooth extractions, root fillings (on front teeth only) or prescrptions if one arises.

It is uncertain as to whether the GMS scheme will return back to providing a more comprehensive package for treating the dental needs of Medical Card holders.

Why do you not do laser teeth whitening at your practice?

Thanks for your question. There are three common ways used to whiten teeth. These are 1/ The use of whitening strips, 2/ 'Take Home' tray whitening and 3/ Laser Teeth whitening.
The strips are effective but can be difficult to place especially if your teeth not straight in alignment or they sometimes don't stick well to the teeth.
Research has shown that 'Take Home' whitening in the trays is safe, long lasting with little relapse. 'Laser' whitening is a misnomer as it does not actually use a laser as part of the procedure but a strong blue light. We do not use so-called laser whitening in our surgery for several reasons. Firstly, it costs more - a lot more Most in-surgery clinical trails fail to show that the light makes any difference to the whitening process. Also, the teeth dry out during the process so it is difficult to know whether the teeth are lighter or just dried out. There is also some evidence that the rate of relapse for 'laser' whitening is also higher than whitening in the trays. Additionally, the concentration of the whitening gel used in laser whitening is much stronger and so has harsher effects on the teeth and soft tissues compared to 'take-home' whitening.