Old/Metal Crowns,Onlays, Crowns and Dentures

Onlays and Inlays

A dental inlay fills the space in between the cusps, or rounded edges, at the center of the tooth's surface. The dental onlay works like an inlay but covers one or more cusps or the entire biting surface of the tooth. Because of their extensive coverage, dental onlays are sometimes referred to as "partial crowns."

The advantage of this versus a crown is that less tooth structure needs to be removed in order to fully protect the tooth. Inlays and onlays can be made of gold, porcelain or lab fabricated composite. For teeth which require crowns, one of the best aesthetic options today is a Zirconia fused to porcelain crown.

Crowns

A dental crown is a tooth-shaped "cap" that is placed over a tooth -- to cover the tooth to restore its shape and size, strength, and improve its appearance. The crowns, when cemented into place, fully encase the entire visible portion of a tooth that lies at and above the gum line.

Types of Dental Crowns

There are four different types of dental crowns.

Ceramic — These are used for restoring front teeth, and are popular in this area for their ability to blend with your natural tooth colour. The crown is made of a porcelain-based material.

Porcelain-fused to metal – This crown provides a stronger bond than regular porcelain because it is connected to a metal structure. It's also extremely durable.

Gold alloys – This crown is a mix of gold, copper and other metals. In addition to providing a strong bond to the tooth, it doesn't fracture, nor does it wear away the tooth itself.

Base metal alloys – This crown is made up of non-noble metals that are highly resistant to corrosion, and make for a very strong crown. It also requires the least amount of healthy tooth to be removed prior to fitting.

Dentures

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.

How do Dentures Work?

With full dentures, a flesh-colored acrylic base fits over your gums. The base of the upper denture covers the palate (the roof of your mouth), while that of the lower denture is shaped like a horseshoe to accommodate your tongue.

Dentures are custom-made in a dental laboratory from impressions taken of your mouth. Your dentist will determine which of the three types of dentures described below is best for you.

Chipped or fractured teeth, broken down fillings, or teeth that are malformed or discoloured are all conditions which can affect your smile. A crown is a cap that is used in order to help restore or hold together a tooth that has been chipped or damaged.

Crowns can also cover a large filling to help keep it in place, and they can protect a tooth recovering from root canal treatment. Multiple crowns are also used to hold a bridge in place. Their purpose is to restore each tooth to its normal shape and size, while both strengthening and improving its appearance.

A crown is recommended for a number of reasons:
  • To restore fractured teeth
  • To protect weak teeth from fracturing
  • To repair a tooth when there is not enough original tooth remaining
  • To conceal badly shaped or discoloured teeth
  • To protect teeth from fracturing following root canal treatment
  • To disguise extensive damage caused by decay
  • To attach a bridge
  • To cover a dental implant.

Natural looking porcelain attached to a durable metal shell is the most common construction used to create a crown because of its strength. However, a crown can also be made of gold alloys or non-precious alloys, ceramic, acrylic (plastic) or composite resin, or any combination of these.

Tooth location, the position of the gum tissue, the amount of tooth that shows in the smile, the colour and shade of the tooth, and the function of the tooth are all taken into consideration when choosing which material to use.

Having a crown fitted may require two or three dental visits. At the first appointment, the tooth to be crowned will be numbed and reduced in size to accommodate the crown, and then a mould of your tooth will be taken for the laboratory to use in the manufacture of the crown. A temporary crown will be placed over the tooth until the custom (final) crown is available.

Crowns are permanent fixtures, but they can occasionally come loose and need to be replaced. Caring for a crown requires proper dental and gum care as instructed by a dentist or hygienist.

Wisdom Teeth

A normal adult mouth will contain 32 teeth. Each quarter of a mouth has eight teeth. The molar at the back has become known as the ‘wisdom tooth’. Often they need to be removed and because of their position they can present unique problems both before and after surgery.

Wisdom teeth are often short of space and therefore do not fully grow (erupt) into the mouth. They often have a piece of gum over the back part of their biting surface; this makes them vulnerable to infection (pericoronitis). Lower wisdom teeth are very commonly infected. Such infections give symptoms such as swelling over the back part of the jaw, inability to open the mouth (trismus), pain especially to bite on the area, and a bad taste.

The infection can be prevented by good oral hygiene and stopping smoking. If the infection becomes established then hot salty water mouth rinses can be very helpful. The upper third molar often bites on the gum overlying the tooth and so the dentist may suggest that the upper wisdom tooth be removed or ground down. Antibiotics, commonly metronidazole or a penicillin, are given to help combat this illness.

Wisdom teeth are also susceptible to dental decay and gum disease (periodontal disease) and their presence may contribute to decay or gum disease in the adjacent molar tooth. There are other more unusual reasons why wisdom teeth are removed in hospitals such as cysts, tumours, and fractures of the jaw in this region.

Not all wisdom teeth will need to be removed. There are now national guidelines issued by the National Institute for Clinical Excellence, which stipulate the conditions for their removal. Most symptomless wisdom teeth should be left unless there is evidence that they are going to give rise to symptoms in the near future.

Although infections are unusual in upper wisdom teeth (unless they are decayed), they often grow in such a way that they rub the cheek. If the lower wisdom teeth are to be removed then most surgeons would consider removing the upper on the same side to prevent it growing too far down (over-erupting) in the future.

Every patient about to have their wisdom teeth removed will have heard horror stories or had friends who have suffered greatly. Whilst a minority of patients do have problems, most patients do not. Upper wisdom teeth are usually very straightforward to remove unless badly decayed. Lower wisdom teeth are often removed under a local anaesthetic with or without sedation. After the area is numbed, gently cutting the gum and moving it to one side exposes the tooth. Some teeth require a little piece of bone to be removed and this is done with a drill. Just as when a filling is done the drill requires water irrigation and so the nurse will suction around the wound to enable the dentist to see the tooth. Sometimes the tooth will be cut into pieces to aid its removal. Following the removal the wound is washed and the gum stitched into place.

There is no doubt that the surgery is easier for the dentist if the area is healthy. If the patient takes steps to keep the tooth as clean as possible with good toothbrushing and rinsing the area with hot salt water mouth rinses or Corsodyl mouth wash, then this will reduce gum swelling (gingivitis) and make it easier for the dentist to operate. Reducing or stopping smoking reduces the chances of problems after the teeth have been taken out.

The dentist may use dissolvable stitches. Some dentists prefer to use non-dissolving stitches and will make an appointment to remove them, usually between 1 and 2 weeks later. If they do need to be removed then this is usually straightforward and painless.

Patients may experience symptoms after surgery, which may resemble those of an infection. Swelling and discomfort together with an inability to open the mouth fully may be worrying especially when these reach their peak, usually three days after surgery. Most dentists would prescribe antibiotics for difficult lower wisdom teeth extractions in order to avoid any potential infection.

There are many ways in which the patient can help the wound to heal. The medication prescribed should be taken in the manner directed. Hot salt water mouth rinses should be used regularly for five minutes four times a day for a week. The water should be tepid but not too hot as to burn. A tablespoon full of salt should be allowed to dissolve in a coffee mug sized amount of this water. The mouthwash is then held over the wisdom teeth socket until it is cooled and then spat out.

Discomfort is common following any operation on the body. Most patients find that any pain is easily treated by painkillers such as paracetamol or ibuprofen (assuming that there are no reasons why they may not take this medication, eg stomach ulcer). However, if the pain becomes severe then it may be that a dry socket is developing. A return to the dentist will be necessary.

A dry socket is when the clot in the socket gets broken down leaving exposed raw bone. The pain usually comes on seven days after the operation. The pain is deep-seated and described as throbbing. Risk factors include difficult extractions, smokers, poor oral hygiene and ladies on the oral contraceptive pill. It is treated by washing the socket out thoroughly and placing a dressing in the wound. The discomfort typically lasts 7-10 days and may require a further appointment during this time.

All patients will be numb in the lower lip or tongue for a few hours afterwards. If this persists it may be that the surgery has stretched or damaged one of two nerves in the area. The nerve to the lower lip runs in a bony canal in the lower jaw. The roots of the wisdom tooth may be intimately involved with the nerve and may cause temporary or permanent damage. The nerve to the tongue runs alongside the roots of the lower wisdom tooth in the gum. If the numbness persists for more than a week then the dentist who removed the tooth should be consulted. About one percent of patients will have some numbness post-surgery although the vast majority would expect a rapid full recovery. About one percent of the one percent can expect a slower recovery. Rarely, the numbness can be permanent.

If the socket continues to bleed, the most important thing is to stay calm. The amount of blood loss appears greater because of all the saliva that is mixed with it. Remove all of the clots in the mouth, if necessary with fingers. Take a swab or clean hankie and put it under the hot tap. Wring the gauze dry and place it directly over the wound and bite hard. The swab should be kept inside the mouth for at least 15 minutes. This will stop 90 percent of all bleeding sockets. If the bleeding persists, contact the dental surgery immediately.



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