General Dentist (G.P)
Dr. Anju Mitosh, General Dentist (B.D.S)
Outstanding dental health for a lifetime, or finally having the beautiful smile of your dreams — whatever your goals, our DENTIST’S and ORTHODONTIST’S suggestions for your care are based upon sound principles and the highest standards of health care that ensure you the best long-term results.
Your initial appointment enables us to review your medical and dental history, discuss your treatment goals and conduct a comprehensive dental examination. Once we gather all essential information, we will share our findings and provide you with information and options to achieve your goals.
IMPORTANT: Patients under 18 must be accompanied by a parent or guardian.
Please alert the office if you have any adverse reaction/allergies to drugs or a medical condition that may be of concern, such as a heart murmur, diabetes, high blood pressure, artificial heart valves or joints, rheumatic fever, etc.; or if you are on heart medications, aspirin therapy, anticoagulant therapy, etc.
If you need ROOT CANAL treatment youre not alone. Millions of teeth are treated and saved each year with root canal, or endodontic, treatment. Learn how root canal treatment can relieve your tooth pain and save your smile.
To understand a root canal procedure, it helps to know about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is a soft tissue called the pulp. The pulp contains blood vessels, nerves and connective tissue, and helps to grow the root of your tooth during development. In a fully developed tooth, the tooth can survive without the pulp because the tooth continues to be nourished by the tissues surrounding it.
Endodontic treatment treats the inside of the tooth. Endodontic treatment is necessary when the pulp becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep decay, repeated dental procedures on the tooth, faulty crowns, or a crack or chip in the tooth. In addition, trauma to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.
How does endodontic treatment save the tooth?
During root canal treatment, the inflamed or infected pulp is removed and the inside of the tooth is carefully cleaned and disinfected, then filled and sealed with a rubber-like material called gutta-percha. Afterwards, the tooth is restored with a crown or filling for protection. After restoration, the tooth continues to function like any other tooth.
Saving the natural tooth with root canal treatment has many advantages:
- Efficient chewing
- Normal biting force and sensation
- Natural appearance
- Protects other teeth from excessive wear or strain
Endodontic treatment helps you maintain your natural smile, continue eating the foods you love and limit the need for ongoing dental work. With proper care, most teeth that have had root canal treatment can last as long as other natural teeth and often for a lifetime.
What are DentalCrownsandToothBridges?
Both crowns and most bridges are fixed prosthetic devices. Unlike removable devices such as dentures, which you can take out and clean daily, crowns and bridges are cemented onto existing teeth or implants, and can only be removed by a dentist.
How do Crowns Work?
A crown is used to entirely cover or "cap" a damaged tooth. Besides strengthening a damaged tooth, a crown can be used to improve its appearance, shape or alignment. A crown can also be placed on top of an implant to provide a tooth-like shape and structure for function. Porcelain or Ceramiccrowns can be matched to the color of your natural teeth. Other materials include gold and metal alloys, acrylic and ceramic. These alloys are generally stronger than porcelain and may be recommended for back teeth. Porcelain bonded to a metal shell is often used because it is both strong and attractive.
Your dentist may recommend a crown to:
- Replace a large filling when there isnt enough tooth remaining
- Protect a weak tooth from fracturing
- Restore a fractured tooth
- Attach a bridge
- Cover a dental implant
- Cover a discolored or poorly shaped tooth
- Cover a tooth that has had root canal treatment
How do Bridges Work?
A bridge may be recommended if youre missing one or more teeth. Gaps left by missing teeth eventually cause the remaining teeth to rotate or shift into the empty spaces, resulting in a bad bite. The imbalance caused by missing teeth can also lead to gum disease and temporomandibular joint (TMJ) disorders.
Bridges are commonly used to replace one or more missing teeth. They span the space where the teeth are missing. Bridges are cemented to the natural teeth or implants surrounding the empty space. These teeth, called abutments, serve as anchors for the bridge. A replacement tooth, called a pontic, is attached to the crowns that cover the abutments. As with crowns, you have a choice of materials for bridges. Your dentist can help you decide which to use, based on the location of the missing tooth (or teeth), its function, aesthetic considerations and cost. Porcelain or ceramic bridges can be matched to the color of your natural teeth.
How are Crowns and Bridges Made?
Before either a crown or a bridge can be made, the tooth (or teeth) must be reduced in size so that the crown or bridge will fit over it properly. After reducing the tooth/teeth, your dentist will take an impression to provide an exact mold for the crown or bridge. If porcelain is to be used, your dentist will determine the correct shade for the crown or bridge to match the color of your existing teeth.
Using this impression, a dental lab then makes your crown or bridge, in the material your dentist specifies. A temporary crown or bridge will be put in place to cover the prepared tooth while the permanent crown or bridge is being made. When the permanent crown or bridge is ready, the temporary crown or bridge is removed, and the new crown or bridge is cemented over your prepared tooth or teeth.
How Long do Crowns and Bridges Last?
While crowns and bridges can last a lifetime, they do sometimes come loose or fall out. The most important step you can take to ensure the longevity of your crown or bridge is to practice good oral hygiene. A bridge can lose its support if the teeth or bone holding it in place are damaged by dental disease. Keep your gums and teeth healthy by Brushing with fluoride toothpaste twice a day and flossing daily. Also see your dentist and hygienist regularly for checkups and professional cleanings.
To prevent damage to your new crown or bridge, avoid chewing hard foods, ice or other hard objects.
What types of crowns are available?
All Ceramic Crown – Cosmetically these crowns look the best and are usually indicated for front teeth. These crowns have no grey metal inside them, so if in time the gum recedes, there will be no grey metal margin on show around the crown. An example of this would be Zirconium containing crowns that have a tooth colored Zirconium core with porcelain on top.
Metal Ceramic Crown – These crowns have a metal core inside and porcelain bonded to their outside. The core inside can be made from precious, semi-precious or non-precious metals and it provides the strength behind these crowns. However the porcelain bonded to the metal cores is not very strong and from time to time can fracture.
Metal Ceramic crowns are usually used on back teeth although some dentists use them for front teeth as well. The aesthetics of Metal Ceramic crowns is not as good as all ceramic crowns, however their strength is higher.
All Zirconium Crowns – These crowns look yellow/brown in color and are usually used for back teeth. These crowns have no porcelain, so the risk of fracture is less than all ceramic and metal ceramic crowns but as they have no porcelain, their aesthetics is compromised compared to all ceramic and metal ceramic crowns.
In terms of tooth reduction these crowns need minimal tooth reduction and are less damaging to the tooth as less tooth tissue is removed for their construction. All Zirconium crowns are ideal for situations where gold crowns historically have been the best option.
Gold Crowns – These crowns are the strongest crowns available but are poor from an aesthetic point of view. They are usually used for back teeth especially in people who suffer from grinding and clenching habits.Gold crowns can be made very thin and as such need minimal tooth reduction and are less destructive of tooth tissue compared to metal ceramic and all ceramic crowns.
What is the procedure for having dental crowns?
- Assessment of the tooth clinically and with an X-ray to ensure the roots of the tooth are sound and the tooth is vital. Preparation of the tooth for a crown and taking impressions for the lab to construct the crown.
- Fit of the final crown once it’s returned from the lab.
What types of Bridges are available?
Dental Bridges are false teeth that replace missing teeth by anchoring to one or two of the neighboring teeth. The false tooth is known as the pontic and the anchoring teeth are known as abutments. They are an alternative to dental implants for whose patients who do not wish to have surgery.
There are different types of bridges.
- All ceramic bridges
- Porcelain fused to metal bridges
- Acrylic bridges
What are dental cleanings (scale and polish) and why have them?
Dental cleanings involve removing plaque (soft, sticky, bacteria infested film) and tartar (calculus) deposits that have built up on the teeth over time. Your teeth are continually bathed in saliva which contains calcium and other substances which help strengthen and protect the teeth. While this is a good thing, it also means that we tend to get a build-up of calcium deposits on the teeth. This chalky substance will eventually build up over time, like limescale in a pipe or kettle. Usually it is tooth coloured and can easily be mistaken as part of the teeth, but it also can vary from brown to black in colour.
If the scale or calculus (tartar, as dentists like to call it) is allowed to accumulate on the teeth it will unfortunately provide the right conditions for bacteria to thrive next to the gums. The purpose of the cleaning and polishing is basically to leave the surfaces of the teeth clean and smooth so that bacteria are unable to stick to them and you have a better chance of keeping the teeth clean during your regular home care.
Also it leaves your teeth feeling lovely and smooth and clean, which is nice when you run your tongue around them. Actually, come to think of it, there’s nothing worse than someone you fancy running their tongue around your teeth and finding a piece of spinach or something! Still, if they’re hungry…The professional cleaning of teeth is sometimes referred to as prophylaxis (or prophy for short). It’s a Greek word which means “to prevent beforehand” – in this case, it helps prevent gum diseases
A filling replaces part of a tooth that has been lost because of decay or accidental damage. All fillings are toothcoloured, carefully selected to match the original shade and shape of the tooth.
A filling will normally be carried out under local anaesthetic. The affected area will be cleared of decay or loose filling, the tooth will be washed and dried. Then the filling will be inserted and smoothed off before a bright light is applied to set the filling. The filling will then be trimmed off and polished.
Why should I consider white fillings?
Most people have fillings of one sort or another in their mouths. Nowadays fillings are not only functional, but can be natural looking as well. Many people don’t want silver fillings that show when they laugh or smile because they are more conscious about the way they look.
Are they as good as silver amalgam fillings?
White fillings have always been considered less long lasting than silver amalgam fillings. But there are now new materials available with properties comparable to silver amalgam, and these are proving to be very successful. The life expectancy of a white filling can depend greatly on where it is in your mouth and how heavily your teeth come together when you bite. We can advise you on the life expectancy of your fillings.
Is it worth replacing my amalgam fillings with white ones?
It is usually best to change fillings only when we decide that an old filling needs replacing. If so you can ask to have it replaced in a tooth-coloured material. We sometimes prefer not to put white fillings in back teeth, as they are not always successful. One way around this would be to use crowns or inlays, but this can mean removing more of the tooth and can be more expensive.
What are tooth-coloured fillings made of?
This can vary, but they are mainly made of glass particles, synthetic resin and a setting ingredient.
Are there any alternatives to fillings?
There are alternatives such as crowns and inlays although they can cost a lot more. Veneers can be used on front teeth instead of crowns or fillings.
What is Veneers?
Veneers are ultra-thin shells of ceramic (porcelain) or a composite resin material, which are bonded to the front of teeth. This procedure requires little or no anesthesia and can be the ideal choice for improving the appearance of the front teeth. Veneers are placed to mask discolorations, to brighten teeth and to improve a smile. This procedure can greatly enhance your smile and can heighten self-esteem.
Why a veneer?
Veneers are an excellent alternative to crowns in many situations. They provide a much more conservative approach to changing a tooths color, size or shape. Veneers can mask undesirable defects, such as teeth stained by tetracycline and damage due to an injury or as a result of a root-canal procedure. They are ideal for masking discolored fillings in front teeth. Patients with gaps between their front teeth or teeth that are chipped or worn may consider veneers. Generally, veneers will last for many years, and the technique has shown remarkable longevity when properly performed.
What happens during the procedure?
Patients may need up to three appointments for the entire procedure: diagnosis and treatment planning, preparation and bonding.Its critical that you take an active role in the smile design. Spend time in the planning of the smile. Understand the corrective limitations of the procedure. Have more than one consultation, if necessary, to feel comfortable that your dentist understands your objectives.
To prepare the teeth for the veneers, the teeth are lightly buffed to allow for the small added thickness of the veneer. Usually, about half a millimeter of the tooth is removed, which may require a local anesthetic. Composite resin veneers are generally done in one appointment. After the tooth is prepared, the dentist carefully bonds and sculpts the composite material onto your teeth. For ceramic veneers, a mold is taken of the teeth, which is sent to the laboratory for the fabrication of the veneers. This may take several days. If the teeth are too unsightly, a temporary veneer can be placed, at an additional cost.
When your ceramic veneers are ready, the dentist places each veneer on the teeth to check their fit and get a sense of the shade or color. While the veneers are resting on your teeth, view the results, and pay particular attention to the color. At this point, the color of the veneers can still be adjusted with the shade of the cement to be used. The color cannot be altered after veneers are cemented. To apply the veneer, the tooth is cleansed with specific chemicals to achieve a bond. Once a special cement is sandwiched between the veneer and tooth, a light beam hardens the cement.
How about maintenance?
For about a week or two, you will go through a period of adjustment as you get used to your "new" teeth that have changed in size and shape. Brush and floss daily. After one or two weeks, your dentist will ask you to return for a follow-up appointment.
What are realistic expectations?
Veneers are reasonable facsimiles of natural teeth, not perfect replacements. Its not uncommon to see slight variations in the color of veneers upon close inspection, as this occurs even in natural teeth. Nevertheless, this procedure can greatly enhance your smile and can heighten self-esteem.
Although permanent teeth were meant to last a lifetime, there are a number of reasons why tooth extraction may be needed. A very common reason involves a tooth that is too badly damaged, from trauma or decay, to be repaired. Other reasons include:
A crowded mouth. Sometimes dentists pull teeth to prepare the mouth for orthodontia. The goal of orthodontia is to properly align the teeth, which may not be possible if your teeth are too big for your mouth. Likewise, if a tooth cannot break through the gum (erupt) because there is not room in the mouth for it, your dentist may recommend pulling it.
Infection. If tooth decay or damage extends to the pulp -- the center of the tooth containing nerves and blood vessels -- bacteria in the mouth can enter the pulp, leading to infection. Often this can be corrected with root canal therapy (RCT), but if the infection is so severe that antibiotics or RCT do not cure it, extraction may be needed to prevent the spread of infection.
Risk of infection. If your immune system is compromised (for example, if you are receiving chemotherapy or are having an organ transplant) even the risk of infection in a particular tooth may be reason enough to pull the tooth.
Periodontal (Gum) Disease. If periodontal disease -- an infection of the tissues and bones that surround and support the teeth -- have caused loosening of the teeth, it may be necessary to the pull the tooth or teeth.
Continue reading below...
What to Expect With Tooth Extraction
Dentists and oral surgeons (dentists with special training to perform surgery) perform tooth extractions. Before pulling the tooth, your dentist will give you an injection of a local anesthetic to numb the area where the tooth will be removed. If you are having more than one tooth pulled or if a tooth is impacted, your dentist may use a strong general anesthetic. This will prevent pain throughout your body and make you sleep through the procedure.
If the tooth is impacted, the dentist will cut away gum and bone tissue that cover the tooth and then, using forceps, grasp the tooth and gently rock it back and forth to loosen it from the jaw bone and ligaments that hold it in place. Sometimes, a hard-to-pull tooth must be removed in pieces.
Once the tooth has been pulled, a blood clot usually forms in the socket. The dentist will pack a gauze pad into the socket and have you bite down on it to help stop the bleeding. Sometimes the dentist will place a few stitches -- usually self-dissolving -- to close the gum edges over the extraction site.
Sometimes, the blood clot in the socket breaks loose, exposing the bone in the socket. This is a painful condition called dry socket. If this happens, your dentist will likely place a sedative dressing over the socket for a few days to protect it as a new clot forms.
An aesthetic dental trend that’s becoming a classic? Dental jewels are becoming very popular with younger generations, which are worn on central or lateral incisors. There are lots of variations and types: dental jewels can be made of gold, platinum or crystals, but a combination of precious stone and metal is also not unheard of. It can be shaped as the one’s initials, symbols or whatever that helps express the personality of its owner. Leading jewellery manufacturers have seen the opportunity early enough, so each manufacturer now offers its own collection of dental jewels. It only enhances the demand for these gimcrack ornaments that an increasing number of media stars, popular with the youth, are wearing jewels on their teeth.
A few years ago, the installation of dental jewels took up to half an hour, and during the process they used corrosive liquids to clean the enamel. Today, the process takes much shorter time and is greatly simplified. It can only be performed by a qualified dentist – do not try it at home! – Who places the chosen jewel on a properly cleansed tooth with a harmless adhesive. The process now days take few minutes, with no drilling or any pain, and requires no special preparations. However, it is recommended to have the teeth whitened prior to getting a dental jewel, as the shiny little ornament will only look good on impeccably white teeth.
A denture is a removable replacement for missing teeth and surrounding tissues. Two types of dentures are available -- Complete and Partial dentures. Complete dentures are used when all the teeth are missing, while partial dentures are used when some natural teeth remain.
Complete dentures can be either "conventional" or "immediate." Made after the teeth have been removed and the gum tissue has begun to heal, a conventional denture is ready for placement in the mouth about eight to 12 weeks after the teeth have been removed.
Unlike conventional dentures, immediate dentures are made in advance and can be positioned as soon as the teeth are removed. As a result, the wearer does not have to be without teeth during the healing period. However, bones and gums shrink over time, especially during the healing period following tooth removal. Therefore a disadvantage of immediate dentures compared with conventional dentures is that they require more adjustments to fit properly during the healing process and generally should only be considered a temporary solution until conventional dentures can be made.
A removable partial denture or bridge usually consists of replacement teeth attached to a pink or gum-colored plastic base, which is connected by metal framework that holds the denture in place in the mouth. Partial dentures are used when one or more natural teeth remain in the upper or lower jaw. A fixed (permanent) bridge replaces one or more teeth by placing crowns on the teeth on either side of the space and attaching artificial teeth to them. This "bridge" is then cemented into place. Not only does a partial denture fill in the spaces created by missing teeth, it prevents other teeth from changing position. A precision partial denture is removable and has internal attachments rather than clasps that attach to the adjacent crowns. This is a more natural-looking appliance.
How Are Dentures Made?
The denture development process takes about three to six weeks and several appointments. Once your dentist or prosthodontist (a dentist who specializes in the restoration and replacement of teeth) determines what type of appliance is best for you, the general steps are to:
- Make a series of impressions of your jaw and take measurements of how your jaws relate to one another and how much space is between them.
- Create models, wax forms, and/or plastic patterns in the exact shape and position of the denture to be made. You will "try in" this model several times and the denture will be assessed for color, shape, and fit before the final denture is cast.
- Cast a final denture
- Adjustments will be made as necessary
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